轻量型网片可以提高腹腔镜全腹膜外腹股沟疝修补术后的功能结局

Lightweight mesh improves functional outcome in laparoscopic totally extra-peritoneal inguinal hernia repair

前瞻性研究旨在比较腹腔镜全腹膜外腹股沟疝修补术(TEP)中,采用新型轻量型网片和传统重量型网片的差异,所有手术均在同一疝中心完成。方法自2004年11月到2005年7月,共有250例病人接受了腹腔镜TEP,采用轻量型(Ultrapro,30g/m)2或重量型网片(Prolene,100g/m2)。通过病历资料回顾及电话问卷调查获得随访数据。术后早期及远期均对病人进行随访,以评估术后结局的变化。结果 250例中有188例(75%)获得随访。在术后平均4个月及15个月进行的随访中发现,轻量型网片组和重量型网片组在疼痛或不适感的发生率及程度上没有差别。轻量型网片组在术后早期及远期对体力活动的影响显著小于重量型网片组,尤其是举重(9%vs.21%,平均随访4个月,Mann-WhitneyU,P=0.024)、行走(1%vs.11%,平均随访5个月,Mann-WhitneyU,P=0.006)及剧烈运动(7%vs.19%,平均随访15个月,Mann-Whitney-U,P=0.012)。腹股沟区的网片感或不适感两组差异无统计学意义。结论采用轻量型网片行腹腔镜TEP可以改善术后早期及远期的功能结局。轻量型网片可以显著减少对所有体力活动的影响。两者的疼痛都较轻微,表明腹腔镜手术的优势。

Objective This has led to various types of mesh being engineered, with a growing interest in a lighter weight mesh. The aim of this prospective study was to compare the outcome after laparoscopic totally extra-peritoneal （TEP） inguinal repair using new lightweight or traditional heavyweight mesh performed in a single specialist centre. Methods Between November 2004 and July 2005, 250 patients underwent laparoscopic TEP inguinal repair using either lightweight （Uhrapro, 30g/m^2） or heavyweight （Prolene, 100 g/m^2） mesh. Follow-up data was obtained using case note review and telephone-based questionnaire. Patients were followed up within the early and late post-operative periods to assess any changes in outcome. Results Follow-up information was obtained for 188 （75%） out of 250 patients. There was no difference between lightweight and heavyweight groups in the incidence or severity of pain/ discomfort at mean 4 and 15 months follow-up. There was significantly less interference with physical activity at short and long term follow-up in the lightweight group, in particular lifting （9% vs 21% at mean 4 months, Mann-Whitney U, P = 0.024）, walking （1% vs 11% at mean 15 months, Mann-Whitney U, P = 0.006） and vigorous activities （7% vs 19% at mean 15 months, Mann-Whitney-U, P = 0.012）. There was no significant difference in awareness of mesh or stiffness in the groin. Conclusions Laparoscopic TEP inguinal hernia repair with a lightweight mesh improves functional outcome in the short and long term. There was significantly less interference with all aspects of physical activity with the lightweight mesh. Pain in both groups was very mild, highlighting the benefits of laparoscopic surgery.