开放与腔镜腹膜前腹股沟疝修补术的对照研究
发布时间：2019-06-19 21:12
【摘要】：研究目的既往与腹腔镜腹股沟疝修补术(TAPP或TEP)相比较的研究中,开放手术多采用李金斯坦术式。然而,与腹腔镜疝修补术不同的是,李金斯坦术式操作位置为肌前,补片也放置于肌前,而非腹膜前。理想的情况下,为减少偏倚的发生,在比较开放疝修补术和腹腔镜疝修补术的区别时,两者的补片放置位置应该一致。该历史性队列研究中的目的在于,采用一种开放腹膜前腹股沟疝修补术--即改良Kugel(MK)术式作为对照,回顾性比较分析开放与腹腔镜腹膜前腹股沟疝修补术的术后疗效,进一步明确开放与腹腔镜腹股沟疝修补术的差异。研究方法纳入上海市“疝与腹壁外科疾病诊治中心”的两所医院,即上海交通大学医学院附属第九人民医院和附属瑞金医院在2008年01月至2010年12月3年期间行开放MK腹股沟疝修补术或腹腔镜腹股沟修补术的18周岁以上的腹股沟疝患者。根据手术方式分为开放组(MK术式)和腹腔镜组(TEP/TAPP术式),收集两组患者的基线资料、复发率,以及术中、术后短期并发症和术后长期并发症等并进行统计分析。研究结果该回顾性队列研究共纳入1760名患者(530例开放,1230例腔镜),其中96.08%的患者完成随访(24-60个月)。开放组患者平均年龄高于腹腔镜组(p0.001)。91.45%的双侧腹股沟疝及82.12%的复发疝患者行腹腔镜疝修补术。总体复发率为0.71%,两组之间无统计学差异(p=0.227)。腹腔镜组总并发症发生率低于开放组(14.47%vs.19.25%,p=0.012),但是威胁生命的并发症发生率相近(1.51%vs.0.98%,p=0.332)。腹腔镜组患者的伤口感染及慢性疼痛发生率显著低于开放组(分别为p=0.016和p0.001),并且腔镜组平均手术时间短,疼痛评分低,恢复快(p0.001)。结论作为腹膜前腹股沟疝修补术,开放MK腹股沟疝修补术和腹腔镜(TEP/TAPP)腹股沟疝修补术均安全有效,威胁生命的并发症及复发率均较低。腔镜疝修补术后感染及慢性疼痛的发生率低,并且手术时间短,术后患者恢复快;但前提是要选择合适的操作途径(TAPP或TEP)并贯彻好技术细节。
[Abstract]:Objective to compare the previous studies with laparoscopic inguinal hernia repair (TAPP or TEP). However, unlike laparoscopic hernia repair, Li Kintan is operated in front of the muscle, and the patch is also placed in front of the muscle, not in front of the abdomen. In order to reduce the occurrence of bias, the position of patch placement should be the same when comparing the difference between open hernia repair and laparoscopic hernia repair. The purpose of this historic cohort study was to compare and analyze the postoperative efficacy of open and laparoscopic anterior inguinal hernia repair with modified Kugel (MK) as control, and to further clarify the difference between open inguinal hernia repair and laparoscopic inguinal hernia repair. Methods the patients over 18 years old who underwent open MK inguinal hernia repair or laparoscopic inguinal hernia repair were included in two hospitals of Shanghai Center for diagnosis and treatment of hernia and abdominal Wall Surgical Diseases, namely, the Ninth people's Hospital and Ruijin Hospital, affiliated to the Medical College of Shanghai Jiaotong University, who underwent open inguinal hernia repair or laparoscopic inguinal repair from January 2008 to December 2010. According to the operation mode, the patients were divided into open group (MK operation) and laparoscopy group (TEP/TAPP operation). The baseline data, recurrence rate, intraoperative, postoperative short-term and long-term complications were collected and analyzed statistically. Results A total of 1760 patients (530 open, 1230 endoscopic) were included in the retrospective cohort study, of which 96.08% completed follow-up (24 脳 60 months). The average age of the patients in the open group was higher than that in the laparoscopy group (p0.001). Laparoscopic hernia repair was performed in 91.45% of the patients with bilateral inguinal hernia and 82.12% of the patients with recurrent hernia. The overall recurrence rate was 0.71%, and there was no significant difference between the two groups (p 鈮，
本文编号：2502651
[Abstract]:Objective to compare the previous studies with laparoscopic inguinal hernia repair (TAPP or TEP). However, unlike laparoscopic hernia repair, Li Kintan is operated in front of the muscle, and the patch is also placed in front of the muscle, not in front of the abdomen. In order to reduce the occurrence of bias, the position of patch placement should be the same when comparing the difference between open hernia repair and laparoscopic hernia repair. The purpose of this historic cohort study was to compare and analyze the postoperative efficacy of open and laparoscopic anterior inguinal hernia repair with modified Kugel (MK) as control, and to further clarify the difference between open inguinal hernia repair and laparoscopic inguinal hernia repair. Methods the patients over 18 years old who underwent open MK inguinal hernia repair or laparoscopic inguinal hernia repair were included in two hospitals of Shanghai Center for diagnosis and treatment of hernia and abdominal Wall Surgical Diseases, namely, the Ninth people's Hospital and Ruijin Hospital, affiliated to the Medical College of Shanghai Jiaotong University, who underwent open inguinal hernia repair or laparoscopic inguinal repair from January 2008 to December 2010. According to the operation mode, the patients were divided into open group (MK operation) and laparoscopy group (TEP/TAPP operation). The baseline data, recurrence rate, intraoperative, postoperative short-term and long-term complications were collected and analyzed statistically. Results A total of 1760 patients (530 open, 1230 endoscopic) were included in the retrospective cohort study, of which 96.08% completed follow-up (24 脳 60 months). The average age of the patients in the open group was higher than that in the laparoscopy group (p0.001). Laparoscopic hernia repair was performed in 91.45% of the patients with bilateral inguinal hernia and 82.12% of the patients with recurrent hernia. The overall recurrence rate was 0.71%, and there was no significant difference between the two groups (p 鈮，
本文编号：2502651
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