腹腔镜下腹股沟疝修补与局麻下Rutkow腹股沟疝修补术的比较

Clinical comparison on totally extraperitoneal hernia repair and Rutkow tension-free hernioplasty under local anaesthesia

目的探讨完全腹膜外腹腔镜下腹股沟疝修补术(TEP)是否优于局麻下Rutkow填充式无张力腹股沟疝修补术。方法将60例腹股沟疝患者随机分为TEP组(30例)和Rutkow组(30例)。TEP组中斜疝27例、直疝3例,其中1例因腹壁下动脉出血中转Rutkow术;Rutkow组中斜疝26例、直疝4例。比较两组患者手术时间、术后患者恢复活动时间、住院天数、术后当天及术后第4天疼痛评分,记录术后并发症发生率(阴囊浆液肿、切口积液等),并随访患者术后局部外观满意度、患侧复发率。结果住院天数、术后当天及术后第4日疼痛评分、术后局部外观满意度,TEP组均优于Rutkow组(P<0.05);手术时间、术后恢复活动时间,Rutkow组均优于TEP组(P<0.05);术后复发率两组比较差异无统计学意义(P>0.05)。TEP组术后较多的并发症为阴囊气肿、浆液肿,而Rutkow组术后较多的并发症为术后出血、切口脂肪液化、切口感染等。结论两种手术方式各有优缺点,腹腔镜手术组患者术后感觉优于传统无张力修补术,两者的远期效果相同。

Objective To evaluate whether the totally extraperitoneal hernia repair （TEP） is superior to Rut-kow tension-free hernioplasty under local anaesthesia. Methods The clinical data of 60 patients with inguinal hernia were randomly underwent TEP （TEP group） and Rutkow procedure （Rutkow group）. TEP group （n=30） included 27 cases of indirect hernia and 3 cases of direct hernia, in which 1 was transferred to Rutkow procedure because of inferior epigastric artery bleeding. Rutkow group （n=30） included 26 cases of indirect hernia and 4 cases of direct hernia. The two groups were compared in terms of operation time, time for recovering activity, length of hospital stay, the pain scores on the day of operation and the fourth day after operation. The incidence of postoperative complications （scrotum seroma, wound fluid, etc.） was recorded. The patients’satisfaction to postoperative local appearance and the recurrence rate were observed. Results TEP group was significantly better than Rutkow group for average length of hospital stay, pain score on the day of operation and the fourth day after operation, and the patients’satisfaction to postoperative local appearance （P0.05）, but Rutkow group was significantly better than TEP group for operation time and time for recovering activity （P0.05）. The recurrent rate showed no statistically significant difference between the two groups （P0.05）. The major complications of TEP were scrotal emphysema and seroma, while those of Rutkow tension-free hernioplasty were incision fat liquefaction, incision infection and postoperative hemorrhage. Conclusion There were different merits and demerits for each procedure. The postoperative experience of Rutkow tension-free hernioplasty was better than TEP, but the clinical efficacy has no statistically significant difference.