腹腔镜经腹膜前腹股沟疝修补(TAPP)术中应用不同方式关闭直疝缺损的临床对比研究

Clinical Comparative Study of Laparoscopic TransabdominalPreperitoneal Prosthesis(TAPP)with Different Methods of Closure of Direct Hernia Defect

目的:比较TAPP术中三种不同方式处理直疝缺损的临床效果及安全性。方法:回顾性分析自2018年6月—2019年12月行腹腔镜经腹腹膜前单侧腹股沟直疝修补术的116例患者的临床资料,按处理直疝缺损的不同方式分为圈套器组、缝合组及疝钉组,比较三组的直疝缺损大小、术中操作时间、术后第一天疼痛评分及术后并发症的发生率。结果:圈套器组的直疝缺损大小与缝合组间比较无显著统计学差异(P=0.08),圈套器组和缝合组的直疝缺损小于疝钉组,差异存在显著统计学差异(P<0.001);圈套器组的术中操作时间与疝钉组无明显统计学差异(P=0.84),圈套器组和疝钉组的术中操作时间小于缝合组,差异存在显著统计学差异(P<0.001)。三组患者术后第一天疼痛评分无明显统计学差异(P=0.23)。对于术后并发症的发生,三组患者术后血清肿的发生率无显著统计学差异(χ^2=0.78,P=0.89);三组患者术后复发的发生率无明显统计学差异(χ^2=0.64,P=0.91),三组患者无术后慢性疼痛及补片感染病例。结论:在腹腔镜腹股沟疝修补术中三种关闭直疝缺损的方式均具有临床有效性及安全性,如何选择关闭直疝缺损的方式应根据患者及术者的具体情况制定个体化治疗方案。

Objective To compare the clinical efficacy and safety of three different methods in the closure of direct hernia defect in transabdominal preperitoneal prosthesis(TAPP).Methods The clinical data of 116 patients who underwent laparoscopic transabdominalpreperitoneal prosthesis from June 2018 to December 2019 were analyzed retrospectively.According to the different methods of closure of direct hernia defect,they were divided into endoloop group,suture group and staple fixation group.The size of direct hernia defect,intraoperative time,pain score on the first day after operation and the incidence of postoperative complications were compared among the three groups.Results There was no significant difference in the size of direct hernia defect between the endoloop group and the suture group(P=0.08),but the direct hernia defect in the endoloop group and the suture group was smaller than that in the staple fixation group,which the difference was statistically significant(P<0.001).There was no significant difference in the intraoperative operation time between the endoloop group and the staple fixation group(P=0.84),but the intraoperative operation time in the endoloop group and the staple fixation group was significantly lower than that in the suture group(P<0.001).There was no significant difference in pain score on the first day after operation among the three groups(P=0.23).For the occurrence of postoperative complications,there was no significant difference in the incidence of seroma among the three groups(χ^2=0.78,P=0.89),and there was no significant difference in the incidence of recurrence among the three groups(χ^2=0.64,P=0.91).There were no cases of chronic pain and infection among the three groups.Conclusion The three methods of closing direct hernia defect in laparoscopic transabdominalpreperitoneal prosthesis are clinically effective and safe.To choose the way of closing direct hernia defect should make individualized plan according to the specific conditions of patients and operators.