聚丙烯小平片与改良Kugel补片在股疝修补术中应用的前瞻性随机对照研究

A prospectively randomized controlled study between mini-mesh and modified Kugel patch in femoral hernia repair

目的比较聚丙烯小平片与改良Kugel补片在股疝修补术中应用的临床疗效。方法选取2012年7月至2016年12月期间郑州大学第一附属医院收治的99例原发性单侧成年股疝患者进行前瞻性研究。采用随机对照研究方法,按随机数字表法将入组患者分为小平片组(采用聚丙烯小平片)和Kugel组(采用改良Kugel补片)。记录手术时间、术后切口疼痛评分(术后1周)、使用止痛药、术后住院时间及术后并发症(尿潴留、切口感染、血清肿、股静脉血栓形成等)情况,并在术后3个月、1年及2年对患者进行随访。随访内容包括慢性疼痛、异物感、生活质量及疝复发情况。结果 99例患者中,97例完成随访,纳入分析,其中Kugel组患者48例,小平片组49例。小平片组的手术时间短于Kugel组(P=0.030),但2组患者的止痛药使用率、术后住院时间、尿储留发生率、术后1周静息时切口疼痛视觉模拟评分(visual analog scale,VAS)及术后1周咳嗽时切口疼痛VAS评分比较差异均无统计学意义(P>0.05)。2组均无切口感染、血清肿及股静脉血栓形成发生。术后3个月、1年和2年时,2组患者的慢性疼痛发生率、异物感发生率和生活质量量表评分(36-item short-form general survey,SF-36)比较差异均无统计学意义(P>0.05)。97例患者获访,随访时间均为2年,随访期间2组均无疝复发。结论在股疝修补术中应用聚丙烯小平片同改良Kugel补片的效果近似,且手术时间一定程度缩短,具有一定的应用价值。

Objective To compare the outcomes after mini-mesh approach to modified Kugel technique in femoral hernia repair. Methods The clinical data of 99 patients with primary unilateral femoral hernia who were admitted to The First Affiliated Hospital of Zhengzhou University from July 2012 to December 2016 were prospectively analyzed. A randomized controlled study was performed based on a random number table. All patients were allocated into mini-mesh group and Kugel group. The outcomes including operative time, wound pain scores(1 week after operation),analgesic used, hospital stay after operation, urinary retention, wound infection, seroma, and femoral vein thrombosis were recorded. Patients were followed-up at 3 months, 1 year, and 2 years after operation. Follow-up data included chronic pain, foreign body feeling, quality of life, and recurrence. Results Ninety-seven patients completed follow-up.There were 48 patients in the Kugel group and 49 patients in the mini-mesh group. The operation time of the mini-mesh group was significantly shorter than that of the Kugel group(P=0.030). There was no significant difference in analgesic used, hospital stay after operation, urinary retention, visual analog scale of wound pain at rest(VAS) 1 week postoperatively, and VAS of wound pain on coughing 1 week postoperatively between the two groups(P>0.05). No patient had wound infection, seroma or femoral vein thrombosis in the two groups. At 3 months, 1 year, and 2 years follow-up,there was no significant difference in chronic pain, foreign body feeling, and SF-36 score between the two groups(P>0.05).Ninety-seven patients completed 2 years follow-up, with no recurrence occurred during follow-up period. Conclusions The operative outcomes of mini-mesh repair are comparable to modified Kugel repair with a reduced operation time in femoral hernia patients. It is a safe and promising technique.