腹腔镜经腹腹膜前疝修补术联合腹股沟区小切口在腹股沟疝治疗中的应用

Laparoscopic transperitoneal hernia repair combined with inguinal small incision in the treatment of inguinal hernia

目的探讨腹腔镜经腹腹膜前疝修补术(TAPP)联合腹股沟区小切口治疗难复性及嵌顿性腹股沟疝患者的临床疗效。方法回顾性分析2016年1月至2019年4月,常熟市第二人民医院62例一期行疝修补手术的单侧难复性或嵌顿性腹股沟疝患者的临床资料,其中行腹股沟区小切口联合TAPP修补术患者16例,行TAPP修补术患者21例,行开放无张力修补术患者25例。结果TAPP联合腹股沟区小切口组与TAPP组住院时间、手术时间、切口并发症、排尿困难及睾丸坏死发生率等方面比较,差异无统计学意义(P>0.05);而在住院费用及术后阴囊/会阴肿胀发生率方面比较,差异有统计学意义(P<0.05)。TAPP联合腹股沟区小切口组与开放组比较,在住院时间、术后切口并发症发生率及排尿困难发生率比较,差异有统计学意义(P<0.05);而在住院费用、手术时间、其他术后并发症发生率比较,差异无统计学意义(P>0.05)。结论TAPP联合腹股沟区小切口治疗难复性或嵌顿性腹股沟疝行可缩短住院时间或减少术后并发症的发生,值得在临床中应用推行。

Objective To investigate the clinical effect of laparoscopic transabdominal preperitoneal hernia repair(TAPP)combined with inguinal small incision in the treatment of irreducible or incarcerated inguinal hernia.Methods The clinical data of 62 patients undergoing primary hernia repair in Changshu second people's Hospital from January 2016 to April 2019 were analyzed retrospectively.Among them,16 patients underwent TAPP repair combined with inguinal small incision,21 patients underwent TAPP repair,and 25 patients underwent open tension-free repair.Results There were no differences in length of stay,operation time,wound complication,dysuria,and testicular ischemic necrosis between TAPP group and TAPP combined with inguinal small incision group(P>0.05).While in terms of hospitalization costs and the incidence of postoperative scrotal/perineum swelling,the differences were statistically significant(P<0.05).Compared with the open group with TAPP combined with inguinal small incision,there were statistically significant differences in hospital stay,postoperative wound complication rate and dysuria rate(P<0.05).While in terms of hospitalization costs,operation time,and other incidence of postoperative complications,the difference was not significant(P>0.05).Conclusion Treatment of irreducible or incarcerated inguinal hernia with TAPP combined with inguinal small incision can reduce hospitalization time or reduce the incidence of postoperative complications,and it is worth applying in clinic.