经脐入路和传统腹腔镜经腹腹膜前腹股沟疝修补术的比较

A Comparative Study Between Transumbilical Approach and Traditional Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair

目的 比较经脐入路腹腔镜和传统腹腔镜经腹腹膜前腹股沟疝修补术(transabdominal preperitoneal prosthesis, TAPP)的临床效果。方法 对2020年1月~2021年6月我科64例腹股沟疝进行回顾性分析,由患者选择手术方式,行经脐TAPP和传统TAPP各32例。比较2组手术时间、术中出血量、术后24 h切口疼痛评分、术后住院时间、住院费用、术后并发症发生率、切口满意度评分及复发情况。结果 经脐组手术时间显著长于传统组[(94.3±10.7) min vs.(60.4±4.4) min,t=16.593,P=0.000],但术后切口疼痛评分低[(1.3±0.5)分vs.(3.1±0.7)分,t=-12.647,P=0.000],术后住院时间短[(1.7±0.7) d vs.(4.3±1.0) d,t=-12.149,P=0.000],住院费用低[(16.0±0.6)千元vs.(18.5±0.7)千元,t=-15.594,P=0.000],切口满意度评分高[(12.8±1.1)分vs.(8.6±1.5)分,t=12.635,P=0.000]。2组术中出血量、术后并发症发生率差异无统计学意义(P>0.05)。2组术后随访14~32个月[分别为(23.6±5.3)月和(23.3±5.8)月],来院复查,均无复发。结论 经脐入路TAPP治疗腹股沟疝在术后切口疼痛、切口满意度、住院时间、住院费用等方面明显优于传统TAPP。

Objective To compare the clinical effects of transumbilical endoscopic surgery(TUES)and traditional laparoscopic transabdominal preperitoneal inguinal hernia repair(TAPP).Methods A retrospective analysis of 64 cases of inguinal hernia treated in our department from January 2020 to June 2021 was carried out.According to the patients’choice,they were divided into transumbilical TAPP group(n=32)and traditional TAPP group(n=32).The operation time,intraoperative bleeding,postoperative 24 h incision pain score,postoperative hospital stay,hospitalization cost,postoperative complication rate,incision satisfaction score,and recurrence were compared between the two groups.Results The operation time of patients in the transumbilical group was significantly longer than that in the traditional group,with a statistically significant difference between the two groups[(94.3±10.7)min vs.(60.4±4.4)min,t=16.593,P=0.000],but in the transumbilical group the score of incision pain was significantly lower[(1.3±0.5)points vs.(3.1±0.7)points,t=-12.647,P=0.000],the postoperative hospital stay was significantly shorter[(1.7±0.7)d vs.(4.3±1.0)d,t=-12.149,P=0.000],the hospitalization cost was significantly lower[(16.0±0.6)×103 yuan vs.(18.5±0.7)×103 yuan,t=-15.594,P=0.000],and the score of incision satisfaction was significantly higher[(12.8±1.1)points vs.(8.6±1.5)points,t=12.635,P=0.000].There were no significant differences in the amount of intraoperative bleeding and the incidence of postoperative complications between the two groups(P>0.05).The two groups were followed up for 14-32 months[mean,(23.6±5.3)and(23.3±5.8)months,respectively],and no recurrence was found.Conclusion Laparoscopic transabdominal preperitoneal inguinal hernia repair via umbilical approach(TUES-TAPP)is superior to traditional laparoscopic transabdominal preperitoneal inguinal hernia repair(TAPP)in terms of postoperative incision pain,incision satisfaction,hospital stay,and hospitalization cost.