腹腔镜下经腹膜前疝修补术和开放无张力疝修补术治疗腹股沟嵌顿疝的临床研究

发布时间：2018-10-10 06:08

【摘要】：目的:本研究通过观察腹腔镜下经腹膜前疝修补术(laparoscoplc trans-abdominal preperitoneal hernia repair,TAPP)治疗腹股沟嵌顿疝的临床效果,为临床治疗腹股沟区嵌顿疝提供参考手术方式。方法:选取青海大学附属医院腹部腔镜外科2012年11月至2014年10月腹股沟嵌顿疝患者65例,A组:20例(行腹股沟嵌顿疝腹腔镜下复位+TAPP);B组:21例(行腹股沟嵌顿疝切开复位+腹股沟疝修补术,OR);C组:24例(行腹股沟嵌顿疝切开复位+疝囊高位结扎,high ligation of hernia sac,HL)。评价指标:三组手术时间、住院时间、术中出血量、术后疼痛发生率、术后胃肠功能恢复时间、以及并发症相关指标比较。结果:所有患者经治疗后,均治愈出院。(1)A组手术时间较B组、C组手术时间长(P0.05);(2)A组住院时间、术中出血量、术后下床活动时间、术后胃肠功能恢复时间及止痛药物使用例数,与B、C组进行比较,差异均有统计学意义(P0.05);(3)三组术后皮下血肿、腹腔感染、阴囊肿胀及切口感染指标比较,差异无统计学意义(P0.05);(4)A组术后复发率低于B、C组,差异有统计学意义(P0.05);B组复发率同样低于C组,差异有统计学意义(P0.05)。结论:腹腔镜下经腹膜前疝无张力修补术(TAPP)术中可以充分探查腹腔,避免了遗漏坏死的肠管风险,其具有创伤小、术后恢复快、住院时间短及术后复发率低等优势,因此认为,其是治疗腹股沟嵌顿疝的一种安全、有效的术式,临床上可根据患者的实际情况适时应用。
[Abstract]:Objective: to observe the clinical effect of laparoscopic anterior peritoneal hernioplasty (laparoscoplc trans-abdominal preperitoneal hernia repair,TAPP) in the treatment of incarcerated inguinal hernia, and to provide a reference for clinical treatment of incarcerated inguinal hernia. Methods: from November 2012 to October 2014, 65 patients with incarcerated inguinal hernia in the affiliated Hospital of Qinghai University were selected from 65 patients with inguinal incarcerated hernia. Group A: 20 cases (performed laparoscopic reduction of inguinal incarcerated hernia TAPP) group B: 21 cases (performed inguinal incarcerated hernia resection) Open reduction inguinal hernioplasty (OR) Group C (24 cases with inguinal incarcerated hernia) were treated with open reduction of high ligation of hernia sac and high ligation of hernia sac,HL. Evaluation measures: operative time, hospitalization time, intraoperative bleeding volume, postoperative pain incidence, postoperative gastrointestinal function recovery time, and complications were compared among the three groups. Results: all the patients were cured and discharged after treatment. (1) the operation time of group A was longer than that of group B (P0.05); (2), the amount of bleeding during operation, the time of getting out of bed after operation, the time of recovery of gastrointestinal function after operation and the number of cases using analgesic drugs. Compared with group C, the difference was statistically significant (P0.05); (3). The postoperative subcutaneous hematoma, celiac infection, scrotal swelling and wound infection were not significantly different in group A (P0.05); (4), the recurrence rate of group A was lower than that of group B (P0.05). The recurrence rate of group B was also lower than that of group C (P0.05). Conclusion: laparoscopic transurethral tension-free repair of preperitoneal hernia (TAPP) can fully explore the abdominal cavity and avoid the risk of missing necrotic bowel. It has the advantages of small trauma, quick postoperative recovery, short hospital stay and low recurrence rate. It is a safe and effective method for the treatment of inguinal incarcerated hernia.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.2

【参考文献】