腹腔镜完全腹膜外疝修补术免固定术治疗老年腹股沟疝的临床疗效

Effect of TEP with fix-free technique on chronic pain and quality of life in patients with inguinal hernia

目的探究腹腔镜完全腹膜外疝修补术(TEP)免固定术治疗老年腹股沟疝的临床疗效。方法选取2014年10月到2018年3月,池州市人民医院收治的596例腹股沟疝患者作为研究对象。随机分为A组和B组,每组患者298例。A组采用单点固定TEP术,B组采用免固定TEP术。对比分析2组患者手术时间、术中出血量、切口长度、下床活动时间、进食时间、排气时间、住院时间、术后疼痛、并发症发生情况、生活质量以及复发情况。结果B组患者术中出血量、手术时间和切口长度均明显少于A组,差异均有统计学意义(P<0.05)。B组患者术后排气时间、进食时间、下床活动时间和住院时间均明显少于A组,差异均有统计学意义(P<0.05)。2组患者术前4 h VAS评分比较,差异无统计学意义(P>0.05);但B组术后3 d、术后1个月、术后3个月和术后6个月的VAS评分均明显低于A组,差异均有统计学意义(P<0.05)。B组并发症发生率明显低于A组,差异有统计学意义(P<0.05)。2组患者术前、术后生活质量均明显好转,组内比较,差异均有统计学意义(P<0.05);且B组患者好转程度明显优于A组,差异均有统计学意义(P<0.05)。术后1年,B组慢性疼痛和复发率均明显低于A组,且具有显著统计学差异(P<0.05)。结论将免固定技术与TEP术相结合不仅能够缩短手术时间、进食时间、排气时间、住院时间和下床活动时间,而且减少了术后疼痛和并发症的发生。将免固定技术应用于TEP降低了慢性疼痛和术后复发发生率,且提高了患者的生活质量。

Objective To explore the clinical effect of laparoscopic totally extraperitoneal hernia repair with fix-free technique on elderly inguinal hernia.Methods A total of 596 patients with inguinal hernia admitted to the People's hospital Chizhou from October 2014 to March 2018 were selected as subjects.The patients were randomly divided into group A(n=289)and group B(n=289).The single-point fixed TEP was performed in the group A.The fix-free TEP was taken in the group B.Operation time,intraoperative blood loss,incision length,time to get out of bed,time to eat,time to exhaust,length of stay,postoperative pain,complications,quality of life,and recurrence between the two groups were compared.Results The intraoperative blood loss,operation time and incision length of group B patients were significantly less than those of group A(P<0.05).The postoperative exhaust time,eating time,get out of bed time and hospitalization stay of group B were significantly less than those of group A(P<0.05).The VAS scores of patients in group B at 3 days,1 month,3 months,and 6 months after operation were significantly lower than those in group A(P<0.05).The incidence of complications in group B was significantly lower than that in group A(P<0.05).The improvement in the quality of life of the patients in the group B was significantly better than that in group A(P<0.05).At 1 year after operation,the incidence of postoperative chronic pain and recurrence in group B were significantly lower than those in group A(P<0.05).Conclusion Combining fix-free technique with TEP surgery can not only shorten operation time,the time of eating,exhausting,and getting out of bed,and length of stay,but also reduce the occurrence of postoperative pain and complications.It can reduce the incidence of chronic pain and postoperative recurrence,and can improve the patient's quality of life.