腹腔镜疝修补(TAPP)与开放式无张力性疝修补术治疗成人腹股沟疝的临床对比分析

Laparoscopic Herniorrhaphy Compared with Open Methods of Groin Hernia Repair in Adult

目的研究比较腹腔镜疝修补术(TAPP)与开放式无张力疝修补术治疗成人腹股沟疝的临床疗效。方法随机选取该院2015年1月—2016年6月间收治的100例腹股沟疝患者作为研究对象,随机分为开放组和TAPP组,各50例。开放组患者采用开放式无张力疝修补术治疗,TAPP组采用腹腔镜经腹腹膜前补片植入术治疗,比较两组患者的手术时间、下床活动时间、痛感持续时间、术后住院时间、术中出血量、住院费用,以及术后并发症、复发率等情况。结果(1)TAPP组下床活动时间、痛感持续时间、术后住院时间明显短于开放组,术中出血量明显少于开放组;手术时间明显长于开放组,住院费用亦显著高于开放组,差异有统计学意义(t=4.312、4.429、9.284、5.374、3.748、12.512,P<0.05)。(2)TAPP组患者中切口感染、切口积液、腹股沟区疼痛者发生率明显低于开放组(χ~2=3.374、3.284、4.768,P<0.05);两组患者尿潴留、阴囊血肿等并发症组间比较差异无统计学意义(P>0.05)。TAPP组并发症总发生率为26.0%,显著低于开放组58.0%,差异有统计学意义(χ~2=3.446,P<0.05)。(3)两组均未有患者复发,差异无统计学意义(P>0.05)。结论腹腔镜疝修补术更加安全可靠,患者恢复更快,疗效更佳,但缺点在于手术时间长,治疗成本更高,两种术式各有优势,患者可根据情况选择。

Objective This paper tries to analyze and compare the clinical effect of TAPP and open methods of groin hernia repair in adults.Methods 100 patients with inguinal hernia treated in this hospital from January 2015 to January 2016 in June were random selection divided into the open group and the TAPP group with each 50 cases.The open group were treated in tension-free hernioplasty treatment,and the TAPP group were treated in laparoscopic hernia repair treatment.It aims to compare the operation time,ambulation time,pain duration,postoperative hospitalization time,intraoperative blood loss,hospitalization cost,postoperative complications,and recurrence rate etc.of the two groups.Results①The ambulation time,pain duration,and postoperative hospitalization time in TAPP group were significantly shorter than the open group,and the amount of bleeding was significantly less than that in the open surgery group;while operation time was significantly longer than the open group,the hospitalization expenses was significantly higher than that of the open group,the difference was statistically significant(t=4.312,4.429,9.284,5.374,3.748,12.512,P<0.05).②The infection of incision,incision effusion,groin pain incidence in TAPP group was significantly lower than that of the open group(χ2=3.374,3.284,4.768,P<0.05);no significant difference was found between the two groups of patients with urinary retention,scrotal hematoma and other complications between groups(P>0.05).The complication rate of TAPP group was 26.0%,which was significantly lower than that of the open group(58.0%),the difference was statistically significant(χ2=3.446,P<0.05).③There was no recurrence in the two groups for recurrence rate.The difference was not statistically significant(P>0.05).Conclusion Laparoscopic herniorrhaphy repair is more safe and reliable.Patients could recover faster,but the disadvantage is the longer operation time and higher treatment cost.Two kinds of surgical methods have their own advantages,and patients can choose according to the situation.