腹腔镜经腹腹膜前修补手术与Lichtenstein手术对术后疼痛及全身炎症反应的影响

Effects of laparoscopic transabdominal preperitoneal repair versus Lichtenstein procedure on postoperative pain and systemic inflammatory response:A prospective randomized controlled study

目的对比腹腔镜经腹腹膜前修补术和Lichtenstein手术治疗原发腹股沟疝的全身炎症反应、术后疼痛和并发症情况。方法收集2018年1月至2019年12月北京市房山区中医医院普外科收治90例的单侧腹股沟疝患者资料,包括术前、术后24 h和术后7 d的C反应蛋白、白细胞介素6、白细胞和中性粒细胞水平。采用视觉模拟评分量化疼痛程度,分析手术时间与术后免疫反应的相关性。结果2组患者的术前资料无统计学差异。2组患者的术后C反应蛋白、白细胞介素6、白细胞、中性粒细胞水平以及术后24 h疼痛评分无明显差异(P>0.05)。2组患者的C反应蛋白水平和术后7 d疼痛评分没有差异(P>0.05)。腹腔镜组手术时间长于Lichtenstein手术组,手术时间与术后7 d的视觉模拟评分呈弱相关性(R=0.32)。2组患者随访期内并发症发生率无统计学差异(P>0.05)。结论腹腔镜经腹腹膜前修补手术与Lichtenstein相比,在术后疼痛、免疫反应和并发症方面不具备明显优势,且手术时间相对更长。

Objective To compare systemic inflammation,postoperative pain,and complications in the treatment of primary inguinal hernia by laparoscopic transabdominal preperitoneal and Lichtenstein procedure.Methods Data of 90 patients with unilateral inguinal hernia admitted to Fangshan district hospital of TCM from January 2018 to December 2019 were collected,including the levels of C-reactive protein,interleukin-6,white blood cell count and neutrophils before operation,at 24 hours and 7 days after operation.Visual analogue score was used to quantify pain severity and to analyze the correlation between operative time and postoperative immune response.Results There was no statistical difference in preoperative data between the two groups.There were no significant differences in the levels of CRP,IL-6,leukocytes,neutrophils and postoperative pain score at 24 hours after operation between the two groups(P>0.05).There was no difference in C-reactive protein levels or pain scores at 7 days postoperatively between the two groups(P>0.05).The duration of surgery was longer in the TAPP group than in the Lichtenstein group,and there was a weak correlation between the duration of surgery and the VAS score at 7 days postoperatively(R=0.32).There was no significant difference in the incidence of complications between the two groups during the follow-up period(P>0.05).Conclusion Laparoscopic transabdominal preperitoneal repair does not have significant advantages over Lichtenstein procedure in terms of postoperative pain,immune response and complications,and the operative time is relatively longer.