腹腔镜修补术治疗中青年腹股沟斜疝的效果评价

Evaluation of laparoscopic repair in the treatment of young and middle-aged indirect inguinal hernia

目的评价腹腔镜全腹膜外斜疝修补术治疗中青年腹股沟斜疝的效果及安全性。方法选取2016年7月至2018年11月,新疆医科大学第一附属医院收治的中青年腹股沟斜疝患者160例,根据手术方法不同将其分为2组,每组患者80例。试验组采用腹腔镜全腹膜外斜疝修补术,对照组采用开放式全腹膜外斜疝修补术。观察并比较2组患者手术及住院指标、术后疼痛视觉模拟评分(VAS)、手术前后性功能、血清炎症指标、生活质量改善情况及术后相关并发症的发生率。结果试验组术中出血量、下床活动时间、住院时间明显低于对照组,住院费用明显高于对照组,差异有统计学意义(P<0.05);试验组手术时间略长于对照组,但差异无统计学意义(P>0.05)。试验组术后1 d及术后7 d VAS评分均低于对照组,差异有统计学意义(P<0.05);术前,2组血清CRP、IL-8及TNF-α水平比较,差异无统计学意义(P>0.05);术后2组血清炎性因子水平均升高,与同组术前水平比较,差异有统计学意义(P<0.05);试验组血清CRP、IL-8及TNF-α水平低于对照组,差异有统计学意义(P<0.05)。术前,2组患者睾丸体积及睾丸动脉最大血流速度比较,差异无统计学意义(P>0.05);术后,2组患者两项指标均有明显改善,组内比较差异有统计学意义(P<0.05);试验组睾丸体积及睾丸动脉最大血流速度高于对照组,差异有统计学意义(P<0.05)。术后6个月2组患者并发症总体发生率比较,差异有统计学意义(P<0.05)。术后6个月,试验组生理功能、生理职能、总体健康及平均得分稍高于对照组,差异有统计学意义(P<0.05);2组患者社会功能、情感职能、躯体疼痛、精神健康及活力评分比较,差异无统计学意义(P>0.05)。结论采用腹腔镜全腹膜外斜疝修补术治疗中青年腹股沟斜疝疗效明显,可明显缩短术后疼痛持续时间,降低手术相关并发症的发生率,改善生活质量,同时对正常的解剖结构影响较小。

Objective To evaluate the efficacy and safety of laparoscopic total extraperitoneal herniorrhaphy(TEP)in the treatment of young and middle-aged indirect inguinal hernia.Methods A total of 160 young and middle-aged patients with indirect inguinal hernia treated inthe First Affiliated Hospital of Xinjiang Medical University from July 2016 to November 2018 were divided into two groups according to different surgical methods.80 cases in the observation group were treated with laparoscopic TEP repair,and 80 cases in the control group were treated with open TEP repair.The indexes of operation and hospitalization,the difference of postoperative VAS score,the improvement of sexual function,serum inflammatory index and quality of life before and after operation,and the incidence of postoperative complications were observed and compared between the two groups.Results The amount of intraoperative bleeding,the time of getting out of bed and the length of hospitalization in the observation group were significantly lower than those in the control group,and the cost of hospitalization in the observation group was significantly higher than that in the control group.The operation time in the observation group was slightly longer than that in the control group,but there was no significant difference between the two groups.The VAS score of the observation group at 1st d and 7th d after operation was significantly lower than those of the control group.There was no significant difference in the levels of serum CRP,IL-8 and TNF-α between the two groups before operation,but the levels of serum inflammatory factors in both groups increased after operation(P<0.05).The levels of serum CRP,IL-8 and TNF-αin the observation group after operation were significantly lower than those in the control group(P<0.05).Before operation,there was no significant difference in testicular volume and maximum blood flow velocity of testicular artery between the two groups(P>0.05).After operation,the two indexes of the two groups were significantly improved,and there was significant difference between the two groups(P<0.05).The testicular volume and maximum blood flow velocity of testicular artery in the observation group were significantly higher than those in the control group(P<0.05).Six months after operation,there was significant difference in the overall incidence of complications between the two groups(P<0.05).Six months after operation,the scores of physiological function,physiological function,overall health and average score of the observation group were slightly higher than those of the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the scores of social function,emotional function,physical pain,mental health and vitality between the two groups(P>0.05).Conclusion Laparoscopic total extraperitoneal indirect hernia repair is effective in the treatment of young and middle-aged indirect inguinal hernia,which can significantly shorten the duration of postoperative pain,reduce the incidence of operation-related complications and improve the quality of life.At the same time,it has little effect on the normal anatomical structure,so it is worth popularizing and implementing in clinic.