腹腔镜下全腹膜外腹股沟疝修补术与经正中线切口腹膜前腹股沟疝修补术的比较研究

发布时间：2017-12-26 23:24

本文关键词：腹腔镜下全腹膜外腹股沟疝修补术与经正中线切口腹膜前腹股沟疝修补术的比较研究　出处：《中国微创外科杂志》2016年02期 　论文类型：期刊论文

【摘要】：目的比较腹腔镜下全腹膜外腹股沟疝修补术(total extraperitoneal repair,TEP)与经正中线切口腹膜前腹股沟疝修补术治疗成人腹股沟疝的效果。方法 2011年1月~2014年12月,94例成人腹股沟疝采用腹腔镜下完全腹膜外游离腹膜前间隙,放置补片(TEP组),83例成人腹股沟疝采用下腹正中小切口游离腹膜前间隙,放置补片(开放组),比较2组手术时间、住院时间、住院费用、术后应用止痛药物情况、血清肿与切口裂开情况等。结果 TEP组手术时间(76±14)min,明显长于开放组(47±8)min(t=16.623,P=0.000);住院费用(9568.95±1422.23)元,明显高于开放组(5327.75±662.76)元(t=24.881,P=0.000);开放组术后应用镇痛剂(15例vs.6例,χ2=5.760,P=0.016)、切口脂肪液化裂开(4例vs.0例,P=0.046,)例数均明显高于TEP组;TEP组住院时间(4.9±0.6)d,与开放组(5.0±0.5)d无统计学差异(t=-1.195,P=0.234);2组血清肿无统计学差异(6例vs.1例,χ2=2.937,P=0.087)。177例随访3~12个月,平均7.4月,2组均无疝复发、补片感染、慢性疼痛、睾丸萎缩等并发症发生。结论开放手术在手术时间和住院费用上较TEP有明显优势,但术后疼痛、切口并发症高于TEP组,更适合双侧疝及复发疝,对单侧初发疝的治疗无明显优势。
[Abstract]:Objective to compare the effect of laparoscopic totally extraperitoneal total extraperitoneal repair (TEP) and anterior median inguinal herniorrhaphy in the treatment of inguinal hernia in adults. Methods ~2014 in January 2011 December, 94 cases of adult inguinal hernia by laparoscopic totally extraperitoneal free preperitoneal space, place the patch (TEP group), 83 cases of adult inguinal hernia by abdominal incision is small free preperitoneal space, place the patch (open group), compared 2 groups of operation time, hospitalization time and cost application of analgesic drugs, seroma and wound dehiscence after operation. Results the operation time of TEP group (76 + 14) min, significantly longer than the open group (47 + 8) min (t=16.623, P=0.000); hospitalization expenses (9568.95 + 1422.23), significantly higher than that of open group (5327.75 + 662.76) element (t=24.881, P=0.000); the open group of postoperative analgesic (15 cases of vs.6 an example, X 2=5.760, P=0.016), incision fat liquefaction dehiscence (4 cases vs.0 cases, P=0.046 cases) were significantly higher than that in TEP group; in TEP group (4.9 + 0.6) d, and the open group (5 + 0.5) d no significant difference (t=-1.195, P=0.234); the 2 groups showed no seroma the difference (6 vs.1 cases, X 2=2.937, P=0.087). 177 cases were followed up for 3~12 months, with an average of 7.4 months. There were no complications such as hernia recurrence, patch infection, chronic pain and testicular atrophy in the 2 groups. Conclusion open surgery has a significant advantage over TEP in terms of operative time and hospitalization cost, but postoperative pain and incision complications are higher than those of TEP group. It is more suitable for bilateral hernia and recurrent hernia, and has no obvious advantage for the treatment of unilateral primary hernia.
【作者单位】：首都医科大学附属北京世纪坛医院普通外科;
【基金】：北京市卫生和计划生育委员会“北京市卫生系统高层次卫生技术人员培养计划”(项目编号:Z201412201712)
【分类号】：R656.21
【正文快照】： 疝的治疗应尽量简单,根据解剖知识、技术修复腹壁,根据疝形成的机制防止复发[1]。腹股沟疝修补术根据手术路径与疝环的关系有前、后入路之分[2]。目前,开放后入路手术被越来越多的尝试用于初发疝的治疗。腹腔镜下全腹膜外腹股沟疝修补术(total extraperitoneal repair,TEP)是

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