TAPP与Li-chtenstein疝修补术治疗成人复发性腹股沟疝的疗效及术后疼痛SF-MPQ评分变化

Effect of TAPP and Li-chtenstein inguinal herniorrhaphy for adult recurrent inguinal hernia and changes of postoperative pain SF-MPQ score

目的:对比分析腹腔镜经腹腔腹膜前疝修补术(TAPP)与Li-chtenstein修补术治疗成人复发性腹股沟疝的疗效及对患者术后SF-MPQ评分的影响。方法:收集2014年1月至2017年1月我院收治的成人复发性腹股沟疝患者99例随机分为两组:观察组53例行TAPP治疗,对照组40例行Li-chtenstein修补术。对比两组围手术期指标,术后1 d、7 d、3个月、6个月、12个月,采用简版McGill疼痛问卷(SF-MPQ)评价疼痛情况,统计术后慢性疼痛发生率、复发率。结果:两组的手术时间比较,差异无统计学意义(P> 0. 05);观察组的术中出血量、术后首次下床活动时间、住院时间均较对照组明显降低(P <0. 05);术后1 d、7 d、3个月、6个月,观察组的SF-MPQ评分显著低于对照组(P <0. 05);术后12个月,组间SF-MPQ评分比较,差异无统计学意义(P> 0. 05);观察组术后慢性疼痛及总并发症发生率分别为3. 39%、8. 47%,显著低于对照组的15. 00%、27. 50%(P <0. 05);观察组术后随访未再复发,对照组1例(2. 50%)复发,组间比较差异无统计学意义(P> 0. 05)。结论:TAPP是治疗成人复发性腹股沟疝的有效术式,术后康复快、安全性好且慢性疼痛少。

Objective: To compare the efficacy of laparoscopic trans-abdominal preperitoneal prosthetic repair( TAPP) and Li-chtenstein inguinal herniorrhaphy for adult recurrent inguinal hernia and the influence on postoperative pain SF-MPQ score. Methods: 99 casesof adultswith recurrent inguinal hernia from January 2014 to January 2017 in our hospital were enrolled,who were randomly divided into two groups: 59 patients in the observation group treated with laparoscopic trans-abdominal preperitoneal prosthetic repair( TAPP),40 patients in the control group treated with Li-chtenstein inguinal herniorrhaphy. The perioperative indicators were compared between the two groups,the Short-form MPQ( SF-MPQ) was used to evaluate the painat on the 1 stday,7 thday,in 3 rd month,6 thmonth and 12 thmonth after surgery,the incidence of postoperative chronic pain and recurrence rate was compared. Results: There was no significant difference in the operative time between the two groups( P > 0. 05),the intraoperative blood loss,out-of-bed activity time and the hospital stay in the observation group were significantly lower than those in the control group( P < 0. 05). On the 1 stday,7 thday,3 rdmonth,in the 6 thmonth after surgery,SF-MPQ score in the observation group was significantly lower than that of the control group( P <0. 05),but there was no significant difference in the SF-MPQ score in the 12 thmonth after surgery between the two groups( P > 0. 05);The postoperative chronic pain and total complication rate in the observation group were 3. 39%and 8. 47%,respectively,which were significantly lower than 15. 00% and 27. 50% in the control group( P <0. 05);No more recurrence was found in the observation group,and one patient( 2. 50%) recurrence,there was no significant difference between the two groups( P > 0. 05). Conclusion: TAPP is an effective treatment for adult recurrent inguinal hernia,for its rapid recovery,good safety and less chronic pain.