肝肾脏器移植术后腹股沟疝的2种手术方式效果分析

Effects of two surgical approaches for inguinal hernia after liver and kidney transplantation

目的 比较经腹腔腹膜前疝修补术(TAPP)和开放腹股沟疝无张力修补术(Lichtenstein式)对肝肾脏器移植术后腹股沟疝患者的疗效和安全性。方法 回顾性分析肝肾脏器移植术后腹股沟疝患者17例的临床资料。根据手术方式,将其中14例采用TAPP的患者设为试验1组,同时期无脏器移植手术史的20例患者作为对照1组;另外,3例采用Lichtenstein式的患者设为试验2组,同时期无脏器移植手术史的10例患者作为对照2组。统计分析手术时间、出血量、术后恢复情况,并分析不同脏器移植对手术方式选择的影响。结果 试验1组的手术时间为(50.17±14.52) min,对照1组为(33.77±10.19) min,差异有统计学意义(P<0.05);2组出血量、术后下床时间和出院时间等方面比较,差异无统计学意义(P>0.05)。试验2组的手术时间为(41.87±12.55) min,对照2组为(27.14±10.64) min,出血量分别为(10.78±7.56) mL和(5.40±1.56) mL,差异有统计学意义(P<0.05)。试验1组和试验2组在手术出血量和出院时间方面比较,差异有统计学意义(P<0.05)。结论 TAPP可以提高患者的手术效果和安全性,减少并发症的发生,而对于肾移植合并输尿管移植术后腹股沟疝患者,Lichtenstein式较为安全。

Objective To compare the efficacy and safety of transabdominal preperitoneal hernia repair(TAPP) and open tension-free inguinal hernia repair(Lichtenstein technique) for inguinal hernia after liver and kidney transplantation.Methods A retrospective analysis was conducted on data of 17 patients with inguinal hernia after liver and kidney transplantation.According to the surgical methods,14 patients with TAPP were assigned to experimental group 1,and 20 patients without a history of organ transplantation during the same period were assigned to control group 1.Additionally,3 patients with the Lichtenstein technique were assigned to experimental group 2,and 10 patients without a history of organ transplantation during the same period were assigned to control group 2.Statistical analysis was performed to compare operation time,blood loss,and postoperative recovery,and to analyze the impacts of different organ transplantation on surgical method selection.Results The operation time in experimental group 1 was(50.17±14.52) minutes,which was significantly longer than(33.77±10.19) minutes in the control group 1(P<0.05).No significant differences were observed between the two groups in terms of blood loss,postoperative ambulation time,and hospital discharge time(P>0.05).In experimental group 2,the operation time was(41.87±12.55) minutes and the blood loss was(10.78±7.56) mL,which was significantly longer than(27.14±10.64) minutes and higher than(5.40±1.56) mL in control group 2(P<0.05).There were significant differences in surgical blood loss and hospital discharge time between experimental group 1 and experimental group 2(P<0.05).Conclusion TAPP can improve surgical outcomes and safety,and reduce occurrence of complications.For patients with inguinal hernia after kidney transplantation combined with ureteral transplantation,the Lichtenstein technique is safer.