腹腔镜腹股沟疝修补术的术式选择

A study on the approach to laparoscopic repair for groin hernias

目的比较经腹腹膜前补片植入术(TAPP)和全腹膜外补片植入术(TEP)的安全性和有效性,探讨腹腔镜腹股沟疝修补术的术式选择。方法回顾性分析1997年1月至2005年1月行腹腔镜腹股沟疝修补术的235例(274例次)患者的临床资料,其中TAPP 139例(163例次),TEP 96例(111例次),随访时间6～24个月(中位时间15个月)。结果手术无中转,TAPP和TEP在手术时间、术后住院天数、术后疼痛分数VAS、2周以内恢复非限制性活动人数上差异无统计学意义(均 P>0．05);TAPP和TEP的复发率分别为1．8％和0．9％(P=0．524),总并发症率分别为15．3％和 10．8％(P=0．282),前3位并发症依次为血清肿(5．5％比4．5％,P=0．707),暂时性神经感觉异常 (5．5％比3．6％,P=0．464)和尿潴留(3．1％比2．7％,P=1．000);TAPP住院费用高于TEP(P= 0．000)。结论 TAPP和TEP都是安全有效的无张力手术,外科医生的临床经验比术式选择更为重要。

Objective To compare the safety and efficiency of laparoscopic transabdominal preperitoneal （TAPP） and totally extraperitoneal （TEP） procedure for herniorrhaphy. Methods Between Jan 1997 and Jan 2005, 235 patients （274 hernias） underwent laparoscopic inguinal hernia repair with 163 TAPP in 139 patients and 111 TEP procedures in 96 patients. Postoperative patients were followed-up for 6-24 months. Results No conversion was necessary. There were no significant differences between TAPP and TEP when considering operating time, postoperative hospital stay, VAS and time to return to daily activity. The recurrence rate was 1.8% and 0. 9% respectively in TAPP and TEP（ P = 0. 524）. The total incidence of postoperative complications were 15.3% and 10. 8% respectively （P =0. 282） , with seroma, transient neurapraxia and urinary retention being 5.5% vs. 4. 5% （ P = 0. 707 ） , 5.5% vs. 3. 6% （ P = 0. 464） and 3. 1% vs. 2. 7% （P = 1. 000）. The inhospital cost was significantly higher in TAPP than in TEP（ P = 0. 000）. Conclusion TAPP and TEP are both safe and efficient tension-free technique. Surgeons＇ experience was more important than choice of approach to laparoscopic repair for groin hernias.