三种腹股沟疝修补术的临床对比研究

Clinical comparative study of three inguinal hernia repair

目的探讨经腹腔腹膜前疝修补术(TAPP)、腹腔镜下完全腹膜外疝修补术(TEP)、疝环充填式无张力疝修补术对腹股沟疝的治疗效果差异。方法选择2019年6月至2022年6月宣城市人民医院普外科诊治的90名腹股沟疝患者作为研究对象。依随机数字表法分为开放组(疝环充填式无张力疝修补术)、TAPP组(经腹腔腹膜前疝修补术)和TEP组(腹腔镜下完全腹膜外疝修补术),各30例。比较3组手术相关指标(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(术后6、24 h、1个月采用视觉模拟评分法评估),术前及术后48 h血清炎性反应指标[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)],术后3个月内并发症(尿潴留、血清肿、伤口感染、腹胀、复发)发生情况。结果失血量、肛门排气时间,开放组>TAPP组和TEP组(P<0.05),TAPP组与TEP组差异无统计学意义(P>0.05);术后下床活动时间开放组>TAPP组>TEP组(P<0.05);手术耗时开放组<TAPP组和TEP组(P<0.05),TAPP组与TEP组差异无统计学意义(P>0.05);总医疗费用开放组<TEP组<TAPP组(P<0.05)。3组术后6、24 h疼痛视觉模拟评分(VAS)差异有统计学意义(P<0.05),术后6 h,TEP组<TAPP组<开放组(P<0.05),术后24 h,TAPP组和TEP组均<开放组(P<0.05),3组术后1个月VAS差异无统计学意义(P>0.05)。CRP、TNF-α、IL-6检验值,3组术前差异均无统计学意义(P>0.05),3组术后48 h,差异均有统计学意义(P<0.05),TEP组CRP检验值<TAPP组<开放组(P<0.05),TAPP组和TEP组TNF-α、IL-6检验值均<开放组(P<0.05)。3组术后3个月内并发症发生率差异有统计学意义(P<0.05),TAPP组和TEP组均<开放组(P<0.05)。结论三种方法治疗腹股沟疝各有优势,在临床工作中需要依据患者的情况进行选择。

Objective To explore the difference in therapeutic effect of transabdominal preperitoneal hernia repair(TAPP),laparoscopic total extraperitoneal hernia repair(TEP),and mesh plug tension-free hernia repair on inguinal hernia patients.Methods 90 patients with inguinal hernias diagnosed and treated in the General Surgery Department of Xuancheng People's Hospital from June 2019 to June 2022 were selected as the research subjects.According to the random number table method,they were divided into three groups:the open group(hernia ring filling for tension-free hernia repair),the TAPP group(transabdominal preperitoneal hernia repair),and the TEP group(total extraperitoneal hernia repair),with 30 cases in each group.The three groups were compared in terms of operation-related indicators(operation time,blood loss,postoperative ambulation time,anal exhaust time,total medical expenses),pain severity(visual analogue scale was used to evaluate pain at 6 h,24 h,and 1 month after operation).The serum inflammatory response indexes[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)]before and after surgery,as well as the incidence of complications(urinary retention,seroma,wound infection,abdominal distension,recurrence)within 3 months of surgery,were measured.Results The blood loss and anal exhaust time in the open group were higher than those in the TAPP group and TEP group(P<0.05),and there was no significant difference between TAPP group and TEP group(P>0.05).The time of postoperative ambulation in open group>TAPP group>TEP group(P<0.05).The operation time of open group was less than that of TAPP group and TEP group(P<0.05),and there was no significant difference between TAPP group and TEP group(P>0.05).The total medical expenses of open group<TEP group<TAPP group(P<0.05).There were significant differences in visual analogue scale(VAS)scores between the three groups at 6 h and 24 h after operation(P<0.05).At 6 h after operation,TEP group was lower than TAPP group and open group(P<0.05).At 24 h after operation,TAPP group and TEP group were lower than open group(P<0.05).There was no significant difference among the three groups at 1 month after operation(P>0.05).There was no significant difference in CRP,TNF-αand IL-6 among the three groups before operation(P>0.05).At 48 hours after operation,the differences among the three groups were statistically significant(P<0.05),CRP in TEP group<TAPP group<open group(P<0.05).The levels of TNF-αand IL-6 in TAPP group and TEP group were lower than those in open group(P<0.05).There was a significant difference in the incidence of complications within 3 months after operation among the three groups(P<0.05),and the incidence of complications in the TAPP and TEP groups was lower than that in the open group(P<0.05).Conclusion Each of the three methods has its own advantages in the treatment of inguinal hernia,and it is necessary to choose according to the patient's condition in clinical work.