腹腔镜疝修补术与开放式无张力疝修补术治疗成人腹股沟疝的有效性及安全性比较

Comparison of the Effectiveness and Safety of Laparoscopic Hernia Repair and Open Tension-free Hernia Repair for the Treatment of Adult Inguinal Hernia

目的探讨腹腔镜疝修补术与开放式无张力疝修补术治疗成人腹股沟疝的有效性与安全性。方法随机选择2020年1月—2023年1月莆田学院附属医院胃肠外科收治的350例成人腹股沟疝患者,以随机数表法将其分为观察组(175例)和对照组(175例),对照组患者应用开放式无张力疝修补术治疗,观察组患者应用腹腔镜疝修补术治疗,比较两组患者的临床疗效,手术时间、下床活动时间、痛感持续时间、术中出血量、住院时间等手术及恢复指标,患者术后1~3 d视觉模拟评分(Visual Analogue Scale,VAS),发生切口感染、尿潴留等并发症发生率以及随访6个月的复发率。结果观察组治疗总有效率为97.71%,高于对照组的81.14%,差异有统计学意义(χ^(2)=25.417,P<0.05)。观察组手术时间比对照组长,术中出血量、下床活动时间、痛感持续时间和住院时间等手术、恢复指标均短于对照组,差异有统计学意义(P均<0.05)。术后1~3 d观察组患者VAS评分低于对照组,差异有统计学意义(P<0.05)。并发症发生率为8.57%,低于对照组的20.57%,差异有统计学意义(P<0.05)。两组随访6个月均未存在复发病例。结论针对成人腹股沟疝患者应用腹腔镜疝修补术治疗比开放式无张力疝修补术治疗更有效,安全性更高,患者术后疼痛少,恢复时间短。

Objective To explore the effectiveness and safety of laparoscopic hernia repair and open tension-free hernia repair in the treatment of adult inguinal hernia.Methods 350 adult inguinal hernia patients admitted to the Department of Gastrointestinal Surgery of Affiliated Hospital of Putian College from January 2020 to January 2023 were randomly selected,and were divided into observation group(175 cases)and control group(175 cases)by randomized numerical table method;patients in the control group were treated with open tension-free hernia repair,and patients in the observation group were treated with laparoscopic hernia repair.Compared the clinical efficacy,operation time,time to get out of bed,duration of pain,intraoperative bleeding,hospitalization time and other surgical and recovery indexes,the patients'postoperative 1-3 d Visual Analogue Scale(VAS),the occurrence of incisional infections,urinary retention and other complications,and the recurrence rate of the follow-up of 6 months between the two groups of patients.Results The total effective rate of treatment in the observation group was 97.71%,which was higher than 81.14%in the control group,and the difference was statistically significant(χ^(2)=25.417,P<0.05).The operation time of the observation group was longer than that of the control group,and the operation and recovery indexes such as intraoperative bleeding,time to get out of bed,duration of pain and hospitalization time were shorter than those of the control group,and the differences were statistically significant(all P<0.05).The VAS scores of patients in the observation group were lower than those of the control group in the postoperative period from 1-3 d,and the difference was statistically significant(P<0.05).The complication rate was 8.57%,lower than 20.57%in the control group,and the difference was statistically significant(P<0.05).No recurrence cases existed in both groups at 6 months of follow-up.Conclusion The application of laparoscopic hernia repair for adult inguinal hernia patients is more effective and safer than open tension-free hernia repair,with less postoperative pain and shorter recovery time.