不同类型补片在腹腔镜下完全腹膜外腹股沟疝修补术中的应用效果比较

Comparison of different types of patches in laparoscopic total extraperitoneal inguinal hernia repair

目的比较不同类型补片在腹腔镜下完全腹膜外腹股沟疝修补术中的应用效果。方法选取2018年5月至2019年2月乐平市人民医院收治的66例腹股沟疝患者作为研究对象,采用随机数字表法分为A、B、C三组,每组22例。对三组患者行腹腔镜下完全腹膜外腹股沟疝修补术,A组采用自固定补片进行手术,B组采用3DMax补片实施手术,C组采用聚丙烯平片进行手术。比较三组患者手术时间、术中出血量、切口长度、住院时间、视觉模拟评分(VAS)、并发症总发生率、随访3年复发率。结果三组患者手术时间、切口长度比较,差异无统计学意义(P>0.05);A、B组患者的术中出血量均少于C组,住院时间均短于C组,差异有统计学意义(P<0.05)。整体分析发现,VAS评分组间比较、时间点比较及交互作用差异均有统计学意义(P<0.05)。三组患者术后1、3、12 d的VAS评分均低于术前,三组患者术后3、12 d的VAS评分均低于术后1 d,三组患者术后12 d的VAS评分均低于术后3 d,差异有统计学意义(P<0.05);C组术后3、12 d的VAS评分高于A、B组,差异有统计学意义(P<0.05)。三组患者并发症总发生率比较,差异无统计学意义(P>0.05)。A、B组术后1、3年复发率低于C组,差异有统计学意义(P<0.017)。结论相较于聚丙烯平片,自固定补片、3DMax补片用于腹腔镜下完全腹膜外腹股沟疝修补术中,可改善患者围手术期指标,降低疼痛及复发风险,安全性较高,在临床中应予以关注。

Objective To compare the application effects of different types of patches in laparoscopic total extraperitoneal inguinal hernia repair.Methods A total of 66 patients with inguinal hernia admitted to Leping People's Hospital from May 2018 to February 2019 were selected as the research objects,and they were divided into A,B and C group according to random number table method,with 22 cases in each group.All patients underwent laparoscopic total extraperitoneal inguinal hernia repair.Group A was operated with self-fixing patch,group B was operated with 3DMax patch,and group C was operated with polypropylene plain film.The operation time,intraoperative blood loss,incision length,hospital stay,visual analogue scale(VAS),complication rate and recurrence rate were compared among the three groups.Results There were no statistically significant differences between the three groups in terms of operative time and incision length(P>0.05).Patients in groups A and B had less intraoperative bleeding and shorter hospital stay than group C,the differences were statistically significant(P<0.05).Overall analysis revealed that there were statistically significant differences in time point comparisons and interactions of VAS scores among groups,the differences were statistically significant(P<0.05).The VAS scores of patients in all three groups at 1,3 and 12 d after surgery were lower than those before surgery,the VAS scores of patients in all three groups at 3 and 12 d after surgery were lower than those at 1 d after surgery,and the VAS scores of patients in all three groups at 12 d after surgery were lower than those at 3 d after surgery,with statistically significant differences(P<0.05).The VAS scores of group C at 3 and 12 d after surgery were higher than those of group A and B,the differences were statistically significant(P<0.05).There was no significant defference in the total incidence of complications between the three group(P>0.05).The recurrence rates at 1 and 3 year after surgery in group A and B were lower than those in group C,and the differences were statistically significant(P<0.017).Conclusion Compared with polypropylene plain film,self-fixing patch and 3DMax patch for laparoscopic total extraperitoneal inguinal hernia repair can improve perioperative indicators,reduce pain and recurrence risk,with higher safety,clinical attention should be paid.