全腹膜外腹腔镜疝修补术与开放手术治疗女性腹股沟疝的比较

Comparison of Totally Extraperitoneal Repair and Open Surgery for Female Inguinal Hernia

目的探讨全腹膜外腹腔镜疝修补术(totally extraperitoneal repair,TEP)治疗女性腹股沟疝的临床疗效。方法回顾性分析我院2016年1月~2022年5月105例女性腹膜前疝修补术的临床资料,其中63例行TEP(腔镜组),42例行经腹股沟前入路腹膜前疝修补术(开放组),比较2组手术指标和随访结果。结果2组均顺利完成手术,腔镜组6例术中探查发现对侧隐匿疝,同期修补。双侧疝腔镜组手术时间较开放组短[(102.7±14.6)min(n=30)vs.(113.4±12.8)min(n=13),t=-2.285,P=0.028],单侧疝手术时间2组差异无统计学意义(P>0.05)。腔镜组术后24 h疼痛视觉模拟评分(Visual Analogue Scale,VAS)、术后住院时间、异物感发生率优于开放组[(2.2±0.4)分vs.(2.6±0.7)分,t=-3.481,P=0.001;(7.1±2.4)d vs.(10.7±3.5)d,t=-5.841,P=0.000;7.9%(5/63)vs.23.8%(10/42),χ^(2)=5.185,P=0.023]。2组术中出血量、术后血清肿发生率和术后复发率差异无统计学意义(P>0.05)。结论对于女性腹股沟疝,TEP和经腹股沟前入路腹膜前疝修补术均安全且疗效显著。TEP可及时发现对侧隐匿疝,保留子宫圆韧带完整性,且具有双侧手术时间短、术后疼痛轻、住院时间短等优点。

Objective To investigate the clinical effect of totally extraperitoneal hernia repair(TEP)in the treatment of female inguinal hernia.Methods Clinical results of 105 cases of female inguinal hernia in our hospital from January 2016 to May 2022 were analyzed retrospectively.There were 63 cases treated with totally extraperitoneal hernia repair(laparoscopic group)and 42 cases with pre-peritoneal herniorrhaphy via anterior inguinal approach(open group).The operative indexes and follow-up results of the two groups were compared.Results The operations were successfully completed in all the patients.There were 6 cases in the laparoscopic group found the occult hernia on the other side by intraoperative examination,which were repaired at the same time.For bilateral female inguinal hernia,the operation time of the laparoscopic group was shorter than that of open group[(102.7±14.6)min(n=30)vs.(113.4±12.8)min(n=13),t=-2.285,P=0.028].However,the operation time of unilateral inguinal hernia had no significant difference between the two groups(P>0.05).The laparoscopic group was superior to the open group in Visual Analogue Scale(VAS)scores of postoperative 24 h pain,postoperative hospital stay,and incidence of foreign body sensation[(2.2±0.4)points vs.(2.6±0.7)points,t=-3.481,P=0.001;(7.1±2.4)d vs.(10.7±3.5)d,t=-5.841,P=0.000;7.9%(5/63)vs.23.8%(10/42),χ^(2)=5.185,P=0.023].There was no significant difference in terms of intraoperative blood loss,incidence of seroma,and recurrence rate(P>0.05).Conclusions For female inguinal hernia,totally extraperitoneal hernia repair and pre-peritoneal herniorrhaphy via anterior inguinal approach are both safe and effective.Totally extraperitoneal hernia repair has obvious advantages in detecting occult hernia in time,preserving the continuity of uterine round ligament,shortening operation time for bilateral inguinal hernia,reducing postoperative pain,and shortening postoperative hospital stay.