腹膜外间隙内环口缩窄治疗巨大腹股沟斜疝的应用体会

Application of extraperitoneal space ring coarctation in the treatment of giant oblique inguinal hernia

目的:探讨腹膜外间隙内环口缩窄治疗巨大腹股沟斜疝的临床效果。方法:纳入82例巨大腹股沟斜疝患者作为研究对象,采用随机数表法进行简单抽样,将患者分为观察组与对照组,每组41例。对照组行完全腹膜外间隙补片修补术,观察组行腹膜外间隙内环口缩窄联合补片修补术。对比分析两组围术期状况、疼痛、氧化应激情况,记录两组术后并发症发生率、术后1年复发率。结果:观察组手术时间长于对照组(P<0.05),术后下床时间、住院时间短于对照组(P<0.05);不同术式疼痛评分与时间不存在交互效应(P>0.05),两组术前、术后第1天与第5天疼痛评分呈下降趋势(P<0.05),组间相比差异无统计学意义(P>0.05);术后第1天,两组总抗氧化能力均降低(P<0.05),两组皮质醇、晚期蛋白氧化产物水平均升高(P<0.05),两组术后各指标差异无统计学意义(P>0.05)。观察组总并发症发生率低于对照组(P<0.05),两组复发率差异无统计学意义(P>0.05)。结论:全腹膜外疝修补术联合内环口缩窄治疗巨大腹股沟斜疝疗效更佳、围手术期恢复更好,可降低并发症的发生风险,具有一定的临床应用价值。

Objective:To investigate the application effects of extraperitoneal space ring coarctation in the treatment of giant oblique inguinal hernia.Methods:A total of 82 patients with giant oblique inguinal hernia were enrolled as the research subjects.The patients were divided into observation group and control group according to the simple sampling of random number table method,with 41 cases in each group.Control group underwent totally extraperitoneal herniorrhaphy with patch,and observation group underwent extraperitoneal space ring coarctation combined with patch repair.The perioperative status and pain were compared between the two groups.The oxidative stress indexes were evaluated,and the incidence of postoperative complications were recorded in the two groups,and the recurrence was followed up and observed during 1 year after surgery.Results:The surgical time in observation group was longer than that in control group(P<0.05).The postoperative ambulation time and hospital stay in observation group were shorter than those in control group(P<0.05).There were no interaction effects between pain visual analogue score and time of different surgical methods(P>0.05).Pain visual analogue score in the two groups showed a downward trend before surgery and on the 1st day and 5th day after surgery(P<0.05),and there was no significant difference between the two groups(P>0.05).On the first day after surgery,the total antioxidant capacity level in the two groups was decreased(P<0.05),while the levels of cortisol and advanced oxidation protein products were increased in the two groups(P<0.05),and there were no statistically significant differences in above indexes between the two groups after surgery(P>0.05).The total incidence of complications in observation group was lower than that in control group(P<0.05),there was no significant difference in the recurrence rate between the two groups(P>0.05).Conclusions:Totally extraperitoneal herniorrhaphy combined with ring coarctation has better efficacy and better perioperative status in the treatment of giant oblique inguinal hernia,can reduce the risk of complications,and has clinical application value.