腹腔镜与无张力疝修补治疗复发性腹股沟疝对比分析

Comparison of laparoscopic vs open mesh techniques for recurrent inguinal hernias

目的评价腹腔镜下治疗复发性腹股沟疝的安全性与有效性,讨论术式的选择。方法回顾性分析2008年1月至2012年1月收治的58例复发性腹股沟疝的临床资料。其中腹腔镜腹股沟疝修补术(LIHR)27例,开放式无张力修补术31例。术后患者均得到随访,随访时间2～42个月(中位时间18个月)。结果二组手术时间差异(P=0.072)、术后住院天数无差异(P=0.067)、术后第二天疼痛分数(VAS)差异(P=0.084)、2周内恢复非限制性活动例数差异(P=1.000)均无统计学意义;二组患者在随访期内均无复发,总并发症发生率分别为6.7%和9.1%,差异无统计学意义(P=1.000)。结论 LIHR在治疗复发性腹股沟疝时与开放式无张力修补术同样安全有效,术式选择取决于前次手术的类型和手术医师的临床经验。

Objective To evaluate the clinical safety and efficacy of laparoscopic inguinal hernia repair（LIHR） for recurrent hernia, and discuss the procedure preferences. Methods From Jan 2008 to Jan 2012, a non-randomized control study was done in the 58 recurrent inguinal hernias,including 27 patients LIHR and 31 patients open mesh repair. All patients were followed up for 2 to 42 months with a median of 18 months. Results There was no significant difference between LIHR and open mesh repair regarding operating time （P = 0.072）, postoperative hospital stay （P = 0.076） ,visual analogue pain score （P = 0.084） and time to return to usual activity （P = 1. 000）. There was no recurrence in two groups and the total incidence rates of postoperative complication were 6.7 % and 9.1%, respectively no difference was observed within two groups （P = 1. 000）. Conclusions LIHR and open mesh repair are safe and effective techniques for recurrent inguinal hernia. The choice of method should be based on the last repair type and investigators＇ experiences.