不同固定方式在Lichtenstein腹股沟疝修补术应用的对比研究

Comparative study of different fixations in Lichtenstein tension-free repair for inguinal hernia

目的比较不同固定方式在Lichtenstein腹股沟疝修补手术中的应用价值。方法回顾性分析2012年6月至2014年4月上海市闵行区中心医院收治的194例男性新发单侧腹股沟疝患者,采用随机数字表法分为3组:自固定组使用自固定补片;缝合固定组使用聚丙烯补片,传统缝合固定;联合固定组使用聚丙烯补片,医用胶联合缝线固定。比较三组手术时间、术后并发症、术后3 d疼痛评分、术后1个月慢性疼痛评分及异物感发生率、术后短期(1年内)复发率。结果缝合固定组手术时间为(57±6)min,长于自固定组的[41±5 min,t=3.655,P=0.002]及联合固定组的[48±5 min,t=2.672,P=0.016],自固定组和联合固定组间手术时间比较,差异无统计学意义(t=0.468,P=0.646)。三组患者均未出现伤口感染,血清肿发生例数差异无统计学意义(χ2=2.302,P=0.316)。缝合固定组术后3 d及术后1个月疼痛评分阳性比例高于自固定组(χ2=6.224、7.069,P=0.013、0.008)和联合固定组(χ2=4.430、4.608,P=0.035、0.032),自固定组和联合固定组间术后3 d疼痛评分阳性比例无统计学意义(χ2=0.311、0.978,P=0.577、0.323)。三组患者术后1个月异物感发生率差异无统计学意义(χ2=0.261,P=0.878)。三组患者术后短期(12个月)均未观察到复发。结论在Lichtenstein腹股沟疝修补术中,自固定及医用胶联合缝线固定相比传统缝线固定可减少患者手术时间,减轻术后疼痛,疗效安全、可靠,均具有较高的临床应用价值。

Objective To compare the application value of different fixations in Lichtenstein inguinal hernia repair. Methods From June 2012 to April 2014,194 men with primary unilateral inguinal hernia who were admitted to Shanghai Minxing Central Hospital were randomly divided into 3 groups： mesh repair group with self-gripping mesh,suture fixation group using normal polypropylene（ PP） mesh fixed by suture,the combined fixation group with PP mesh fixed by suture and medical glue. The data was collected regarding operation time,complication,postoperative pain at 3 days or 1 month,foreign body sensation rate and short-term（ 1 year） recurrence rate. Results The mean operation time was（ 57 ± 6） minutes in the suture fixation group,which was much longer than that in the self-gripping group [（ 41 ± 5） minutes; t =3. 655,P = 0. 002] and the combined fixation group [（ 48 ± 5） minutes; t = 2. 672,P = 0. 016]. There was no significant difference in the mean operation time between the self-gripping group and combined fixation group（ t = 0. 468,P = 0. 646）. No incision infection and recurrence was observed in three groups,there was no difference in the incidence of seroma（ χ2= 2. 302,P = 0. 316）. The postoperative pain rate at3 days and chronic pain at 1 month after operation in the suture fixation group were higher than those in the self-gripping group（ χ2= 6. 224,7. 069; P = 0. 013,0. 008） and the combined fixation group（ χ2= 4. 430,4. 608; P = 0. 035,0. 032）,but without any difference comparing self-gripping group with combined fixation group（ χ2= 0. 311,0. 978; P = 0. 577,0. 323）. There was no significant difference in the incidence of foreign body sensation in the three groups at 1 month after surgery（ P = 0. 878,χ2= 0. 261）,and no recurrence was observed in the three groups at 12 month follow-up. Conclusion Compared with the normal suture fixation,either self-gripping mesh or combined suture and medical glue fixation in Litchenstein inguinal hernia repair can reduce the operation time and pain after operation,and both of them are effective,safe and reliable.