腹腔镜腹股沟疝修补术与开放腹股沟疝修补术并发血清肿的比较

Study on diagnosis and treatment of seroma after laparoscopic inguinal hernia repair and open inguinal hernia repair

目的比较腹腔镜腹股沟疝修补术与开放腹股沟疝修补术并发血清肿的情况及防治策略。方法收集汕头市第二人民医院2015年9月至2016年9月连续收治的腹股沟疝患者共117例,根据手术方式分为腹腔镜手术组(TAPP组)及开放腹股沟疝手术组(Lichtenstein组),通过统计对比两组血清肿的发生率、发生特点及诊治经过,研究对比其发生的影响及防治策略。结果TAPP组64例,年龄范围25~73岁,中位年龄57岁;斜疝58例,直疝4例,股疝2例,其中难复性疝3例;Lichtenstein组53例,年龄范围24~84岁,中位年龄63岁;斜疝41例,直疝10例,股疝2例,其中难复性疝7例。两组临床血清肿发生率差异无统计学意义(P=0.875);各型临床血清肿发生率差异均无统计学意义(均P>0.05)。其中0~Ⅱ型血清肿患者无需治疗,经过随访血清肿能够自行消退;Ⅲ~Ⅳa型临床血清肿患者可以行局部穿刺抽液并行加压治疗,经治疗后好转;Ⅳb型经过引流及抗炎治疗后好转。结论两种方式腹股沟疝修补术后并发临床血清肿的发生率及治疗方法基本相同。

Objective To compare the influence of laparoscopic inguinal hernia repair (TAPP) and open inguinal hernia repair(Lichtenstein) on clinical serum swelling and the prevention and treatment strategy.Methods From September 2015 to September 2016,117 patients with inguinal hernia in the Second People's Hospital of Shantou were selected.The patients were divided into TAPP group and Lichtenstein group according to the operation mode.The incidence of seroma,occurrence,characteristics and diagnosis and treatment of the two groups were compared.Results There were 64 cases in the TAPP group,aged 25-73 years old,the median age was 57 years,58 cases of indirect inguinal hernia,4 cases of direct hernia,2 cases of femoral hernia,3 cases of refractory hernia.There were 53 cases in the Lichtenstein group,aged 24-84 years old,the median age was 63 years,41 cases of indirect inguinal hernia,10 cases of direct hernia,2 cases of femoral hernia,7 cases of refractory hernia.There was no statistically significant difference in the incidence rate of seroma between the two groups (P=0.875). There were no statistically significant differences in the incidence rate of different types of seroma (all P>0.05). There was no need for treatment of 0-II type seroma.The type III-IVa clinical seroma could be given local puncture parallel compression treatment,improved after treatment.After drainage and anti-inflammatory treatment,type IVb seroma was improved.Conclusion There is no difference in the incidence of seroma and the treatment between the two surgical procedures after inguinal hernia repair.