聚丙烯补片与猪小肠黏膜下层脱细胞组织基质补片在腹腔镜疝修补术中的应用效果比较

Comparison of application effects of polypropylene mesh and porcine small intestinal submucosal acellular tissue matrix mesh in laparoscopic hernia repair in treatment of adult patients with inguinal hernia

目的:比较聚丙烯补片与猪小肠黏膜下层脱细胞组织基质(SIS)补片在腹腔镜疝修补术(TAPP)中的应用效果。方法:选取2017年4月至2019年4月该院收治的82例成人腹股沟疝患者进行前瞻性研究,按照随机数字表法分为研究组与对照组各41例。两组均行TAPP,术中对照组采用聚丙烯补片治疗,研究组采用SIS补片治疗,比较两组手术相关指标(术中出血量、手术时间、术后疼痛时间、下床活动时间和住院时间)水平、术后不同时间(术后6 h、12 h、1 d、3 d、9 d)疼痛程度[视觉模拟评分法(VAS)]评分、并发症发生率、股静脉血栓发生率、腹股沟异物感消失时间、腹股沟麻木消失时间和复发率。结果:研究组术中出血量少于对照组,手术时间、术后疼痛时间、下床活动时间和住院时间均短于对照组,差异有统计学意义(P<0.05);术后1、3、9 d,研究组VAS评分少于对照组,差异有统计学意义(P<0.05);随访3个月,研究组腹股沟异物感消失时间均短于对照组,复发率低于对照组,差异有统计学意义(P<0.05);两组并发症发生率、腹股沟麻木消失时间和股静脉血栓发生率比较,差异无统计学意义(P>0.05)。结论:SIS补片应用于成人腹股沟疝患者TAPP术中可减少术中出血量,降低术后VAS评分和术后3个月复发率,以及缩短手术时间、术后疼痛时间、下床活动时间、住院时间和腹股沟异物感消失时间,效果优于聚丙烯补片治疗。

Objective:To compare application effects of polypropylene mesh and porcine small intestinal submucosal acellular tissue matrix(SIS)mesh in laparoscopic hernia repair(TAPP)in treatment of adult patients with inguinal hernia.Methods:A prospective study was conducted on 82 adult patients with inguinal hernia who were admitted to this hospital from April 2017 to April 2019.They were divided into study group and control group according to the random number table method,41 cases in each.Both groups underwent TAPP.During the surgery,the control group was treated with polypropylene patch,while the study group was treated with SIS patch.The levels of surgery-related indicators(intraoperative blood loss,operation time,postoperative pain time,ambulation time,and hospitalization time),the pain levels[visual analogue scale(VAS)]score at different postoperative time(6 h,12 h,1 d,3 d,9 d after the surgery),the incidence of complications,the incidence of femoral vein thrombosis,the groin foreign body sensation disappearance time,the groin numbness disappearance time,and the recurrence rate were compared between the two groups.Results:The intraoperative blood loss in the study group was lower than that in the control group;the operation time,the postoperative pain time,the ambulation time and the hospitalization time were shorter than those of the control group;and the differences were statistically significant(P<0.05).1,3,9 d after the surgery,the VAS scores of the study group were lower than those of the control group,and the differences were statistically significant(P<0.05).During the 3-month follow-up,the groin foreign body sensation disappearance time of the study group was shorter than that of the control group,the recurrence rate was lower than that of the control group,and the differences were statistically significant(P<0.05).However,there were no significant difference in the incidence of complications,the groin numbness disappearance time and the incidence of femoral vein thrombosis between the two groups(P>0.05).Conclusions:The SIS mesh in the laparoscopic hernia repair for the adult patients with inguinal hernia can reduce the intraoperative blood loss,the postoperative VAS score and the 3-month postoperative recurrence rate and shorten the operation time,the postoperative pain time,the ambulation time,the hospitalization time and the groin foreign body sensation disappearance time.Moreover,it is superior to polypropylene mesh treatment.