经腹腹膜前疝修补术与局麻下腹股沟疝无张力修补术的对比研究

Comparative study of transabdominal preperitoneal hernia repair and tension free repair of inguinal hernia under regional anesthesia

目的探讨经腹腹膜前疝修补术与局麻下腹股沟疝无张力修补术的优势。方法回顾性分析2014年1月-2015年1月首都医科大学大兴区人民医院普外科收治的64例腹股沟疝手术患者的临床资料。其中腹腔镜组34例，行经腹腹膜前疝修补术[采用善释D（9＊13）补片]；传统组30例，行局麻下腹股沟疝无张力修补术（采用善释D10补片）。结果两组患者均顺利完成手术，比较两组手术时间（P=0．000）、术后下床活动时间（P=0．000）、术后住院时间（P=0．003）、肛门排气时间（P=0．000）差异有统计学意义；两组伤口血清肿（P=0．216）、血肿（P=1．000）、镇痛药物应用（P=0．090）、术后1年内复发率（P=1．000）差异无统计学意义。结论经腹腹膜前疝修补术及局麻下腹股沟疝无张力修补术均是安全有效的，两者各有所长，医师应该根据患者病情合理地选择手术方式。

Objective To explore the difference between laparoscopic transabdominal preperitoneal hernia repair （TAPP） and open preperitoneal hernia repair for the treatment of inguinal hernia under local anesthesia. Methods A total of 64 cases with inguinal hernia underwent hernia repair in Beijing Daxing District Hospital of Capital Medical University from January 2014 to January 2015 were retrospectively analyzed. Thirty-four cases in test group were applied with TAPP and used D（9 ＊ 13） mesh to repair for inguinal hernia ,and 30 cases in tradi- tional group with open preperitoneal hernia repair which used D10 mesh to repair for inguinal hernia. Results All operations were successfully completed. There was statistically significant difference in operation time （P = 0. 000）, postoperative activity time（ P = 0. 000）, postoperative hospitalization time （ P = 0. 003 ） and pass flatus time （ P = 0. 000） between these two groups. There was no statistically significant difference in wound seroma（P = 0. 216）, hematoma （ P = 1. 000） , analgesics （ P = 0.090） and recurrence rate of the first year （ P = 1. 000 ）. Conclusions Both TAPP and tension free repair of inguinal hernia under regional anesthesia are safe and effective methods for the treatment of inguinal hernia, which has its advantages. Surgeon should choose the suitable procedure according to patient＇s condition reasonably.