腹腔镜和开放无张力疝修补术临床研究

Clinical Research on Laparoscope and Open Tension-free Hernia Repair

目的腹腔镜和开放式无张力腹股沟疝修补术的临床效果对比研究。方法回顾性分析曲阜市中医院2012年1月—2015年1月收治的126例腹股沟疝修补术患者的临床资料,按照手术方式的不同分为腹腔镜疝修补网片固定术组(A组,41例)、腹腔镜疝修补网片免固定术组(B组,46例)和开放式无张力疝修补术组(C组,39例),比较3组患者术后相关的临床指标。结果 3组患者手术均得到较好的疗效,A、B组患者在术中出血量(4.8±2.5)、(4.1±2.3)m L、术后进食时间(8.1±4.5)、(7.3±4.2)h、术后下床时间(4.1±1.8)、(3.7±1.5)h、住院时间(3.1±1.5)、(2.8±1.7)d明显小于C组(8.3±2.9)m L,(13.4±5.1)h,(19.3±3.2)h,(5.9±2.5)d,差异有统计学意义(P<0.01),B、C组患者在住院费用(6 341±418.0)、(5 913±471.0)元明显少于A组(9 309±537.0)元,差异有统计学意义(P<0.05),A、B组(无疼痛患者)患者在术后疼痛明显少于C组(9例),差异有统计学意义(P<0.05),B组患者在切口感染、切口血肿、术后疼痛、术后慢性疼痛、肠粘连、复发和A组、C组比较差异无统计学意义。结论腹腔镜和开放式无张力腹股沟疝修补术均是安全有效的术式,腹腔镜疝修补网片免固定术式简单实用、费用低、易于推广。

Objective To comparatively research the clinical effect of laparoscope and open tension-free hernia repair.Methods 126 cases of patients with open tension-free hernia repair admitted and treated in our hospital from January 2012 to January 2015 were selected and divided into three groups according to the different operation methods, the laparoscopic hernioplasty fixation group(A group, 41 cases), laparoscopic hernioplasty without fixation group,(B group, 46 cases) and open tension-free hernia repair(C group, 39 cases), and the related clinical indexes after operation were compared between the three groups. Results Both groups obtained a better curative effect, the intraoperative bleeding amount, postoperative food-taking time, time to get out of bed after operation and length of stay in the group A and group B were obviously lower than those in the group B, and the differences were statistically significant [(4.8 ±2.5)、(4.1±2.3)m L,(8.1±4.5)、(7.3±4.2)h,(4.1±1.8)、(3.7±1.5)h,(3.1±1.5)、(2.8±1.7)d vs(8.3±2.9)m L,(13.4±5.1)h,(19.3±3.2)h,(5.9±2.5d)](P<0.01), and the hospitalization cost in the group B and group C was obviously lower than that in the group A[(6 341 ±418.0),(5 913±471.0)yuan vs(9 309±537.0) yuan, and the difference was statistically significant(P<0.05),and the postoperative pains in the group A and group B(no pain patients) was obviously lower than that in the group C(9 cases) and the difference was statistically significant(P <0.05),and the differences in the incision infection, incision haematoma, postoperative pains, postoperative chronic pains, ankylenteron and recurrence between the three groups were not statistically significant. Conclusion The laparoscope and open tension-free hernia repair are the safe and effective operation methods, and the laparoscopic hernia repair mesh without fixation is easy and practical, and the cost is low, which is easy to promote.