腹腔镜完全腹膜外疝修补术与腹腔镜经腹腹膜前疝修补术在老年腹股沟疝中的应用价值及对呼吸功能的影响

Application value and influence on respiratory function of TEP and TAPP surgical procedure in elderly patients with inguinal hernia

目的探究腹腔镜完全腹膜外疝修补术(TEP)与腹腔镜经腹腹膜前疝修补术(TAPP)手术方式在老年腹股沟疝中的应用价值及对呼吸功能的影响。方法选取2018年2月至2019年8月,庐江县人民医院腹股沟疝老年患者90例,按照手术方式分为TEP组和TAPP组,每组45例。比较2组患者手术效果、呼吸功能、术后复发、慢性疼痛及并发症的发生情况。结果TAPP组的患者恢复正常活动时间显著高于TEP组,差异有统计学意义(P<0.05)。2组患者建立气腹后10(T1)、30(T2)、60(T3)、90 min(T4)的呼吸末二氧化碳分压(PETCO2)、气道分压(Paw)较建立气腹前(T0)均升高,且TEP组气腹后T1、T2、T3、T4的PETCO2、Paw均高于TAPP组,差异有统计学意义(P<0.05)。2组患者手术时间、住院费用、术中出血量、视觉模拟疼痛评分(VAS)、术后住院时间、复发及并发症、术后慢性疼痛的发生情况差异均无统计学意义(P>0.05)。结论TEP与TAPP对老年腹股沟疝均有良好的治疗效果,TEP在促进术后恢复方面具有优势,但对老年患者术中呼吸功能影响更为明显。

Objective To investigate the application value and effect of laparoscopic totally extraperitoneal hernia repair(TEP)and laparoscopic transabdominal preperitoneal hernia repair(TAPP)on the respiratory function under general anesthesia in elderly patients with inguinal hernia.Methods 90 elderly patients with inguinal hernia admitted to Lujiang People's Hospital were selected and divided into the TEP group and the TAPP group according to surgical methods,with 45 cases in each group.The operation effect,respiratory function,postoperative recurrence,chronic pain and complications were compared between the two groups.Results The duration for patients to resume normal activities in the TAPP group were significantly higher than those in the TEP group,with statistical differences(P<0.05).The levels of end-of-breath carbon dioxide partial pressure(PETCO2)and airway partial pressure(Paw)at 10 min(T1),30 min(T2),60 min(T3)and 90 min(T4)after pneumoperitoneum in the two groups were higher than those before pneumoperitoneum was established(T0),and the levels of PETCO2 and Paw at T1,T2,T3 and T4 in the TEP group were higher than those in the TAPP group,with statistical differences(P<0.05).There were no statistical differences between the two groups in operation time,hospitalization expenses,intraoperative blood loss,and the score of visual analogue pain(VAS),postoperative hospital stay,recurrence and complications,and occurrence of postoperative chronic pain(P>0.05).Conclusion TEP and TAPP have good therapeutic effects on elderly inguinal hernia.TEP has advantages in promoting postoperative recovery,but it has more obvious influence on respiratory function.