单孔法与三孔法腹腔镜腹股沟疝修补疗效对比分析

Curative effectiveness of single-hole vs. three-hole laparoscopy for inguinal hernia repair

目的探讨单孔法与三孔法腹腔镜疝修补术治疗腹股沟疝的疗效差异。方法回顾性地收集自2011年6月至2016年6月于我科就诊并行腹腔镜腹股沟疝修补术的205例病人的临床资料。按照拟行手术方式不同(是否中转更改手术方式不作为影响分组因素),将本次研究纳入的205例病人分为单孔组129例和三孔组76例,比较组间病人性别构成、年龄分布、平均体质量指数(body mass index,BMI)、手术时间、中转手术率(单孔法转三孔法或腹腔镜法转传统开放手术)以及术后并发症发生率的差异。结果组间一般资料比较显示,两组病人性别构成、平均年龄、平均BMI及疝类型(单侧、双侧)差异均无统计学意义(均P>0.05);单孔组手术时间为(55.3±22.8)min,三孔组为(49.4±14.9)min,组间差异无统计学意义(P=0.06);单孔组无中转行三孔法手术病例,两组中转行传统开放手术率基本接近,组间差异无统计学意义(P=0.98);两组术后尿潴留、切口感染发生率差异无统计学意义(均P>0.05),而单孔组病人术后疼痛程度相对较轻,术后住院时间相对较短,与三孔组相比,差异均有统计学意义(均P<0.05);两组病人总体住院费用,单孔组为(2.21±0.65)万元,三孔组为(2.55±0.89)万元,差异无统计学意义(P>0.05);两组病人术后血肿形成、皮下气肿、慢性疼痛发生率相比,差异均无统计学意义(均P>0.05),但与三孔组相比,单孔组的上述并发症发生率均有降低趋势。结论单孔法腹腔镜腹股沟疝修补术是一种临床应用相对安全且卫生经济学指标表现更具优势的新兴微创手术方式,更好地吻合了加速康复外科的理念,值得临床进一步研究证实。

Objective To investigate the difference in the curative effectiveness of single-hole vs. three-hole laparoscopy for inguinal hernia repair. Methods The clinical data of 205 patients diag- nosed as having inguinal hernia undergoing laparoscopic inguinal hernia repair in our department from June 2011 to June 2016 were retrospectively collected. 205 patients were divided into single- （129 ca- ses） and three-hole （76 cases） groups, and the differences in patients＇ sex structure, age distribution, the average BMI,operation time, transit operation rate （conversion of single-hole method to three-hole method or laparoscopy to the traditional open surgery） and the incidence of postoperative complications were compared between two groups. Results There were no significant differences in gender struc- ture, average age, average BMI and hernia type （unilateral or bilateral） （P〉0. 05 for all） between two groups. The operation time in the single-hole group was relatively long （single-hole group vs. three- hole group： 55.3 ± 22. 8 vs. 49. 4 ± 14. 9 min）, but the difference showed no statistically significant difference between two group （P = 0. 06）, and there was no significance difference in conversion rate between two groups （P = 0. 98）. There was no significance difference in postoperative urinary retention and infection of incision between two groups, but postoperative pain degree was milder, and postopera- tive hospital time was shorter in the single-hole group than in the three-hole group with the differencebeing statistically significant （P〈0. 05）. There was no significant difference in general hOspltahzatlon cost between two groups （single-hole group vs. three-hole group：2. 21 ± 0. 65 vs. 2. 55 ± 0. 89） （P〉0.05）. There was no significant difference in the incidence postoperative hematoma formation, subcuta- neous emphysema,and chronic pain between two groups （P〉0. 05）, but as compared with the three- hole group, incidence of complications in single-hole group had a decreased trend. Conclusions Single hole laparoscopic inguinal hernia repair is relative safe, and has more advantages on health economic in- dicators and minimally invasive surgery,which matches the concept of fast track surgery better and is worth of further clinical study.