3D立体补片在腹腔镜经腹腹膜前疝修补术中的应用

Application of 3D mesh in laparoscopic transabdominal preperitoneal hernia repair

目的探讨3D立体补片在腹腔镜经腹腹膜前疝修补术(TAPP)中的效果。方法收集2014年4月至2017年3月在上海中医药大学附属市中医医院外科住院手术治疗的腹股沟疝患者60例(66侧),自主选择腹腔镜修补术。按照选用补片不同分为试验组和对照组。试验组患者给予部分可吸收3D立体补片,对照组患者给予轻量聚丙烯平补片,均采用TAPP术进行修补。比较2组手术时间、腹股沟区疼痛异物感、术中出血量、术后下床活动时间及术后并发症发生情况。结果试验组和对照组手术时间分别为(37±12)min和(41±11)min,差异有统计学意义(t=9.75,P<0.05);试验组和对照组腹股沟区疼痛异物感分别为2例(6.67%)与5例(16.67%),差异有统计学意义(χ^2=1.14,P<0.05);试验组和对照组术中出血量(14.8±3.8)ml与(15.2±4.3)ml,差异有统计学意义(t=0.382,P>0.05);试验组和对照组术后下床活动时间分别为(19.8±9.2)h与(24.9±10.1)h,差异无统计学意义(t=2.042,P>0.05)。2组患者均观察随访2~3年,未发现严重持续疼痛及复发等并发症。结论TAPP术中应用部分可吸收3D立体补片免固定技术具有操作简便、手术时间短、术后异物感发生率低等特点,值得临床推广应用。

Objective To investigate the effect of 3D mesh in laparoscopic transabdominal preperitoneal hernia repair(TAPP).Methods From April 2014 to March 2017,60 patients(66 sides)with inguinal hernia treated in the Chinese Medicine Hospital affiliated to Shanghai University of Traditional Chinese Medicine were collected,and laparoscopic repair was self-determined selected.According to different mesh selection,the patients were divided into study group and control group.The patients in the study group were given partial absorbable 3D mesh,and the patients in the control group were given lightweight polypropylene flat mesh,all of which were repaired by TAPP.The operation time,pain and foreign body sensation in the groin area,intraoperative blood loss,postoperative leaving bed time,and postoperative complications were compared between the two groups.Results The operation time of the study group and the control group were(37±12)minutes and(41±11)minutes,respectively.The difference was statistically significant(t=9.75,P<0.05).The groin pain and foreign body sensation in the study group and control group were 2 cases(6.67%)and 5 cases(16.67%),respectively.The difference was statistically significant(χ^2=1.14,P<0.05).The intraoperative blood loss of the study group and the control group was(14.8±3.8)ml and(15.2±4.3)ml,the difference was statistically significant(t=0.382,P>0.05).The time of leaving bed in the study group and the control group was(19.8±9.2)hours and(24.9±10.1)hours,respectively,and the difference was not statistically significant(t=2.042,P>0.05).Patients in both groups were observed and followed for 2 to 3 years,and no serious persistent pain and recurrence complications were found.Conclusion The application of partially absorbable 3D mesh technology during TAPP surgery has the characteristics of simple operation,short operation time,and low incidence of foreign body sensation after surgery.It is worthy of clinical application.