腹腔镜和开放无张力疝修补术临床研究

发布时间：2019-06-20 21:52

【摘要】：目的:通过对腹腔镜疝修补网片固定术组、腹腔镜疝修补网片免固定术组和开放式无张力疝修补术组,3组患者的手术治疗结果对比研究,探讨3组不同的腹股沟疝修补方法临床效果的优劣,得到适宜于临床推广应用疝修补手术方法。方法:回顾性分析,曲阜市中医院2012年1月至2015年1月,同期126例腹股沟疝修补术患者的临床资料,按照手术方式的不同分为腹腔镜疝修补网片固定术组(A组,41例)、腹腔镜疝修补网片免固定术组(B组,46例)和开放式无张力疝修补术组(C组,39例),比较3组患者的手术时间、术中出血量、术后疼痛、术后慢性疼痛、术后下床活动时间、术后进食时间、住院时间、住院费用、切口感染、切口血肿、血清肿、尿潴留、肠粘连、疝复发等情况,术后随访1-2年观察患者近、远期并发症。统计分析患者的手术时间、术中出血量、术后疼痛、术后慢性疼痛、术后下床活动时间、术后进食时间、住院时间、住院费用、切口感染、切口血肿、血清肿、尿潴留、肠粘连、疝复发的差异以及对比三种术式的手术效果,用t检验与x2检验进行统计分析。结果:腹腔镜疝修补网片固定术组(A组,41例)、腹腔镜疝修补网片免固定术组(B组,46例)和开放式无张力疝修补术组(C组,39例)3组患者手术均得到较好的疗效,3组患者年龄、性别、患病类型等一般资料比较,差异均无统计学意义。B组患者在手术时间、术中出血量、术后进食时间、术后下床时间、住院时间明显小于A组,差异无统计学意义。B组患者住院费用明显少于A组差异有统计学意义(P0.05)。A组患者在术中出血量、术后进食时间、术后下床时间、住院时间明显小于C组,差异有统计学意义(P0.01),C组患者在住院费用明显少于A组差异有统计学意义(P0.05),手术时间差异无统计学意义。B组患者在术中出血量、术后进食时间、术后下床时间、住院时间明显小于C组差异有统计学意义(P0.01),B、C组患者在住院费用、手术时间差异无统计学意义。A组、B组患者的并发症和复发情况比较治疗效果无明显差异。但分别于与C组比较差异均有统计学意义。A组在切口感染、切口血肿、血清肿、尿潴留、术后慢性疼痛、肠粘连、复发和C组比较治疗效果差异无统计学意义。A组患者在术后疼痛明显少于C组差异有统计学意义(P0.05)。B组在切口感染、切口血肿、血清肿、尿潴留、术后慢性疼痛、肠粘连、复发和C组比较治疗效果差异无统计学意义。B组患者在术后疼痛明显少于C组差异有统计学意义(P0.05)。结论:腹腔镜和开放式无张力腹股沟疝修补术均是安全有效的术式,腹腔镜优于开放无张力疝修补术。腹腔镜腹股沟疝修补术中补片在不用钉合器钉合的情况下仍能达到应用钉合器钉合后相的手术效果,总并发症以及各并发症的发生率三组差异均无统计学意义。腹腔镜网片免固定疝修补术式操作简单、临床实用、并发症少、费用低、易于推广应用。
[Abstract]:Objective: to compare the surgical results of laparoscopic hernia repair mesh fixation group, laparoscopic hernia repair mesh free fixation group and open tension-free hernia repair group, and to explore the advantages and disadvantages of different inguinal hernia repair methods in the three groups, so as to obtain a suitable method for clinical application of hernia repair. Methods: the clinical data of 126 patients undergoing inguinal hernia repair from January 2012 to January 2015 in Qufu Hospital of traditional Chinese Medicine were analyzed retrospectively. according to the different surgical methods, the patients in group A (41 cases), group B (46 cases) and group C (39 cases) were divided into three groups: group A (41 cases), group B (46 cases) and group C (39 cases). The amount of intraoperative bleeding, postoperative pain, postoperative chronic pain, postoperative time of getting out of bed, postoperative eating time, hospitalization expenses, incision infection, incision hematomas, serum swelling, urinary retention, intestinal adhesion, hernia recurrence, etc., were followed up for 1-2 years to observe the short-term and long-term complications of the patients. The differences of operation time, intraoperative bleeding volume, postoperative pain, postoperative chronic pain, postoperative time of getting out of bed, postoperative eating time, hospitalization expenses, incision infection, incision hematomas, serum swelling, urinary retention, intestinal adhesion and recurrence of hernia were statistically analyzed. T test and x2 test were used for statistical analysis. Results: laparoscopic hernia repair mesh fixation group (group A, 41 cases), laparoscopic hernia repair mesh free fixation group (group B, 46 cases) and open tension-free hernia repair group (group C, 39 cases) had better curative effect. There was no significant difference in age, sex, disease type and other general data among the three groups. The time of getting out of bed after operation was significantly smaller than that of group A, and the difference was not statistically significant. The hospitalization expenses of group B were significantly lower than those of group A (P 0.05). The amount of bleeding during operation, the time of eating after operation, the time of getting out of bed and the time of hospitalization in group). A were significantly lower than those in group C, the difference was statistically significant (P 0.01). The hospitalization expenses of group C were significantly lower than those of group A (P 0.05), but there was no significant difference in operation time. The amount of bleeding during operation, the time of eating after operation, the time of getting out of bed and the time of hospitalization in group B were significantly lower than those in group C (P 0.01). There was no significant difference in hospitalization expenses and operation time in group B. there was no significant difference in hospitalization expenses and operation time in group A. there was no significant difference in the amount of bleeding during operation, the time of eating after operation, the time of getting out of bed after operation. There was no significant difference in the treatment effect between complications and recurrence in group B. However, there was significant difference between group A and group C. there was no significant difference in incision infection, incision hematomas, serum swelling, urinary retention, postoperative chronic pain, intestinal adhesion and recurrence between group A and group C. there was significant difference in postoperative pain between group A and group C (P 0.05). B group, chronic pain, intestinal adhesion, chronic pain and intestinal adhesion). There was no significant difference in postoperative pain between group B and group C. there was significant difference in postoperative pain between group B and group C (P 0.05). Conclusion: laparoscopic and open tension-free inguinal hernia repair are safe and effective, and laparoscopy is superior to open tension-free hernia repair. Laparoscopic inguinal hernia repair patch can still achieve the effect of nailing after nailing without nailing. There is no significant difference in the total complications and the incidence of complications among the three groups. Laparoscopic mesh free hernia repair has the advantages of simple operation, clinical practice, less complications and low cost, so it is easy to be popularized and applied.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.21

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