腹腔镜下腹股沟疝修补术的术式选择与效果

Selection of laparoscopic surgical procedure for inguinal hernia repair

目的:探讨腹腔镜腹股沟疝修补术的手术方法选择。方法:回顾分析广西医科大学第一附属医院2004年1月—2008年1月经腹腔腹膜前腹腔镜腹股沟疝修补术(TAPP)和完全腹膜外腹腔镜腹股沟疝修补术(TEP)162例(178侧)患者的临床资料,比较两组的术中出血量、手术时间、术后肛门排气时间、术后住院天数、术后并发症、术后复发率及远期慢性疼痛等临床效果。结果:两组患者术前的一般临床资料具有可比性(均P>0.05),两组均无手术死亡和术后严重并发症病例。下床活动时间、近期并发症、住院天数两组间差异无统计学意义(均P>0.05),但TAPP组的手术时间,复发疝的手术成功率明显高于TEP组(均P<0.05),TEP组肛门排气时间短于TAPP(P<0.05)。结论:腹腔镜腹股沟疝修补术安全性好,两种术式各有优缺点,具体的要根据患者情况及手术者本人的手术技能而定,不能盲目采取统一手术方式。

Objective： To investigate the selection of laparoscopic surgical procedure for inguinal hernia repair. Methods： The clinical data of 162 patients （178 sides）, who underwent totally extraperitoneal （TEP） repairor transabdominal preperitoneal （TAPP） inguinal heruia repair, between January 2004 and January 2008 in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed, The clinical results such as the amount ofintraoperative blood loss, operative time, time to passage of flatus, postoperative hospitalstay, postoperative complications, recurrence rate and long-term chronic pain between the two groups were compared. Results： The general data of the two groups before operation were comparable （all P〉0.05）. There was nooperative mortality and no serious postoperative complications occurred in any of the groups. The time to ambulation, early complications and length of hospital stay between the two groups had no statisticaldifferences （all P〉0.05）, while the operative time and surgical success rate of recurrent inguinal hernia repair of TAPP group were significantly higher than those of TEP group （both P〈0.05）, and the time to passage of flatus of TEP group was less than that of TAPP group （P〈0.05）. Conclusion： Laparoscopic approaches for inguinal hernia repair are safe and each of the two procedures has its advantages and disadvantages. Thus, the choice of procedure may not be uniform and, instead, should depend on the patient＇s individual condition and surgeon＇s operative experience.