改良腹腔镜T型切开疝囊精细游离操作对阴囊疝TAPP治疗患者术中损伤及术后并发症的影响

Effect of modified laparoscopic T-incision and fine dissociation of hernia sac on intraoperative injury and postoperative complications in patients with scrotal hernia treated with TAPP

目的探讨改良腹腔镜T型切开疝囊静息游离方式在腹腔镜经腹腔腹膜前疝修补术(TAPP)治疗阴囊疝患者的临床效果。方法选取我院2018年5月1日至2020年12月31日收治的阴囊疝患者98例,用随机数字表法将其分为改良组和传统组各49例,两组患者均采用腹腔镜下TAPP手术方式治疗,改良组术中采用改良腹腔镜T型切开疝囊静息游离方式处理阴囊疝疝囊,传统组患者采用传统方式完整剥离疝囊,对比两组患者手术临床指标、血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、外周血白细胞(WBC)、手术后引流量、日常生活能力(ADL)、手术并发症。结果分别对比改良组与传统组的WBC、CRP、IL-6水平在术前、术后1d、术后3d差异均无统计学意义(P>0.05);改良组患者的手术时间低于传统组,差异有统计学意义(P<0.05);改良组与传统组的术中出血量、住院费用、住院时间比较,差异不具有统计学意义(P>0.05);术前,改良组与传统组患者的ADL评分差异无统计学意义(P>0.05);术后3d、术后7d,改良组患者的ADL评分均高于传统组,差异具有统计学意义(P<0.05)。结论腹腔镜TAPP治疗阴囊疝术中采用改良腹腔镜T型切开疝囊静息游离方式能有效缩短手术时间、提高患者术后早期日常生活能力。

Objective To investigate the clinical effect of modified laparoscopic t-incision hernia sac resting free mode in the treatment of scrotal hernia by laparoscopic transperitoneal preperitoneal hernia repair(TAPP).Methods 98 patients with scrotal hernia treated in our hospital from May1,2018 to December31,2020 were randomly divided into improved group and traditional group,with 49 cases in each group.The patients in both groups were treated by laparoscopic TAPP operation.In the improved group,the scrotal hernia sac was treated by modified laparoscopic T-type incision hernia sac restfree method,The hernia sac was completely removed in the traditional way in the traditional group.The clinical indexes,serum C-reactive protein(CRP),interleukin-6(IL-6),peripheral blood leukocytes(WBC),postoperative drainage,ability of daily living(ADL)and surgical complications were compared between the two groups.Results The levels of WBC,CRP and IL-6 in the modified group and the traditional group were compared before operation,1 day after operation,and 3 days after operation.There was no significant difference between the two groups(P>0.05).The operation time of the modified group was lower than that of the traditional group,and the difference was statistically significant(P<0.05).There was no significant difference in the ADL scores between the modified group and the traditional group(P>0.05);3d and 7d after the operation,the ADL scores ofthe modified group werehigherthan those ofthe traditional group,and the difference was statistically significant(P>0.05).Conclusion In the treatment of scrotal hernia with laparoscopic TAPP,the improved laparoscopic T-incision hernia sac resting free mode can effectively shorten the operation time,improve the patients'early postoperative ability ofdaily living.