开放和腹腔镜手术治疗成人腹股沟疝的临床应用

Clinical application of different surgical methods in adult inguinal hernia

目的探讨开放和腹腔镜手术治疗在成人腹股沟疝中的临床应用。方法选取襄阳市中心医院北区2014年3月至2016年3月普外科收治的120例成人腹股沟疝病人为研究对象,根据手术方式将病人分为腹腔镜经腹腔腹膜前疝修补术(腹腔镜组)和开放式无张力疝修补术组(开放组),每组各60例。术后均随访12个月。观察两组手术时间、术后疼痛时间、住院时间、住院费用等基本指标,比较两组术后并发症发生率及术后复发情况。结果开放组手术时间为(48.4±11.8)min,显著短于腹腔镜组的(72.3±14.5)min,差异具有统计学意义(P<0.05);开放组术后疼痛时间、住院时间分别为(46.1±12.5)h、(6.4±1.5)d,显著长于腹腔镜组的(21.6±8.7)h、(2.9±1.2)d,差异具有统计学意义(P<0.05);但开放组住院费用为(4 729.4±281.7)元,显著低于腹腔镜组的(7 159.2±475.6)元,差异具有统计学意义(P<0.05);开放组术后并发症发生率、复发率分别为6.67%、1.67%,腹腔镜组术后并发症发生率、复发率分别为5.00%、1.67%,两组比较差异无统计学意义(P>0.05)。结论开放式无张力疝修补术与腹腔镜疝修补术治疗成人腹股沟疝各有优势,临床上应根据病人的实际情况选择合适的治疗方式。

Objective To investigate the clinical application of open and laparoscopic surgery in adult inguinal hernia.Methods 120 cases of adult inguinal hernia admitted in the Department of General Surgery,the Central Hospital of Xiangyang from March2014 to March2016 were selected as the research objects,and divided into laparoscopic transabdominal preperitoneal hernia repair group（laparoscopic group）and open tension-free hernia repair group（open group）in terms of the surgical procedures,60 cases in each group.All patients were followed up for 12 months.The operation time,postoperative pain time,hospital stay and hospitalization expenses were observed and compared between two groups.The incidence of postoperative complications and postoperative recurrence were compared between the two groups.Results The operation time in the open group was（48.4±11.8）min,significantly shorter than the laparoscopic group（72.3±14.5）min with the difference being statistically significant（P〈0.05）.The postoperative pain time and hospital stay in the open group were（46.1±12.5）h and（6.4±1.5）days respectively,significantly longer than those in the laparoscopic group[（21.6±8.7）h and（2.9±1.2）days]（P〈0.05）.The hospitalization expenses in the open group were（4 729.4±281.7）yuan,significantly less than those in the laparoscopic group（7 159.2±475.6）（P〈0.05）.The incidence of complications and recurrence rate in the open group were 6.67%and 1.67%respectively,and5.00%and1.67%respectively in the laparoscopic group with the difference being not significant between two groups（P〉0.05）.Conclusions Open tension-free hernia repair and laparoscopic hernia repair for adult inguinal hernia each have advantages,and should be chosen based on the actual situations of patients.