腹腔镜经腹腹膜前疝修补术中补片钉合固定与负压吸引固定的对比研究

Comparative study of stapling and vacuum aspiration methods for mesh fixing in laparoscopic transabdominal preperitoneal prosthesis

目的:比较腹腔镜经腹腹膜前疝修补术(transabdominal preperitoneal prosthesis,TAPP)中不同补片固定方法的安全性与有效性。方法:选取2011年7月至2013年3月开展的142例(178例次)TAPP的病例,依据术中补片固定方式分为钉合组(67例,86例次)与负压吸引组(75例,92例次),对两组患者的临床资料与随访资料进行回顾分析。结果:两组手术均顺利完成,术后随访2～21个月(中位时间13个月)。钉合组单侧手术时间平均(56.4±16.27)min,术后平均住院(3.43±0.52)d,住院费用平均(14 837±1 568)元,术后1例复发,复发率1.49%(1/67)。负压吸引组手术时间平均(51.3±14.67)min,术后平均住院(3.51±0.58)d,住院费用平均(11 714±726)元,术后无复发病例。两组在复发率、手术时间、术后住院时间方面差异无统计学意义(P>0.05),平均住院费用负压吸引组明显低于钉合组(P<0.05)。钉合组术后前三位并发症依次为阴囊气肿(10.45%)、阴囊血清肿(5.97%)与暂时性神经感觉异常(4.48%);负压吸引组术后前三位并发症依次为阴囊血清肿(4.00%)、暂时性神经感觉异常(2.67%)、阴囊气肿(1.33%)与尿潴留(1.33%)。负压吸引组阴囊气肿发生率明显低于钉合组(P<0.05),其他术后并发症方面两组差异无统计学意义(P>0.05)。结论:TAPP术中使用钉合法与负压吸引法固定补片均是安全、有效的,术后复发率差异无统计学意义。使用负压吸引法固定补片可节省住院费用,降低术后阴囊气肿发生率,是TAPP术中更经济有效的补片固定方式。

Objective：To compare different methods for mesh fixing in laparoscopic transabdominal preperitoneal prosthesis（TAPP） and evaluate their safety and efficiency.Methods：A retrospective analysis was made on the clinical data of 142 patients（178 sides） who underwent laparoscopic TAPP from Jul.2011 to Mar.2013.According to the means of mesh fixing,patients were divided into two groups,stapling fixing group（67 cases,86 sides） and vacuum aspiration fixing group（75 cases,92 sides）.Results：All the surgeries were successful.Postoperative follow-up time was 2-21 months（median time was 13 months）.Average unilateral operation time for stapling fixing group was（56.4±16.27） min and post-operative hospitalization duration was（3.43±0.52） d.One case recurred and the recurrence rate was 1.49%（1/67）.For vacuum aspiration fixing group,the time was（51.3±14.67） min and（3.51±0.58） d.No recurred case was observed.There was no significant difference in recurrence rate,operation time and post-operative hospitalization duration between two groups（P0.05）.Average hospital costs were（11 714±726） yuan for vacuum aspiration fixing group which was much lower than that of stapling fixing group（14 837±1 568） yuan（P0.05）.The top three post-operation complications for stapling fixing group were emphysema of scrotum（10.45%）,scrotal seroma（5.97%） and temporary nerve paresthesia（4.48%） while for vacuum aspiration fixing group were scrotal seroma（4.00%）,temporary nerve paresthesia（2.67%）,emphysema of scrotum（1.33%） and uroschesis（1.33%）.The incidence of emphysema of scrotum was much lower in vacuum aspiration fixing group（P0.05）.No significant difference was observed in other complications（P0.05）.Conclusions：Both methods for mesh fixing in laparoscopic inguinal hernia repair（TAPP） are safe and effective and there are no significant differences in recurrence.However,the vacuum aspiration fixing method is more economical with lower costs and incidence of emphysema of scrotum.