经腹腹膜前腔镜腹股沟疝修补术治疗腹股沟疝的临床效果研究

Study on clinical effect of transabdominal preperitoneal hernia repair in the treatment of inguinal hernia

目的 分析经腹腹膜前腔镜腹股沟疝修补术(TAPP)治疗腹股沟疝的临床效果。方法 选择98例腹股沟疝患者,以入院前后顺序分成对照组(49例)和观察组(49例)。对照组开展传统疝修补术治疗,观察组开展TAPP治疗。比较两组手术前后胃肠功能相关指标、血清炎性因子、应激激素指标、疼痛因子及生活质量。结果 观察组肠鸣音恢复时间(14.31±3.20)h、首次肛门排气时间(18.73±1.35)h以及首次排便时间(25.75±2.27)h均短于对照组的(17.09±5.78)、(21.98±2.39)、(39.41±3.60)h(t=2.945、8.288、22.467,P<0.05)。观察组术后2d白细胞介素-6、白细胞介素-8、C反应蛋白、肿瘤坏死因子-α水平分别为(15.21±2.15)ng/L、(43.53±6.12)ng/L、(7.78±1.20)mg/L、(26.67±5.11)ng/L,均低于对照组的(18.28±3.62)ng/L、(65.21±7.76)ng/L、(10.56±1.75)mg/L、(32.25±7.63)ng/L(t=5.104、15.356、9.171、4.523,P<0.05)。观察组术后2 d皮质醇、去甲肾上腺素、醛固酮、血管紧张素-Ⅱ水平分别为(259.72±13.10)nmol/L、(92.21±11.82)μg/L、(15.45±2.51)ng/dl、(13.11±1.28)ng/L,均低于对照组的(412.89±15.01)nmol/L、(107.16±15.90)μg/L、(19.91±3.20)ng/dl、(20.73±2.40)ng/L(t=53.818、5.282、7.677、19.610,P<0.05)。观察组术后2d降钙素基因相关肽、P物质、前列腺素E2水平分别为(261.74±35.15)ng/ml、(115.12±12.82)μmol/L、(16.83±3.15)ng/L,均低于对照组的(318.98±39.02)ng/ml、(169.41±20.86)pmol/L、(23.98±3.02)ng/L(t=7.629、15.521、11.469,P<0.05)。观察组术后1个月生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康评分均高于对照组(t=22.881、10.364、8.796、17.771、13.197、14.397、17.285、15.562,P<0.05)。结论 TAPP在腹股沟疝患者中有着良好效果,该术式能够减轻患者应激激素指标及疼痛因子水平,有助于患者早日恢复正常生活。

Objective To analyze the clinical effect of transabdominal preperitoneal hernia repair(TAPP)in the treatment of inguinal hernia.Methods 98 cases of inguinal hernia patients were selected and divided into a control group(49 cases)and an observation group(49 cases)according to the order of admission.The control group was treated with traditional hernia repair,while the observation group was treated with TAPP.The indexes of gastrointestinal function,serum inflammatory factors,stress hormone indexes,pain factors and quality of life before and after surgery were compared between the two groups.Results In the observation group,the recovery time of bowel sound was(14.31±3.20)h,the first anal exhaust time was(18.73±1.35)h and the first defecation time was(25.75±2.27)h,which were shorter than(17.09±5.78),(21.98±2.39)and(39.41±3.60)h in the control group(t=2.945,8.288,22.467;P<0.05).2 d after surgery,the levels of interleukin-6,interleukin-8,C-reactive protein and tumor necrosis factor-αin the observation group were(15.21±2.15)ng/L,(43.53±6.12)ng/L,(7.78±1.20)mg/L and(26.67±5.11)ng/L,which were lower than(18.28±3.62)ng/L,(65.21±7.76)ng/L,(10.56±1.75)mg/L and(32.25±7.63)ng/L in the control group(t=5.104,15.356,9.171,4.523;P<0.05).2 d after surgery,the levels of cortisol,norepinephrine,aldosterone and angiotensin-Ⅱin the observation group were(259.72±13.10)nmol/L,(92.21±11.82)μg/L,(15.45±2.51)ng/dl and(13.11±1.28)ng/L,which were lower than(412.89±15.01)nmol/L,(107.16±15.90)μg/L,(19.91±3.20)ng/dl and(20.73±2.40)ng/L in the control group(t=53.818,5.282,7.677,19.610;P<0.05).2 d after surgery,the levels of calcitonin gene-related peptide,substance P and prostaglandin E2 in the observation group were(261.74±35.15)ng/ml,(115.12±12.82)pmol/L and(16.83±3.15)ng/L,which were lower than(318.98±39.02)ng/ml,(169.41±20.86)pmol/L and(23.98±3.02)ng/L in the control group(t=7.629,15.521,11.469;P<0.05).1 month after surgery,the scores of physical function,role-physical,bodily pain,general health status,energy,social function,role-emotional and mental health of the observation group were higher than those of the control group(t=22.881,10.364,8.796,17.771,13.197,14.397,17.285,15.562;P<0.05).Conclusion TAPP has a good effect in patients with inguinal hernia,which can reduce the levels of stress hormone and pain factors,and help the patients to return to normal life as soon as possible.