经腹腔腹膜前与完全腹膜外入路腹股沟疝修补术后2年的队列研究

Cohort study 2 years after trans-abdominal pre-peritoneal and totally extra-peritoneal inguinal hernia operation

目的分析腹腔镜下经腹腹膜前疝修补术(TAPP)及完全腹膜外疝修补术(TEP)治疗腹股沟疝的临床疗效。方法选择2015年1月至2016年1月中山大学附属第六医院行腹腔镜下修补的138例符合标准的腹股沟疝病人。TAPP治疗的70例腹股沟疝患者为A组,TEP治疗的68例患者为B组。比较二组患者的一般资料、手术时间、术中出血量、住院费用、术后并发症等。结果 TAPP组与TEP组的平均住院费用分别为(9229.0±72.8)元和(8928.4±127.5)元(t=5.243,P=0.042),差异有统计学意义。二组手术时间、术中出血量、术后住院时间、术后恢复正常活动时间差异均无统计学意义(t=7.015、1.742、1.161、0.091,P=0.057、0.084、0.248、0.927)。并发症方面,二组腹股沟区血清肿、尿潴留、术后疼痛、阴囊气肿、肠梗阻等并发症发生率比较,差异均无统计学意义(χ~2=0.104、0.229、0.079、0.771、0.145,P=0.747、0.633、0.779、0.380、0.703)。2组术中均未出现重要血管、腹腔器官等意外损伤。术后随访2年,无1例复发和补片感染发生。结论 TAPP及TEP治疗腹股沟疝均能获得较满意的结果,TEP较TAPP能减少住院费用。初学者或普通外科医生应首选TAPP,TAPP能为TEP打下基础,TEP适合从事疝外科的专科医师。

Objective To investigate clinical efficiency of laparoscopic transabdominal preperitoneal repair （TAPP） and laparoscopic totally extraperitoneal （TEP） in the treatment of inguinal hernia. Methods A total of 138 patients with inguinal hernia performed laparoscopic hernioiThaphy in the Sixth Affliated Hospital of Sun Yat-sen University between January, 2015 and January, 2016 were enrolled into the study, 70 patients treated with TAPP were group A, and 68 eases repaired by TEP were group B. Baseline data, operative time, blood loss, hospitalization cost, postoperative complications and so on of the two groups were compared. Results The mean cost was 9229.0 ± 72.8 yuan for TAPP group and 8928.4±127.5 yuan for TEP group （t=5.243, P=0.042）, the difference was statistically significant. There were no significant difference in operative time, blood loss, postoperative length of stay and recovery time between TAPP and TEP （t=7.015, 1.742, 1.161, 0.091, P=0.057, 0.084, 0.248, 0.927）. The differences of the complications, inguinal seroma, uroschesis, postoperative pain, scrotal emphysema, intestinal obstruction, were not statistically significant （X2=0.104, 0.229, 0.079, 0.771, 0.145 ,P=0.747,0.633, 0.779, 0.380, 0.703）. There were no showed accidental injm7 of major vessels or abdominal organs between two groups. After the follow-up of 2 years, no recun＇ence and mesh infection were found. Conclusion Both TAPP and TEP for the treatment of inguinal hernia are safe and effective, compared with TAPP, TEP could shorten reduce hospitalization cost. TAPP should be the first choice for beginners or general surgeons. TAPP can lay a foundation for TEP, which is suitable for specialists in hernia surgery.