经腹膜前间隙微创与开放脐疝修补术的前瞻性对照研究

Prospective Controlled Study of Minimally Invasive and Open Umbilical Hernia Repair Through Preperitoneal Space

目的 探讨经腹膜前间隙微创脐疝修补术(minimally invasive repair of umbilical hernia through preperitoneal space, MI-RUHP)与经腹膜前间隙开放脐疝修补术(open umbilical hernia repair through preperitoneal space, O-RUHP)的临床疗效。方法 选择2018年11月~2020年10月成人脐疝患者40例,按照前瞻性非随机方法分为2组,MI-RUHP和O-RUHP组各20例,2组一般资料差异无统计学意义(P>0.05)。比较2组手术时间、术后第1天疼痛视觉模拟评分(Visual Analogue Scale, VAS)、术后住院时间、住院费用、术后并发症及术后2年复发率。结果 与O-RUHP相比,MI-RUHP手术时间长[66.00(49.5~77.0)min vs. 52.30(40.3~60.8)min,Z=-4.207,P=0.000],住院费用高[10.10(9.2~10.8)千元vs. 8.10(7.2~8.6)千元,Z=-5.410,P=0.000],但术中出血量少[(10.5±2.5)ml vs.(29.3±2.3)ml,t=-24.313,P=0.000],术后疼痛轻[(2.51±0.41)分vs.(5.28±0.43)分,t=-20.727,P=0.000],住院时间短[4.0(4~5)d vs. 7.0(6~7)d,Z=-5.786,P=0.000],2组术后并发症发生率差异无统计学意义(P>0.05)。术后随访2年,MI-RUHP无复发,O-RUHP复发2例(术后第11、15个月),差异无统计学意义(P=0.487)。结论 在患者身体及经济条件允许的情况下,经腹膜前间隙微创脐疝修补术创伤小,术后恢复快,并发症少,可作为脐疝治疗的优选方案。

Objective To investigate the clinical effect of minimally invasive repair of umbilical hernia through preperitoneal space(MI-RUHP)and open umbilical hernia repair through preperitoneal space(O-RUHP).Methods A total of 40 adult patients with umbilical hernia from November 2018 to October 2020 were enrolled.A prospective non-randomized control method was used to divide the patients into two groups:MI-RUHP was performed in 20 cases and O-RUHP was performed in 20 cases.There were no significant differences in preoperative general data between the two groups(P>0.05).The operation time,Visual Analogue Scale(VAS)of pain on the first day after surgery,length of postoperative hospital stay,hospital cost,postoperative complication,and 2-year recurrence rate were compared between the two groups.Results As compared to the O-RUHP group,the MI-RUHP group had longer operation time[66.00(49.5-77.0)min vs.52.30(40.3-60.8)min,Z=-4.207,P=0.000],more expensive hospitalization expenses[10.10(9.2-10.8)×103 yuan vs.8.10(7.2-8.6)×103 yuan,Z=-5.410,P=0.000],but less intraoperative blood loss[(10.5±2.5)ml vs.(29.3±2.3)ml,t=-24.313,P=0.000],less postoperative pain[(2.51±0.41)points vs.(5.28±0.43)points,t=-20.727,P=0.000],and shorter postoperative hospital stay[4.0(4-5)d vs.7.0(6-7)d,Z=-5.786,P=0.000].The incidence of postoperative complications had no statistically significant difference between the two groups(P>0.05).After 2 years of follow-ups,there was no recurrence in the MI-RUHP group and 2 cases of recurrence in the O-RUHP group(11 and 15 months after surgery,respectively).The difference was not statistically significant(P=0.487).Conclusion If the patient’s physical and economic conditions permit,laparoscopic repair through preperitoneal space can be used as the preferred treatment for umbilical hernia,with less trauma,faster postoperative recovery,and fewer complications.