腹腔镜经腹腹膜前疝修补术与完全腹膜外疝修补术术式选择和安全性讨论

Safety and efficacy of totally extraperitoneal and transabdominal preperitoneal laparoscopic inguinal hernia repair

目的探讨腹腔镜完全腹膜外疝修补术(TEP)和腹腔镜经腹腹膜前疝修补术(TAPP)在腹股沟疝中的应用及注意事项。方法回顾性分析2015年1月至2016年6月,句容市人民医院行TAPP及TEP手术的282例患者的临床资料及术后10~26个月的术后随访资料。将282例患者分成2组,145例患者行TAPP术式,137例患者行TEP术式。比较2组患者的手术时间、术后出院时间、治疗费用、术后并发症及回访复发情况。结果 TAPP组手术时间(55.3±11.3)min,TEP组(56.5±15.4)min,2组比较,差异无统计学意义(P<0.05)。住院时间观察组(2.5±0.5)d,对照组(2.2±0.3)d,2组比较,差异无统计学意义(P<0.05)。患者术后急慢性疼痛比较,差异无统计学意义(P>0.05)。平均住院费用TAPP组(10 246±671)元,TEP组(10 387±743)元,2组差异无统计学意义(P>0.05)。随访期间TAPP组无复发,TEP组1例复发。TAPP组术后浆液肿较TEP组多,与我们的病例选择有关。结论 TAPP与TEP在腹股沟疝都是安全有效的治疗方法,手术时间,住院时间及复发率无明显差别。针对不同的患者情况,选择合理的腹腔镜手术方式,TAPP、和TEP治疗腹股沟疝均安全有效。患者痛苦少,术后恢复快。

Objective To investigate the safety and efficacy of laparoscopic transabdominal preperitoneal （TAPP） and totally extraperitoneal （TEP） repair in the treatment of inguinal hernia. Methods This study was conducted from January 2015 to June 2016. 282 patients with groin hernias were performed with either TAPP or TEP techniques. A total of 145 patients were in TAPP group and 137 were in TEP group. The operation time, hospital duration, postoperative pain, cost and postoperative complications were compared in both groups. Results The operation time of TAPP was （55.3 ± 11.3） minutes, and the operation time of TEP was （56.5 ± 15.4） minutes, there was no significant difference （P 〈 0.05）. There were alSO no significant differences in the hospital stay, hospital cost, recurrence, and acute and chronic postoperative pain between the two groups. While, there were significant more seroma in TAPP group. We speculated that it was due the patient selection bias in TAPP group. Conclusions The TEP and TAPP techniques of laparoscopic repair of inguinal hernia are comparable regarding most of the parameters, and they are both safe and effective. Surgeons can choose one of the techniques according to their skills and patients＇ characteristics.