腹腔镜疝修补术与开放疝修补术对高原地区患者术后疼痛及创伤应激影响的对比研究

A prospective controlled study of effect for laparoscopic inguinal hernia repair and open repair on postoperative pain and trauma stress in patients at high altitude

目的探讨腹腔镜经腹腹膜前疝修补术(TAPP)与开放疝修补术(PLUG)对高原地区腹股沟疝患者术后疼痛及创伤应激的影响。方法选取2017年1月至2018年5月在我院接受治疗的腹股沟疝患者96例,根据治疗方法不同分为研究组及对照组,各48例,分别行TAPP及开放无张力腹股沟疝修补术。比较2组手术指标、术后疼痛及创伤应激指标水平;记录术后并发症情况。结果研究组患者手术时间较对照组延长,而术中失血量、术后排气时间以及术后住院时间显著少于或短于对照组(均P<0.05);术后12、24 h以及3 d时比较,研究组VAS评分均显著低于对照组(均P<0.05);术后3 d,2组患者血清C反应蛋白(CRP)、皮质醇和白细胞介素-6(IL-6)水平均较术前显著升高(P<0.05);组间比较,研究组均显著低于对照组(均P<0.05);研究组和对照组患者的并发症发生率分别为术后尿潴留(2.08%vs.4.17%)、血清肿(29.17%vs.22.92%)、阴囊血肿(2.08%vs.4.17%)、复发(0 vs.2.08%)、感染(0%vs.2.08%),2组患者均未出现慢性疼痛的病例,2组比较无明显差异(P>0.05)。结论TAPP治疗高原地区腹股沟疝可明显减少术中出血及术后疼痛感,降低机体创伤应激反应,但手术时间较长,相应的医疗费用增加,因此临床应根据患者具体情况选择术式。

Objective To investigate the effect of laparoscopic preperitoneal hernia repair(TAPP)and open procedure(PLUG)on postoperative pain and trauma stress in patients with inguinal hernia at high altitude.Methods 96 patients with inguinal hernia who were treated in our hospital from January 2017 to May 2018 were selected.They were divided into study group and control group according to different treatment methods,48 cases in each,and which were treated with TAPP and open tension-free inguinal hernia repair surgery.The surgical indexes,postoperative pain and trauma stress indexes were compared,and the postoperative complications were recorded.Results The operation time in the study group was longer than that in the control group,and the blood loss,postoperative exhaust time,and postoperative hospital stay were significantly shorter than those in the control group(all P<0.05).At 12 h,24 h,and 3 days after operation,the VAS scores in the study group were significantly lower than those in the control group(all P<0.05).The serum CRP,cortisol and IL-63 days after operation were significantly higher than before operation(P<0.05);the study group were significantly lower than the control group(all P<0.05).Patients in the 2 group had postoperative urinary retention(2.08%vs.4.17%),inguinal seroma(29.17%vs.22.92%),scrotal hematoma(2.08%vs.4.17%),recurrence(0%vs.2.08%)and incision infection(0%vs.2.08%).No chronic pain case was observed in both 2 groups.There was no significant difference between the two groups(P>0.05).Conclusion TAPP treatment of inguinal hernia at high altitude can significantly reduce intraoperative bleeding and postoperative pain and reduce the body's trauma stress response,but the operation time is longer and the corresponding medical costs increase.Therefore,the clinical method should be selected according to the specific conditions of patients.