两种腹腔镜手术与Lichtenstein术治疗腹股沟斜疝的效果对比

Comparison of the therapeutic effects of two kinds of laparoscopic surgery and open herniorrhaphy for indirect inguinal hernia

目的探讨腹腔镜完全腹膜外疝修补术(TEP),经腹腹膜前疝修补术(TAPP)及Lichtenstein术治疗腹股沟斜疝的疗效对比。方法选择2019年1月至2021年12月太仓市中医院手术治疗的90名腹股沟斜疝患者作为研究对象。依据手术方法分为开放组(n=30),TAPP组(n=30),TEP组(n=30)。比较3组患者的手术相关指标(手术耗时、失血量、术后下床活动时间、肛门排气时间、总医疗费用),疼痛严重程度[采用视觉模拟评分(VAS)法于术后6 h、24 h、1个月评估],血清应激反应指标[术前及术后48 h的去甲肾上腺素(NE)、肾上腺素、促肾上腺皮质激素(ACTH)、皮质醇],术后6个月内的并发症(尿潴留、腹胀、肠梗阻、血清肿、慢性疼痛)发生情况。结果3组失血量、术后下床活动时间、肛门排气时间差异均有统计学意义(P<0.05),且TAPP组、TEP组优于开放组;手术耗时、总医疗费用开放组优于TAPP组、TEP组,术后下床活动时间、总医疗费用TEP组优于TAPP组,差异均有统计学意义(P<0.05)。3组术后6、24 h的疼痛评分差异有统计学意义(P<0.05),且TAPP组、TEP组优于开放组;术后6 h疼痛评分TEP组优于TAPP组(P<0.05);3组术后1个月疼痛评分差异无统计学意义(P>0.05)。3组患者术前NE、肾上腺素、ACTH、皮质醇差异无统计学意义(P>0.05)。3组术后48 h的NE、肾上腺素、ACTH、皮质醇差异均有统计学意义(P<0.05),且TAPP组、TEP组较开放组低,其中NE、皮质醇术后48 h,TEP组低于TAPP组(P<0.05)。3组术后6个月内并发症发生率差异有统计学意义(P<0.05),TAPP组、TEP组较开放组并发症发生率明显降低。TAPP组与TEP组比较,差异无统计学意义。结论应用TAPP、TEP、Lichtenstein术治疗腹股沟疝各有优势,临床需要依据患者的具体情况进行选择。

Objective To evaluate the efficacy of laparoscopic totally extra-peritoneal hernia repair(TEP),trans-abdominal preperitoneal hernia repair(TAPP)and open hernia repair in the treatment of indirect inguinal hernia.Methods 90 patients with indirect inguinal hernia who were treated in Taicang Traditional Chinese Medicine Hospital from January 2019 to December 2021 were selected as the study subjects.All patients were divided into three groups according to different surgical methods,including open group(n=30),TAPP group(n=30),and TEP group(n=30).The operation related indexes(operation time,blood loss,time to get out of bed after operation,anus exhaust time,and total medical expenses)of the three groups were compared.The pain severity[visual analog scale(VAS)]of patients in the three groups was compared at 6,24 h and 1 month after operation.The serum stress response indexes[noradrenaline(NE),adrenaline,adrenergic rash stimulating hormone(ACTH),cortisol]of the three groups were compared before and 48 hours after operation.The complication indicators(urinary retention,flatulence,intestinal obstruction,seroma,chronic pain)of the three groups were compared within 6 months after surgery.Results The differences of blood loss,time of getting out of bed after operation,anal exhaust time of the three groups were statistically significant(P<0.05),and TAPP group and TEP group were better than open group.The operation time and total medical expenses of the open group were better than those of the TAPP group and the TEP group.The time to get out of bed after operation and total medical expenses in TEP group were significantly better than those in TAPP group(P<0.05).There was a statistically significant difference in the pain scores of the three groups at 6 h and 24 h after operation(P<0.05),and TAPP group and TEP group were better than open group.The pain score of TEP group was better than that of TAPP group at 6 hours after operation(P<0.05).There was no statistically significant difference in the pain scores among the three groups at 1 month after operation(P>0.05).There was no significant difference in the level of NE,adrenaline,ACTH and cortisol among the three groups before operation(P>0.05).At 48 h after operation,the level of NE,adrenaline,ACTH and cortisol in the three groups were statistically significant(P<0.05),and the levels in TAPP group and TEP group were lower than those in open group.At 48 h after operation,the level of NE and cortisol in TEP group was lower than those in the TAPP group(P<0.05).The difference of complication data within 6 months after operation among the three groups was statistically significant(P<0.05).The incidence of complications in TAPP group and TEP group was significantly lower than that in open group.There was no significant difference between TAPP group and TEP group.Conclusion In the treatment of patients with inguinal hernia,TAPP,TEP and open surgery have their own advantages,clinical selection should be made according to the patient's condition.