腹腔镜经腹膜前与完全腹膜外疝腹股沟疝修补术临床分析

Clinical comparison between transabdominal preperitoneal repair and totally extraperitoneal repair in inguinal hernia repair

目的探讨两种术式的优点与局限性,为临床诊治提供依据。方法回顾性分析2013年6月至2014年12月,新疆生产建设兵团医院收治的经腹腹膜前疝修补术（transabdominal preperitoneal,TAPP）及完全腹膜外疝修补术（totally extraperitoneal,TEP）161例患者的临床资料,均采用腹腔镜下微创手术,随访6~15个月（中位数10个月）,统计分析手术时间、手术费用、术后住院时间、并发症、术后活动恢复时间。结果 TAPP组手术时间较TEP组长,差异有统计学意义（P〈0.05）;手术费用、术后住院时间比较,差异无统计学意义（P〉0.05）;TEP患者术后活动恢复时间较TAPP快,差异有统计学意义（P〈0.05）。结论 TAPP术中有可能发现对侧隐匿性疝,但手术时间相对较长,因损伤腹膜,术后活动恢复较慢;完全腹膜外疝修补术可保持腹膜完整性,术后活动恢复相对较快,但对腔镜下操作要求高,若疝囊分离破裂往往需中转TAPP,因腹膜前间隙血管较多,损伤后可能导致术区血肿。对术者腔镜解剖认知、操作要求更为严格。

Objective To discuss the advantages and limitations of transabdominal preperitoneal repair（ TAPP） and totally extraperitoneal repair（ TEP）,and to provide reference for clinical practice.Methods The patients with inguinal hernia who underwent TAPP and TEP repair in Xinjiang Production and Construction Corps Hospital from June 2013 to December 2014 were enrolled in this study. All of them were followed up for 6- 15 months（ the median was 10 months）. The operation time,cost,postoperative hospital stay,complications and recovery of postoperative activities were statistically analyzed. Results The operation time of TAPP was longer compared to TEP group,the difference was statistically significant（ P〈 0. 05）; the recovery time to physical activity in TEP was shoter than that of TAPP（ P〈 0. 05）. Conclusion It is possible to find occult contralateral hernia in TAPP,on the contrary,it may have relatively long operation time,peritoneal injury,delayed postoperative recovery; TEP can maintain the integrity of the peritoneum,and has a relatively rapid postoperative recovery,but it requires further endoscopic operating skills and anatomic knowledge to the surgeons.