局麻无张力疝修补术与腹腔镜全腹膜外疝修补术的临床对比分析

Comparative study on laparoscopic total extraperitoneal hernia repair and tension-free hernioplasty under local anesthesia

目的比较局麻无张力疝修补Lichtenstein手术和腹腔镜全腹膜外疝修补术(total extrapentioneal repair,TEP)的优缺点。方法回顾252例成人腹股沟疝分别进行TEP56例和局麻Lichtenstein196例的临床资料。术后1周和半年进行临床评估。结果术后3d内应用止痛药频率、恢复正常活动时间、术后半年内手术区域慢性疼痛等方面,TEP组均优于Lichtenstein组,两组有显著性差异(P<0.05);并发症、复发率,TEP组与Lichtenstein组两者无显著性差异(P>0.05);手术时间、初次下床活动时间、术后住院时间、住院费用等方面Lichtenstein组优于TEP组,两者差异有显著性(P<0.05)。结论TEP具有伤口小、疼痛轻、恢复快的优点,但费用高。局麻Lichtenstein手术操作简单、费用低、适应证广,适合老年病人。

Objective To compare the clinical efficiency of laparoscopic total extraperitoneal hernia repair （TEP） with Lichtenstein tension-free hernioplasty under local anesthesia （TFH）. Methods The clinical data of 252 adult patients with inguinal hernia were retrospectively studied. Fifty-six cases were repaired by TEP, and 196 cases had TFH. Clinical evaluation was made at one week and at half a year after operation. Results In TEP group, the frequency of analgesic use in 72 hours after operation, the time of return to regular activity, and chronic local pain were significant better than those in TFH group （ P 〈 0.05 ）. There was no significant difference between the two groups in complication and recurrence rate （ P 〉 0.05 ）. But in Lichtenstein procedure group, the operation time, length of postoperative hospital stay, time to ambulation, and cost, were more better than those in TEP group （ P 〈 0.05 ）. Conclusions TEP has small incision, less pain and quick recovery, but with high cost. The TFH is simple, lower cost, and wide indications, espicially suitable for elderly patients.