腹腔镜全腹膜外疝修补术与开放腹膜前疝修补术的临床对比分析

Clinical comparative analysis of laparoscopic totally extraperitoneal repair and open preperitoneal repair

目的探讨经腹腔镜完全腹膜外疝修补术（TEP）与开放腹膜前间隙疝修补术治疗成人腹股沟疝的临床疗效。方法回顾性分析2013年1~12月昆明医科大学附属延安医院普外一科（昆明疝与腹壁外科治疗技术中心）实施的成人无张力疝修补术166例,分为TEP组79例,开放腹膜前间隙疝修补术组87例,比较两种手术方式的近期效果,包括手术时间、术中出血量和术后并发症、术后住院时间、住院总费用等;随访观察术后复发及远期并发症。结果所有疝手术患者均实施临床路径管理,TEP组手术时间、术中出血量与开放组比较,差异无统计学意义（P〉0.05）,术后疼痛发生率较开放组明显较少,术后出现并发症明显减少（P〈0.05）,但手术费用较高（P〈0.05）,随访12~24个月,所有患者均无复发。结论 TEP与开放腹膜前疝修补术相比,术后并发症少,大大提高了患者的生活质量,但麻醉风险相对高,手术费用高,在临床工作中应根据患者的具体情况选择相应的个体化手术术式,进而取得最佳的治疗效果。

Objective To discuss the clinical effect of TEP and open preperitoneal repair in adult inguinal hernia. Methods A retrospective study was conducted on 166 cases of inguinal hernia who underwent tension-free repair in Yan＇an Hospital between January 2013 and December 2013. Patients were assigned to two groups,TEP group（ n = 79） and Open preperitoneal repair group（ n = 87）. The short term effect including operation time, bleeding volume and postoperative complications, postoperative hospitalization time,total cost of hospitalization,etc.,were compared,and patients were followed up to observe postoperative recurrence and long-term complications. Results All patients underwent clinical pathway management. TEP group and open group had no significant differences in operation time,intraoperative bleeding volume（ P 0. 05）. The incidence of postoperative pain was significantly reduced compared with the open group,while TEP group had higher cost of operation（ P 0. 05）. All patients were free of recurrence after 12 to 24 months follow-up. Conclusion Compared with the open preperitoneal repair,TEP has less postoperative complications and greatly improving the quality of life in patients,but at the expense of high risk of anesthesia and cost. In order to achieve the best therapeutic effect in clinic,we should choose the operation method corresponding to the individual patient＇s specific situation.