腹腔镜下疝修补术在腹股沟疝中的临床应用价值

Clinical value of laparoscopic hernioplasty in treating inguinal hernia

目的比较传统疝修补术、无张力疝修补术以及腹腔镜下疝修补术治疗腹股沟疝的临床疗效和安全性。方法将105例腹股沟疝患者依据手术方式分为传统疝修补术组(A组,32例)、无张力疝修补术组(B组,34例)、腹腔镜下疝修补术组(C组,39例)。比较3组手术和术后恢复情况。结果 3组手术时间为:A组(44.5±10.8)min,B组(36.8±8.9)min,C组(60.4±18.5)min,其差异有统计学意义(P<0.01);术中出血量[(46.0±6.9)、(35.1±6.1)、(21.4±4.7)ml],离床活动时间[(2.7±0.4)、(1.4±0.5)、(1.0±0.5)d],住院时间[(9.7±2.4)、(6.0±3.5)、(5.2±2.1)d],差异有统计学意义(P<0.01),A组与B组住院费用[(5 164.5±540.3)元,(5 120.7±354.8)元]显著低于C组[(7 944.9±650.1)元,P<0.01]。术后1、3、5 d时3组疼痛视觉模拟评分(VAS)A组显著高于B组和C组,B组显著高于C组,差异均有统计学意义(P<0.05,P<0.01)。B、C两组并发症总发生率(20.6%,5.1%)显著低于A组(59.4%,P<0.01)。C组术后2年内腹股沟疝复发率显著低于A组(5.1%vs.28.1%,P<0.05),与B组(11.8%)比较差异无统计学意义(P>0.05)。结论腹腔镜下疝修补术具有创伤小、痛苦轻、恢复快、并发症少、复发率低等优势,但对操作者要求严格,且医疗费用相对较高。

Objective To compare the clinical effect and safety of traditional, tension-free and laparoscopic hernioplasty for inguinal hernia. Methods One hundred and five patients with inguinal hernia were divided into group A （traditional hernioplasty, 32 cases）, group B （tension-free hernioplasty, 34 cases）, and group C （laparoscopic hernioplasty, 39 cases） according to the operation method. The operation and postoperative recovery condition of the three groups were compared. Results The length of operation time was group B〉 group A〉 group C. The bleeding time, postoperative activity time, hospital stay was group A〉group B〉group C （P〈0.01）. The hospitalization expense of group A and group B were lower than that of group C （P〈0.01）. The postoperative VAS was group A〉group B〉group C （P〈0.05 or P〈0.01）. The incidence of postoperative complications in group B and C were obviously lower than that in group A （P〈 0.01）. The recurrence rate within two years in group C was obviously lower than that in group A （P〈 0.05）, while there was no significantly different between group B and group C （P〉 0.05）. Conclusion The laparoscopic hernioplasty for inguinal hernia has the advantage of minor trauma, rapid postoperative recovery, few complication and low recurrence rate. Nevertheless, the operation is strict with operator and has higher medical expenses. Clinician should select suitable operation method according to the patientˊs situation, economy, the patientˊs and the familyˊs will.