免气囊、免固定完全腹膜外腹腔镜腹股沟疝修补术（TEP）的临床研究

发布时间：2019-04-01 12:00

【摘要】：目的:进行免气囊、免固定完全腹膜外腹腔镜腹股沟疝修补术(TEP)和开放性无张力疝修补术临床疗效的对比性研究,以探讨免气囊、免固定TEP的临床可行性。方法:选择包头医学院第一附属医院普外一科自2012年02月至2013年10月期间收治的46例腹股沟疝患者进行回顾性分析。其中23例行开放性无张力疝修补术(开放组),采用连续硬膜外麻醉。23例行免气囊、免固定TEP术(TEP组),采用全身麻醉。观察并记录两种术式的手术时间、术中出血量、术后住院天数、术后并发症的发生情况、术后使用镇痛剂情况、住院费用等指标。结果:手术时间:开放组为(54.6±10.0)min,TEP组为(45.4±5.8)min,(P0.05),有统计学意义;术中出血量:开放组为(37.0±10.6)ml,TEP组为(19.6±7.7)ml,(P0.05),有统计学意义;术后住院天数:开放组为(5.3±1.7)d,TEP组为(2.4±0.5)d,(P0.05),有统计学意义;住院费用:开放组为(9952.7±2180.6)元,TEP组为(7570.8±1388.7)元,(P0.05),无统计学意义;术后使用镇痛剂情况:开放组有14例,TEP组有2例;开放组术后总的并发症有6例,分别为:阴囊血肿3例,切口血肿2例,睾丸扭曲1例。TEP组术后总的并发症2例,均为阴囊血肿。两组患者比较,(P0.05),术后各种并发症和总的并发症发生率差异无统计学意义。并且两组术后随访2-24个月,随访期间内均未发现复发病例。结论:进行免气囊、免固定TEP术在手术时间、术中出血量、术后住院天数等方面明显优于开放性无张力疝修补术,而两者术后并发症、住院费用等方面差异不明显。由此可以显示免气囊、免固定TEP和传统疝修补术均能治愈腹股沟疝,但TEP较传统疝修补术更具有优越性;免气囊、免固定TEP手术是一种微创,安全可行的手术,特别适合在贫困的边远地区展开及推广。
[Abstract]:Aim: to compare the clinical effects of open tension-free hernia repair (TEP) and open tension-free hernioplasty (TEP) without balloon-free fixation and complete extraperitoneal laparoscopic inguinal hernia repair in order to explore the clinical feasibility of free-balloon and fixed-free TEP. Methods: 46 patients with inguinal hernia admitted to the first affiliated Hospital of Baotou Medical College from February 2012 to October 2013 were analyzed retrospectively. Open tension-free herniorrhaphy (open group) was performed in 23 cases, continuous epidural anesthesia was performed in 23 cases, airbag-free and fixed-free Tepp (TEP group) were performed in 23 cases, and general anesthesia was used in 23 cases. The time of operation, the amount of bleeding during the operation, the days of hospitalization, the occurrence of postoperative complications, the use of analgesic after operation, the cost of hospitalization and so on were observed and recorded. Results: the operation time was (54.6 卤10.0) min,TEP in the open group, (45.4 卤5.8) min, () in the open group, and there was significant difference between the open group and the open group (P < 0.05). Intraoperative bleeding volume: the open group was (37.0 卤10.6) ml,TEP group was (19.6 卤7.7) ml, (P0.05), there was statistical significance; The postoperative hospitalization days were (5.3 卤1.7) days in the open group and (2.4 卤0.5) d, () days in the TEP group (P 0.05). The hospitalization cost was (9952.7 卤2180.6) yuan in the open group and (7570.8 卤1388.7) yuan in the TEP group (P0.05), and there was no statistical significance in the use of analgesic after operation: 14 cases in the open group and 2 cases in the TEP group; The total complications of open group were 3 cases of scrotum hematoma, 2 cases of incision hematoma and 1 case of testicular distortion. The total complications of TEP group were scrotum hematoma in 2 cases, scrotal hematoma in 3 cases, incision hematoma in 2 cases and testicular distortion in 1 case. Compared with the two groups, there was no significant difference in the incidence of complications and total complications between the two groups (P0.05). The two groups were followed up for 2 months and 24 months, and no recurrence was found during the follow-up period. Conclusion: TEP is superior to open tension-free herniorrhaphy in terms of operation time, intraoperative bleeding, postoperative hospitalization days and so on. However, there is no significant difference in postoperative complications and hospitalization cost between the two groups. It can be shown that balloon-free, fixed-free TEP and traditional herniorrhaphy can cure inguinal hernia, but TEP has more advantages than traditional herniorrhaphy. Balloon-free, fixed-free TEP surgery is a minimally invasive, safe and feasible operation, especially suitable for deployment and promotion in poor remote areas.
【学位授予单位】：内蒙古科技大学包头医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R656.21

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