不同术式的疝修补术治疗成人腹股沟疝后的临床疗效观察

摘要

Objective:To investigate the clinical effect and safety of transabdominal preperitoneal (TAPP), totally exntraperitoneal prosthesis (TEP) and open tension free hernia repair (Rutkow) in the treatment of adult inguinal hernia.Methods: Clinical data of 936 cases (1116 sides) of adult inguinal hernia treated in our hospital from January 2009 to January 2016 were analyzed retrospectively.The patients were divided into TAPP group, TEP group and open group, according to different treatment methods, 152 cases (174 sides), 336 cases (449 sides) and 448 cases (493 sides), respectively.The operation time, the VAS pain score at first day of postoperative, length of stay, postoperative complications of two groups were observed.After 6~40 months (media 21 months) follow up, the recurrence of two groups were observed.Results: Operation time: unilateral hernia: TAPP group > TEP group > open group, the difference was statistically significant (P < 0.05).Bilateral hernia: TAPP and open group > TEP group, the difference was statistically significant (P < 0.05), there was no significant difference between the TAPP group and the open group (P > 0.05).Length of stay: the open group was significantly longer than the TAPP group and TEP group (P < 0.05), while there was no significant difference between the TAPP group and the TEP group (P > 0.05).Incidence of complications: open group > TAPP group and TEP group, the difference was statistically significant (P < 0.05), there was no significant difference between TAPP group and TEP group (P > 0.05).The recurrence rate of open group was 0.89%, the recurrence rate of TAPP group was 0.66%, the recurrence rate of TEP group was 0.60%, and there was no significant difference in recurrence rate between the three groups (P > 0.05).The postoperative urinary retention, chronic pain or numbness in the open group were higher than those in the TAPP group and TEP group (P < 0.05).Conclusion: TAPP and TEP in the treatment of adult inguinal hernia is satisfactory, especially in the treatment of bilateral inguinal hernia, can significantly reduce the degree of postoperative pain, shorten the length of stay, reduce postoperative urinary retention, chronic pain or numbness, and other complications.%目的:探讨腹腔镜经腹腔腹膜前疝修补术(TAPP)、完全腹膜外腹腔镜疝修补术(TEP)和开放式无张力疝修补术(Rutkow术式)治疗成人腹股沟疝的临床疗效及安全性.方法:回顾性分析2009年1月至2016年1月在我院接受治疗的936例(1116侧)成人腹股沟疝患者的临床资料,根据患者所接受手术方式的不同分为TAPP组、TEP组和开放组,分别152例(174侧)、336例(449侧)、448例(493侧).观察三组手术时间、术后第1天疼痛评分(VAS)、住院时间、术后并发症.术后随访6~40个月(中位时间21个月),观察术后复发情况.结果:手术时间:单侧疝:TAPP组>TEP组>开放组,差异有统计学意义(P<0.05).双侧疝:TAPP组和开放组>TEP组,差异有统计学意义(P<0.05).而TAPP组和开放组差异无统计学意义(P>0.05).术后第1天疼痛评分(VAS):开放组>TAPP组和TEP组,差异有统计学意义(P<0.05).而TAPP组和TEP组差异无统计学意义(P>0.05).住院时间:开放组明显长于TAPP组和TEP组(P<0.05),而TAPP组和TEP组差异无统计学意义(P>0.05).并发症发生率:开放组>TAPP组和TEP组,差异有统计学意义(P<0.05).而TAPP组和TEP组差异无统计学意义(P>0.05).开放组复发率0.89%,TAPP组复发率0.66%,TEP组复发率为0.60%,三组术后复发率比较无统计学差异(X2=0.243,P>0.05).开放组术后出现尿潴留、慢性疼痛或麻木感均高于TAPP组及TEP组(X2=9.142,19.084,P<0.05).结论:TAPP和TEP治疗成人腹股沟疝效果满意,尤其治疗双侧腹股沟疝优势明显.可明显减轻患者术后疼痛程度,缩短患者住院时间,减少术后尿潴留、慢性疼痛或麻木感等并发症.