腹腔镜腹股沟疝修补术中疝固定器与医用胶固定补片的疗效研究

The comparative study between compont medical adhesive and auto-suture tacks in the meshes’ fixation of TAPP

目的探讨医用胶在腹腔镜经腹腹膜前修补术（TAPP）中固定补片的安全性和有效性。方法 2009年1-7月,对60例初发腹股沟疝患者进行TAPP手术治疗,术中采用疝固定器和医用胶固定补片随机对照试验,术后随访7-14个月。结果两组患者均无复发,疝固定器组术后血清肿2例,医用胶组1例;疝固定器组术后慢性疼痛1例。疝固定器组和医用胶组的手术时间分别为（37±10）min和（55±10）min,疝固定器组显著短于医用胶组（P=0.036）;术后住院天数分别为（3.2±1.3）d和（2.9±1.2）d,两组无显著性差异（P=0.231）;疝固定器组住院费用[（9267±785）元]显著高于医用胶组[（6542±863）元,P=0.000]。术后疼痛分数疝固定器组显著高于医用胶组（P〈0.05）。结论 TAPP术中使用医用胶粘合固定补片不增加术后复发,而且有止血作用,可减少术后慢性疼痛和血肿的发生,减少住院费用,疗效安全、可靠。

Objective To investigate the safety and availability of compont medical adhesive in the meshes’ fixation of TAPP. Methods Sixty cases of primary inguinal hernia treated by the TAPP in our department during Jan to Jul 2009 were reviewed. A control study in the operation between compont medical adhesive and auto-suture tacks was carried out and all were follow-up for 7~14 months. Results Both of the two groups had no relapse. Hematoma occurred in two case of auto-suture tacks group and one in the compont medical adhesive group. Pain experienced in the auto-suture tacks group in one or none in the compont medical adhesive group. The operative time in the auto-suture tacks group was （37±10）min and the compont medical adhesive group was （55±10）min（P = 0.036）. The postoperative length of stay in the auto-suture tacks group was （3.2±1.3） days and the compont medical adhesive group was （2.9±1.2） days, without significant difference （P = 0.231）. The cost of hospitalization in the auto-suture tacks group was （9267±785）yuan and the compont medical adhesive group was （6542±863）yuan （P = 0.000）. There were more cases with postoperative pain in the auto-suture tacks group than the compont medical adhesive group （P ≤ 0.05）. Conclusions The appliacation of the compont medical adhesive in the TAPP has hemostasis effect and can reduce the occurrence of postoperative hematoma and pain. It is a safe and available treatment approach.