3DMax补片与普通平片应用于TAPP治疗腹股沟疝的疗效分析

Effect Analysis on 3DMax Patch and Plain Film Applied to TAPP Treatment of Inguinal Hernia

目的比较腹腔镜下经腹腔腹膜前疝修补应用3DMAX补片与普通补片在治疗腹股沟疝的临床疗效。方法回顾性分析哈尔滨医科大学附属第二医院2009年1月至2014年5月期间收治的120例因腹股沟疝行腹腔镜下经腹腔腹膜前疝修补术(TAPP)患者的临床资料,根据术中运用补片的不同分为平片组(45例)和3DMax组(75例)2组。3DMax组补片无固定,平片组补片采用金属钉钉合固定。分析2组患者的临床疗效。结果 2组患者在手术时间、术中出血量及术后住院时间方面比较其差异均无统计学意义(P>0.05);3DMax组术后患者离床活动时间为(20.2±8.1)h,平片组为(26.3±9.2)h,3DMax组患者术后平均离床活动时间明显较平片组早,其差异有统计学意义(P=0.041);3DMax组的耗材费和住院总费用均明显低于平片组(P=0.001、P=0.038);术后随访1、3及9个月,2组患者腹股沟区有异物感者的比例3Dmax组低于平片组(P=0.045);术后1及3个月的神经疼痛VAS评分3DMax组低于平片组(P<0.05),而术后6个月,2组间神经疼痛VAS评分差异无统计学意义(P>0.05)。术后2组患者均无复发病例。结论腹腔镜下TAPP手术中使用3DMax补片具有手术操作更简单,住院费用减少,恢复更快,术后腹股沟神经疼痛及异物感更轻,并发症更少等优点,值得临床推广应用。

Objective To compare the clinical efficacy of abdominal preperitoneal laparoscopic hernia repair with 3DMax patch and plain film for treatment of inguinal hernia. Methods The clinical and follow-up survey data of 120 patients with inguinal hernia in The Second Affiliated Hospital of Harbin Medical University, between January 2009 and May 2014, which were treated by laparoscopic transabdominal preperitoneal repair （TAPP） were retrospectively analyzed. One hundred and twenty cases were divided into two groups： plain film group （45 cases） and 3DMax group （75 cases） according to the intraoperative use of different patchs. The patches of 3DMax group were not fixed, the patches of plain film group were fixed with metal nails. The postoperative clinical effect of two groups were analyzed. Results The operative time, intraoperative blood loss, and postoperative hospitalization days of two groups were no statistical significance （P〉0.05）. The postoperative off bed activity time of patients in 3DMax group and plain film group was （20.2_＋8.1） h and （26.3_＋9.2） h, respectively, the average offbed activity time in 3DMax group was significantly earlier than that in plain film group （P=0.041）. The material expenses and hospitalization expenses of the 3DMax group were significantly lower than those of the plain film group （P=0.001, P---0.038）. The incidence of foreign body sensation of inguinal region in 1, 3, and 9 months after operation of 3DMax group were lower than those of plain film group （P=0.045）. The VAS score in 1 and 3 months after operation of 3DMax group were lower than those of plain film group （P〈0.05）, but there was no statistically significant in 6 months after operation of 2 groups （P〉0.05）. There was no recurrence case in two groups. Conclusions The use of 3DMax patch in laparoscopic TAPP operation have more simple operation, hospitalization expenses decreased, recovery faster, postoperative inguinal nerve pain and foreign body sensation more lighter, and complications more less. It is worthy of clinical popularization and Application.