腹腔镜下无张力疝修补术治疗成人疝气的效果分析

Analysis of the Effect of Laparoscopic Tension-free Hernia Repair on Adult Hernia

目的探讨腹腔镜下无张力疝修补术治疗成人疝气的效果分析。方法方便选取2018年6月-2019年6月在该院外科治疗的94例成人疝气患者按手术方式不同分为两组,对照组使用开放性无张力疝修补术,观察组使用腹腔镜下无张力疝修补术,对比两组的各项手术及恢复指标、术后不同时间点疼痛情况、并发症发生率、术后炎性因子及氧化应激因子水平。结果观察组手术时间(67.23±7.64)min、术中出血量(20.32±5.21)mL、术后疼痛持续时间(1.12±0.23)d、肛门排气时间(11.26±2.15)h、下床活动时间(22.18±5.42)h、住院时间(4.68±0.45)d均明显少于对照组的(89.35±9.57)min、(35.79±8.46)m L、(2.42±0.35)d、(15.67±3.03)h、(35.69±8.94)h、(8.17±1.04)d(t=5.948、5.429、4.014、4.303、4.976、4.657,P<0.05);观察组术后6 h、12 h、24 h、3 d、7 d的VAS疼痛评分为(4.65±2.05)分、(3.98±1.96)分、(3.37±1.46)分、(2.55±1.08)分、(2.03±0.76)分明显低于对照组的(6.58±2.11)分、(5.87±1.82)分、(5.31±1.69)分、(4.03±1.36)分、(3.48±1.15)分(t=4.672、4.314、4.378、4.144、4.097,P<0.05);观察组切口感染、尿潴留、阴囊血肿、疝复发等并发症发生率为4.26%明显低于对照组的17.02%(χ^2=9.273,P<0.05);观察组术后CRP、IL-8、TNF-α、MDA水平分别为(11.35±2.63)mg/L、(23.15±9.36)ng/L、(7.52±1.27)ng/L、(26.23±2.24)μmol/L明显低于对照组的(29.38±3.29)mg/L、(58.28±5.43)ng/L、(23.94±3.76)ng/L、(29.56±2.47)μmol/L,而SOD水平(89.34±8.49)nmol/mL明显高于对照组的(72.12±6.51)nmol/mL(t=5.446、6.253、5.167、4.032、4.759,P<0.05)。结论腹腔镜下无张力疝修补术治疗成人疝气的效果显著,能有效减轻术后疼痛,加快术后恢复速度,降低术后炎症反应及氧化应激反应程度,减少并发症的发生,具有积极的临床意义。

Objective To investigate the effect of laparoscopic tension-free hernia repair on adult hernia.Methods convenient selected 94 adult patients with hernia treated in the hospital from June 2018 to June 2019 were divided into two groups according to different surgical methods.The control group used open tension-free hernia repair,and the observation group used laparoscopic tension-free for hernia repair,the operation and recovery indicators of the two groups were compared,the pain at different time points after the operation,the incidence of complications,the levels of postoperative inflammatory factors and oxidative stress factors.Results Operation time of observation group was(67.23±7.64)min,intraoperative blood loss(20.32±5.21)mL,postoperative pain duration(1.12±0.23)d,anal exhaust time(11.26±2.15)h,time to get out of bed(22.18±5.42)h and hospitalization time(4.68±0.45)d were significantly less than the control group’s(89.35±9.57)min,(35.79±8.46)mL,(2.42±0.35)d,(15.67±3.03)h,(35.69±8.94)h,(8.17±1.04)d(t=5.948,5.429,4.014,4.303,4.976,4.967,P<0.05);VAS pain scores of the observation group at 6 h,12 h,24 h,3 d,7 d after surgery(4.65±2.05)points,(3.98±1.96)points,(3.37±1.46)points,(2.55±1.08)points,(2.03±0.76)points were significantly lower than the control group’s(6.58±2.11)points,(5.87±1.82)points,(5.31±1.69)points,(4.03±1.36)points,(3.48±1.15)points(t=4.672,4.314,4.378,4.144,4.097,P<0.05);wound infection and urinary retention incidence of complications such as scrotal hematoma and hernia recurrence in the observation group was 4.26%,which was significantly lower than that of the control group17.02%(χ^2=9.273,P<0.05);the postoperative CRP,IL-8,TNF-αand MDA levels in the observation group were(11.35±2.63)mg/L,(23.15±9.36)ng/L,(7.52±1.27)ng/L,(26.23±2.24)μmol/L were significantly lower than the control group(29.38±3.29)mg/L,(58.28±5.43)ng/L,(23.94±3.76)ng/L,(29.56±2.47)μmol/L,and the SOD level(89.34±8.49)nmol/mL was significantly higher than the control group(72.12±6.51)nmol/mL(t=5.446,6.253,5.167,4.032,4.759,P<0.05).Conclusion Laparoscopic tension-free hernia repair is effective in treating adult hernias.It can effectively reduce postoperative pain,accelerate postoperative recovery,reduce postoperative inflammation and oxidative stress,and reduce complications,with positive clinical significance.