腹腔镜完全腹膜外腹股沟疝修补术（TEP）与局麻下开放式无张力疝修补术的对比研究

发布时间：2018-11-20 07:50

【摘要】：目的：通过比较腹腔镜完全腹膜外腹股沟疝修补术(Totally Extraperitoneal Prosthetic, TEP)与局麻下开放式无张力疝修补术治疗成人腹股沟疝的临床疗效,探求哪一种成人腹股沟疝修补术更加高效、合理、经济。方法：收集北京大学深圳医院2012年10月至2014年10月所进行的60例TEP术(TEP组)和60例局麻下开放式无张力疝修补术(局麻开放组)进行同期非随机对照研究。术后通过门诊和电话联系的方式对两组患者进行随访,比较两组患者术前、术中、术后的相关参数。结果：TEP组对比局麻开放组,手术时间长[(71±9.8)min VS (48±15.6)min (P 0.01)];术中出血量多[(16±8.8)ml VS(11±4.5)ml(P0.01)]；术后初次下床活动时间短[(7±6.4)h VS(13±7.2)h(P0.01)]；术后第1天VAS疼痛评分低[(2±0.6)VS(4±0.7),(P0.01)]；术后住院时间长[(4±0.8)d VS(3±1.2)d(P0.05)]；住院费用高[(8755±329)元VS(5462±298)元(P0.01)]；术后使用止痛药例数差异无统计学意义[6.7%(4/60)VS 10%(6/60)(P0.05)]。术后随访周期在2-24个月,中位随访时间为16个月。TEP组术后的总并发症为7例,分别为：阴囊积液者3例,尿潴留者2例,肠梗阻者1例,复发者1例；局麻开放组术后的总并发症7例,分别为：阴囊积液2例,尿潴留1例,切口血肿1例,慢性疼痛1例,射精痛1例,复发1例。两组总并发症发生率差异无统计学意义(P0.05)。结论：TEP是众多腹腔镜疝修补手术中较为理想的术式,安全有效,而局麻下开放式无张力疝修补术同样具有TEP无法比拟的优势。两种术式各有特点,在临床应用上具有互补性,均值得临床推荐使用。在具体的手术方式选择上,医师应该根据患者的具体情况,为其制定个性化的治疗方案,这样才能达到最佳的临床效果和卫生经济学效益。
[Abstract]:Objective: to compare the clinical effects of laparoscopic total extraperitoneal inguinal hernia repair (Totally Extraperitoneal Prosthetic, TEP) and open tension-free hernia repair under local anesthesia in adult inguinal hernia and to find out which adult inguinal hernia repair is more effective. Reasonable, economical. Methods: 60 cases of TEP (TEP group) and 60 cases of open tension-free herniorrhaphy under local anesthesia (open group) were collected from October 2012 to October 2014 in Shenzhen Hospital of Peking University. The two groups were followed up by outpatient service and telephone contact after operation, and the parameters before, during and after operation were compared. Results: compared with the open local anesthesia group, the operation time of TEP group was longer (71 卤9.8) min VS (48 卤15.6) min (P 0.01), and the amount of intraoperative bleeding was more (16 卤8.8) ml VS (11 卤4.5) ml (P 0.01). The first time of getting out of bed was short (7 卤6.4) h VS (13 卤7.2) h (P0.01), the VAS pain score was low on the first day after operation [(2 卤0.6) VS (4 卤0.7), (P0.01)]. The postoperative hospitalization time was long [(4 卤0.8) d VS () 3 卤1.2) d (P0.05], the hospitalization cost was high [(8755 卤329) yuan VS (5462 卤29.8) yuan (P0.01)]; There was no significant difference in the number of painkillers used after operation [6.7% (4 / 60) VS 10% (6 / 60) (P0.05)]. The postoperative follow-up period was 2-24 months and the median follow-up time was 16 months. In TEP group, the total postoperative complications were: scrotal effusion in 3 cases, urinary retention in 2 cases, intestinal obstruction in 1 case, recurrence in 1 case; In the open local anesthesia group, the total complications were scrotum effusion (2 cases), urinary retention (1 case), incision hematoma (1 case), chronic pain (1 case), ejaculation (1 case) and recurrence (1 case). There was no significant difference in the incidence of total complications between the two groups (P0.05). Conclusion: TEP is an ideal technique for laparoscopic herniorrhaphy, which is safe and effective, and open tension-free hernia repair under local anesthesia is also superior to TEP. The two types of operation have their own characteristics and complementary in clinical application, which are worthy of clinical recommendation. In the selection of specific surgical methods, doctors should make individualized treatment plans for patients according to their specific conditions, so as to achieve the best clinical effect and health economic benefits.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656.2

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