腹腔镜经腹腹膜前疝修补术与Lichtenstein修补术的随机对照研究

A randomized controlled trial comparing the transabdominal preperitoneal technique and the Lichtenstein procedure in the treatment of inguinal hernia

目的:研究腹腔镜经腹腹膜前疝修补术(TAPP)的安全性和临床疗效。方法:2005年3月至2008年3月期间,我们采用前瞻性随机对照法,将252例成人腹股沟疝患者随机分成两组,TAPP组126例,Lichtenstein组126例。比较两组平均手术时间、术后平均住院时间、术中术后并发症、术后疼痛评分(NRS)、使用镇痛药物、平均下床活动时间、平均恢复正常活动时间、术后复发以及手术费用等项,随访10.1(2～36)个月。结果:使用镇痛药物、下床活动时间、住院天数、恢复正常活动时间、术后疼痛程度,TAPP组优于Lichtenstein组,两组比较差异有显著性(P<0.05)。手术时间、总并发症发生率、复发率在TAPP组少于Lichtenstein组,但差异无显著性(P>0.05)。手术费用方面,TAPP组高于Lichtenstein组(P<0.05)。结论:TAPP治疗腹股沟疝是安全、可行的,具有创伤小、恢复快、切口美观等优势,尤其适用于Ⅲ型和Ⅳ型病人。但TAPP费用比Lichtenstein高,这可能是目前TAPP尚未广泛开展的主要原因。

Objective To evaluate the safety and efficacy of transabdominal preperitoneal technique （TAPP） in the treatment of inguinal hernia. Methods A prospective randomized controlled trial comparing the TAPP and Lichtenstein procedures was conducted during the period from March 2005 to March 2008. A total of 252 inguinal hernia patients were randomly assigned into the TAPP group （n=126） and Lichtenstein group （n=126）, respectively. The average operating time, duration of hospital stay, complications, numerical rating scale （NRS）, analgesia requirement, time to recovery, recurrence rate, as well as the cost of the treatment in both groups were compared. Results The analgesia requirement, time to recovery, duration of hospital stay, and NRS were significantly better in the TAPP group than those in the Lichtensten group （P〈0.05）. No significant difference was found in operating time, rates of complications and recurrence between the two groups. The cost of the TAPP was higher than that of the Lichtenstein group. Conclusions TAPP is a safe and feasible technique for inguinal hernia repair, especially for type Ⅲ and Ⅳ cases. Yet, the relatively high cost might be a reason for its postponed popularization.