青年腹股沟疝患者腹腔镜腹股沟疝修补术中应用猪小肠黏膜下层生物补片疗效分析

Application of porcine small intestinal submucosal mesh in laparoscopic inguinal hernia repair in young patients with inguinal hernia

目的比较青年腹股沟疝患者腹腔镜腹股沟疝修补术中采用猪小肠黏膜下层生物补片与人工合成补片的疗效及安全性。方法2019年11月—2022年12月河南省人民医院、郑州市中心医院、洛阳市中心医院、郸城县妇幼保健院诊治青年(14~24岁)腹股沟疝患者196例,其中采用生物补片修补者42例为生物补片组,采用人工合成补片修补者154例为人工合成补片组。比较2组腹股沟疝特征、手术时间、术中出血量、术后住院时间;术后随访3个月~3年,记录术后24 h及末次随访时视觉模拟评分(VAS),术后近期并发症(血清肿、切口感染)及远期并发症(复发、局部隆起、异物感、慢性疼痛)发生情况。结果生物补片组术后住院时间[4.0(3.0,4.0)d]长于人工合成补片组[2.0(1.0,3.0)d](Z=-6.943,P<0.001),腹股沟疝类型、腹股沟疝侧别、嵌顿疝比率及内环直径、手术时间、术中出血量与人工合成补片组比较差异均无统计学意义(P>0.05)。生物补片组术后血清肿发生率(19.0%)高于人工合成补片组(1.9%)(χ^(2)=15.130,P<0.001),术后24 h VAS评分、切口感染发生率与人工合成补片组比较差异均无统计学意义(P>0.05)。术后随访(17.3±8.8)个月,2组患者均无复发;生物补片组末次随访时VAS评分[2.0(1.0,2.0)分]低于人工合成补片组[2.0(2.0,3.0)分](Z=-2.093,P=0.041),局部隆起、异物感、慢性疼痛发生率与人工合成补片组比较差异均无统计学意义(P>0.05)。结论与人工合成补片相比,青年腹股沟疝患者腹腔镜腹股沟疝修补术中采用猪小肠黏膜下层生物补片术后远期疼痛强度较弱,对生活质量影响较小,不增加远期并发症发生率,但术后恢复时间较长,血清肿发生率较高。

Objective To compare the efficacy and safety of porcine small intestinal submucosal biological mesh versus artificial synthetic mesh in laparoscopic inguinal hernia repair in young patients.Methods Totally 196 young inguinal hernia patients aged from 14 to 24 years were diagnosed and treated in Henan Provincial People's Hospital,Zhengzhou Central Hospital,Luoyang Central Hospital,and Dancheng County Maternal and Child Health Care Hospital from November 2019 to December 2022,among whom 42 patients used biological mesh(biological mesh group)and 154patients used synthetic mesh(synthetic mesh group).The characteristics of inguinal hernia,operation lasting time,intraoperative blood loss,and length of postoperative hospital stay were compared between two groups.The visual analogue score(VAS)24 h postoperatively and at the latest follow-up,and the occurrences of short-term postoperative complications(seroma,incision infection)and long-term complications(recurrence,local bulging,foreign body sensation,chronic pain)were recorded between two groups.Results The length of postoperative hospital stay was longer in biological mesh group[4.0(3.0,4.0)d]than that in synthetic mesh group[2.0(1.0,3.0)d](Z=-6.943,P<0.001),and there were no significant differences in the hernia type,diseased side,incarcerated hernia rate,internal rings diameter,operation lasting time,and intraoperative blood loss between two groups(P>0.05).The incidence of postoperative seroma was higher in biological mesh group(19.0%)than that in synthetic mesh group(1.9%)(χ^(2)=15.130,P<0.001),and there were no significant differences in the VAS score 24 h postoperatively and incision infection rate between two groups(P>0.05).The postoperative follow-up was for(17.3±8.8)months,and no recurrence was found.The VAS score was lower in biological mesh group[2.0(1.0,2.0)]than that in synthetic mesh group[2.0(2.0,3.0)]at the latest follow-up(Z=-2.093,P=0.041),and there were no significant differences in the incidences of local bulging,foreign body sensation and chronic pain between two groups(P>0.05).Conclusion Compared with synthetic mesh,the porcine small intestinal submucosal biological mesh has the advantages of weak long-term pain intensity,less impact on quality of life and no increase in the long-term complication rate after laparoscopic inguinal hernia repair in young patients with inguinal hernia,but its postoperative recovery time is longer and the incidence of seroma is higher.