完全腹膜化腹腔镜腹腔内置补片术与经腹腹膜前补片植入术治疗股疝的对照研究

Comparison of laparoscopic total peritoneum intraperitoneal onlay mesh and transabdominal preperitoneal prosthesis in femoral hernioplasty

目的:探讨完全腹膜化腹腔镜腹腔内置补片术(total peritoneum intraperitoneal onlay mesh,TPIPOM)治疗股疝的安全性及优越性。方法:回顾分析2006年1月至2009年12月应用TPIPOM治疗32例股疝患者的术后恢复情况及随访结果,并与同期30例腹腔镜经腹腹膜前补片植入术(transabdominal preperitoneal prosthesis,TAPP)对比分析。结果:两组均顺利完成手术,TPIPOM组手术时间[(32.8±5.4)min vs.(62.4±8.2)min]、术中出血[(8.1±4.0)ml vs.(36.1±7.1)ml]、下床活动时间[(1.2±0.3)d vs.(1.9±0.3)d]、术后疼痛持续时间[(1.2±0.5)d vs.(2.1±0.7)d]、住院时间[(4.3±1.1)d vs.(5.6±1.5)d]、术后异物感发生率(0 vs.17%)、住院费用[(5 200.0±750.2)元vs.(8 301.1±800.2)元]均优于TAPP组,差异有统计学意义(P<0.05)。两组患者术后平均随访(20.2±8.3)个月,均无复发。结论:完全腹膜化腹腔镜腹腔内置补片术治疗股疝安全、有效,具有患者创伤小、康复快、住院时间短、费用低、不易复发、无异物感等优点,值得推广应用。

Objective：To explore the safety and superiority of total peritoneum intraperitoneal onlay mesh in laparoscopic femoral hernioplasty.Methods：Thirty-two patients with femoral hernia were performed with total peritoneum intraperitoneal onlay mesh（TPIPOM） while 30 patients were performed with transabdominal preperitoneal prosthesis（TAPP） from Jan.2006 to Dec.2009.Results：All patients in two groups were successfully performed.The average operative time,intraoperative blood volume,off-bed time,duration of postoperative pain,postoperative duration of hospital stay,the incidence of foreign body sensation and the total hospital cost in TPIPOM group were less than those in TAPP group [（32.8±5.4） min vs.（62.4±8.2） min,（8.1±4.0） ml vs.（36.1±7.1） ml,（1.2±0.3） d vs.（1.9±0.3） d,（1.2±0.5） d vs.（2.1±0.7） d,（4.3±1.1） d vs.（5.6±1.5） d,0 vs.17%,（5 200.0±750.2）yuan vs.（8 301.1±800.2） yuan,P0.05].There was no recurrence report during the period of follow-up（20.2±8.3） month.Conclusions：The surgery of TPIPOM for femoral hernioplasty is safe and feasible and shows superiority in terms of invasion,operative time,hospital cost,postoperative complications and recovery.