单侧GilbertⅢ型腹股沟斜疝患者腹腔镜腹股沟疝修补术中完全剥离与横断疝囊的临床效果比较

Clinical effect comparison of complete dissection and transection of hernia sac in patients with unilateral Gilbert typeⅢoblique inguinal hernia in laparoscopic trans-abdominal preperitoneal hernioplasty

目的对比观察疝囊完全剥离与横断两种处理方式在腹腔镜经腹腹膜前疝修补术(TAPP)治疗单侧GilbertⅢ型腹股沟斜疝中的临床效果。方法回顾性分析82例单侧GilbertⅢ型腹股沟斜疝患者的临床资料,根据术中疝囊处理方式不同分为横断组(n=44)和剥离组(n=38);比较两组手术时间、疝囊处理时间、术中出血量、疼痛视觉模拟评分(VAS)、住院时间、住院费用以及术后并发症情况。结果横断组手术时间、疝囊处理时间短于剥离组,术中出血量少于剥离组,差异均有统计学意义(t分别=7.03、10.45、6.14,P均<0.05);两组术后12 h、24 h和48 h的VAS评分比较,差异均无统计学意义(t分别=1.42、1.43、1.53,P均>0.05);两组术后住院时间、住院费用比较,差异均无统计学意义(t分别=0.98、0.47,P均>0.05);横断组血清肿发生率低于剥离组,差异有统计学意义(χ^(2)=4.64,P<0.05),两组术后尿潴留、暂时性感觉神经障碍和切口感染发生率比较,差异均无统计学意义(χ^(2)分别=0.21、1.39、1.17,P均>0.05)。结论疝囊完全剥离与横断两种方式在TAPP治疗GilbertⅢ型腹股沟斜疝术中均安全、有效,对于疝囊剥离困难时,横断疝囊有助于缩短手术时间,减少术后血清肿发生。

Objective To compare and observe the clinical curative effect of complete dissection and transection of hernia sac in patients with unilateral Gilbert typeⅢoblique inguinal hernia in laparoscopic trans-abdominal preperitoneal hernioplasty(TAPP).Methods A retrospective analysis was performed on the clinical data of 82 patients with unilateral Gilbert typeⅢoblique inguinal hernia undergoing TAPP,and they were divided into transection group(n=44)and dissection group(n=38)according to different intraoperative treatment methods for hernia sacs.The operation time,treatment time of hernia sac,intraoperative blood loss,score of visual analogue scale(VAS),hospitalization time,hospitalization cost and postoperative complications were compared between two groups.Results The operation time and treatment time of hernia sac in transection group were shorter than those in dissection group,and intraoperative blood loss was less than that in dissection group(t=7.03,10.45,6.14,P<0.05).There was no significant difference in VAS scores at 12h,24h and 48h between the two groups(t=1.42,1.43,1.53,P>0.05).There was no significant difference in hospitalization duration and hospitalization cost between the two groups(t=0.98,0.47,P>0.05).The incidence of postoperative seroma in transection group was lower than that in dissection group(χ^(2)=4.64,P<0.05),but there were no significant differences in the incidence of postoperative urinary retention,temporary sensory nerve disorder and incision infection between the two groups(χ^(2)=0.21,1.39,1.17,P>0.05).Conclusion Both complete dissection and transection of hernia sac are safe and effective in the treatment of Gilbert typeⅢoblique inguinal hernia in TAPP.For difficult dissection of hernia sac,transection of hernia sac is beneficial to shorten operation time and reduce incidence of postoperative seroma.