腹腔镜经腹腹膜前疝修补术与完全腹膜外疝修补术在老年腹股沟疝患者临床应用

Comparative study on the clinical application of TAPP and TEP in elderly patients with inguinal hernia

目的探讨腹腔镜经腹腹膜前疝修补术(TAPP)及腹腔镜完全腹膜外疝修补术(TEP)在老年腹股沟疝患者的临床应用研究。方法选取2014年1月至2015年12月,中煤第五建设公司职工医院和东南大学附属徐州医院共同收治的腹股沟疝老年患者350例为研究对象,随机分为2组,A和B组。其中A组患者175例行TAPP术式,B组患者175例行TEP术式。术后随访3~12个月。从2组的手术时间、术后使用镇痛药物的例数、术后第1天疼痛评分、术后下床活动时间、术后住院天数、术后复发率、术后并发症、住院总费用和术后生活满意度等探讨不同术式对老年人的可行性及优劣。结果 350例患者均顺利完成手术。2组术后具体并发症、手术后第1天疼痛分数、术后使用镇痛药例数、手术后停留置导尿时间、手术后患者住院天数、手术后患者恢复正常活动时间以及患者住院总费用上比较差异无统计学意义(P>0.05);2组患者手术时间、术后复发率比较,差异有统计学意义(P<0.05)。结论腹腔镜腹股沟疝修补术在老年患者的使用中,有复发率低的优点;TAPP和TEP手术疗效无显著差异,各有优劣;选择手术方式可主要根据手术医师的熟练度以及患者的身体状况、经济状况等条件。

Objective To study the clinical situation of laparoscopic hernia repair in elderly patients with inguinal hernia. Methods A total of 350 elderly patients with inguinal hernia who underwent surgical treatment from January 2014 to December 2015 were randomly divided into group A and group B. 175 patients in group A underwent laparoscopic transabdominal preperitoneal repair （ TAPP）, and 175 patients in group B underwent laparoscopic totally extraperitoneal repair （TEP）. All patients were followed up for 3 to 12 months. In this study, the operation time, the case number of analgesic drugs used after surgery, postoperative pain score on 1st day, postoperative ambulation time, postoperative hospital stay, postoperative recurrence rate, postoperative complications, total cost of hospitalization and postoperative life satisfaction and other aspects of a comprehensive approach to several elderly patients were analyzed. Results All 360 patients underwent successful surgery. The time of operation, postoperative complications, postoperative pain score on 1 st day, postoperative analgesic use, postoperative catheterization removat time, postoperative hospital stay, and postoperative recovery of normal activities were not different between the two groups （P 〉 0.05 ）, and there was no significant difference in recurrence rate between the two groups （ P 〉 0. 05）. Conclusion Laparoscopic inguinal hernia repair has the advantage of low recurrence rate in elderly patients ; TAPP and TEP have no significant difference in outcomes ; The choice of the surgical approach can be mainly based on the surgeon＇s proficiency and the patient＇s physical condition, economic conditions and other conditions.