不同疝修补术治疗成年男性腹股沟疝临床比较

Clinical Comparison of Different Hernia Repair in the Treatment of Adult Male Inguinal Hernia

目的:比较腹腔镜经腹腹膜前疝修补术(TAPP)、完全腹膜外疝修补术(TEP)及开放疝修补术治疗成年男性腹股沟疝的效果。方法:采用回顾性分析,收集2017年12月—2020年12月于单县东大医院行腹股沟疝切除术患者作为研究对象,采用倾向性评分匹配(PSM)均衡组间协变量,共纳入121例患者,根据手术方式分为A组(36例行TAPP),B组(39例行TEP),C组(46例行开放手术疝修补术)。比较三组相关指标,所有患者均随访至2021年12月,比较三组复发情况。结果:A组、B组术中出血量少于C组,A组、B组术后疼痛持续时间、术后下床时间、住院时间均短于C组,C组手术时间短于A组、B组,A组手术时间短于B组,差异有统计学意义(P<0.05)。三组术后3 d、5 d胃泌素(GAS)水平、睾丸动脉最大血流速度比较,C组低于A组和B组,差异有统计学意义(P<0.05);A组、C组手术前后GAS比较,差异有统计学意义(P<0.05);C组手术前后睾丸动脉最大血流速度比较,差异有统计学意义(P<0.05)。A组、B组并发症发生率低于C组,差异有统计学意义(P<0.05);三组复发率比较,差异无统计学意义(P>0.05)。结论:TEP和TAPP与开放疝修补术比较创伤小,对局部血流影响小,并发症少;TEP与TAPP和开放疝修补术比较对消化系统影响更小,但TEP手术时间长,对术者要求高。

Objective:To compare the effect of laparoscopic transabdominal preperitoneal prosthesis(TAPP),totally extraperitoneal hernia repair(TEP)and open surgical hernia repair in the treatment of adult male inguinal hernia.Method:A retrospective analysis was conducted to collect patients who underwent inguinal hernia resection in Dongda Hospital of Shan County from December 2017 to December 2020 as the research objects,a total of 121 patients were included by using propensity score matching(PSM)to balance the inter-group covariates.According to the surgical method,they were divided into group A(36 cases of TAPP),group B(39 cases of TEP),and group C(46 cases of open surgical hernia repair).The relevant indicators among three groups were compared,all patients were followed up to December 2021,and the recurrence among three groups was compared.Result:The intraoperative blood loss in group A and group B were less than that in group C,the duration of postoperative pain,postoperative ambulation time and hospitalization time in group A and group B were shorter than those in group C,the operation time in group C was shorter than those in group A and group B,the operation time in group A was shorter than that in group B,the differences were statistically significant(P<0.05).The levels of gastrin(GAS)and the maximum blood flow velocity of testicular artery were compared among three groups at 3 d and 5 d after surgery,and those in group C were lower than those in group A and group B,the differences were statistically significant(P<0.05);there was statistically significant difference in GAS between group A and group C before and after surgery(P<0.05);the maximum blood flow velocity of testicular artery before and after surgery in group C was compared,and the difference was statistically significant(P<0.05).The incidence of complications in group A and group B were lower than that in group C,the differences were statistically significant(P<0.05);there was no significant difference in the recurrence rate among three groups(P>0.05).Conclusion:Compared with open hernia repair,TEP and TAPP had less trauma,less influence on local blood flow and fewer complications.Compared with TAPP and open hernia repair,TEP has less impact on the digestive system,but the operation time of TEP is longer and the requirements of the surgeon are higher.