腹腔镜无张力修补术与开放手术治疗原发性腹壁疝的疗效比较

Comparison of Effect of Laparoscopic Tension-free Repair and Open Surgery on Primary Abdominal Hernia

目的:比较腹腔镜无张力疝修补术与开放式疝修补术治疗原发性腹壁疝的临床疗效。方法:将某院2017年11月~2019年2月间治疗的70例原发性成人腹壁疝患者作为研究对象,采用数字双盲法将患者分为对照组和观察组各35例。对照组采用常规开放式疝修补术,观察组采用腹腔镜无张力疝修补术,比较两组手术时间、术中出血量、住院时间、术后24h疼痛评分及临床并发症,随访12个月复发率。结果:观察组手术时间、术中出血量、住院时间及术后24h VAS评分少于或低于对照组(P<0.05);观察组术后并发症发生率8.57%(3/35)明显低于对照组28.57%(10/35)(P<0.05);术后12个月,观察组复发2例,复发率为6.25%,对照组复发3例,复发率为8.57%;两组随访12个月复发率(观察组6.25%,对照组8.57%)比较差异无统计学意义(P>0.05)。结论:腹腔镜无张力疝修补术和开放式疝修补术均为腹壁疝的有效治疗手段,相较开放式疝修补术,腹腔镜无张力疝修补术在缩短手术时间,减少出血量,降低术后疼痛与并发症,促进术后康复方面的优势更为明显。

Objective:To compare the clinical efficacy of laparoscopic tension-free hernia repair and open hernia repair in the treatment of primary abdominal hernia.Methods:70 cases of primary adult abdominal hernia treated in a hospital from November 2017 to February 2019 were studied.The patients were divided into control group(35 cases)and observation group(35 cases)by digital double-blind method.The control group received conventional open hernia repair and the observation group received laparoscopic tension-free hernia repair.The operation time,intraoperative blood loss,length of stay,postoperative pain score after 24h and clinical complications were compared between the two groups,and the recurrence rate was followed up for 12 months.Results:The operative time,intraoperative blood loss,length of stay and VAS score 24h after operation in the observation group were less or lower than those in the control group(P<0.05).The incidence of postoperative complications in the observation group was 8.57%(3/35),significantly lower than that in the control group(28.57%,10/35,P<0.05).Twelve months after the operation,2 cases of recurrence occurred in the observation group,with a recurrence rate of 6.25%.3 cases of recurrence occurred in the control group,the recurrence rate was 8.57%,with no statistical significance(P>0.05).Conclusion:Both laparoscopic tension-free hernia repair and open hernia repair are effective treatment for abdominal wall hernia.Compared with open hernia repair,laparoscopic tension-free hernia repair has more advantages in shortening operation time,reducing bleeding volume,reducing postoperative pain and complications,and promoting postoperative rehabilitation.