两种后入路腹膜前间隙修补术治疗成人腹股沟疝的临床观察

Clinical comparison between TAPP and Kugel herniorrhaphy in adult inguinal hernia

目的比较两种后入路腹膜前间隙修补术TAPP和Kugel术在成人腹股沟疝治疗中的手术效果。方法对2014年1月至2016年1月台州市立医院收治的194例成人单侧腹股沟疝患者的临床资料进行回顾性分析,其中TAPP术96例,Kugel术98例。观察并比较两组手术时间、术后离床活动时间、术后住院时间、手术费用及术后并发症等方面的差异。结果 TAPP组手术时间、术后离床时间、住院时间均较Kugel组短,差异有统计学意义(t=2.315、2.195、2.521,P=0.022、0.029、0.013),而住院费用比Kugel组费用高,差异有统计学意义(t=8.210,P=0.000)。比较两组的并发症如切口感染、异物感、慢性疼痛、血清肿的发生率差异无统计学意义,但TAPP组血清肿发生率在Ⅲ型腹股沟疝病例要高于Kugel组,差异有统计学意义(χ~2=4.254,P=0.039)。随访期间TAPP组有2例Ⅲ型腹股沟疝复发,但与Kugel组比较差异无统计学意义。结论 TAPP与Kugel疝修补术都是腹股沟疝修补安全有效的手术方式,但对于腹股沟Ⅲ型疝,临床中应根据患者腹股沟疝具体分型及术者经验进行个体化术式选择。

Objective To compare the clinical effect of transabdominal preperitoneal （TAPP） and Kugel herniorrhaphy in treating adult inguinal hernia. Methods The data of adult inguinal hernia patients admitted to Taizhou Municipal Hospital from January 2014 to January 2016 were retrospectively analyzed. One hundred and ninety-four cases of primary unilateral inguinal hernia were treated with TAPP operation （96 cases） or Kugel operation （98 cases）. The differences in clinical efficacy, postoperative complications and cost were compared between the two groups. Results TAPP operation was superior to Kugel operation in operative time, mean activity time and mean hospitalization time （t=2.315, 2.195, 2.521, P=0.022, 0.029, 0.013）. TAPP group had a higher total hospital costs than Kugel group, and the consequence showed statistically significance between the two groups （t=8.210, P=0.000）. There were no significant differences in the complications such as incision infection, foreign body sensation, chronic pain and seroma. But seroma in Type HI of TAPP group was higher than in Kugel group （x^2=4.254, P=0.039）. Two postoperative recurrent cases of Type m occured in TAPP group, but there was no significant difference. Conclusions Both TAPP and Kugel herniorrhaphies are recommended approaches to repair the myopectineal orifice with their safety, effectiveness and convenience. The individual choice depends on the type of hemia and economic factor of patients.