小切口腹股沟疝补片修补术应用价值探讨

Small incision inguinal hernia mesh repair

目的探讨小切口腹股沟疝补片修补术的应用价值。方法前瞻性随机对照研究176例成人腹股沟疝手术,其中58例行小切口腹股沟疝补片修补术,65例行疝环充填式无张力疝修补术(MPH),53例行全腹膜外腹腔镜疝修补术(TEP),比较三组病例的切口长度、手术时间、住院费用、术后恢复时间、手术并发症、复发率等。结果三组病例的切口长度、术后复发率、手术时间、住院费用和术后恢复时间比较差异有统计学意义(P<0.05),小切口腹股沟疝补片修补组平均切口长度(3.7±0.8)cm,术后复发率最低;MPH组切口最长、手术时间最短;TEP组手术时间最长、费用最高,但切口最短、术后恢复时间最短。三组的手术并发症发生率差异无统计学意义(P>0.05)。结论三种手术方式各有特点,对不适于TEP而腹横筋膜薄弱并有高度复发因素的腹股沟疝患者,尤其老年瘦弱者,小切口腹股沟疝补片修补术是更好的选择。

Objective To explore the value of small incision inguinal hernia mesh repair. Methods One hundred and seventy-six cases who underwent inguinal herniorrhaphy from January 2012 to January 2014 were included in this prospective controlled study,with 58 cases in small incision inguinal hernia mesh repair（ SIIHMR） group,65 cases in mesh plug hernioplasty（ MPH） group and 53 cases in total extraperitoneal（ TEP） group. The effectivness,complications and cost of varied approachs of inguinal hernia repair were analyzed and compared among the three groups. Results The incision length,recurrence,operating time,cost and recovery time were significantly different among the three groups（ P〈0. 05）. There were a lower recurrence and an average length of（ 3. 7 ± 0. 8） cm in the SIIHMR group. The longest incision and shortest operating time occurred in the MPH group,and the longest operating time and the highest cost. The shortest incision and the fastest recovery occurred in the TEP group. The complication rates were not significantly different among the three groups（ P〈0. 05）. Conclusion The three kinds of hernioplasty have their own characteristics,SIIHMR is suitable for the patients who have inguinal hernia with weak transverse fascia or high recurrence risk,especially elderly patients.