腹腔镜腹股沟直疝修补术中缝合关闭疝缺损对预防术后血清肿的效果

Effect of hernia defect closure in laparoscopic direct inguinal hernia repair on the prevention of postoperative seroma

目的探讨腹腔镜腹股沟直疝修补术中缝合关闭疝缺损对预防术后血清肿的效果。方法采用前瞻性随机对照研究方式,将2017年1月至2018年12月,清河县中心医院收治的200例腹股沟直疝患者随机分为试验组和对照组,2组患者均接受腹腔镜经腹腹膜前疝修补术,试验组患者在术中使用0号涤纶缝线缝合关闭疝环和直疝疝囊腔;对照组患者不处理疝环,2组患者术后7 d、1个月和3个月分别复查腹股沟区彩色多普勒超声,对比腹股沟区血清肿的发生情况并评估血清肿的积液量,同时比较2组患者手术时间、住院时间、术后慢性疼痛和复发情况等。结果术后7 d、1个月复查局部彩色多普勒超声,对照组血清肿积液量分别为(30.63±6.86)ml、(20.19±5.94)ml明显高于试验组(15.45±4.16)ml、(11.00±2.23)ml,差异均有统计学意义(P<0.05);对照组术后3个月血清肿积液量(13.18±5.13)ml与实验组(10.00±0.00)比较ml,差异无统计学意义(P>0.05)。试验组手术时间(53.21±8.21)min高于对照组(47.60±5.34)min,差异有统计学意义(P<0.05);试验组住院时间(3.09±0.55)d与对照组(3.08±0.63)d基本相同,差异无统计学意义(P>0.05);2组患者术后随访期间均未出现慢性疼痛及复发。结论腹腔镜腹股沟直疝修补术中缝合关闭缺损这一操作安全有效,可显著减少术后血清肿发生率,且不增加术后感染、疼痛及复发等风险。

Objective To investigate the effect of hernia defect suture closure in laparoscopic direct inguinal hernia repair on prevention of postoperative seroma.Methods A prospective randomized controlled study was conducted on 200 cases of inguinal hernia in Qinghe County Central Hospital from January 2017 to December 2018.The patients were randomly divided into the experimental group and the control group.Both groups underwent laparoscopic transabdominal preperitoneal hernia repair(TAPP).In the experimental group,hernia ring and sac closure with polyester sutures was performed.The patients in the two groups were reexamined with color Doppler ultrasound in the groin area 7 days,1 month and 3 months after the operation,to compare the occurrence of seroma in the groin area and to evaluate the serum fluid volume.The operation time,hospitalization time,postoperative chronic pain and recurrence in the two groups were compared.Results At 7 d and 1 month after the operation,the color Doppler ultrasound showed that the serum fluid volume in the control group[(30.63±6.86)ml and(20.19±5.94)ml]was significantly higher than those in the experimental group[(15.45±4.16)ml and(11.00±2.23)ml],the differences were statistically significant(P<0.05).At 3 months after the operation,there was no significant difference between the experimental group and the control group in the serum fluid volume[(13.18±5.13)ml vs(10.00±0.00)ml,P>0.05].The operation time of the experimental group was(53.21±8.21)minutes longer than that of the control group(47.60±5.34)minutes,the difference was statistically significant(P<0.05);the hospitalization time of the experimental group was(3.09±0.55)days was comparable with that of the control group(3.08±0.63)days,the difference was not statistically significant(P>0.05);there was no chronic pain and recurrence in the follow-up period of the two groups.Conclusion Defect closure in the laparoscopic direct inguinal hernia repair operation is safe and effective,and it can significantly reduce the incidence of postoperative seroma,without increasing the risk of postoperative infection,pain and recurrence.