腹腔镜完全腹膜外疝修补术、腹腔镜经腹膜前疝修补术与开放式无张力疝修补术治疗腹股沟疝的效果比较

Effect comparison of laparoscopic total extraperitoneal hernia repair, laparoscopic preperitoneal hernia repair and open tension-free hernia repair in the treatment of inguinal hernia

目的探索腹腔镜完全腹膜外疝修补术(TEP)、腹腔镜经腹膜前疝修补术(TAPP)与开放式无张力疝修补术治疗腹股沟疝的效果,分析不同手术方式对患者复发、外周血C反应蛋白(CRP)及白介素-6(IL-6)水平的影响。方法选取2019年2月—2020年6月北京市仁和医院普外二科收治的159例腹股沟疝患者进行回顾性分析,根据手术方法分为三组,观察1组的53例患者行TEP术,观察2组的53例患者行TAPP术,对照组的53例患者行开放式无张力疝修补术。比较三组患者的术中出血量、手术时间、术后下床活动时间、住院时间;比较三组患者的血清指标、疼痛视觉模拟量表(VAS)评分;比较三组患者的并发症总发生率及复发率。结果观察1组和观察2组的手术时间、术后下床活动时间、IL-6比较,差异无统计学意义(P>0.05);观察1组的术中出血量少于观察2组,住院时间短于观察2组,差异有统计学意义(P<0.05);观察1组、观察2组的术中出血量少于对照组,手术时间、术后下床活动时间、住院时间短于对照组,差异有统计学意义(P<0.05)。观察1组术后48 h的CRP以及术后24、48 h的VAS评分低于观察2组,差异有统计学意义(P<0.05);观察1组、观察组2组术后48 h的IL-6、CRP以及术后24、48 h的VAS评分均低于对照组,差异有统计学意义(P<0.05);观察1组和观察2组的术后并发症总发生率、复发率比较,差异无统计学意义(P>0.05)。观察1组的术后并发症总发生率、复发率低于对照组,差异有统计学意义(P<0.017)。观察2组的术后并发症总发生率、复发率低于对照组,但经校正,差异无统计学意义(P>0.017)。结论在治疗腹股沟疝时,运用TEP、TAPP术能够降低复发率,减轻炎症反应。相较于TAPP术,TEP术的安全性更显著。

Objective To explore the effect of laparoscopic total extraperitoneal hernia repair(TEP),laparoscopic preperitoneal hernia repair(TAPP)and open tension-free hernia repair for inguinal hernia,to analyze the effect of different surgical methods on recurrence,C-reactive protein(CRP)and interleukin-6(IL-6)levels in peripheral blood of patients.Methods A retrospective analysis was conducted on 159 cases of inguinal hernia patients admitted to the Second Department of General Surgery,Beijing Renhe Hospital from February 2019 to June 2020,and they were divided into three groups according to surgical methods.Fifty-three patients in the observation group 1 received TEP,53 patients in the observation group 2 received TAPP,and 53 patients in the control group received open tension-free hernia repair.The amount of intraoperative blood loss,operation time,postoperative activity time out of bed and hospitalization time of the three groups were compared.Serum indexes and visual analogue scale(VAS)scores of three groups were compared.The total incidence and recurrence rate of complications were compared among the three groups.Results There were no significant differences in operation time,postoperative activity time and IL-6 between the observation group 1 and the observation group 2(P>0.05).The amount of intraoperative blood loss in observation group 1 was less than that in observation group 2,and the length of hospital stay was shorter than that in observation group 2,with statistical significances(P<0.05).The amount of intraoperative blood loss in observation group 1 and observation group 2 was less than that in control group,and the duration of operation,postoperative activity time out of bed and hospital stay were shorter than those in control group,with statistical significances(P<0.05).The CRP and VAS score at 48 h after operation in the observation group 1 were lower than those in the observation group 2,the differences were statistically significant(P<0.05).IL-6 and CRP at 48 h after operation and VAS scores at 24 and 48 h after surgery in observation group 1 and observation group 2 were lower than those in control group,the differences were statistically significant(P<0.05).The total incidence and recurrence rate of postoperative complications in observation group 1 were lower than those in control group,and the difference was statistically significant(P<0.017).The total incidence and recurrence rate of postoperative complications in the observation group 2 were lower than those in the control group,but after adjustment,the differences were not statistically significant(P>0.017).Conclusion In the treatment of inguinal hernia,the use of TEP and TAPP can reduce the recurrence rate and reduce the inflammation.Compared with TAPP,the safety of TEP is more significant.