非编织补片和编织补片在腹腔镜腹股沟疝修补术中应用的对比研究

Application of mesh versus non-mesh surgical patch in the laparoscopic repair

目的探讨非编织补片在腹股沟疝腹腔镜修补术中应用的安全性、有效性以及术后合并症和补片的皱缩率情况。方法 2009年1月至2009年6月,对60例初发腹股沟疝患者进行腹腔镜疝修补手术治疗,随机选择非编织补片和编织补片,分析患者资料,包括手术时间、术后住院时间、住院费用、围术期合并症发生率,术后9~14个月随访慢性疼痛、异物感的发生率以及复发率和测定补片皱缩率等。结果 60例患者手术无中转,非编织补片组和编织补片组平均手术时间、术后住院天数、术后血清肿以及住院费用方面差异均无统计学意义,术后慢性疼痛非编织组1例（3.3%）明显少于编织组3例（10%）,编织组异物感5例（16.7%）明显高于非编织组2例（6.7%）。术后超声实测补片1、3、6、9个月横径皱缩变化,术后1个月起非编织组补片横径皱缩明显低于编织组（P〈0.05）,差异具有统计学意义。结论腹腔镜疝修补术使用非编织补片和编织补片均是安全有效的,非编织补片术后皱缩率明显低于编织补片,非编织补片术后慢性疼痛和异物感的发生率低于编织补片。

Objective To explore the efficacy,safety,complication and shrinkage of mesh and non-mesh surgical patch in the application of transabdominal preperitoneal prosthetic（TAPP）.Methods Data of 60 cases with primary inguinal hernia treated with the laparoscopic TAPP herniorrhaphy in our department during Jan 2009 to Jul 2009 were reviewed.The patients were randomized in to two groups to receive mesh and the non-mesh surgical patches in the operation,respectively,and the patients were followed up for 9~14 months.Analysis of the data,including operation duration,postoperative length of stay,cost of hospitalization,postoperative complication,chronic pain,foreign body sensation,recurrence rate and shrinkage.Results It showed that in all of the 60 cases the TAPP was finished,there was no significant difference in operation duration,postoperative length of stay,cost of hospitalization and the occurrence of hematoma between the 2 groups.The chronic pain sensation occurred in 1 case（3.3%） of non-mesh group,which was lower than the surgical mesh group（3 cases,10%）,the foreign body sensation occurred in 2 cases（6.7%） of the non-mesh group,which was lower than the surgical mesh group（5 cases,16.7%）.The measurement of the meshes＇ diameter was used to calculate the shrinkage by the ultrasound（post operation 1,3,6,9 months）.From the second month after the operation,less shrinkage of non-mesh group than the surgical mesh group was seen（P0.05）.Conclusion The non-mesh patch was more effective and safe than the mesh in TAPP,the non-mesh patch could reduce the occurrence of chronic pain and foreign body sensation,caused less shrinkage.