部分小肠微创切除在绞窄性腹股沟疝患者中的应用研究

Effect of laparoscopy-assisted partial small bowel resection on patients with strangulated inguinal hernia

目的探讨腹腔镜部分小肠切除术联合开放式无张力疝修补对绞窄性腹股沟疝患者的应用研究。方法选取2008年1月-2015年12月于该院收治的98例绞窄性腹股沟疝患者作为研究对象,根据手术方案分为微创组(n=41,腹腔镜部分小肠切除术联合开放式无张力疝修补术)和开腹组(n=57,开放式小肠切除术联合Bassini修补术)。比较两组术前基线资料、手术时间、术后并发症、术后住院天数、生存状况和疝复发率。结果两组术前基线资料比较,差异均无统计学意义(P>0.05),具有可比性。微创组的术后慢性疼痛不适的发生率、复发率均明显低于开腹组,差异均有统计学意义(P<0.05)。两组的手术时间、切口感染、腹股沟淤血或血肿发生率、术后住院天数和围手术期死亡率等资料比较,差异均无统计学意义(P>0.05)。结论对绞窄性腹股沟疝患者而言,腹腔镜部分小肠切除术联合开放式无张力疝修补术不仅能充分利用无张力补片修补的优点,并避免了肠管切除对补片的污染,降低了感染和复发风险,值得临床推广应用。

Objective To investigate the effect of laparoscopy-assisted partial small bowel resection combined with open tension-free hernioplasty on patients with strangulated inguinal hernia. Methods 98 patients with strangulated inguinal hernia from January 2013 to December 2015 in our hospital were enrolled in the study and divided into the minimally invasive group （n = 41, laparoscopy-assisted partial small bowel resection combined with open tensionfree hernioplasty） and laparotomy group （n = 57, open partial small bowel resection combined with Bassini repair） according to the operation mode. Preoperative baseline data, operation time, postoperative complications, postoperative hospital stay, survival status and recurrence rate were compared between two groups. Results There were no significant differences in preoperative baseline data between the two groups （P 〉 0.05）. The incidence of postoperative chronic pain and recurrence in the minimally invasive group were significantly lower than that in laparotomy group （P 〈 0.05）. There were no significant differences in operation time, incidence of incision infection, inguinal bruising or hematoma, postoperative hospital stay, perioperative mortality between the two groups （P 〉 0.05）. Conclusions For patients with strangulated inguinal hernia, laparoscopy-assisted partial small bowel resection combined with open tension-free hernioplasty could not only make full use of advantages of tension-free repair patch, but also avoid pol- lution of the bowel resection to patch, which can reduce the risk of infection and recurrence, it is worthy of clinical application.