两种疝囊残端处理方法在经腹腹膜前腹股沟疝修补术中的疗效比较

Comparison on the application of two hernia sac stump treatment methods in transabdominal preperitoneal prosthesis

目的探讨两种疝囊残端处理方法在经腹腹膜前腹股沟疝修补术(TAPP)中的应用效果。方法选取2020年4月至2022年7月宿州市第一人民医院收治的112例原发性腹股沟疝患者为研究对象,采用随机数表法分为A组和B组,各56例。2组患者均行TAPP治疗,疝囊残端远端处理方式不同,A组缝合固定于腹直肌下缘,B组旷置不予固定。比较2组患者的围手术期指标(手术时间、术中出血量、住院时间)、手术前后炎症反应水平(淀粉样蛋白A、降钙素原和C反应蛋白)、术后视觉模拟评分(VAS),以及随访期间的并发症(尿潴留、血清肿、术区麻木、睾丸萎缩)发生情况和血清肿抽液量。结果2组围手术期指标比较,差异均无统计学意义(P>0.05);2组炎症反应水平均高于术前,但A组炎症反应水平低于B组(P<0.05);2组第1、2、3 d VAS评分的组间、时间点、交互比较,差异均有统计学意义(P<0.05),且A组第1、2、3 d VAS评分均低于B组(P<0.05);随访期间,2组并发症总发生率比较,差异无统计学意义(P>0.05)。A组血清肿抽液量(21.38±5.42)ml低于B组(41.76±7.15)ml,差异有统计学意义(P<0.05)。结论对于原发性腹股沟疝患者,TAPP术中疝囊残端缝合固定于腹直肌下缘,在减轻炎症反应、缓解术后疼痛、降低血清肿风险和血清肿抽液量方面,优于残端旷置。

Objective To explore the application effect of two hernia sac stump treatment methods in transabdominal preperitoneal prosthesis(TAPP).Methods A total of 112 patients with primary inguinal hernia undergoing TAPP in Suzhou First People's Hospital were enrolled as the research objects between April 2020 and July 2022.According to random number table method,they were divided into group A and group B,56 cases in each group.According to different hernia sac stump treatment methods,group A was given hernia sac stump suture at inferior margin of rectus abdominis,while group B was given free stump in abdominal cavity.The perioperative indexes(operation time,intraoperative blood loss,hospitalization time),inflammatory response indexes(amyloid A,procalcitonin,C-reactive protein)before and after surgery,postoperative score of visual analogue scale(VAS),occurrence of complications(urinary retention,seroma,numbness in the operative area,orchiatrophy)during follow-up and seroma extraction volume were compared between the two groups.Results There were no significant differences in perioperative indicators between the two groups(P>0.05).Inflammatory marker levels increased in both groups postoperatively,but Group A had lower levels than Group B(P<0.05).The VAS scores on postoperative days 1,2,and 3 in Group A were significantly lower than those in Group B(P<0.05).There was no significant difference in the overall incidence of complications during follow-up between the two groups(P>0.05).The seroma fluid volume in Group A(21.38±5.42 ml)was significantly lower than that in Group B(41.76±7.15 ml)(P<0.05).Conclusion For patients with primary inguinal hernia undergoing TAPP surgery,suturing and fixing the hernia sac remnants to the lower edge of the rectus abdominis muscle is superior to leaving them free in terms of reducing inflammatory response,relieving postoperative pain,reducing the risk of seroma,and seroma fluid volume.