经下腹正中切口腹膜前无张力疝修补术和完全腹膜外疝修补术在成人腹股沟疝治疗中的应用

Open anterior preperitoneal tension-free hernia repair and laparoscopic totally extraperitoneal hernia repair in treatment of adult inguinal hernia

目的对比分析成人腹股沟疝治疗中应用经下腹正中切口腹膜前无张力疝修补术和完全腹膜外疝修补术(TEP)的临床效果。方法选择2018年3月至2019年1月,中国医科大学附属第四医院收治腹股沟疝患者100例。按照术式不同分为观察组和对照组。其中观察组患者接受经下腹正中切口腹膜前无张力疝修补术进行治疗,对照组患者接受TEP接受治疗。分析2组患者手术时间、术后疼痛评分、并发症发生率、住院时间、住院费用和复发率。结果 2组患者均完成手术,观察组患者手术时间(51.08±8.63)h、住院费用(7445.42±562.18)元明显低于对照组(66.89±11.45)h、(10785.38±1208.76)元;观察组患者住院时间(8.12±1.68)d、疼痛评分(4.89±1.05)分明显高于对照组(5.08±1.55)d、(2.98±1.02)分,差异均有统计学意义(P均<0.001);2组患者的并发症发生率比较,差异无统计学意义(P>0.05);对照组患者复发率(8%)高于观察组患者复发率(0),差异有统计学意义(χ~2=4.17、P=0.04)。结论经下腹正中切口腹膜前无张力疝修补术具有手术时间短、住院费用低和复发率低等特点,但是住院时间和疼痛评分均高于TEP,两种手术方式均各有优劣势,而经下腹正中切口腹膜前无张力疝修补术更适合在基层医院推广和应用。

Objective To compare and analyze the clinical effects of open anterior preperitoneal tension-free hernia repair and laparoscopic totally extraperitoneal hernia repair(TEP)in the treatment of adult inguinal hernia.Methods From March 2018 to January 2019,100 patients with inguinal hernia in the Fourth Affiliated Hospital of China Medical University were treated as the research object,and they were divided into the observation group and the control group according to the order in which they were admitted to the hospital.The observation group received open anterior preperitoneal tension-free hernia repair,while the control group received TEP repair.The operation time,postoperative pain score,complication rate,hospitalization stay,hospitalization cost and recurrence rate of the two groups were analyzed.Results Both groups of patients completed the operation,and the operation time of the observation group was(51.08±8.63)hours,hospitalization cost was(7,445.42±562.18)yuan,and these were significantly lower than those in the control group[(66.89±11.45)hours,and(10,785.38±1208.76)yuan].And the hospitalization stay and pain score in observation group were(8.12±1.68)days,and(4.89±1.05)score,respectively.These were significantly higher than those in the control group hospital stay[(5.08±1.55)days,(2.98±1.02)score].There was no significant difference in the incidence of complications between the two groups(P>0.05).The recurrence rate of the control group(8%)was higher than that of the observation group(0),and the difference was statistically significant(P=0.04).Conclusion Open anterior preperitoneal tension-free hernia repair has the characteristics of short operation time,low hospitalization cost and low recurrence rate.However,the hospitalization time and pain score are higher than TEP.Both methods have advantages and disadvantages,and the open anterior preperitoneal tension-free hernia repair is more suitable for promotion and application in primary hospitals.