腹腔镜完全腹膜外腹股沟疝修补术（TEP）中补片免钉合固定与钉合固定的对比研究

发布时间：2018-03-05 20:38

本文选题：腹股沟疝　切入点：腔镜下疝修补　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:对比分析腹腔镜完全腹膜外腹股沟疝修补术中补片应用疝钉固定与不用疝钉固定2种手术方式,探讨腹腔镜完全腹膜外腹股沟疝修补术中免钉合器技术的安全性及可靠性。方法:统计分析青岛大学附属医院自2014年9月至2016年6月收治的腹股沟疝患者120例,按照治疗方法的不同分为观察组60例和对照组60例,观察组采用免钉合腹腔镜完全腹膜外疝修补术,对照组采用钉合腹腔镜完全腹膜外疝修补术,术后随访一年左右。统计分析患者的年龄,术中、术后并发症,术后复发率的差异以及对比两种术式的手术效果,用t检验与x2检验进行统计分析。结果:(1)免钉合组病人平均年龄42.47±16.51岁,钉合组病人平均年龄43.03±17.55岁,两组年龄之间没有统计学差异P=0.753(P0.05)。(2)免钉合组病人术后疼痛等级为II级及以上者1例,钉合组病人术后疼痛等级为II级及以上者5例,两组术式的术后疼痛程度之间有统计学差异P=0.035(P0.05),免钉合的方法可以有效减轻术后疼痛程度。(3)免钉合组病人出现1例术后慢性疼痛,钉合组病人出现6例术后慢性疼痛,两组术式的术后慢性疼痛之间有统计学差异P=0.029(P0.05),免钉合的方法可以有效减少术后慢性疼痛的发生。(4)免钉合组手术时间平均59.36±15.7min,钉合组手术时间平均78.44±15.6min,两组手术时间之间没有统计学差异p=0.618(P0.05);(5)免钉合组平均术中出血量16.08±6.28ml,钉合组平均术中出血量17.03±6.01ml,两组术中出血量之间没有统计学差异P=0.821(P0.05)。(6)免钉合组患者术后出现2例腹股沟区血清肿,钉合组患者术后出现3例腹股沟区血清肿,两组之间无统计学差异P=0.648(P0.05)。(7)免钉合组患者术后未出现尿潴留及补片排异等并发症,钉合组患者术后出现1例尿潴留,两者之间没有统计学差异p=0.681(P0.05)。(8)免钉合组患者术后住院时间2.23±1.15天,钉合组患者术后住院时间2.42±1.07天,两组术后住院时间无统计学差异P=0.171(P0.05)。(9)免钉合组患者术后未见疝复发,钉合组患者术后出现1例疝复发,两组术后疝复发率无统计学差异P=0.981(P0.05)。(10)免钉合组住院费用13565.65±2356.78元,钉合组住院费用16396.35±2124.12元,虽然钉合组平均费用要比免钉合组费用高,但是没有统计学差异P=0.065(P0.05)。结论:腹腔镜完全腹膜外腹股沟疝修补术中补片在不用钉合器钉合的情况下仍能达到应用钉合器钉合后相的手术效果,总并发症以及各并发症的发生率两组差异均无统计学意义。而且免钉合器的情况下患者术后疼痛程度及慢性疼痛的情况较应用钉合器钉合要更好一些,并且可以减轻患者的经济负担。
[Abstract]:Objective: to compare and analyze two operative methods of complete extraperitoneal inguinal herniorrhaphy by laparoscope, using hernia nail fixation and without herniation nail fixation. To investigate the safety and reliability of the nail-free technique in laparoscopic total extraperitoneal inguinal hernia repair methods: 120 cases of inguinal hernia treated in Qingdao University affiliated Hospital from September 2014 to June 2016 were analyzed statistically. According to the different treatment methods, 60 cases were divided into the observation group (n = 60) and the control group (n = 60). The observation group was treated with nail-free laparoscopic complete extraperitoneal hernia repair, and the control group was treated with nailing laparoscopic complete extraperitoneal hernia repair. All patients were followed up for about one year. The differences in age, intraoperative, postoperative complications, postoperative recurrence rate, and comparison between the two surgical procedures were statistically analyzed. Results the mean age of the patients in the nail-free group was 42.47 卤16.51 years old, and that in the nail group was 43.03 卤17.55 years old. There was no significant difference in age between the two groups (P _ (0.753) P _ (0.05) P _ (0.05)) there was no significant difference between the two groups (P _ (0.753) P _ (0.05)) there was one case of postoperative pain grade II or above in the nail free group, and 5 cases in the nail group. There was significant difference between the two groups in the degree of postoperative pain. The nailing free method could effectively reduce the postoperative pain degree of 1 patient in the nail free group, and 6 patients in the nail group, and there were 6 cases of postoperative chronic pain in the nail free group, and there was a significant difference between the two groups in the degree of postoperative pain, and there was a significant difference in the degree of postoperative pain between the two groups. There was a significant difference in postoperative chronic pain between the two groups. The nailing free method could effectively reduce the occurrence of postoperative chronic pain. The mean time of operation was 59.36 卤15.7min in the no-nail group and 78.44 卤15.6min in the nail group. The operative time of the two groups was 78.44 卤15.6min. There was no statistical difference between the two groups (p _ (0.618) P _ (0.05)) the mean intraoperative blood loss was 16.08 卤6.28 ml in the nail free group, and 17.03 卤6.01 ml in the nail group. There was no statistical difference between the two groups in the intraoperative bleeding volume (P _ (0.821) P _ (0.05)). In the nail free group, there were no postoperative complications such as urinary retention and patch rejection, and one patient in the nail group had urinary retention after operation, and there was no significant difference between the two groups in blood serum swelling in the inguinal area. The patients in the nail free group had no complications such as urinary retention and patch rejection. The patients in the nail group had one case of urinary retention after the operation, and there was no significant difference between the two groups. There was no significant difference between the two groups (P < 0. 681, P 0. 05, P < 0. 05)) the postoperative hospitalization time of the patients in the nail-free group was 2. 23 卤1.15 days, and that in the nail-free group was 2. 42 卤1. 07 days. There was no significant difference between the two groups in the postoperative hospitalization time (P 0. 171, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P < 0. 9). There was no recurrence of hernia in the nail-free group. There was no significant difference in the recurrence rate of hernia between the two groups. The hospitalization cost of the nail free group was 13565.65 卤2356.78 yuan, and the hospitalization cost of the nail group was 16396.35 卤2124.12 yuan, although the average cost of the nail group was higher than that of the non-nail group. But there was no statistical difference between P0. 065 and P0. 05. Conclusion: the patch during laparoscopic total extraperitoneal inguinal herniorrhaphy can still achieve the effect of nailing after nailing without nailing. There was no significant difference in the total complications and the incidence of each complication between the two groups. And can reduce the patient's economic burden.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.21

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