Lichtenstein术式和腹腔镜下经腹腔腹膜前间隙术式在复发性腹股沟疝修补中的应用比较

Comparison of Lichtenstein repair and laparoscopic transabdominal preperitoneal repair of recurrent inguinal hernias

目的探讨应用Lichtenstein和经腹腹膜前疝修补术(TAPP)术式在传统复发性腹股沟疝修补术中的价值。方法采用前瞻性的随机对照试验,选取2009年1月至2013年12月绍兴市人民医院收治的56例复发性腹股沟疝患者,随机分为Lichtenstein组(29例)和TAPP组(26例)。比较二组术前、术中、术后疗效的相关因素。结果 Lichtenstein组和TAPP组平均手术时间相比,差异无统计学意义[(51±6)min vs(53±6)min,P=0.338]。TAPP组相比Lichtenstein组,术后疼痛较轻[(1.9±1.0)分vs(3.0±1.3)分,P<0.001]。Lichtenstein组有7例出现术后并发症(感染、血肿、浆液肿、尿潴留),而在TAPP组有8例出现并发症(血肿、浆液肿、尿潴留),二组比较差异无统计学意义(P=0.585)。二组在随访期间均无疝复发。Lichtenstein组有5例(17.2%)在术后6个月时仍存在术后慢性疼痛,TAPP组3例(11.6%),二组比较差异无统计学意义(P=0.829)。结论对于应用传统修补方法 (无补片)复发的腹股沟疝的治疗,应该首选TAPP,但如果不能进行腹腔镜手术,Lichtenstein手术也是一种选择。

Objective To compare outcomes of two procedures for recurrent inguinal hernia following traditional suture repair： Lichtenstein repair vs TAPP repair. Methods A prospective randomized controlled trial was conducted,and in total,56 patients with recurrent inguinal hernia in Shaoxing People＇ s Hospital,Shaoxing Hospital of Zhejiang University,from January 2011 to December 2013,were randomly assigned to two groups： 29 patients in Lichtenstein group and 26 patients in TAPP group. Preoperative,intraoperative and postoperative factors were compared between the two groups. Results Average operation time for Lichtenstein group was（ 50. 9 ± 6. 1） minutes,compared with（ 52. 5 ± 6. 2） minutes for TAPP patients,but the difference did not reach statistical significance（ P = 0. 338）. In TAPP group,the patients had less pain in the postoperative period than those in Lichtenstein group [（ 1. 9 ± 1. 0） scores vs（ 3. 0 ±1. 3） scores,P 0. 001]. In the Lichtenstein group,a total of 7 postoperative complications（ infection,hematoma,seroma,urinary retention） were observed,compared with 8 in the TAPP group（ P = 0. 585）.There were no cases of hernia recurrence during the follow-up period. Chronic pain（ more than 6 months after the operation） developed in 5 patients from the Lichtenstein group（ 17. 2%） and in 3 patients from the TAPP group（ 11. 6%）,but the difference was not significant（ P = 0. 829）. Conclusion For the treatment of recurrent inguinal hernias following traditional repair（ no mesh）,TAPP repair should be the first choice.If there are any contraindications for the laparoscopy,Lichtenstein repair shows to be an alternative.