成人腹腔镜腹股沟疝修补术和开放式腹股沟疝修补术的临床研究

发布时间：2018-03-28 11:25

本文选题：腹股沟疝　切入点：腹腔镜　出处：《泸州医学院》2014年硕士论文

【摘要】：目的：通过成人腹腔镜腹股沟疝修补术（LIHR）和开放式腹股沟疝修补术的前瞻性随机临床研究，进一步明确腹腔镜治疗腹股沟疝的安全性及优越性。方法：将宜宾市第一人民医院普外科2012年1月～2013年1月收治的100例成人腹股沟疝患者按入院顺序进行编号，随机分为奇数组和偶数组，其中奇数组50例患者安排到腹腔镜组，偶数组50例安排到开放组。腹腔镜组患者给予全身麻醉，奇数组前25例患者施行完全腹膜外网片修补术（TEP）和奇数组后25例患者施行经腹腔腹膜前网片修补术（TAPP）；开放组50例患者全部接受双层平片无张力疝修补术。100例病例进行长达1年的观察随访（门诊随访、电话随访或医护人员上门随访的方式相结合），记录患者术后恢复情况和并发症的情况，建立统计资料。观察和比较两组患者的以下指标：包括手术时间、住院费用、术后并发症、术后复发、术后使用镇痛药物例数、切口疼痛持续时间、术后下床活动时间、术后参加正常活动、患者对切口满意程度进行统计分析。结果：两组腹股沟疝患者在性别、年龄、疝的类型、发病部位、伴发病等临床资料方面差异无显著性（P0.05），两组资料之间具有可比性。开放组50例患者，全部接受双层平片无张力疝修补术。腹腔镜组共50例，25例患者行TAPP治疗，有1例中转为开放无张力疝修补术；25例病例行TEP治疗，其中仅有2例中转为TAPP治疗。腹腔镜组手术时间59.11±14.1（5分），住院费用12540.3±2582.3（元），住院时间3.57±1.52（天）；开放组手术时间40.21±11.11（分），住院费用6709.6±1477.8（元），住院时间6.39±3.63（天）。腹腔镜组手术时间长、住院费用高，与开放组比较统计学有显著性差异（P=0.000,0.000）。腹腔镜组住院时间明显缩短，与开放组比较差异性显著（P=0.047）。两组术后并发症方面（局部血肿，修补区域疼痛，阴囊肿胀，尿潴留，补片感染）比较差异无统计学意义（X2=0.65，P=0.275）；腹腔镜组术后无复发，开放组术后复发1例，，两组在术后复发统计学上无显著性差异（P=0.484）。腹腔镜组疝修补术后有3例患者使用了镇痛药物，而开放组疝修补术后为4例；两组病例在术后下床活动时间（P=0.001）和切口疼痛持续时间（P=0.001）上差异有统计学意义；两组病例在术后参加正常活动（P=0.230）和切口满意程度（P=0.242）上统计学无显著性差异。结论：腹腔镜疝修补术手术时间较开放式疝修补术长，住院总费用高于开放组，但术中、术后的近期并发症及远期并发症和复发率的发生概率均无明显差别，而行腹腔镜疝修补术的患者具有术后恢复快、开始工作的时间早、术后切口疼痛持续时间短、术后使用镇痛药物较少、等优点；而且，腹腔镜腹股沟疝修补术更符合人体的正常解剖生理结构，因此成人腹股沟疝的患者行腹腔镜疝修补术是安全的、可行的，并在术后恢复方面腹腔镜腹股沟疝修补术较开放式疝修补术有其独特的优势。
[Abstract]:Objective: to investigate the prospective randomized clinical study of laparoscopic inguinal hernioplasty (LIHR) and open inguinal hernia repair (OGH) in adults. Methods: 100 adult patients with inguinal hernia treated by the first people's Hospital of Yibin from January 2012 to January 2013 were numbered according to the order of admission. They were randomly divided into odd number group and even number group, in which 50 patients in odd number group were assigned to laparoscopic group and 50 patients in even number group were assigned to open group. The first 25 patients with odd array underwent complete external peritoneal mesh repair (TEP) and 25 patients with odd-numbered group underwent transhepatic anterior peritoneal mesh repair (TAPPN), while 50 patients in the open group received tension-free hernioplasty with double-layer plain film. 100 patients were treated with transurethral repair of tension hernia. Follow up for up to one year (outpatient follow-up, The methods of telephone follow-up or on-site follow-up were used to record the patients' recovery and complications, and to establish statistical data. The following indexes were observed and compared between the two groups: operation time, hospitalization cost, Postoperative complications, postoperative recurrence, postoperative use of analgesic drugs, duration of incision pain, time to get out of bed after operation, normal activities after operation, Results: two groups of inguinal hernia patients in gender, age, type of hernia, location of the disease, There was no significant difference in clinical data between the two groups. 50 patients in the open group received tension-free hernioplasty with double-layer plain film, and 25 patients in the laparoscopic group were treated with TAPP. In one case, 25 cases underwent open tension-free hernioplasty, and 25 cases were treated with TEP. In the laparoscopic group, the operation time was 59.11 卤14.1min, the hospitalization cost was 12540.3 卤2582.3 yuan, the hospitalization time was 3.57 卤1.52days, the open group operation time was 40.21 卤11.11 (min), the hospitalization cost was 6709.6 卤1477.8 yuan, the hospitalization time was 6.39 卤3.63. The hospitalization cost was high, there was significant difference between the open group and the open group. The length of stay in the laparoscopy group was significantly shorter than that in the open group, and the difference was significant compared with the open group. The postoperative complications (local hematoma, pain in the repaired area, swelling of scrotum) in the two groups were significantly different from those in the open group. There was no significant difference in urinary retention and patch infection (P < 0. 275), but there was no recurrence in laparoscopy group, 1 case in open group, 1 case in open group, 1 case in laparoscopy group, 1 case in open group, 1 case in laparoscope group, 1 case in open group. There was no significant difference in postoperative recurrence between the two groups (P < 0. 484). In the laparoscopic group, 3 patients were treated with analgesic drugs after herniorrhaphy, while 4 patients in the open group were treated with analgesic drugs after herniorrhaphy. There was significant difference between the two groups in the time of getting out of bed and the duration of incision pain (P 0.001). There was no significant difference between the two groups in terms of normal activity (P < 0.230) and incision satisfaction (P < 0.242). Conclusion: laparoscopic herniorrhaphy is longer than open hernioplasty, and the total cost of hospitalization is higher than that of open group, but during operation, there is no significant difference between the two groups. There was no significant difference in the incidence of short-term complications, long-term complications and recurrence rates. The patients undergoing laparoscopic herniorrhaphy had the advantages of quick recovery, early start of work and short duration of postoperative incision pain. In addition, laparoscopic inguinal hernia repair is more in line with the normal anatomical and physiological structure of the human body, so it is safe and feasible for adult patients with inguinal hernia to perform laparoscopic herniorrhaphy. Laparoscopic inguinal hernia repair has its unique advantages over open hernia repair in postoperative recovery.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R656.21

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