腹腔镜全腹膜外腹股沟疝修补术和开放式腹膜前腹股沟疝修补术在基层医院应用对比

Comparison on application of anterior inguinal hernia repair in primary hospital

目的观察腹腔镜全腹膜外腹股沟疝修补术(TEP)与开放式腹膜前腹股沟疝修补术在基层医院中的应用。方法 80例腹股沟疝患者,根据患者的病情将其分为TEP组和开放组,各40例。TEP组患者采用腹腔镜TEP治疗,开放组采用开放式腹膜前腹股沟疝修补术治疗。比较两组患者术中出血量、手术时间、术后恢复所需要时间、住院时间、术后疼痛视觉模拟评分(VAS)以及并发症发生率、复发率。结果 TEP组患者术中出血量少于开放组,住院时间、术后恢复时间短于开放组,手术时间长于开放组,差异均具有统计学意义(P<0.05)。TEP组术后1、3、5 d的VAS评分分别为(4.53±1.32)、(3.37±1.13)、(2.54±0.94)分,均低于开放组的(6.34±1.71)、(5.28±1.58)、(4.35±1.76)分,差异具有统计学意义(P<0.05)。随访8个月,两组患者术后切口裂开、切口感染感染以及腹股沟区疼痛发生率比较差异无统计学意义(P>0.05);开放组患者复发率为10.0%(4/40),低于TEP组的0,差异具有统计学的意义(P<0.05)。结论腹腔镜TEP所用手术时间虽然比开放式腹膜前腹股沟疝修补术长,但术中能够减少患者的出血量,减轻患者的痛苦以及降低患者术后复发率,可以在基层医院推广应用。

Objective To observe the application of laparoscopic total extraperitoneal repair(TEP)andopen preperitoneal inguinal hernia repair in primary hospital.Methods A total of80inguinal hernia patientswere divided by patient’s condition into TEP group and open group,with40cases in each group.TEP groupreceived laparoscopic TEP for treatment,and open group received open preperitoneal inguinal hernia repair fortreatment.Comparison were made on intraoperative bleeding volume,operation time,postoperative recovery time,hospital stay time,postoperative visual analogue scale(VAS),complication rate,and recurrence rate in two groups.Results TEP group had less intraoperative bleeding volume,shorter hospital stay time and postoperative recoverytime,and longer operation time than the open group.Their difference had statistical significance(P<0.05).TEPgroup had VAS score in postoperative1,3and5respectively as(4.53±1.32),(3.37±1.13)and(2.54±0.94)points,which were all lower than(6.34±1.71),(5.28±1.58)and(4.35±1.76)points in the open group.Their differencehad statistical significance(P<0.05).After8months of follow-up,both groups had no statistically significant difference in postoperative incision dehiscence,incision infection and the incidence of groin pain(P>0.05).Theopen group had lower recurrence rate as10.0%(4/40)than0in TEP group,and the difference had statisticalsignificance(P<0.05).Conclusion Although the operation time of laparoscopic TEP is longer than that of openpreperitoneal inguinal hernia repair,it can reduce bleeding volume,pain and recurrence rate of patients.So it canbe promoted and applied in primary hospitals.