腹腔镜与下腹正中切口开放完全腹膜外修补术治疗双侧腹股沟疝的随机对照研究

Clinical randomized controlled trial of laparoscopic totally extraperitoneal herniorrhaphy and totally extraperitoneal herniorrhaphy via hypogastric midline incision in treatment of bilateral inguinal hernias

目的探讨腹腔镜下完全腹膜外修补术(LTEP)与开放完全腹膜外修补术(OTEP)治疗双侧腹股沟疝的临床应用价值。方法采用随机对照试验的方法,将2015年1月—2017年12月中国人民解放军联勤保障部队第九〇六医院收治的61例男性双侧腹股沟疝患者按照随机数字表法分为LTEP组(n=31)和OTEP组(n=30)。比较两组患者手术相关情况、术后1dC反应蛋白(CRP)、术后并发症的差异。统计软件SPSS23.0进行分析。结果术前两组患者一般情况无显著差异;LTEP组术后下床活动时间、术后住院时间明显短于OTEP组[(5.6±2.2)h比(20.0±5.5)h,P<0.001;(3.0±0.6)d比(4.5±1.0)d,P<0.001],住院费用高于OTEP组[(14779.3±1450.1)元比(13650.0±1787.3)元,P<0.001],术后1dCRPLTEP组显著低于OTEP组[(88.7±18.5)mg/L比(102.0±25.1)mg/L,P=0.022];两组术后均无补片感染、慢性疼痛、阴囊水肿、疝复发;其余手术相关情况、术后并发症无显著差异。结论腹腔镜TEP与下腹正中切口开放TEP治疗双侧腹股沟疝均安全有效,各有利弊,可互为补充。

Objective To explore the clinical value of laparoscopic totally extraperitoneal herniorrhaphy (LTEP) and open to tally extraperitoneal (OTEP) for bilateral inguinal hernias. Methods From January 2015 to December 2017, 61 male patients with bilateral inguinal hernias, who were in accordance with the inclusion criteria, were prospectively randomized into laparoscopic totally extraperitoneal herniorrhaphy group (LTEP group, n=31) or totally extraperitoneal herniorrhaphy via hypogastric midline incision group(OTEP group, n=30). Operative outcomes, postoperative complications, recurrence, the levels of C-reactive protein (CRP) were analyzed. The data were analyzed by statistical software. Results The operative baselines of patients in two groups were equivalent. In patients who received laparoscopic totally extraperitoneal herniorrhaphy, decreased levels of CRP on the 1th day after operation, postoperative ambulation and hospital stay [(88.7±18.5) mg/L vs (102.0±25.1) mg/L, P=0.022];[(5.6±2.2) h vs (20.0±5.5) h, P<0.001;(3.0±0.6) d vs (4.5±1.0) d, P<0.001], were found compared with the OTEP group significantly, LTEP group had more hospitalization expense than OTEP group [(14 779.3±1450.1) yuan vs (13 650.0±1 787.3) yuan, P<0.001]. There were no mesh infection, chronic pain, scrotal edema and recurrence of inguinal hernia in two groups. No difference was found between the two groups in the other operative outcomes and postoperative complications. Conclusion Both laparoscopic totally extraperitoneal herniorrhaphy and totally extraperitoneal herniorrhaphy via hypogastric midline incision are effective and safe in the treatment of bilateral inguinal hernias, each has both advantages and disadvantages, and complement each other.