腹腔镜经腹腹膜前疝修补术与开放式无张力疝修补术治疗腹股沟斜疝患者的效果比较

Comparison of effects of laparoscopic transabdominal preperitoneal hernia repair and open tension-free hernia repair in treatment of patients with indirect inguinal hernia

目的:比较腹腔镜经腹腹膜前疝修补术(TAPP)与开放式无张力疝修补术治疗腹股沟斜疝患者的效果。方法:选取2020年9月至2023年9月该院收治的90例腹股沟斜疝患者进行前瞻性研究,按照随机数字表法将其分为对照组和研究组各45例。对照组采用开放式无张力疝修补术治疗,研究组采用TAPP治疗,比较两组围术期指标水平,手术前后基质金属蛋白酶-2(MMP-2)水平、生命质量[生活质量综合评定问卷-74(GQOLI-74)]评分,术后疼痛程度[视觉模拟评分法(VAS)]评分,以及并发症发生率。结果:研究组首次下床活动时间、手术时间均短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05);术后3 d,研究组心理功能、物质生活状态、躯体功能和社会功能等GQOLI-74评分均高于对照组,差异有统计学意义(P<0.05);术后7 d,研究组MMP-2水平低于对照组,差异有统计学意义(P<0.05);术后1、3 d,研究组VAS评分均低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为6.67%(3/45),低于对照组的22.22%(10/45),差异有统计学意义(P<0.05)。结论:TAPP治疗腹股沟斜疝患者可提高生命质量评分,改善围术期指标水平,降低MMP-2水平、VAS评分和并发症发生率,效果优于开放式无张力疝修补术治疗。

Objective:To compare effects of laparoscopic transabdominal preperitoneal hernia repair(TAPP)and open tension-free hernia repair in treatment of patients with indirect inguinal hernia.Methods:A prospective study was conducted on 90 adult patients with primary indirect inguinal hernia admitted to this hospital from September 2020 to September 2023.According to the random number table method,they were divided into control group and study group,45 cases in each group.The control group was treated with open tension-free hernia repair,while the study group was treated with TAPP.The perioperative index levels,the matrix metalloproteinase-2(MMP-2)levels,the quality of life[general quality of life inventory-74(GQOLI-74)]score before and after the surgery,the postoperative pain degree[visual analogue scale(VAS)]score,and the incidence of complications were compared between the two groups.Results:The first out-of-bed time and the operation time of the study group were shorter than those of the control group,the intraoperative blood loss was less than that of the control group,and the differences were statistically significant(P<0.05).At 3 days after the surgery,the GQOLI-74 scores of psychological function,material life status,physical function and social function in the study group were higher than those in the control group,and the differences were statistically significant(P<0.05).At 7 days after the surgery,the level of MMP-2 in the study group was lower than that in the control group,and the difference was statistically significant(P<0.05).At 1 and 3 days after the surgery,the VAS scores of the study group were lower than those of the control group,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the study group was 6.67%(3/45),which was lower than 22.22%(10/45)in the control group,and the difference was statistically significant(P<0.05).Conclusions:TAPP in the treatment of the patients with indirect inguinal hernia can improve the quality of life scores,improve and reduce the levels of perioperative indexes,and reduce the levels of MMP-2,the VAS scores and the incidence of complications.Moreover,it is superior to open tension-free hernia repair.