杂交手术与经腹腹膜前修补手术治疗难复性腹股沟疝的疗效对比分析

Comparison between hybrid surgery and transabdominal preperitoneal surgery in treatment of irreducible inguinal hernia: A case-control study

目的对比杂交技术与单纯腹腔镜技术在难复性腹股沟疝修补术中的治疗效果。方法回顾性分析2011年6月至2017年12月首都医科大学疝和腹壁外科共计60例行腹腔镜腹股沟疝修补手术患者的资料,30例患者应用杂交技术的患者作为观察组,30例应用单纯腹腔镜技术的患者作为对照组,对比两组患者手术时间、术中出血量、术后住院时间、住院费用、术后并发症等指标。结果观察组和对照组的中位数手术时间分别为45(35~65)min和50(35~70)min,两组的术中出血量中位数分别10(5~15)ml和5(2~10)ml,术后中位数住院时间为2(1~4)d和2(1~3)d,住院费用为9 646(9 066~11 560)元和9 494(8 989~10 660)元,术中对照组发生输精管损伤1例,精索血管损伤2例,腹壁下血管损伤1例,观察组未出现术中相关并发症。围手术期观察组的并发症发生率分别为排尿困难分别为6.7%和10.0%,阴囊血肿分别为3.4%和0%,伤口疼痛分别为46.7%和6.7%,发热的发生率分别为16.7%和20.0%。术后随访1年,两组均无术后复发、感染病例。观察组和对照组血清肿发生率分别为26.7%和33.3%,对照组出现慢性疼痛和异物感各1例,观察组未出现异物感和慢性疼痛的病例。观察组术后急性伤口疼痛发生率明显高于对照组(P<0.05),其他方面两组比较差异无统计学意义。结论杂交技术治疗难复性腹股沟疝是可行性,虽可能增加术后急性疼痛的发生率,但在避免输精管和精索血管损伤方面可能具有一定优势。

Objective To compare the effects between hybrid surgery and transabdominal preperitoneal surgery in treatment of irreducible inguinal hernia. Methods A total of 60 patients who underwent laparoscopic inguinal hernia repair between June 2011 and December 2017 were included in the study. Patients were divided into two group: hybrid surgery group (observation group, n=30) and transabdominal preperitoneal group (control group, n=30). The operation time, intraoperative bleeding, hospital stay, hospital cost and complications were analyzed. Results The operative time of observation group and control group was 45 (35-65) minutes and 50(35-70) minutes, respectively. Intraoperative blood loss of two groups was 10(5-15) ml and 5(2-10) ml. The length of postoperative hospital stay was 2(1-4) days and 2(1-3) days in the two groups, respectively. And the hospitalization cost of two groups was 9 646 (9 066-11 560) yuan and 9 494(8 989-10 660) yuan, respectively. The intraoperative complications occurred in 4 cases in control group, including 1 case of vas deferens injury, 2 cases of spermatic vessel injury and 1 case of inferior epigastric artery injury. No intraoperative complications occurred in observation group. Perioperative complications in observation group and control group included dysuria (6.7% vs 10.0%), scrotum hematoma (3.4% vs 0%), wound pain (46.7% vs 6.7%) and fever (16.7% vs 20.0%). Twelve months of follow-up was completed in all the patients, and no recurrence or infections occurred in the two groups. The incidence of seroma in observation group and control group was 26.7%, 33.3%, respectively. One case of foreign body sensation and one case of chronic pain occurred in control group. The incidence of perioperative wound pain in patients undergoing hybrid surgery was higher than those undergoing transabdominal preperitoneal surgery (P<0.05), but no statistical differences were observed for other variables between the two groups (all P>0.05). Conclusion Hybrid surgery is safe and feasible for the treatment of irreducible inguinal hernia. Though with a higher incidence of postoperative acute pain, it may have advantages of avoiding injuries of the vas deferens and spermatic vessels.