Ⅰ、Ⅱ型腹股沟疝腹腔镜经腹腹膜前疝修补术中不固定补片与缝合固定补片的比较研究

A comparative study of non-fixed mesh and suture fixation mesh in laparoscopic transabdominal preperitoneal hernia repair for classification Ⅰ and Ⅱ inguinal hernia

目的:比较Ⅰ、Ⅱ型腹股沟疝行腹腔镜经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)中缝合固定补片与不固定补片的临床疗效。方法:回顾分析2015年9月至2016年10月为123例成年初发单侧Ⅰ、Ⅱ型腹股沟疝患者行TAPP的临床资料,其中71例术中采用3-0可吸收线缝合补片于耻骨梳韧带、联合肌腱与腹直肌(缝合组),52例未固定补片(未固定组),对比两组患者相关临床指标。结果:两组患者性别构成、年龄、腹股沟疝的类型与分型等差异无统计学意义,手术均成功完成。与未固定组相比,缝合组术中出血量[(14.5±0.8)ml vs.(7.7±0.7)ml]较多(P<0.001),手术时间、疝囊处理(横断vs.剥离)、术后住院时间、血清肿、慢性疼痛与复发率等差异无统计学意义(P>0.05)。结论:TAPP术中缝合固定补片会增加术中出血的风险,不固定补片同样可取得满意持久的修补效果。同时缝合固定补片不会延长术后住院时间、增加慢性疼痛,是值得考虑的补片固定方式。

Objective：To compare the clinical efficacy of non-fixed mesh and suture fixation mesh in laparoscopic transabdominal preperitoneal （TAPP） hernia repair for classification Ⅰ and Ⅱ inguinal hernia.Methods：Retrospective analysis was made on clinical data of 123 patients with primary and unilateral inguinal hernia （classification Ⅰ and Ⅱ） who underwent laparoscopic TAPP from Sep.2015 to Oct.2016,of which 71 patients were treated with mesh fixation by 3-0 absorbable suture that was anchored to the Cooper ligament,conjoint tendon and rectus abdominis,and 52 patients were treated with non-fixed mesh.Clinical indicators of the two groups were compared.Results： An operation were successful.There were no significant differences in the gender,age,type,classification of inguinal hernia,operating time,hernia sac treatment （transection vs.stripping）,postoperative length of hospital stay,seroma incidence,chronic groin pain or recurrence rate between the two groups.Intraoperative blood loss for mesh fixation and non-fixation was （14.5±0.8） ml vs.（7.7±0.7） ml respectively （P〈0.001）.Conclusions：In TAPP,mesh without fixation is an efficient method in treatment of classification I and Ⅱ inguinal hernia and decreases the risk of intraoperative bleeding caused by suture fixation.Meanwhile,suture fixation may be worth considering as a kind of mesh fixation method,which does not extend the length of postoperative hospital stay or increase the incidence of chronic groin pain.