腹腔镜完全腹膜外疝修补术中应用自固定补片的临床效果

Clinical effect of self-fixation mesh in laparoscopic totally extraperitoneal hernia repair

目的探讨腹腔镜完全腹膜外疝修补术(TEP)中应用自固定补片的临床效果。方法回顾性分析2016年7月至2018年6月保定市第二医院收治的88例腹股沟疝患者的临床资料。根据植入补片的不同分为试验组(55例)和对照组(33例)。2组患者均行TEP,对照组置入聚丙烯平片,试验组置入自固定补片。比较2组患者的手术相关临床参数、术前及术后不同时间、视觉模拟评估法(VAS)评分、术后并发症及疝复发情况和术后额外镇痛用药情况。结果试验组铺置补片时长及住院时间均明显短于对照组(P<0.05),2组手术时长及术后自主活动时间无明显差异(P>0.05)。2组患者术后2 h至3 d VAS评分先升高后降低,且均明显低于术前(P<0.05),试验组术后12 h至3 d VAS评分均明显低于对照组(P<0.05)。试验组并发症发生率明显低于对照组(P<0.05)。随访6个月,2组均未复发。与对照组比较,试验组额外镇痛用药比例、用药时间和用药剂量明显减少(P<0.05)。结论 TEP术中置入自固定补片可明显降低术后疼痛的发生率,减少镇痛药的使用,且术后并发症少,安全有效。

Objective To study the clinical effect of self-fixation mesh in laparoscopic totally extra-peritoneal hernia repair(TEP).Methods The clinical data of 88 patients with inguinal hernia admitted to our hospital from July 2016 to June 2018 were retrospectively analyzed,they were divided into the experiment group(n=55)and the control group(n=33)according to the different meshs.TEP was performed in both groups,the control group was placed in polypropylene plain film,the experiment group was placed in a self-fixation mesh.The clinical parameters of the 2 groups,the VAS scores at different time before and after surgery,the postoperative complications,the recurrence of hernia and the postoperative analgesia medication of the two groups were compared.Results The paving mesh time and operative time in the experiment group were significantly shorter than the control group(P<0.05),there was no significant difference in the operation time and postoperation spontaneous activity time between the two groups(P>0.05).The VAS scores from 2 h to 3 d postoperation of the two groups first increased and then decreased,and they were significantly lower than preoperation(P<0.05),the VAS scores from 2 hours to 3 days postoperationin the experiment group was significantly lower than the control group(P<0.05).The incidence of complications in the experiment group was significantly lower than the control group (P<0.05), and there was no recurrence in the two groups followed up for 6 months. Compared with the control group, the proportion of additional analgesic medication, medication time and medication dose in the experimental group were significantly reduced (P<0.05). Conclusion Insertion of the self-fixation patch during TEP can significantly reduce the incidence of postoperative pain, reduce the use of analgesics and have fewer postoperative complications, it's safe and effective.