齐齐哈尔市131例腹股沟疝患者无张力修补术与传统疝修补术的疗效分析

发布时间：2018-09-10 06:06

【摘要】：背景:腹外疝是外科中最常见的疾病之一,以腹股沟疝发病率最高,腹股沟疝可分为腹股沟斜疝和直疝。斜疝是最常见的腹外疝,发病率约占腹外疝总数的90%,或占腹股沟疝的95%。腹股沟疝成人不可以自愈,手术是唯一的治愈方法。目前主要存在两种手术方式:传统的疝囊高位结扎疝修补术和无张力疝修补术,通过查阅相关文献,发现这两种疝修补术均能治愈成人腹股沟疝,各自具有本身的优势,同时也存在各自缺点。对于腹股沟疝临床术式的选择,目前仍有在争论。目的:通过对131例在齐齐哈尔医学院附属第三医院普外科住院手术的腹股沟疝患者病历资料的分析,比较传统修补术和无张力修补术治疗腹股沟疝的临床疗效,为该院推广应用无张力疝修补术治疗腹股沟疝提供参与和依据。方法:收集2011年至2014年在齐齐哈尔医学院附属第三医院普外科住院手术的腹股沟疝患者病历资料131例,根据手术方式分为:传统手术组41例和无张力疝手术组90例。比较分析两组患者手术时间、术中出血量、术后最高体温及其出现时间、术后平均住院时间、术后下床活动时间、排气时间、住院费用,以及术后并发症:尿潴留、阴囊肿胀、切口异物感、术后疼痛、切口感染、血肿及血清肿等。结果:无张力修补术式组术中出血量少于传统术式组,术后下床时间早,排气时间早,手术费用高于传统术式,差异具有统计学意义(P0.05);无张力修补术组并发症尿:潴留、术后、疼痛、阴囊肿胀、切口异物感、切口感染、最高体温及其出现时间、血肿及血清肿等发生以及手术时间、住院天数与传统术式组相比,差异无统计学意义(P0.05)。结论:1.无张力疝修补术在术中的出血量少,对组织损伤小,有利于组织的恢复。2.施行无张力疝修补术的患者术后排气时间早,胃肠蠕动恢复快、进食时间早、营养损失少,有利于伤口的愈合。3.施行无张力疝修补术施行的患者术后下床时间早,减少卧床时间,有利于老年手术患者某些并发症的预防。4.无疑力疝修补术组患者各种术后并发症的发生率不高于传统术式组。5.施行无张力疝修补术的患者住院费用显著高于施行传统术式的患者。医院必须通过一系列措施,降低患者住院费用,缩小与传统疝修补术住院费用的差距来促进无张力疝修补在临床上的推广应用。
[Abstract]:Background: external abdominal hernia is one of the most common diseases in surgery. The incidence of inguinal hernia is the highest. Inguinal hernia can be divided into indirect inguinal hernia and direct hernia. Indirect hernia is the most common external hernia, accounting for about 90% of the total number of external hernia, or 95% of inguinal hernia. Inguinal hernia adults cannot heal themselves. Surgery is the only cure. At present, there are two main surgical methods: traditional high ligation hernia repair and tension-free herniorrhaphy. By consulting relevant literature, it is found that both hernioplasty can cure adult inguinal hernia, and each of them has its own advantages. At the same time, there are their own shortcomings. The choice of clinical operation for inguinal hernia is still controversial. Objective: to analyze the medical records of 131 cases of inguinal hernia treated in general surgery department of the third affiliated Hospital of Qiqihar Medical College, and to compare the clinical effect of traditional repair and tension-free repair in the treatment of inguinal hernia. To provide the basis for the application of tension-free hernioplasty in the treatment of inguinal hernia. Methods: from 2011 to 2014, 131 cases of inguinal hernia were collected from general surgery department of the third affiliated Hospital of Qiqihar Medical College. According to the operation mode, 131 cases were divided into traditional operation group (41 cases) and tension-free hernia group (90 cases). The time of operation, the amount of blood lost during operation, the maximum body temperature after operation, the time of appearance, the average time of hospitalization, the time of getting out of bed, the time of exhaust, the cost of hospitalization, and the postoperative complications: urinary retention, scrotal swelling, and postoperative complications were compared and analyzed between the two groups. Incision foreign body sensation, postoperative pain, wound infection, hematoma and serum swelling. Results: the amount of intraoperative bleeding in the tension free repair group was less than that in the traditional operation group, the time of getting out of bed was earlier, the time of exhaust was earlier, the cost of operation was higher than that of the traditional operation, the difference was statistically significant (P0.05), the complications of tension free repair group: urine retention, postoperative, postoperative, Pain, scrotum swelling, incision foreign body sensation, wound infection, maximum body temperature and its occurrence time, hematoma and serum swelling, and operation time, hospital stay were not significantly different from the traditional operation group (P0.05). Conclusion 1. Tension-free hernioplasty has less bleeding and less tissue damage, which is beneficial to tissue recovery. The patients who underwent tension-free hernioplasty had earlier exhaust time, faster recovery of gastrointestinal peristalsis, earlier feeding time and less nutrition loss, which was beneficial to wound healing. The patients undergoing tension-free hernioplasty get out of bed early after operation and reduce bed-rest time, which is helpful to prevent some complications in elderly patients. There is no doubt that the incidence of postoperative complications in the force-hernia repair group is not higher than that in the traditional herniorrhaphy group. The hospitalization cost of tension-free herniorrhaphy was significantly higher than that of traditional herniorrhaphy. In order to promote the clinical application of tension-free hernioplasty, hospitals must reduce the cost of hospitalization and reduce the difference between the cost of traditional hernia repair and that of traditional hernioplasty.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.2

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