下腹部正中切口腹膜前无张力疝修补术与完全腹膜外疝修补术临床对比研究

Clinical study of preperitoneal tension-free hernia repair and totally extra peritoneal hernia repair via Lower abdominal median incision

目的探讨经下腹正中切口腹膜前无张力疝修补术（后入路组）和完全腹膜外疝修补术（TEP组）在成人腹股沟疝治疗中的临床效果。方法回顾性分析2012年1月至2013年12月,嘉应学院医学院附属医院85例腹股沟疝患者的临床资料,根据手术方式分为二组,后入路组43例,TEP组42例。比较二组患者手术时间、住院时间、术后疼痛评分、住院费用、围手术期并发症（切口感染、阴囊血肿、尿潴留等）发生情况及复发情况。结果二组手术均顺利完成,TEP组患者的住院时间、术后疼痛评分均低于后入路组,差异有统计学意义（t=3.070、6.006,P=0.007、0.000）,而手术时间和住院费用高于后入路组,差异有统计学意义（t=6.730、7.890,P=0.003、0.000）。二组患者并发症发生率比较差异无统计学意义（χ2=0.079,P=0.778）。随访6~24个月,平均（19±4）个月,TEP组分别于术后1年和15个月各复发1例,后入路组术后3个月复发1例,均再次手术后治愈。结论 TEP患者术后疼痛轻,下床活动早,住院时间短。经下腹部正中切口腹膜前无张力疝修补术费用低、技术易掌握,对双侧腹股沟疝、常规前进路的开放术后复发疝更为适合,值得基层医院推广。

Objective To investigate the clinical outcome of the open preperitoneal tension-free hernia repair via lower abdominal median incision （ posterior approach group） and totally extraperitoneal hernia repair （TEP group） in treatment of adult inguinal hernia. Methods The clinical data of 85 patients from January 2012 to December 2013 in Affiliated Hospital of Medicine College of Jiaying University were retrospectively analyzed, including 42 cases in TEP group and 43 cases in posterior group. The two groups were compared with operation time, hospitalization time, postoperative pain score, hospital cost and postoperative complications （wound infection, scrotal hematoma, urine retention, et al）. Results Both procedures were successfully completed. The TEP group had significantly shorter length of stay and pain score than posterior approach group （ t = 3. 070, 6. 006, P = 0.007, 0.000）, but revealed more operation time and cost than the other group （t = 6. 730, 7. 890, P = 0. 003, 0. 000）. There was no significant difference with regard to complications （χ2 = 0. 079, P = 0. 778）. After a follow- up of 6 to 24 months （average 19 ~ 4 months）, 2 cases of recurrence in TEP group （at 1 years and 15 months after the operations, respectively） and one case in posterior approach group （at 3 month） occurred, and the reoperation were needed in these patients. Conclusion TEP has the advantages of less pain, early mobilization and short hospital stay. While, preperitoneal inguinal hernia repair via a lower abdominal median incision had a lower cost, and can be easy to master, especially suitable in patients with bilateral inguinal hernias or recurrent hernia after conventional anterior approach. It is worthy of promotion in primary hospitals.