经腹腔镜腹膜前间隙修补术与Lichtenstein无张力疝修补术治疗青年腹股沟疝的短期康复效果比较

Comparison of Short-term Rehabilitation Effect of Transabdominal Preperitoneal and Lichtenstein Surgery in Treatment of Young Patients with Inguinal Hernia

目的比较经腹腔镜腹膜前间隙修补术(TAPP)与Lichtenstein无张力疝修补术治疗青年腹股沟疝的短期康复效果。方法回顾性分析2013年6月至2020年6月在北京积水潭医院行手术治疗的137例青年(年龄18~44岁)腹股沟疝患者的临床资料,依据不同手术方式分为TAPP组(57例)和Lichtenstein组(80例)。TAPP组采用经腹腔腹膜前间隙修补术治疗,Lichtenstein组采用Lichtenstein无张力疝修补术治疗。比较两组围手术期指标(手术时间、术中出血量、恢复正常生活时间),术后患者活动状态下的数字评分法(NRS)评分,以及术后并发症发生情况。结果TAPP组手术时间长于Lichtenstein组[(104.2±29.3)min比(84.8±29.0)min](P<0.01),恢复正常生活时间短于Lichtenstein组[2(1,3)d比4(3,7)d](P<0.01),两组术中出血量比较差异无统计学意义(P>0.05)。术后第1、4、7天,TAPP组NRS评分均低于Lichtenstein组[2(2,2)分比3(2,4)分、1(0,1)分比2(1,2)分、0(0,0)分比1(0,1)分](P<0.01)。TAPP组近期总并发症发生率为7.02%(4/57),Lichtenstein组为5.00%(4/80),两组比较差异无统计学意义(P>0.05)。远期随访结果显示,TAPP组出现慢性疼痛10例(17.54%),Lichtenstein组为16例(20.00%),两组比较差异无统计学意义(P>0.05)。结论TAPP和Lichtenstein无张力疝修补术均是治疗腹股沟疝安全有效的手术方式,但TAPP较Lichtenstein无张力疝修补术的恢复时间更短和NRS评分更低,这对处于工作年龄的青年患者而言,可以更迅速地返回工作岗位。

Objective To compare the short-term rehabilitation effect of transabdominal preperitoneal(TAPP)and Lichtenstein surgery in young patients inguinal hernia.Methods The clinical data of 137 young patients(aged 18-44 years)who underwent inguinal hernia repair in Beijing Jishuitan Hospital from Jun.2013 to Jun.2020 was retrospectively analyzed.They were divided into a TAPP group(57 cases)and a Lichtenstein group(80 cases)according to different surgical methods.Perioperative indexes(operation time,intraoperative blood loss,time to return to normal life),postoperative numeric rating scale(NRS)score of patients in active state,and postoperative complications were compared between the two groups.Results The operation time in the TAPP group was longer than that in the Lichtenstein group[(104.2±29.3)min vs(84.8±29.0)min](P<0.01),and the time to return to normal life was shorter than that in the Lichtenstein group[2(1,3)d vs 4(3,7)d](P<0.01).There was no significant difference in intraoperative blood loss between the two groups(P>0.05).At the 1st,4th and 7th day after surgery,NRS scores in the TAPP group were lower than those in the Lichtenstein group[2(2,2)vs 3(2,4),1(0,1)vs 2(1,2),0(0,0)vs 1(0,1)](P<0.01).The total rate of recent complications was 7.02%(4/57)in the TAPP group and 5.00%(4/80)in the Lichtenstein group,and there was no statistically significant difference between the two groups(P>0.05).Long-term follow-up results showed that there were 10 cases(17.54%)of chronic pain in the TAPP group and 16 cases(20.00%)in the Lichtenstein group,and there was no statostocally significant difference between the two groups(P>0.05).Conclusion TAPP and Lichtenstein are both safe operation modes for treating inguinal hernia,but the TAPP has advantage of shorter recovery time and lower NRS score over Lichtenstein operation,which can help the young patients of working age to go back to work sooner.