腹腔镜经腹腹膜前疝修补术疝囊横断与剥离治疗Ⅲ型腹股沟斜疝的疗效

Clinical analysis of laparoscopic hernia repair with hernia sac dissection or transection in male patients with Gilbert Ⅲ inguinal hernia

目的探讨腹腔镜经腹腹膜前疝修补术(trans-abdominal preperitoneal hernia repair,TAPP)疝囊横断与剥离两种处理方式在成人男性单侧腹股沟斜疝(GilbertⅢ型)修补术中的临床疗效。方法回顾性分析2012年3月至2017年12月,徐州市中医院60例TAPP术后腹股沟斜疝(GilbertⅢ型)患者的临床资料。按疝囊处理方式分为横断组(26例)和剥离组(34例),比较2组手术时间、术中出血量、术后疼痛视觉模拟评分(visual analogue scale,VAS)、并发症的发生、住院时间和复发率等。结果剥离组患者手术时间和手术出血量均明显高于横断组,差异均有统计学意义(t=5.020、6.832,P均<0.05);横断组患者术后第1天VAS评分均明显低于剥离组患者,差异均有统计学意义(t=5.266、3.933,P均<0.05);横断组患者并发症发生情况低于剥离组患者,差异有统计学意义(χ~2=4.344,P<0.05)。术后复发率及住院时间比较,差异均无统计学意义(P>0.05)。结论TAPP横断和剥离两种疝囊处理方式均为安全有效的手术方式,但横断疝囊的处理方式具有手术时间短、VAS评分低、出血量少和术后并发症少等优点。

Objective To investigate the clinical efficacy between hernia sac dissection and sac transection in laparoscopic trans-abdominal preperitioneal herniorrhaphy(TAPP)in treatment of unilateral Gilbert III inguinal hernia in adult males.Methods The clinical data of 60 cases of male inguinal hernia(GilbertⅢ)treated in Xuzhou Traditional Chinese Medicine Hospital were retrospectively analyzed.All patients were treated with TAPP,and they were divided into the sac transection group(n=26)and sac dissection group(n=34).The operation time,intraoperative bleeding,scores of visual analogue scale(VAS),incidence of complications,length of hospital stay and postoperative recurrent rate were observed and compared between the two groups.Results The operation time and the amount of bleeding during operation were significantly higher in the sac dissection group than those in the sac transection group(t=5.020,6.832,both P<0.05).The scores of VAS in the sac transection group were significantly lower than those in the sac dissection group on the first day after operation(t=5.266,3.933,all P<0.05).The incidence of complications in the sac transection group was lower than that in the sac dissection group(x^2=4.343 9,P<0.05).There were no significant differences between the two groups in length of hospital stay and postoperative recurrent rate of hernia(x^2=0.700 2,P>0.05).Conclusion Both methods can achieve satisfactory clinical outcome,but the transection method has the advantages of short operative time,low scores of VAS,less bleeding and complications.