开放式与腹腔镜全腹膜外疝修补术的比较研究

Comparative study of open and laparoscopic total extraperitoneal herniorrhaphy

目的探讨开放式全腹膜外腹股沟疝修补术和腹腔镜全腹膜外腹股沟疝修补术的临床疗效及安全性。方法采用随机对照方法,将112例成人腹股沟疝患者分成两组各56例,分别进行开放式全腹膜外腹股沟疝修补术(开放式组)和腹腔镜全腹膜外腹股沟疝修补术(TEP组),观察两组患者手术时间、术中出血量、术后住院时间、术后并发症、疝复发率、学习曲线、住院费用等。结果开放式组除术后住院时间比TEP组延长外(P<0.001),其手术时间、学习曲线和住院费用均比TEP组明显减少(P<0.001);两组患者术中出血量和术后并发症比较差异无统计学意义(P>0.05)。结论开放式组和TEP组治疗成人腹股沟疝同样安全有效。TEP组住院费用高,学习曲线长;开放式弥补了TEP的缺点,住院费用低,学习曲线短,只要常规手术器械,易于学习和掌握,具有广阔的应用前景。

Objective To explore the clinical efficacy and safety of open and laparoscopic total extraperitoneal herniorrhaphy. Methods 112 adult patients of inguinal hernia were randomly divided into two groups, each of 56 patients：TEP group were repaired with total extraperitoneal herniorrhaphy, and Open group were repaired with open total extraperitoneal hemiorrhaphy. The observation indexes included operation time, intraoperative blood loss, postoperative hospital stay, postoperative complications, hernia recurrence rate, the learning curve, and hospitalization expense. Results Although postoperative hospital stay were longer, operation time, learning curve, hospitalization expense were less in Open group than those in TEP group （P 〈0. 001）. There was no statistical difference in intraoperative blood loss or postoperative complications between the two group（P 〉 0.05）. Conclusion TEP and open surgery are equally effective and safe in the treatment of adult inguinal hernia. High costs of hospitalization and long learning curve feature in the TEP group. Open group has the advantages of low costs, short learning cure, needing of conventional operation equipment, and being easy to learn and master, suggesting its broad application.