疝环充填式 平片式与传统式疝修补术的对比研究

A comparative study of tension-free mesh plug or flat mesh repair and traditional repair for inguinal hernia

目的比较疝环充填式、平片式无张力疝修补术与传统疝修补术治疗腹股沟疝的临床效果,为腹股沟疝制定合理的手术方案。方法回顾分析我院2004-2015年实施成人腹股沟疝修补术83例,按照不同的手术方式,将疝环充填式无张力疝修补术、平片无张力疝修补术与传统疝修补术分别设为充填组、平片组和传统组,比较3组手术指标(手术时间、住院时间、术后下床活动时间、术后疼痛、术后牵扯感、住院费用)、术后并发症(切口感染、阴囊水肿、切口血肿、异物感、排异反应、复发)。结果充填组与平片组手术时间、住院时间、术后下床活动时间、术后疼痛较传统组短或少(P<0.05);充填组和平片组住院费用高于传统组,3组间住院费用差异有统计学意义(P<0.05);传统组术后牵扯感高于充填组和平片组(P<0.05);充填组异物感高于传统组和平片组(P<0.05);其他并发症比较差异无统计学意义(P>0.05)。结论无张力疝修补术效果好、恢复较快,但是异物感和住院费用高。

Objective To compare the clinical efficacy of hernia ring-filling tension-free, flat-face tension-free and traditional surgical techniques in the treatment of inguinal hernia, and to develop a reasonable surgical plan for patients with inguinal hernia.Methods Eighty-three patients who underwent inguinal hernia repair surgeries in our hospital from 2004 to 2015 were retrospectively analyzed. Patients were divided into three groups, based on the differences on surgical methods： the hernia ring-filling group, the flat-face tension-free group and traditional hernia repair group. A number of surgical parameters, including operation time, length of hospitalization, postoperative off-bed time, postoperative pain, postoperative muscle dragging effects, and hospitalization costs were compared. Postoperative complications, including incisional infection, scrotal edema, incisional hematoma, foreign body sensation, rejection, and recurrence were analyzed for all three groups.Results Compared with the traditional group, the operation duration, length of hospitalization, postoperative off-bed time and postoperative pain in the hernia ring-filling group and the flat-face tension-free group were significantly shorter or less than those in the traditional group （ P 〈0.05）. The hospitalization costs for the hernia ring-filling group and the flat-face tension-free group were significantly higher than those of the traditional group. The differences in hospitalization costs among the three groups were statistically significant （ P 〈0.05）. The traditional group had higher postoperative muscle dragging effect than the other two groups （ P 〈0.05）. The foreign body sensation effect in the hernia ring-filling group was significantly higher than that of the other two groups （ P 〈0.05）. There were no significant differences in post-operative complications among the three groups （ P 〉0.05）.Conclusion The tension-free hernia repair surgery techniques achieved great clinical efficacy with shorter recovery time, but patients experienced higher foreign body sensation effects and their hospitalization costs are significantly higher than that of the traditional method. The choices of using which technique is to be decided in a case-by-case manner.