腹腔镜全腹膜外腹股沟疝修补术中不同补片固定方式的中远期疗效对比研究

Comparative study of mid-and long-term results following laparoscopic totally extraperitoneal repair for inguinal hernia with different mesh fixed ways

目的对比腹腔镜全腹膜外腹股沟疝修补术中使用3D免固定补片和钉合固定平片对中远期临床疗效的影响。方法收集2013年1月至2014年8月在中山大学附属第三医院胃肠外科行腹腔镜下全腹膜外腹股沟疝修补术的131例患者住院和随访资料,比较3D免固定补片组和钉合固定平片组患者的手术时间、术后疼痛和生活质量等数据。结果两组患者无中转开腹病例,随访期间均未见疝复发。3D补片组的手术时间比钉合固定平片组短(t=3.061,P=0.002),术后6个月和1年慢性疼痛发生率(χ~2=4.943、5.035,P=0.026、0.025)以及术后6个月、1年和2年的异物感发生率(χ~2=4.185、5.035、5.035,P=0.041、0.029、0.025)均比钉合固定平片组少,术后生活质量评分比钉合固定平片组高(t=2.633、2.088、2.000,P=0.009、0.039、0.048)。结论腹腔镜全腹膜外腹股沟疝修补术中使用3D免固定补片可缩短手术时间,减少术后疼痛,提升生活质量,是值得推广的疝修补手术方式。

Objective To investigate the clinical effect of different mesh fixed ways in laparoscopic totally extraperitoneal repair for inguinal hernia. Methods A retrospective review of one hundred and thirty-one patients undergoing laparoscopic totally extraperitoneal repair for inguinal hernia using 3D non- stapled mesh or stapled mesh between January 2013 and August 2014 was performed. Data were compared between two groups including operation time, postoperative pain and life quality. Results There was no turning to open operation and postoperative recurrence in both groups, while operation time was shorter in 3D mesh group （ t=3.061, P=0.002 ）. Compared with stapled mesh group, patients in 3D mesh group reported a lower rate of chronic pain in 6 months and 1 year postoperatively （x^2=4.943, 5.035, P=0.026, 0.025 ）, and a lower rate of foreign body sensation （x^2=4.185, 5.035, 5.035, P=0.041, 0.029, 0.025 ）, but higher scores in quality of life in 6 months, 1 year and 2 years, after primary hernia repair （ t=2.633, 2.088, 2.000, P=0.009, 0.039, 0.048 ）. Conclusion Laparoscopic totatly extraperitoneal repair with 3D nonstaple mesh for inguinal hernia is a feasible way to shorten operation time, decrease chronic pain rate and improve quality of life.