腹腔镜下完全腹膜外疝修补术与经腹腔腹膜前疝修补术治疗成人单侧初发腹股沟疝的效果比较

Comparison of the effect of laparoscopic totally extraperitoneal herniorrhaphy and transgastric abdominal pre-peritoneal herniorrhaphy in the treatment of unilateral primary inguinal hernia in adults

目的比较腹腔镜下完全腹膜外疝修补术(TEP)与经腹腔腹膜前疝修补术(TAPP)治疗成人单侧初发腹股沟疝的临床效果。方法选取2019年5月至2021年6月江苏省太仓市中医医院收治的82例单侧初发腹股沟疝患者为研究对象,采用随机数字表法将其分为TEP组(给予TEP治疗)和TAPP组(给予TAPP治疗),每组41例。比较两组手术相关指标、住院费用、血气变化指标[手术前后动脉血二氧化碳分压差值(ΔPaCO_(2))、术中经皮二氧化碳分压监测(TcCO_(2))最大值与术前TcCO_(2)的差值(ΔTcCO_(2))、达到TcCO_(2)最大值的时间(T_(max))]、术后疼痛情况、术后并发症及术后6个月复发情况。结果TEP组手术时间、Tmax短于TAPP组,住院费用低于TAPP组,ΔPaCO_(2)、ΔTcCO_(2)均高于TAPP组,差异有统计学意义(P<0.05)。两组术中失血量、住院时间、疼痛持续时间、术后24 h视觉模拟评分法评分、术后并发症总发生率、术后6个月复发率比较,差异无统计学意义(P>0.05)。结论成人单侧初发腹股沟疝采用TEP在手术时间、住院费用方面优于TAPP,在减少手术中体内二氧化碳方面TAPP具有优势,两种手术方式治疗成人单侧初发腹股沟疝术后疼痛情况相近,且均安全、有效。

Objective To compare the clinical effect of laparoscopic totally extraperitoneal herniorrhaphy(TEP)and transgastric abdominal pre-peritoneal herniorrhaphy(TAPP)in the treatment of unilateral primary inguinal hernia in adults.Methods A total of 82 patients with unilateral primary inguinal hernia admitted to Taicang Hospital of Traditional Chinese Medicine in Jiangsu Province from May 2019 to June 2021 were selected as the research objects.They were divided into TEP group(receiving TEP treatment)and TAPP group(receiving TAPP treatment)by random number table method,with 41 cases in each group.Operation-related indexes,hospitalization costs,blood gas changes(the difference of partial pressure of carbon dioxide in arterial blood[ΔPaCO_(2)]before and after surgery,the difference of the intraoperative maximum of transcutaneous monitoring of partial pressure of end-tidal carbon dioxide[TcCO_(2)]and the preoperative TcCO_(2)[ΔTcCO_(2)],the time to reach the maximum TcCO_(2)[T_(max)]),postoperative pain,postoperative complications,and recurrence six months after surgery were compared between the two groups.Results Operating time and Tmax in TEP group were shorter than those in TAPP group,hospitalization cost was lower than that in TAPP group,ΔPaCO_(2) andΔTcCO_(2) were higher than those in TAPP group,and the differences were statistically significant(P<0.05).There were no significant differences in intraoperative blood loss,length of hospital stay,duration of pain,24 h postoperative visual analog scale score,total incidence of postoperative complications,and recurrence rate at six months after surgery between the two groups(P>0.05).Conclusion TEP is superior to TAPP in terms of surgical time and hospitalization cost,and TAPP has advantages in reducing carbon dioxide in vivo during surgery.The two surgical methods are similar in the treatment of postoperative pain in adults with unilateral primary inguinal hernia,and both are safe and effective.