腹腔镜疝修补术与开放疝修补术的效果比较

A comparative study on the effects of transabdominal preperitoneai hernia repair and open hernia repair surgery in the treatment of adult inguinal hernia

目的评价不同阶段腹腔镜腹股沟疝修补术（TAPP）和开放式疝修补术（Rutkow术）的临床疗效。方法我院2003年1月至2005年12月行TAPP术56例（TAPPI组），同期行开放式疝修补术78例（Rutkow组），2010年1—12月行TAPP术76例（TAPPⅡ组）。回顾性分析3组患者的临床资料和治疗效果，包括手术时间、术后住院时间、术后下床活动时间、术后正常活动时间、住院费用、术后进食时间以及术后并发症的发生情况。结果TAPPⅡ组术后住院时间、术后进食时间、术后下床时间和术后正常活动时间低于TAPPI组和Rutkow组[（2．6±1．6）、（4．1±2．6）、（4．2±1．9）d，（8．6±3．1）、（22．2±3．8）、（20．7±3．2）h，（4．6±2．2）、（18．3±2．3）、（20．5±3．1）h，（8．6±2．9）、（15．2±3．3）、（17．1±3．8）d]，差异均有统计学意义（P均〈0．05），而TAPPI组与Rutkow组间差异均无统计学意义（P均〉0．05）；TAPPI组手术时间长于Rutkow组和TAPPⅡ组[（113．3±18．6）、（50．4±11．8）、（48．6±12．1）min]，差异有统计学意义（P均〈0．05），而Rutkow组与TAPPⅡ组差异无统计学意义（P〉0．05）。3组术后并发症及复发率比较，差异均无统计学意义（P均〉0．05）。结论随着技术的熟练，腹腔镜腹股沟疝修补术具有创伤小、并发症少、手术时间短以及复发率低的优点，是一种比较理想的腹股沟疝修补术式。

Objective To evaluate the clinical outcomes of different stages of transabdominal preperitoneal hernia repair （TAPP） and open hernia repair surgery （Rutkow） in treating adult inguinal hernia. Methods The clinical data of patients with inguinal hernia undergoing hernia repair （ TAPP, TAPP I group：56 patients administered TAPP during January 2003 to December 2005;TAPP II group：76 patients administered TAPP during January to December 2010） and Rutkow hernia-ring filling （Rutkow group： 78 patients administered Rutkow during January 2003 and December 2005 ） were analyzed retrospectively. Clinical indexes and effective indicators were observed to compare the treatment effects of the operation procedures, including duration of surgery, post-operation hospital stay, post-operation leaving bed time, post-operation free activity time, hospitalization costs, time of beginning taking food, and complications. Results The TAPP II group had significantly shorter average length of stay, time of beginning taking food, post-operation leaving bed time and post-operation free activity time than the other two groups （ average length of stay ： （2. 6 ± 1.6） d vs. （4. 1 ±2. 6） d vs. （4. 2 ± 1.9） d; time of beginning taking food ： （ 8. 6 ± 3.1 ） h vs. （22. 2 ± 3.8 ） h vs. （20. 7 ± 3.2） h;post-operation leaving bed time： （4. 6-± 2. 2） h vs. （18. 3 ± 2. 3 ） h vs （20. 5 ± 3. 1 ） h; Post-operation free activity time ： （8.6 ± 2. 9 ） d vs. （ 15.2 ± 3.3 ） d vs. （ 17.1 ± 3.8 ） d; P 〈 0. 05 ）. There were no significant differences between TAPP I and Rutkow groups on average length of stay, time of beginning taking food, postoperation leaving bed time and post-operation free activity time （ P 〉 0. 05 ）. TAPP I group had significantly longer duration of operation than the other two groups （（ 113.3 ± 18.6） min vs. （50. 4 ± 11.8 ） min vs. （48.6 ± 12. 1 ） min,P 〈0. 05 ）. There was no difference on surgery duration between Rutkow and TAPP II groups （P 〉 0. 05 ）. No difference was observed regarding rates of postoperative complications and recurrence （P 〉 0. 05）. Conclusion With the advancement of technology, TAPP shows more advantages compared to traditional herniorrhaphy, such as minimal trauma, fewer complications and shorter duration of operation and lower recurrence rate. TAPP is an excellent hernia repair for inguinal hernia.