腹腔镜下两种术式治疗成人腹股沟疝的临床疗效及心理观察

Clinical outcome observation and psychological status investigation of two kinds of procedure for inguinal hernia in adult patients

目的探讨腹腔镜下经腹腹膜前疝修补术(TAPP)与完全腹膜外疝修补术(TEP)治疗成人腹股沟疝的临床疗效及对患者心理情况的影响。方法回顾性分析2012年5月至2014年9月,中山市民众医院216例成人腹股沟疝患者,将其按患者意愿选择术式划分为TAPP组(126例)与TEP组(90)例,分别行TAPP与TEP术式。对比二组术后疼痛时间、术后住院时间、复发情况、住院费用,以评价手术效果;统计二组患者入院时、术前、术后、出院时焦虑自评量表(SAS)得分,评价患者焦虑程度变化。结果二组术后疼痛时间、术后住院时间、复发率对比,差异无统计学意义(P=0.574、0.619、0.397)。TEP组住院费用明显更高,差异有统计学意义(P=0.009);手术前、手术后、出院前,TEP组患者SAS评分明显低于TAPP组,差异有统计学意义(P=0.000、0.000、0.000)。结论腹腔镜下TAPP及TEP疝修补术均具备较好的临床疗效,TEP方案虽然住院费用较高,但能较好地缓解患者焦虑心理,二者各有优势,需合理选择。

Objective To investigate the clinical efficacy of laparoscopic transabdominal preperitoneal hernia repair （TAPP） and totally extraperitoneal hernia repair （TEP） , and to evaluate the influence of the two procedures. Methods From May 2012 to September 2014, 216 cases of inguinal hernia in Zhongshan City Public Hospital were randomly divided into TAPP group （n = 126） and TEP group （n = 90）, according to the procedure performed. The postoperative pain duration, hospital stay, recurrence and hospitalization costs were compared as treatment outcome; The Self-rating Anxiety Scale （SAS） on admission, preoperative, postoperative and discharge time were analyzed to evaluate the anxiety. Results There were no statistically significant differences in the postoperative pain duration, length of hospital stay and rate of recurrence （P =0. 574, 0. 619, 0. 397 ）. Hospitalization expenses in TEP group was obviously higher, and the difference was significant （P =0. 000, 0. 000, 0. 000）. The SAS of patients in TEP group showed significantly lower score at preoperative, postoperative and discharge time, respectively. Conclusion Both laparoscopic TAPP and TEP show a remarkable clinical outcome. TEP procedure needs more expenses, but it is able to better alleviate the anxiety of patients. These two procedures both have their own advantages, should be chosen rationally.