完全腹膜外疝修补术与经腹腹膜前疝修补术对比分析

Comparasion of totally extraperitoneal and transabdominal preperitoneal laparoscopic inguinal hernia repair

目的对比研究完全腹膜外疝修补术(TEP)和经腹腹膜前疝修补术(TAPP)的临床有效性及安全性。方法回顾性分析2011年1月至2013年6月,上海市第七人民医院行腹腔镜腹股沟疝修补术126例患者的临床资料。将126例患者随机分为二组,观察组56例患者行TEP,对照组70例患者行TAPP。比较二组患者的手术时间、术后住院时间、治疗费用、术后并发症及复发。结果观察组患者手术时间(60±5)min,对照组(65±6)min,二组患者差异有统计学意义(t=10.15,P=0.022)。观察组住院时间(5±2)d,对照组(6±2)d,二组患者差异无统计学意义(t=3.68,P=0.076)。观察组无复发,对照组复发2例,差异有统计学意义(χ2=0.31,P=0.020)。观察组平均手术费用(7 246±671)元,对照组(12 387±743)元,二者差异有统计学意义(t=13.25,P=0.001)。二组患者并发症发生率比较差异无统计学意义(χ2=1.05,P=0.075)。结论 TEP和TAPP治疗腹股沟疝均安全有效,但TEP手术时间较短,费用较低,临床推广更具有优势。

Objective To investigate and compare the clinical efficacy and safety of totally extraperitoneal hernia repair （TEP） and transabdominal preperitoneal hernia repair （TAPP）. Methods A total of 126 patients who underwent laparoseopic inguinal hernia repair in Shanghai Seventh People＇s Hospital, from January 2011 to June 2013, were retrospective analyzed. The patients were randomly assigned into two groups, as observation group with TEP （ n = 56） and control group with TAPP （ n = 70）. The operation time, length of postoperative stay, costs of hospitalization, complications, and recurrences were compared between both groups. Results The operation time was （60±5 ） minutes in observation group, and was （65±6） minutes in control group, there was a statistically significant difference between the groups （t = 10. 15, P =0.022）. Length of stay in observation and control group, were （5±2） days and （6±2） days, respectively; no siguifieant differences existed （t = 3.68, P = 0.076）. However, 2 cases of recurrence occurred in control group, none in observation. This difference was statistically significant （X^2 = 0. 31 ,P=0.020）. The average cost in observation group was （7 246±671 ）, less than in control group （ 12 387± 743 ） （ t = 13.25, P = 0.001 ）. No significant difference was found in complication rate between the two groups（X^2 = 1.05 ,P = 0. 075 ）. Conclusion Both TEP and TAPP are safe and effective for inguinal hernia; however, TEP has relatively shorter operation time and less costs, which demonstrates more advantages in clinical practice.