纵向与横向腹膜切开法在老年腹股沟疝TAPP中应用效果研究

Study on the effect of longitudinal and transverse peritoneal incision inTAPP for elderly patients with inguinal hernia

目的探讨纵向与横向腹膜切开法在老年腹股沟疝腹腔镜经腹膜前疝修补术(TAPP)中的应用效果。方法选取该院2021年5月至2023年3月收治的84例行TAPP的老年腹股沟疝患者,依据术中不同腹膜切开法分组,其中42例患者采用横向腹膜切开法(对照组),42例患者采用纵向腹膜切开法(研究组),观察并比较2组相关手术指标、应激反应指标[去甲肾上腺素(NE)、皮质醇(Cor)、醛固酮(ALD)、肾上腺素(E)]、术后疼痛程度及生活质量,以及并发症发生情况。结果研究组患者术中出血量较对照组少,手术时间、补片植入时间、首次下床活动时间及住院时间较对照组短,差异均有统计学意义(P<0.05)。与术前比较,术后2组患者NE、E、ALD、Cor水平均升高,但研究组患者NE、E、ALD、Cor水平较对照组低,差异均有统计学意义(P<0.05)。术后不同时间点视觉模拟评分法(VAS)疼痛评分采用重复测量方差分析可得:2组组间效应差异有统计学意义(F_(组间)=115.291,P<0.001);2组时间点效应差异有统计学意义(F_(时间)=52.438,P<0.001);2组时间与分组有交互效应(F_(时间·组间)=619.351,P<0.001)。进一步单独效应比较:研究组术后6、12、24 h VAS疼痛评分较对照组低,差异均有统计学意义(P<0.05)。术后2组SF-36各项目评分较术前均升高,且研究组SF-36各项目评分较对照组高,差异均有统计学意义(P<0.05)。治疗及随访期间,研究组并发症发生率(4.76%)低于对照组(16.67%),差异无统计学意义(P>0.05)。结论横向与纵向腹膜切开TAPP均可有效治疗老年腹股沟疝患者,但纵向腹膜切开法疗效更佳。

Objective To explore the application effect of longitudinal and transverse peritoneal incision methods in elderly patients with inguinal hernia undergoing transabdominal preperitoneal prosthesis(TAPP).Methods A total of 84 elderly patients with inguinal hernia who underwent TAPP surgery from May 2021 to March 2023 at this hospital were selected.They were divided into two groups based on different peritoneal incision methods performed during surgery.The control group comprised 42 patients who underwent transverse peritoneal incision,while the study group comprised 42 patients who underwent longitudinal peritoneal incision.Surgical indicators,stress response indicators[norepinephrine(NE),cortisol(Cor),aldosterone(ALD),epinephrine(E)],postoperative pain levels,quality of life,and incidence of complications were observed and compared between the two groups.Results The study group had less intraoperative blood loss,shorter operative time,shorter duration of mesh implantation,earlier time to first ambulation,and shorter hospital stay compared to the control group,and the differences were statistically significant(P<0.05).Compared with those before operation,postoperative levels of NE,E,ALD,and Cor increased in both groups,but the levels in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).The visual analogue scale(VAS)scores at different time points postoperatively,analyzed using repeated measures ANOVA,showed significant differences between groups(F_(groups)=115.291,P<0.001),over time(F_(time)=52.438,P<0.001),and in the interaction between time and groups(F_(time×groups)=619.351,P<0.001).Further individual comparisons revealed that VAS scores at 6,12,and 24 hours postoperatively were lower in the study group compared to the control group,with statistically significant differences(P<0.05).The SF-36 scores for all items increased postoperatively compared to preoperative levels in both groups,with higher scores in the study group than in the control group,and the differences were statistically significant(P<0.05).During treatment and follow-up,there was no statistically significant difference in the incidence of complications between the two groups(16.67%vs.4.76%;P>0.05).Conclusion Both transverse and longitudinal peritoneal incision methods in TAPP are effective for treating elderly patients with inguinal hernia,but the longitudinal peritoneal incision method is more effective.