TAPP术与Rutkow术治疗成人腹股沟疝的近期疗效对比

Comparison of the Recent Efficacy of TAPP and Rutkow in the Treatment of Inguinal Hernia

目的比较腹腔镜下经腹腔腹膜前疝修补术(transabdominal preperitoneal prosthesis,TAPP)与开放式疝环充填式无张力疝修补术(rutkow inguinal repair,Rutkow)治疗成人腹股沟疝的近期临床疗效及安全性。方法选取2019年6月至2020年6月本科收治的100例成人腹股沟疝患者作为研究对象,根据随机数表法分为TAPP组和Rutkow组,每组50例,TAPP组采用腹腔镜下经腹腔腹膜前疝修补术治疗,Rutkow组采用开放式疝环充填式无张力疝修补术治疗。对比两组患者的手术时长、术中出血量、术后12 h疼痛评分(numerical rating scale,NRS)、术后下床活动时间、术后住院时间、住院费用、术后并发症等指标差异;术后随访半年,比较两组患者短期复发情况。结果TAPP组患者的手术时间(89.48±36.25)min、住院费用(11629.1±2130.3)元高于Rutkow组的(60.16±12.62)min、(6024.5±1208.5)元,但术中出血量(4.5±1.5)ml、术后12 h NRS(2.8±0.8)分、术后下床活动时间(10.4±2.7)h、术后住院时间(6.2±1.5)d少于Rutkow组的(9.8±2.7)ml、(4.3±0.5)分、(13.6±4.5)h、(8.6±3.2)d,差异有统计学意义(P<0.05);Rutkow组术后并发症发生率(22%)高于TAPP组(6%),差异具有统计学意义(P<0.05)。随访半年均未见复发。结论Rutkow术治疗成人腹股沟疝手术操作相对简单、适应证较宽、麻醉要求低、住院费用低,TAPP术具有手术创伤小、术中出血少、术后恢复快、患者主观感觉良好等特点,临床上应该结合患者具体病情选择合适的手术方式。

Objective To compare the short-term effect and safety of TAPP and Rutkow in the treatment of inguinal hernia.Methods A total of 100 patients with inguinal hernia were selected as subjects between June 2019-June 2020 in General Surgery Department of the Second Peoples Hospital of Hefei.According to the random number table method divided into TAPP group and Rutkow group,each group of 50 cases,TAPP group was treated with laparoscopic anterior peritoneum hernia repair,Rutkow group with open hernia ring filling tension-free hernia repair.Comparison of the two groups of patients operating time,intraoperative blood loss,12 hours after the pain score,postoperative movement time out of bed,postoperative costs,postoperative complications and other clinical indicators;Follow up for half a year after operation,compare the recurrence of the two groups.Results The operation time(89.48±36.25)min、hospitalization cost(11629.1±2130.3)yuan in the TAPP group were significantly higher than that in the Rutkow group(60.16±12.62)min、(6024.5±1208.5)yuan,intraoperative blood loss(4.5±1.5)ml、numerical rating scale(NRS)(2.8±0.8)grade,postoperative time out of bed(10.4±2.7)h、postoperative hospitalization(6.2±1.5)days were significantly less than those in Rutkow(9.8±2.7)ml、(4.3±0.5)grade,(13.6±4.5)h、(8.6±3.2)days.The difference was statistically significant(P<0.05);There was no recurrence after half a year follow-up between the two groups.Conclusions Rutkow surgical treatment of adult inguinal hernia with relatively simple operation,relatively wide surgical indications,low anesthesia requirements and low hospitalization cost.TAPP surgery has the characteristics of small surgical trauma,less intraoperative bleeding,fast postoperative recovery,and good patient subjective feeling.Clinically,the appropriate operation method should be selected according to combination with the patient's specific condition.