猪小肠黏膜下层脱细胞基质补片在不同术式治疗青壮年腹股沟疝中的应用效果

Application efficacy of porcine small intestinal submucosa patch in different procedures for inguinal hernia in young adult patients

目的:探讨猪小肠黏膜下层脱细胞基质(SIS)补片用于腹腔镜经腹腹膜前(TAPP)疝修补术与开放无张力疝修补术(Lichtenstein手术)治疗青壮年腹股沟疝临床效果。方法:回顾性分析2015年2月-2018年2月期间首都医科大学附属北京朝阳医院疝和腹壁外科采用SIS补片行疝修补术的268例青壮年腹股沟疝的患者临床资料,其中152例行Lichtenstein手术(Lichtenstein组),116例行TAPP手术(TAPP)。比较两组患者的相关临床指标。结果:Lichtenstein组手术时间、住院费用明显少于TAPP组,但围术期疼痛评分明显高于TAPP组(均P<0.05);两组在术中出血量、住院时间方面差异均无统计学意义(均P>0.05)。Lichtenstein组术后1周及1、3个月血清肿的发生率均低于TAPP组(均P<0.05)。所有患者均未发生异物感、肠梗阻、肠瘘等并发症。结论:SIS补片应用于青壮年腹股沟疝的开放和腹腔镜疝修补术均有确切的效果,但该补片用于两种术式均有各自的优缺点。

Objective: To investigate the clinical efficacy of using porcine small intestinal submucosa(SIS) patch in laparoscopic transabdominal preperitoneal(TAPP) hernia repair and open tension-free hernioplasty(Lichtenstein procedure) for inguinal hernia in young adults.Methods: The clinical data of 268 young adult patients with inguinal hernia undergoing hernia repair using SIS patch from February 2015 to February 2018 in the Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital were retrospectively analyzed. Of the patients, 152 cases underwent Lichtenstein hernioplasty (Lichtenstein group), and 116 cases received TAPP procedure(TAPP group). The main clinical variables were compared between the two groups of patients.Results: The operative time and hospitalization costs were significantly less in Lichtenstein group than those in TAPP group, but the perioperative pain score was significantly higher in Lichtenstein group than that in TAPP group(all P<0.05). There were no significant differences in terms of intraoperative blood loss and length of hospital stay between the two groups(both P>0.05). The incidence rates of seroma on one week, one month and three months after operation were all significantly lower in Lichtenstein group than those in TAPP group(all P<0.05). No complications such as foreign body sensation, intestinal obstruction and intestinal fistula occurred in any of the patients.Conclusion: In young adult patients with inguinal hernia, using SIS patch has demonstrable efficacy for either open or laparoscopic hernioplasty. However, both procedures using this patch have their advantages and disadvantages.