腹腔镜和开放式无张力疝修补术对患者术后早期疼痛的影响

Effect of Laparoscopic Versus Open Tension-Free Hernioplasty on Early Postoperative Pain for Patients with Inguinal Hernia

目的 探讨应用腹腔镜和开放式无张力疝修补术对患者术后早期疼痛程度及特点的影响。方法本研究统计分析了自贡市第四人民医院2013年7月至2015年6月期间120例初次接受腹股沟疝无张力修补手术患者,根据所采用的手术方式不同分为腹腔镜手术组（n=60）和开放式手术组（n=60）,使用视觉模拟量表（VAS）评分评估患者术后早期的疼痛程度并进行统计学分析。结果 1术后12 h内,2组间患者总体VAS评分比较差异无统计学意义（F=1.674,P=0.198）,但2组患者VAS评分在各时间点比较差异有统计学意义（F=21.186,P=0.000）,进一步对每个时间点2组间的VAS评分进行成组t检验分析,差异均有统计学意义（P〈0.05）;同时,分组与时间的交互作用也具有统计学意义（F=87.038,P=0.000）,提示2组患者VAS评分随时间的变化趋势受分组的影响。2术后7 d内,VAS评分在2组间（F=46.358,P=0.000）以及各时间点间（F=576.387,P=0.000）比较差异均有统计学意义且VAS评分均呈下降趋势,进一步对每个时间点2组的VAS评分进行成组t检验分析,差异亦均有统计学意义（P〈0.050）,从术后第2 d开始,开放式手术组VAS评分均明显高于腹腔镜手术组（P〈0.050）,腹腔镜手术组的VAS评分水平下降幅度大于开放式手术组;同时分组和时间点的交互作用也具有统计学意义（F=19.454,P=0.000）,提示VAS评分随时间点变化的趋势受分组影响。3开放式手术组和腹腔镜手术组患者在术后7 d内疼痛部位及疼痛特点构成比比较差异有统计学意义（χ^2=10.108,P=0.001;χ^2=7.144,P=0.028）,开放式手术组患者疼痛主要体现在伤口区域的锐性疼痛,而腹腔镜手术组患者腹部钝痛的比例更高而伤口区域锐性疼痛的比例更低;整个住院期间使用止痛药物的剂量2组间比较差异无统计学意义（t=0.872,P=0.386）。结论 以腹腔镜技术为代表的微创手术方式在减轻腹股沟疝患者术后疼痛方面具有一定优势,但微创不等于无痛,疝修补手术还有进一步改进的必要。

Objective To compare degree and characteristics of early postoperative pain for patients with inguinal hernia underwent laparoscopic versus open tension-free hernioplasty. Methods The clinical data of 120 patients who underwent tension-free hernioplasty from July 2013 to June 2015 were analyzed. All of the patients were divided into open tension-free hernioplasty group （open group, n=60） and laparoscopic tension-free hernioplasty group （laparoscope group, n=60）. Visual analogue scale （VAS） score was evaluated at different time point. Results （i） Within 12 h after operation, the comparison of total VAS score between the laparoscope group and the open group had no significant difference （F=1.674, P=0.198）, the difference of VAS score in these two groups was significantly different at each time point （F=21.186, P=0.000）, and the variation tendency was influenced by grouping factors （F=87.038, P=0.000）. （2） Within 7 d after opera- tion, the differences of comparison of total VAS score between the laparoscope group and the open group and at each time point were statistically significant （F=46.358, P=0.000; F=576.387, P=0.000） and had a downtrend, further more the variation tendency was influenced by grouping factors （F=19.454, P=0.000）, （3） The composition ratios of pain site and characteristics had significant differences between these two groups within 7d after operation （χ^2=10.108, P=0.001; χ^2=7.144, P=0.028）, the dosage of analgesic drugs between two groups had no significant difference （t=0.872 P=0.386）. Conclusions As a representative of minimally invasive surgery, laparoscopic technology has certain advantages in reducing postoperative pain for patients with inguinal hernia, but minimally invasive technique does not mean to painless. Further improvement is needed by hernia surgery.