自固定补片在腹腔镜腹股沟疝修补术与开放式无张力腹股沟疝修补术中的临床对照研究

Comparison of laparoscopic and open tension-free repair with self-gripping mesh for inguinal hernia

目的对自固定补片在腹腔镜腹股沟疝修补术与开放式无张力腹股沟疝修补术中的临床疗效进行对比分析。方法将重庆医科大学附属第二医院2014年6月至2016年10月,应用自固定补片的465例疝手术患者的临床资料进行回顾性研究,其中开放式腹股沟无张力疝修补术患者213例,腹腔镜经腹腹膜前疝修补术(TAPP)患者201例,腹腔镜完全腹膜外疝修补术(TEP)患者51例,对比分析各组手术时间、住院天数、术后恢复正常活动时间、术后疼痛程度评分(VAS)、术后并发症、复发率等指标。结果各组手术均顺利完成,腹腔镜组的住院天数、术后恢复时间、疼痛程度、切口感染及慢性疼痛发生率明显低于开放组,差异有统计学意义(P<0.05);但开放手术组的手术时间低于腹腔镜组,差异有统计学意义(P<0.05);腹腔镜组与开放组的出血量、血清肿发生率、复发率对比,差异无统计学意义(P>0.05);两种腹腔镜手术各指标对比,差异无统计学意义(P<0.05)。结论无论是两种腹腔镜手术还是开放式无张力疝修补术对治疗腹股沟疝都是安全、可靠的,对不同的患者,应根据患者的年龄、疝类型、是否复发、经济状况等情况进行合理而个体化治疗。

Objective To compare the clinical efficacy of the self-gripping mesh in laparoscopic and open tension-free repair for the treatment of inguinal hernia. Methods A total of 465 cases with inguinal hernia underwent hernia repair in the Second Affiliated Hospital of Chongqing Medical University from June 2014 to October 2016 were retrospectively analyzed. 201 cases were applied with laparoscopic transabdominal preperitoneal prosthetic repair （TAPP）, 51 cases were applied with totally extraperitoneal prosthetic repair （TEP） and 213 cases with open tension-free hernia repair. The operation time, hospitalization days, postoperative time return to normal activities, postoperative pain degree （visual analogue scale, VAS） and postoperative complications of the three groups were compared. Results All operations were successfully completed. The hospitalization days, postoperative recovery time, VAS score, incidence of incisional infection and chronic pain in laparoscopic groups were lower than those in open group （ P 〈 0.05 ）. But laparoscopic groups had longer operation time （ P 〈 0.05 ）. No significant differences were found in blood loss during surgery, seroma, and recurrence between laparoscopic group and open group. There were no statistically significant differences in the two kinds of laparoscopic groups in terms of above indicators （P 〉 0.05）. Conclusion Both laparoscopic repair and open tension-free repair are safe and effective methods for the treatment of inguinal hernia. Either of these surgical procedures has its advantages, and surgeons should choose the individual procedure according to age, hernia type, recurrence, and economic conditions of patients reasonably.