腹腔镜经腹腹膜前疝修补术中补片缝合固定对减轻腹股沟疝患者术后疼痛的效果分析

Analysis of the efficacy of relieving the postoperation pain by using mesh to stuture and fixate tissue during transabdominal preperitoneal hernioplasty in inguinal hernia patients

目的探讨腹腔镜经腹腹膜前疝修补术(TAPP)中采用缝合固定补片减轻腹股沟疝患者术后疼痛的效果。方法回顾性分析2016年1月—2017年1月南方医科大学附属南海医院收治的156例行TAPP治疗的腹股沟疝患者,均为男性,平均年龄50.84岁,年龄范围为33~62岁。根据疝补片固定方法不同将患者分为疝钉组(n=120)和可吸收线组(n=36)。其中疝钉组患者采用疝螺旋钉固定补片,可吸收线组患者采用可吸收线缝合固定补片。采用疼痛视觉模拟评分(VAS)比较两组患者术后疼痛的程度。术后通过门诊复诊及电话随访1年,观察两组患者的腹股沟疝复发情况。计量资料以均数±标准差(Mean±SD)表示,组间比较采用t检验;计数资料组间比较采用χ^2检验。结果疝钉组患者术后出现中度疼痛者19例,发生率为15.8%。可吸收线组患者出现中度疼痛者2例,发生率为5.6%,两组比较差异具有统计学意义(χ^2=2.511,P=0.013)。疝钉组患者的平均疼痛VAS为(3.08±1.36)分,可吸收线组为(2.50±0.91)分,两组比较差异具有统计学意义(t=2.973,P=0.001)。156例患者术后通过门诊复诊及电话随访1年均未复发。结论TAPP术中应用可吸收线缝合固定补片,可有效减轻术后疼痛。

Objective To study the efficacy of relieving the postoperation pain by using mesh to stuture and fixate tissue during transabdominal preperitoneal hernioplasty (TAPP) in inguinal hernia patients. Metholds A retrospective analysis of 156 patients with inguinal hernia who underwent TAPP in Nanhai Hospital Affiliated to Southern Medical University from January 2016 to January 2017 was conducted, they were males, the average age was 50.84 years and the age range was from 33 to 62 years. Patients were divided into sacral nail group (n=120) and absorbable line group (n=36) according to the different methods of fixation of the iliac crest. Among them, the patients in the sacral nail group were fixed with iliac screws, and the patients in the absorbable line group were sutured with absorbable sutures. Pain visual analog scale (VAS) was used to compare the extent of postoperative pain in both groups. After the operation, through the outpatient review and telephone follow-up for 1 year, observed the recurrence of inguinal hernia in both groups. Measurement data were expressed as mean ± standard deviation (Mean±SD), t-test was used for comparison between groups;the Chi-square test was used to compare the count data between the two groups. Results Among them, 19 patients with moderate pain after operation in the nail group had an incidence of 15.8%. Two patients with moderate pain in the absorbable line group had an incidence of 5.6%. The difference between the two groups was statistically significant (χ^2=2.511, P=0.013). The pain VAS of the patients in the sacral nail group was (3.08±1.36), and the absorbable line group was (2.50±0.91), the difference between the two groups was statistically significant (t=2.973, P=0.001). All patients had no recurrence after outpatient review and telephone follow-up for 1 year. Conclusion In TAPP, the application of absorbable suture fixed patch can effectively reduce postoperative pain.