腹腔镜全腹膜外与经腹腹膜前腹股沟疝修补术的临床对比研究

Comparison of Total Extraperitoneal and Transabdominal Preperitoneal in Laparoscopic Inguinal Herniorrhaphy

目的比较腹腔镜全腹膜外（TEP）与经腹腹膜前（TAPP）腹股沟疝修补术的可行性、安全性及有效性。方法回顾性分析2010年3月至2013年10月期间于笔者所在医院行腹腔镜TEP疝修补术（TEP组）和腹腔镜TAPP疝修补术（TAPP组）的95例腹股沟疝患者的临床资料和手术资料，比较TEP组和TAPP组患者的手术时间、术中出血量、术后住院时间、手术费用、术后并发症发生情况等。结果所有患者的手术均获成功，无中转开放手术病例。TEP组与TAPP组患者的手术时间[（65±16）min比（68±17）mini、术中出血量[（7．0±1．2）mL比（8．0±1．4）mL3、术后疼痛分数[（2．0±1．1）分比（1．8±1．1）分]、术后住院时间（（3．1±1．4）d比（3．3±1．2）d]及恢复正常活动时间[（4．2±1．0）d比（4．5±1．2）d]比较差异均无统计学意义∽〉0．05）；TEP组和TAPP组的手术费用分别为（8033＋536）元和（9632＋643）元，TAPP组较高（P=O．007）。术后发生并发症6例（6．3％，6／95），2组各3例，包括阴囊血（清）肿3例、暂时性感觉神经障碍1例，尿潴留2例，2组并发症发生率比较差异也无统计学意义（P=1．000）。所有患者均获访，随访时间为1～35个月、（20．0±10．2）个月，无复发及慢性疼痛发生。结论TEP与TAPP疝修补术均是可行、安全及有效的术式，各有其优缺点，两者在手术并发症方面无明显差别。

[Abstract] Objective To compare the feasibility, safety, and efficiency of laparoscopic total extraperitoneal （TEP） hernia repair surgery and laparoscopic transabdominal preperitoneal （TAPP） hernia repair surgery. Methods The clinical data of 95 patients with inguinal hernia who underwent laparoscopic TEP hernia repair surgery （TEP group） and TAPP hernia repair surgery （TAPP group） from Mar. 2010 to Oct. 2013 in our hospital were retrospectively analyzed, and clinical parameters including operation time, intraoperative blood loss, postoperative hospital stay, postoperative comp- lication, and operation cost of 2 groups were compared. Results All the procedures were successful, none of them was converted to open surgery. There was no significant difference between TEP group and TAPP group when considering operation time[ （65±16） min vs.（68± 17） mini, intraoperativc blood loss [ （7.0± 1.2） mL vs. （8.0± 1.4） mL], visual pain analogue scale [ （2.0 ± 1.1） score vs. （1.8_＋ 1.1） score 1, postoperative hospital stay ~ （3.1 ±1.4） d vs. （3.3±1.2） d], and time to release to regular activities [ （4. 2±1.0） d vs. （4.5± 1.2） d], P〉0.05. But the operation cost of TEP group was significantly lower than that of TAPP group [ （8 033±536） yuan vs. （9 632±643） yuan, P=0. 0071. There were 6 patients （6. 3%, 6/95） suffered complications, 3 cases in TEP group and 3 cases in TAPP group, including 3 cases of seroma or hematoma in scrotum, 1 case of transient neurapraxia, and 3 cases of urinary retention. There was no signi- ficant difference in incidence rate of postoperative complication between the 2 groups （P=I. 000）. All patients werefollowed-up for 1 35 months ~ （20. 0_＋ 10. 2） months] without recurrence and chronic pain. Conclusions TEP and TAPP hernia repair surgery are feasible, safe, effective, and minimally invasive technique for inguinal hernioplasty. There are advantages and disadvantages of both TAPP and TEP hernia repair surgery, but there is no statistically significant difference regarding intraoperative and postoperative complications.