腹腔镜经腹腹膜前疝修补术与Lichtenstein无张力法治疗腹股沟复发疝的前瞻性对照研究

Comparison between Laparoscopic Transabdominal Preperitoneal Herniorrhaphy and Lichtenstein Tension-free Repair for Recurrent Inguinal Hernia: a Prospective Controlled Trial

目的 比较腹腔镜经腹腹膜前疝修补术（transabdominal preperitoneal，TAPP）与Lichtenstein无张力疝修补术治疗腹股沟复发疝的效果。方法 采用前瞻性对照研究将2006年3月～2013年6月65例成人腹股沟复发疝按患者意愿分为TAPP组（n=34）和Lichtenstein组（n=31），比较2组手术时间、术中出血量、术后疼痛评分、术后肛门排气时间、术后住院时间、术后并发症发生率、住院费用以及术后复发率等。结果 65例手术均顺利完成，TAPP组手术时间（44.8±9.7）min明显少于Lichtenstein组（68.1±18.6）min（t=-6.413，P=0.000）；术中出血量中位数10ml（5～50m1）明显少于Liehtenstein组中位数30ml（10～150m1）（Z=-4.349，P：0.000）；术后疼痛评分（2.2±1.5）分明显小于Lichtenstein组（5.5±1.1）分（t=-10.032，P=0.000）；术后住院时间（4.2±1.3）d，明显短于Lichtenstein组（5.6±1.9）d（t=-3.493，P=0.001）；术后复发0例，明显少于Lichtenstein组4例（Fisher＇s检验，P=0.049）；住院费用（10676.8±2018.9）元，明显高于Lichtenstein组（8060.0±990.5）元（t=6.532，P=0.000）；术后肛门排气时间（2.1±0.8）d，明显长于Liehtenstein组（1.5±0.6）d（t=3.394，P=0.001）。结论 TAPP治疗腹股沟复发疝安全可行，在手术时间、术中出血量、术后疼痛评分、术后住院时间、术后复发方面要明显优于Lichtenstein术式，但手术费用较高，手术难度较大，难以广泛开展。

Objective To compare the effect of laparoscopic transabdominal preperitoneal herniorrhaphy with Lichtenstein tension-free repair for recurrent inguinal hernia. Methods A total of 65 patients were involved in this study and received tension- free inguinal hernia repair from March 2006 to June 2013, with 34 patients in TAPP group and 31 patients in Lichtenstein group. The operative time, intraoperative blood loss, postoperative pain scores, postoperative exhaust time, postoperative hospital stay, postoperative complications, hospital cost and recurrence rate were compared between the two groups. Results All the 65 operations were successfully completed. The TAPP group had shorter operative time, less blood loss, lower postoperative pain scores, shorter postoperative hospital stay, and lower recurrence rate than those of the Lichtenstein group [ （44.8 ± 9.7） min vs. （68.1 ± 18.6） rain, t= -6.413,P=0.000）; 10ml（median） vs. 30ml（median）, Z= -4.349,P=0.000; （2.2±1.5）pointsvs. （5.5±1.1） points, t= -10.032,P=0.000; （4.2±1.3） dvs. （5.6±1.9） d, t= -3.493,P=0.001; 0vs. 4, P=0.049]; hospital eost in the TAPP group was significantly higher than that of the Liehtenstein group [ （10 676.8 ± 2018.9） ynan vs. （8060.0±990.5） yuan, t = 6.532, P = 0.000 ] ; exhaust time in the TAPP group was longer than that of the Lichteastein group [ （2.1 ± 0.8） d vs. （ 1.5 ± 0. 6） d, t = 3. 394,P = 0. 001 ]. Conclusions TAPP is a safe and feasible procedure for recurrent inguinal hernia repair. Compared with Lichtenstein procedure, TAPP is superior in operative time, intraoperative blood loss, postoperative pain scores, postoperative hospital stay and postoperative recurrence. However, the relatively high cost and complicated procedures might be reasons for its postponed popularization.