腹腔镜经腹腹膜前与局麻下开放式腹膜前疝修补术治疗股疝的对比研究

Comparative study of TAPP and open peritoneal hernia repair under local anesthesia for the treatment of femoral hernia

目的研究腹腔镜经腹腹膜前疝修补术(TAPP)与局麻下开放式腹膜前间隙疝修补术两种手术方式治疗股疝对比研究。方法收集2015年1月至2016年6月,北京朝阳医院疝和腹壁外科收治40例股疝患者,对其的临床数据进行回顾性分析,根据手术方式不同分为腔镜组与开放组,腔镜组22例(55%),均采用TAPP手术治疗;开放组18例(45%),均采用开放腹膜前疝修补术治疗。比较不同手术方式的2组患者的住院时间、手术时间、术中出血量、术后疼痛、离床时间、术后住院时间,以及术后局部血肿、感染等并发症发生率。结果腔镜组与开放组手术所用时间、术中出血量、住院时间、术后疼痛、术后住院时间比较,差异无统计学意义(P>0.05);术后离床时间比较,差异有统计学意义(P<0.05),考虑与麻醉方式有关。2组均未出现血肿及感染等并发症,局部疼痛较轻,未发生慢性顽固性疼痛。术后随访6~18个月,2组均未出现复发病例。结论技术成熟的术者对于股疝的手术,TAPP与局麻开放式腹膜前疝修补术无明显差异,两种不同的手术方法各有其优缺点,应根据术前评估及术者手术技术水平选择合适的手术方式。

Objective To compare laparoscopic transabdominal preperitoneal repair(TAPP)and open preperitoneal repair under local anesthesia for the treatment of femoral hernia.Methods From January 2015 to June 2016,the clinical data of 40 patients with femoral hernia treated in Beijing Chaoyang Hospital were retrospectively analyzed.The clinical data were retrospectively analyzed and divided into the laparoscopic group and the open group according to different surgical methods.22 cases(55%)of the laparoscopic group were treated with TAPP;18 cases(45%)of the open group were treated with open preperitoneal hernia repair.The hospitalization time,operation time,intraoperative blood loss,postoperative pain,leaving bed time,postoperative hospital stay,and postoperative local hematoma and infection were compared between the two groups.Results There was no significant difference between the laparoscopic group and the open group in terms of operation time,intraoperative blood loss,hospitalization time,postoperative pain,postoperative hospital stay(P>0.05).The difference in the leaving bed time after operation was statistically significant(P<0.05),which was considered related to the anesthesia method.There were no complications such as hematoma and infection in the two groups.The local pain was mild,and no chronic pain occurred.After 6 to 18 months of follow-up,there were no recurrences in the laparoscopic group and the open group.Conclusion For experienced surgeons,there is no significant difference between TAPP and open preperitoneal hernia repair for femoral hernia.Two different surgical methods have their own advantages and disadvantages,and the appropriate surgical method should be selected basing on preoperative evaluation and surgical skill level of the surgeon.