三种不同腹腔镜术式治疗老年复发性腹股沟疝的临床效果比较

Comparison of clinical effects of three laparoscopic surgical treatments for elderly patients with recurrent inguinal hernia

目的:比较腹腔镜腹腔内补片植入术(intraperitoneal onlay mesh,IPOM)、腹腔镜经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)与腹腔镜全腹膜外疝修补术(totally extraperitoneal,TEP)3种手术方式治疗老年复发性腹股沟疝的临床效果。方法:回顾分析为156例老年复发性腹股沟疝患者行腹腔镜手术的临床资料,其中23例行IPOM,106例行TAPP,27例行TEP,术后随访1个月,对比3种术式的手术时间、术后住院时间、术后下床活动时间、术后第1天疼痛VAS评分等情况。结果:IPOM、TAPP、TEP 3组患者平均手术时间为(53.2±13.8)min、(52.6±18.6)min、(56.5±16.8)min;术后住院时间平均(4.2±2.1)d、(3.5±2.8)d、(3.7±1.9)d;术后下床活动时间平均(14.2±3.8)h、(15.5±3.1)h、(15.3±2.9)h;术后第1天疼痛VAS评分平均(2.3±0.3)分、(2.5±0.6)分、(2.6±0.9)分;术后并发症发生率分别为13.04%、16.98%与14.81%,上述指标差异均无统计学意义(P>0.05)。结论:3种腹腔镜疝修补术均适于老年复发性腹股沟疝患者,具体手术方式主要根据上次手术入路及补片层次进行个性化选择。

Objective：To compare the clinical effects of three laparoscopic surgical treatments on elderly patients with recurrent inguinal hernia,which are intraperitoneal onlay mesh（ IPOM）,laparoscopic transabdominal preperitoneal（ TAPP） and totally extraperitoneal（ TEP） hernia repair respectively. Methods：The clinical data of 156 elderly patients with recurrent inguinal hernia were retrospectively analyzed. Among them,there were 23 cases of IPOM,106 cases of TAPP and 27 cases of TEP. Patients were followed up for 1month after surgery,operative time,postoperative hospitalization time,postoperative ambulation time,the first postoperative day pain VAS score in the three groups were compared. Results：The mean operative time in the IPOM,TAPP and TEP groups of were（53. 2 ±13. 8） min,（52. 6 ± 18. 6） min,（56. 5 ± 16. 8） min respectively. The mean postoperative hospital stay of which were（4. 2 ± 2. 1） d,（3. 5 ± 2. 8） d,（3. 7 ± 1. 9） d. The average time of postoperative ambulation were（14. 2 ± 3. 8） h,（15. 5 ± 3. 1） h,（15. 3 ± 2. 9） h.The average VAS pain scores of the 1st postoperative day were（2. 3 ± 0. 3）,（2. 5 ± 0. 6）,（2. 6 ± 0. 9）. The incidence of complications in the three groups were 13. 04%,16. 98% and 14. 81%,the differences among three groups were not statistically significant（ P 0. 05）. Conclusions：Three laparoscopic surgical methods can be effectively used in elderly patients with recurrent inguinal hernia.The personalized surgical program should be selected according to the last surgical approach and the patch level.