腹腔镜疝囊高位结扎术在腹股沟嵌顿斜疝患者中的应用

The application value of laparoscopic high ligation of hernia sac in patients with inguinal incarcerated hernia

目的探究腹腔镜疝囊高位结扎术应用于腹股沟嵌顿斜疝患者的疗效。方法回顾性分析秦皇岛市工人医院普外科于2019年7月至2022年10月收治的腹股沟嵌顿斜疝患者,根据手术方法不同,将其分为开放组与腹腔镜组。开放组实施传统开放疝囊高位结扎术,腹腔镜组实施腹腔镜疝囊高位结扎术。采用倾向性匹配评分法(卡钳值设置0.02)排除基线资料混杂因素影响后,2组最终各获得92例基线资料可比患者,对比2组围手术期指标(手术时间、术中出血量、胃肠道恢复时间及住院时间),并发症情况,术前及术后48 h内视觉模拟评分法(VAS),术前及术后3 d胃肠激素水平(胃泌素、胃动素)、炎症应激反应指标[皮质醇(Cor)、丙二醛(MDA)、去甲肾上腺素(NE)及肿瘤坏死因子-α(TNF-α)]变化。结果腹腔镜组手术时间、术中出血量、胃肠道恢复时间及住院时间均显著小于开放组(P<0.05);腹腔镜组并发症发生率(4.35%)与开放组(8.70%)比较,差异无统计学意义(P>0.05);术后,2组VAS评分均逐渐降低(P<0.05),组内不同时间点差异有统计学意义(P<0.05),且腹腔镜组治疗后6、24 h的VAS评分显著低于开放组(P<0.05);术后24 h,2组患者Cor、MDA、NE及TNF-α显著上升(P<0.05),但腹腔镜组的Cor、MDA、NE及TNF-α水平均显著低于开放组(P<0.05);术后3 d,2组患者胃泌素与胃动素水平显著上升(P<0.05),且腹腔镜组显著高于开放组(P<0.05)。结论相较于传统开放疝囊高位结扎术,腹腔镜疝囊高位结扎术治疗腹股沟嵌顿斜疝患者,其术后恢复更快,应激与炎症反应小,值得应用。

Objective To explore the application value of laparoscopic high ligation of the hernia sac in patients with inguinal incarcerated hernia.Methods Retrospective analysis was performed on patients with incarcerated indirect inguinal hernia admitted to the department of general surgery of our hospital from July 2019 to October 2022.According to different surgical methods,the patients were divided into an open group and a laparoscopic group.The open group performed traditional open high ligation of hernia sac,and the laparoscopic group was given laparoscopic high ligation of hernia sac.After excluding the influence of confounding factors of baseline data by using the propensity matching scoring method(caliper value=0.02),92 patients with comparable baseline data were finally obtained in each group.Perioperative indicators(surgical time,intraoperative blood loss,gastrointestinal recovery time and hospital stay)and complications,pain score(visual analogue scale,VAS)before surgery and at 48 hours after surgery,gastrointestinal hormone levels(gastrin,motilin)and inflammatory stress response indicators[cortisol(Cor),malondialdehyde(MDA),norepinephrine(NE),tumor necrosis factor(TNF-α)]before surgery and at 3 days after surgery.Results The operation time,intraoperative blood loss,gastrointestinal recovery time,and length of hospital stay in the laparoscopic group were significantly shorter than those in the open surgery group(P<0.05).There was no statistically significant difference in the complication rate between the laparoscopic group(4.35%)and the open surgery group(8.70%)(P>0.05).Postoperatively,VAS scores in both groups gradually decreased(P<0.05),with significant differences at different time points within each group(P<0.05).Moreover,the VAS scores at 6 and 24 hours after treatment in the laparoscopic group were significantly lower than those in the open surgery group(P<0.05).At 24 hours post-surgery,the levels of cortisol(Cor),malondialdehyde(MDA),norepinephrine(NE),and tumor necrosis factor-α(TNF-α)increased significantly in both groups(P<0.05),but these levels were significantly lower in the laparoscopic group compared to the open surgery group(P<0.05).On postoperative day 3,gastrin and motilin levels significantly increased in both groups(P<0.05),with the laparoscopic group showing significantly higher levels than the open surgery group(P<0.05).Conclusion Compared with traditional open high ligation of the hernia sac,laparoscopic high ligation of the hernia sac in treating patients with incarcerated indirect inguinal hernia has faster postoperative recovery,a smaller stress response and an inflammatory response.