开放TEP中补片5点固定法的安全性及可行性研究

Study on the safety and feasibility of patch fixation by percutaneous five-point-suture method in opening total extraperitoneal herniorrhaphy

目的评价补片5点固定方法用于开放式TEP中的安全性及可行性。方法回顾分析2013年6月至2017年3月行开放TEP手术患者229例的临床资料,其中2013年6月至2015年3月手术未行补片固定(non-Fixation group,nF组,102例),2015年3月至2017年3月手术行补片固定(Fixation group,F组,127例),对比2组临床资料及术后随访资料。结果F组手术时间长于nF组[(57.78±8.93)min VS(46.08±6.12)min,P<0.05]。2组院内平均止痛药用量、术后住院天数差异无统计学意义[(2.02±6.37)mg VS(3.32±9.02)mg,(5.54±2.07)d VS(5.41±1.52)d,P>0.05]。nF组与F组术后1 d VAS评分差异无统计学意义(5.15±1.23 VS 5.28±1.24,P>0.05)。F组术后2 d、术后3 d、术后7 d VAS评分均显著低于相应时间段的nF组(P<0.05)。nF组与F组术后3 d、术后1个月、术后6个月、术后12个月补片挛缩度差异均无统计学意义(P>0.05)。随访期间nF组与F组补片移位、血清肿、尿潴留、补片排异反应、慢性疼痛等并发症发生率差异均无统计学意义(P>0.05)。nF组随访期间,疝气复发2例,复发率1.96%。F组随访期间未见疝气复发患者。2组疝气复发率差异无统计学意义(P>0.05)。结论开放TEP中行5点固定法不会增加术后并发症发生,仅少量延长的手术时间,可有效地预防疝复发,安全可行。

Objective To investigate the safety and feasibility of patch fixation by percutaneous five-point-suture method in opening total extraperitoneal herniorrhaphy(opening TEP).Methods The clinical data adout 229 patients with inguinal hernia who were treated by opening in our hospital TEP from June 2013 to March 2017 were retrospectively analyzed,of whom,102 patients were treated by surgery without patch fixation(non-fixation group,NF group)from June 2013 to March 2015,and the other 127 patients were treated by patch fixation(fixation group,group F)from March 2015 to March 2017.The clinical data and the follow up data after operation were observed and compared between the two groups.Results The operation time of group F was significantly longer than that in NF group(P<0.05).There were no significant differences in the average analgesic dose and postoperative hospital stay between the two groups(P>0.05).There were no significant differences in VAS scores at 1 day after operation between NF group and group F(P>0.05),however,the VAS scores at 2d,3d,7d after operation in group F were significantly lower than those in NF group(P<0.05).There were no significant differences in patch contracture degrees at 3d,1m,6m,12m after surgery between the two groups(P>0.05).There were no significant differences in the incidences of complications including patch displacement,serum swelling,urinary retention,patch rejection,and chronic pain during follow up between the two groups(P>0.05).During follow-up,there were 2 cases of hernia recurrence in NF group,with the recurrence rate being 1.96%,and there was no case of hernia recurrence in group F during follow up,however,there was no significant difference in the relapse rate of hernia between the two groups(P>0.05).Conclusion The patch fixation by percutaneous five-point-suture method in opening TEP does not increase the incidence of postoperative complicatioms,which only extend a little operation time,and can effectively avoid hernia recurrence,with safety and feasibility.