腹腔镜下经腹腹膜前疝修复术治疗复发性腹股沟疝的效果及对患者应激反应的影响

Effect of Laparoscopic Transperitoneal Hernioplasty for Recurrent Inguinal Hernia and its Effect on Stress Response of Patients

目的探讨腹腔镜下经腹腹膜前疝修复术(TAPP)治疗复发性腹股沟疝的效果及对患者应激反应的影响。方法方便选取该院2015年3月—2018年3月复发性腹股沟疝患者50例,随机数字法分为对照组(平片无张力疝修补术,25例)与观察组(TAPP,25例);比较两组患者围手术期指标水平、应激反应指标水平及术后并发症情况。结果观察组手术时间(41.89±4.09)min、住院时间(2.89±0.67)d及术后下床活动时间(6.15±1.09)h明显短于对照手术时间(56.01±7.12)min、住院时间(5.13±1.06)d、及术后下床活动时间(11.78±2.12)h,观察手术费用(7853.72±523.11)元显著高于对照组(4632.01±316.12)元,比较差异有统计学意义(t=10.027、10.416、13.771、-30.735,P<0.05);术后第3天,对照组组患者皮质醇(734.55±89.81)nmol/L、胰岛素(12.63±3.45)mIU/L、IL-6(45.02±7.22)ng/L均高于观察组皮质醇(589.52±42.43)nmol/L、胰岛素(8.03±2.37)mIU/L、IL-6(38.54±4.17)ng/L,比较差异有统计学意义(t=8.514、6.408、4.532,P<0.05);随访6个月,观察组术后感染、尿潴留、腹股沟异物感、慢性疼痛及疝复发总发生率较对照组显著降低(χ^2=4.500,P=0.034)。结论腹腔镜下经腹腹膜前疝修复术治疗复发性腹股沟疝能改善预后、促进病情恢复,减轻机体应激反应,并降低并发症的发生。

Objective To investigate the effect of laparoscopic transperitoneal hernioplasty(TAPP)for recurrent inguinal hernia and its effect on stress response of patients.Methods Fifty patients with recurrent inguinal hernia in our hospital from March 2015 to March 2018 were convenient randomly divided into control group(tension-free hernioplasty,25cases)and observation group(TAPP,25cases),The levels of perioperative indicators,stress response indicators and postoperative complications were compared between the two groups.Results The operation time(41.89±4.09)min,hospitalization time(2.89±0.67)d,and the time of getting out of bed after operation(6.15±1.09)hin the observation group were significantly shorter than those in the control group(56.01±7.12)min,hospitalization time(5.13±1.06)d,and the time of getting out of bed after operation(11.78±2.12)h.The observation operation cost(7853.72±523.11)yuan was significantly higher than that in the control group(4632.01±316.12)yuan,the difference was statistically significant(t=10.027,10.416,13.771,-30.735,P<0.01);On the third day after operation,the levels of cortisol(734.55±89.81)nmol/L insulin(12.63±3.45)mIU/L and IL-6(45.02±7.22)ng/L in the control group were higher than those in the observation group(589.52±42.43)nmol/L,insulin(8.03±2.37 mIU/L),IL-6(38.54±4.17)ng/L,the difference was statistically significant(t=8.514,6.408,4.532,P<0.01);After 6 months of follow-up,the incidence of infection,urinary retention,inguinal foreign body sensation,chronic pain and hernia recurrence in the observation group was significantly lower than that in the control group(χ^2=4.500,P=0.034).Conclusion Laparoscopic transperitoneal hernioplasty for recurrent inguinal hernia can improve prognosis,promote recovery,alleviate stress response and reduce complications.