开放及腹腔镜无张力疝修补术在双侧腹股沟疝中的应用

THE ANALYSIS OF OPEN AND LAPAROSCOPIC TECHNIQUES FOR TENSION-FREE HERNIA REPAIR FOR PATIENTS WITH BILATERAL INGUINAL HERNIA

目的分析开腹及腹腔镜无张力疝修补术在双侧腹股沟疝治疗中的应用价值。方法回顾分析2011年6月-2013年12月于我院接受完全腹膜外腹腔镜疝修补术治疗的双侧腹股沟疝患者61例，与同期行常规开放无张力疝修补术的54例双侧腹股沟疝患者的临床资料进行对比。结果腹腔镜组手术时间（88．2±15．6）min长于开放组（75．7±21．6）min（P〈0．05）；术后住院时间腹腔镜组（2．6±1．1）d短于开放组（4．2±2．1）d（P〈0．05）；住院费用腹腔镜组（12012．0±2325．2）元高于开放组（9291．3±2010．1）元（P〈0．05）；疼痛评分两组患者术后24、48、72h切口疼痛程度逐渐下降，同一时点比较腹腔镜组均低于开腹组（P〈0．05）；腹腔镜组术中撕裂腹膜3例，未中转其他术式，术后发生急性尿潴留2例。开放组术后急性尿潴留11例，2例发生慢性疼痛，1例切口脂肪液化；随访时间6～24个月，两组均无复发病例。结论开放及腹腔镜无张力疝修补术应用于双侧腹股沟疝均是安全适用的术式，开放术式操作简单、术程短、费用较低，适于基层医院开展；腹腔镜术式创伤小、恢复快、疼痛轻，值得进一步推广。

Objective To analyze the value of open tension - free hemiorrhaghy （OTFH） and laparoscopic totally extraperitoneal prosthesis（LTEP） repair in patients with bilateral inguinal hernia. Methods A retrospective method was used to compare the clinical data of 115 patients with bilateral hernias, of which 61 cases received LTEP and 54 cases underwent OTFH, from June 20ll to December 2013,in our hospital. Results The mean operative time of LTEP group （88.2 ± 15.6 rain） was longer than the OTFH group（75.7±21.6） rain （p 〈0.05）. The dura- tion of hospitalization in LTEP group （ 2.6 ±1.1 ） day was shorter than OTFH group （4.2 ± 2.1 ） d （p 〈 0.05 ）. Hos- pitalization expense of LTEP group（ 12 012.0 ±2 325.2） yuan was higher than the OTFH group（9 291.3 ±2 010.1 ） yuan （p 〈 0. 05 ）. The incision pain by VAS points was gradually decreased in 24 hours, 48 hours, 72 hours after op- eration, and LTEP group was significant lower than OTFH group in the same time point. In LTEP group 3 case had laceration of peritoneum but turn to no other prosthesis, and 2 cases had acute urinary retentions. 11 acute urinary re- tentions occurred in OTFH group, and 2 cases had chronic pain in inguinal area and 1 cases of fat liquefaction. No recurrence was found during a follow - up period of 6 to 24 months in both of 2 groups. Conclusion Both LTEP and OTFH are safe and accessible techniques for patients with bilateral inguinal hernia. OTFH is feasible, and has short process and low cost which is suitable for primary hospitals to carry out. OTFH has the advantages of little trauma, faster postoperative recovery and less complications which is worth promoting in future.