TEP与TAPP治疗老年男性腹股沟疝患者的疗效对比

Effect comparison of TEP and TAPP in the treatment of elderly male inguinal hernia

目的:对比腹腔镜下全腹膜外腹股沟疝修补术(Total extraperitoneal inguinal hernia repair,TEP)和经腹腹膜前疝修补术(Transabdominal anterior peritoneal hernia repair,TAPP)治疗老年男性腹股沟疝(Inguinal hernia,IH)的效果。方法:回顾性选取开封美宝空分医院2018年11月至2019年10月收治的老年男性IH患者89例,根据外科手术方案不同,分为TEP组(n=45)、TAPP组(n=44)。比较两组围术期指标,术前和术后3 m睾丸血流动力学指标[睾丸动脉的收缩期峰流速(Peak systolic velocity,PSA)、舒张期流速(Diastolic flow velocity,EDV)、阻力指数(Resistance index,RI)],术前、术后1 d、术后3 d炎性因子指标,并发症发生率和术后1 y复发率。结果:TEP组手术用时、疼痛持续时长短于TAPP组,住院费用少于TAPP组(P<0.05);术后3 m,两组睾丸动脉的EDV高于术前,RI低于术前(P<0.05),且TEP组睾丸动脉的EDV高于TAPP组,RI低于TAPP组(P<0.05);术后1 d、术后3 d,TEP组炎性因子指标水平均低于TAPP组(P<0.05);两组并发症发生率、复发率对比,无显著差异。结论:TEP治疗老年男性IH缩短手术用时和疼痛持续时长,节约住院费用,有效促进睾丸血流灌注恢复,可有效降低机体的炎性状态,值得临床推广。

Objective:To compare the effect of laparoscopic total extraperitoneal inguinal hernia repair(TEP)and transabdominal anterior peritoneal hernia repair(TAPP)in the treatment of elderly male patients with inguinal hernia(IH).Methods:89 elderly male patients with IH admitted in our hospital from November 2018 to October 2019 were retrospectively selected and divided into TEP group(n=45)and TAPP group(n=44)according to different surgical procedures.Perioperative indexes,testicular hemodynamic indexes[peak systolic velocity(PSA),diastolic flow velocity(EDV)and resistance index(RI)of testicular artery],and inflammatory indexes before and after 3 months of operation,complication rate and recurrence rate after 1 year of operation were compared between TEP group and TAPP group.Results:The operation time and pain duration in TEP group were shorter than those in TAPP group,and the hospitalization cost in TEP group was lower than that in TAPP group(P<0.05);after 3 months of operation,EDV of testicular artery in TEP group was higher than that in TAPP group,RI was lower than that in TAPP group(P<0.05);after 1 day and 3 days of operation,levels of inflammatory indexes in TEP group were lower than those in TAPP group(P<0.05);the rate of complications and recurrence had no significant difference between TEP group and TAPP group.Conclusion:TEP treatment for elderly male IH can shorten the operation time and the duration of pain,save hospital costs,effectively promote the recovery of testicular blood perfusion,which is worth of clinical promotion..