开放式与腹腔镜全腹膜外腹股沟疝修补术的前瞻性随机对照研究

Prospective randomized comparative study on opening and laparoscopy totally extraperitoneal prosthetic herniorrhaphy

目的研究开放式全腹膜外腹股沟疝修补术在临床应用中的价值。方法采用前瞻性随机对照方法,将73例成人腹股沟疝患者分成两组,分别进行开放式全腹膜外腹股沟疝修补术(37例)和腹腔镜全腹膜外腹股沟疝修补术(Totally extraperitoneal prosthetic,TEP)(36例)。手术后1周和1年内对患者作出临床观察和评估,并在3个月和1年时进行电话及门诊随访。观察指标为:手术时间、术后使用镇痛的频率、术后卧床时间、住院天数、手术并发症、正常活动时间、疝复发率、医疗费用、学习曲线等。将两组数据进行统计学处理和分析。结果手术时间、术后使用镇痛的频率、术后卧床时间、住院天数、正常活动时间、疝复发率等方面两组差异无统计学意义(P>0.05)。学习曲线、手术并发症、医疗费用开放组少于TEP组,差异有统计学意义(P<0.05)。结论开放式全腹膜外腹股沟疝修补术住院费用低,只需常规手术器械,学习曲线短,简便易推广,是一种安全有效的术式。

Objective To study the value of opening totaly extraperitaneal herniorrhaphy in the treatment of hernia.Methods IIn a prospective randomized controlled study,73 cases with adult inguinal hernia were divided into two groups.37 cases were repaired with opening totally extraperitoneal herniorrhaphy,and 36 cases received the totally extraperitoneal prosthetic（TEP）.The observe period was within 1 week to 1 year in two groups and the patients were followed-up by telephone or consultation in out-patient clinic between 3 months and 1 year after operation.Outcome measures were：operation time,postoperative the frequency of using analgesic drugs,bed time,duration in hospital,complications,normal time,recurrence rate,medical expenses,period of learning-curve,et al.The two sets of data were processed and analyzed statistically.Results There was no significant difference in two groups in the operation time,frequency of using analgesic drugs,duration in hospital,recurrence rate.The period of learning-curve,complications,medical expenses was more satisfactory in the opening totaly extraperitaneal herniorrhaphy than those in the TEP.There was a significant difference in two groups.Conclusion The medical expenses and period of learning-curve of the opening totaly extraperitaneal herniorrhaphy were less than the TEP,and it was simple and convenient.