自制直针三尾免打结缝线在TAPP腹膜缝合的应用研究

Application of straight needle three-tail non-kontting suture in peritoneal closure in transabdominal preperitoneal inguinal hernia repair

目的观察使用自制直针三尾免打结缝线在腹腔镜下经腹腔腹膜前疝修补术(TAPP)中缝合关闭腹膜的效率和效果。方法选择2013年12月至2015年12月中山大学附属第六医院行腹腔镜下TAPP的238例符合入选标准的腹股沟疝病人。电脑随机数字表分为两组:对照组120例,采用常规弯针缝合;试验组118例,采用直针三尾免打结线缝合。在年龄、性别、体重指数(BMI)、疝类型、缺损大小、疝囊处理、手术时间、腹膜缝合时间、住院费用、术后并发症发生率、视觉模拟评分(VAS)、复发率等方面,对两组病人的情况进行比较。结果试验组与对照组的平均手术时间分别为(44.8±2.7)min和(50.3±3.1)min(t=7.243,P=0.025),腹膜缝合时间分别为(4.2±0.7)min和(9.8±1.1)min(t=9.833,P=0.010),住院费用分别为(8927.4±135.2)元和(9232.5±159.8)元(t=4.782,P=0.041),差异有统计学意义;在术后的补片感染发生率(P=0.759)、复发率(P=0.759)、血清肿发生率(P=0.899)及VAS评分(P=0.375)方面,两组差异无统计学意义。结论相对于传统方法,直针三尾免打结缝线在TAPP腹膜缝合中,能缩短腹膜缝合时间及手术时间,降低手术成本,不增加术后并发症、疼痛、复发的发生。

Objective To investigate efficiency of straight needle three-tail non-kontting suture in peritoneal closure in transabdominal preperitoneal inguinal hernia repair （TAPP）. Methods A total of 238 patients with inguinal hernia performed TAPP in the Sixth Affiliated Hospital of Sun Yat-sen University between December, 2013 and December, 2015 were enrolled into the study, including 120 patients in control group with traditional suture and 118 patients in experiment group with straight needle three-tail non-kontting suture. All the patients received TAPP operation under general anaesthesia. The difference between tow groups were compared in age, gender, BMI, hernia type, defective area, hernia sac handling, operative time, peritoneal closure time, hospitalization cost, postoperative complications, VAS score and recurrence rate. Results The mean operative time was （44.8±2.7）rain for experimental group and（50.3±3.1）min for control group （t =7.243, P=0.025）. The mean peritoneal closure time was （4.2±0.7）min for experimental group and （9.8±1.1）rain for control group（t =9.833 ,P=0.010）. The mean cost was （8927.4±135.2）yuan for experimental group and （9232.5 ± 159.8）yuan for control group （t =4.782, P=0.041 ）. There was no difference in mesh infection （P=0.759）, recurrence （P=0.759）, seroma（P=0.899）and VAS score（P=0.375） between two groups. Conclusion Compared with traditional method, straight needle three-tail non-kontting suture could reduce operative cost as well as shorten operative and peritoneal closure time, without increasing postoperative complications, pain and recurrence.