不同途径下行修补术治疗腹股沟疝的疗效观察

Clinical Observation on Different Repair Methods on the Treatment of Inguinal Hernia

目的探讨腹腔镜无张力疝修补术与开放式无张力疝修补术治疗腹股沟疝的疗效。方法纳入赤壁市人民医院2018年10月—2020年10月90例确诊腹股沟疝并接受无张力疝修补术治疗的患者入组,基于随机数字表法分组,其中45例入开放组,接受开放式无张力疝修补术;另45例入腹腔镜组,接受腹腔镜无张力疝修补术治疗;比较两组手术指标(包括术后肠鸣音恢复时间、肛门排气时间、自主活动时间、术后疼痛持续时间、住院时间)、术前及术后12、24 h疼痛评分以及血清皮质醇(cortisol,COR)、β-内啡肽(β-Endorphin,β-EP)、血管紧张素Ⅱ(angiotensinⅡ,Ang-Ⅱ)水平;比较两组术后并发症发生率与复发情况差异。结果腹腔镜组术后肠鸣音恢复时间、肛门排气时间、自主活动时间、术后疼痛持续时间、住院时间均短于开放组,且与开放组相比,腹腔镜组术后12、24 h疼痛评分显著降低,差异有统计学意义(P<0.05);术后24 h两组血清Cor、β-EP、Ang-Ⅱ水平较术前均有所升高,但腹腔镜组的升高幅度不及开放组,差异有统计学意义(P<0.05);两组并发症发生率(4.44%、6.67%)、疾病复发率(4.44%、11.11%)比较,差异无统计学意义(P>0.05)。结论采用腹腔镜无张力疝修补术可达到与开放式无张力疝修补术相似的根治效果,且具有用时短、创伤小、应激反应小、术后恢复快等优势,在治疗腹股沟疝中应用前景广阔。

Objective To compare the effectiveness of laparoscopic tension-free herniorrhaphy and open tension-free herniorrhaphy in treating inguinal hernia.Methods A total of 90 patients diagnosed with inguinal hernia who received tension-free herniorrhaphy from Chibi General Hospital between October 2018 and October 2020 were enrolled into the group,and grouped based on random number table method.45 of them were enrolled in the open group and received open tension-free herniorrhaphy.Another 45 cases were enrolled in the laparoscopic group and received laparoscopic tension-free herniorrhaphy.The levels of serum cortisol(Cor),β-endorphin(β-EP)and angiotensinⅡ(Ang-Ⅱ)were compared between the two groups,including postoperative bowel sound recovery time,anal exhaust time,autonomic activity time,postoperative pain duration,hospital stay,preoperative and postoperative 12 and 24 h pain scores.The incidence and recurrence of postoperative complications were compared between the two groups.Results The postoperative bowel sound recovery time,anal exhaust time,autonomic activity time,postoperative pain duration and hospital stay in the laparoscopic group were all shorter than those in the open group,and the pain score 12 and 24 h after surgery in the laparoscopic group was significantly lower than that in the open group,the differences were statistically significant(P<0.05).After 24 h of operation,serum Cor,β-EP and Ang-Ⅱfor two groups were increased;the rising degree in laparoscopic group was lower than open group,the differences were statistically significant(P<0.05).There were no significant differences in complication rate(4.44%,6.67%)and disease recurrence rate(4.44%,11.11%)between the two groups(P>0.05).Conclusion Laparoscopic tension-free herniorrhaphy can achieve similar radical treatment effect as open tension-free hernia repair,and has the advantages of short time,less trauma,less stress reaction,quick postoperative recovery,etc.It has broad application prospect in the treatment of inguinal hernia.