比较腹腔镜下全腹膜外与经腹腔腹膜前疝修补术对男性腹股沟疝患者术后康复及睾丸血流的影响

Comparison of the Effects of Laparoscopic Total Extraperitoneal and Transabdominal Preperitoneal Hernia Repair on Postoperative Recovery and Testicular Blood Flow in Male Patients with Inguinal Hernia

目的对比腹腔镜下全腹膜外腹股沟疝修补术(TEP)与经腹腔腹膜前疝修补术(TAPP)对男性腹股沟疝患者的影响。方法选取2022年4月—2023年4月淄博市临淄区妇幼保健院收治的100例男性腹股沟疝患者为研究对象,按随机数字表法将其分为对照组和观察组,每组50例。对照组行TAPP治疗,观察组行TEP治疗。对比两组患者的围手术期指标、术后疼痛、应激反应、睾丸血流及并发症发生情况。结果观察组的术中出血量为(9.53±1.69)mL,少于对照组的(12.26±2.37)mL,手术时间为(58.53±5.83)min,长于对照组的(52.67±6.57)min,术后排气时间、住院时间分别为(22.36±2.58)h、(4.35±0.50)d,均短于对照组的(26.59±3.65)h、(5.89±0.63)d,组间差异有统计学意义(P<0.05)。术后1d,观察组的疼痛视觉模拟评分为(1.56±0.39)分,并发症发生率为16.00%,均低于对照组的(2.03±0.41)分、4.00%,组间差异有统计学意义(P<0.05);观察组的去甲肾上腺素、皮质醇水平分别为(253.62±23.29)pmol/L、(171.38±18.26)nmol/L,均低于对照组的(297.83±26.74)pmol/L、(200.69±21.37)nmol/L,组间差异有统计学意义(P<0.05)。术后1个月,观察组的舒张末期血流速度、收缩期峰值血流速度分别为(3.68±0.41)cm/s、(9.49±1.35)cm/s,均快于对照组的(3.15±0.36)cm/s、(8.21±1.02)cm/s,阻力指数为(0.70±0.13),低于对照组的(0.81±0.16),组间差异有统计学意义(P<0.05)。结论与TAPP相比,TEP会延长手术时间,但其具有创伤小、术后恢复快、并发症少等优势,可减轻男性腹股沟疝患者的术后疼痛与应激反应,对睾丸血流损伤较小。

Objective To compare the effects of laparoscopic total extraperitoneal hernia repair(TEP)and transabdominal preperitoneal hernia repair(TAPP)on male patients with inguinal hernia.Methods One hundred male inguinal hernia patients admitted to Linzi District Maternal and Child Health Hospital in Zibo City from April 2022 to April 2023 were selected as the research objects,and were divided into a control group and an observation group according to random number table method,with 50 cases in each group.The control group received TAPP,while the observation group received TEP.The perioperative indexes,postoperative pain,stress response,testicular blood flow and complications were compared between the two groups.Results The intraoperative blood loss in the observation group was(9.53±1.69)mL,which was less than(12.26±2.37)mL in the control group,and the operative time was(58.53±5.83)min,which was longer than(52.67±6.57)min in the control group,the postoperative exhaust time and hospitalization time were(22.36±2.58)h and(4.35±0.50)d,respectively,which were shorter than(26.59±3.65)h and(5.89±0.63)d in the control group,and the differences between the groups were statistically significant(P<0.05).1 day after surgery,the Visual Analouge Scale score in the observation group was(1.56±0.39)points,and the incidence of complications was 16.00%,which were lower than(2.03±0.41)points and 4.00%in the control group,and the differences between the groups were statistically significant(P<0.05);the levels of norepinephrine and cortisol in the observation group were(253.62±23.29)pmol/L and(171.38±18.26)nmol/L,which were lower than(297.83±26.74)pmol/L and(200.69±21.37)nmol/L in the control group,the differences between the groups were statistically significant(P<0.05).1 monthe after surgery,the end-diastolic blood flow velocity and peak systolic blood flow velocity in the observation group were(3.68±0.41)cm/s and(9.49±1.35)cm/s,respectively,which were faster than(3.15±0.36)cm/s and(8.21±1.02)cm/s in the control group,and the resistance index was(0.70±0.13),which was lower than(0.81±0.16)in the control group,and the differences between the groups were statistically significant(P<0.05).Conclusion Compared with TAPP,TEP can prolong the operation time,but it has the advantages of less trauma,faster postoperative recovery and fewer complications,can reduce the postoperative pain and stress reaction of male inguinal hernia patients,and has less damage to testicular blood flow.