完全腹膜化腹腔内置网片与经腹腹膜前修补术的对比研究  

Comparative study between total peritoneum intraperitoneal onlay mesh and transabdominal preperitoneal repair

作　　者：杨喜光[1] 向国安[2] 张达[3] 陈小勋[1] 陈开运[2] 张兆明[1] 王汉宁[2] 

机构地区：[1]贵港市人民医院胃肠外科,广西537100 [2]广东省第二人民医院普通外科,广州510317 [3]西安市中心医院普通外科,710003

出　　处：《中华疝和腹壁外科杂志（电子版）》2015年第1期1-5,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：吴阶平医学基金会临床科研基金资助项目(No.320675009106);广东省医学科学基金资助项目(No.A2009132);西安市科技计划基金资助项目(No.SF13245)

摘　　要：目的探讨腹腔镜下脐正中襞或脐内侧襞覆盖完全腹膜化腹腔内置网片（TPIPOM）与经腹腹膜前修补术（TAPP）修补腹股沟疝的优缺点。方法回顾性分析2010年1月至2012年1月,广东省第二人民医院行TPIPOM手术患者资料,并与同期行TAPP患者资料进行对比。比较指标包括手术时间、术后住院时间、下床活动时间、术后疼痛持续时间、使用止痛药例数、术前1 d、术后4 h、术后1、2、3 d血白细胞计数（WBC）、C-反应蛋白（CRP）以及炎性因子白介素6（IL-6）、住院费用、术后随访情况等。结果 TPIPOM组完成96例,TAPP组完成72例。TPIPOM组手术时间、术后住院时间、下床活动时间、术后疼痛持续时间、住院费用、使用止痛药患者例数明显少于TAPP组,差异有统计学意义（t=20.7605、3.7748、6.1778、5.5989、15.2444,χ^2=4.495 9,P=0.000 0、0.0002、0.0000、0.000 0、0.000 0、0.0340）。术前1 d,二组患者WBC、CRP和IL-6差异无统计学意义（t=1.4846、1.0233、1.284 2,P=0.139 5、0.3077、0.2008）。术后4 h、术后1、2、3 d,TPIPOM组WBC均低于TAPP组,差异均有统计学意义（t=3.1816、7.147 8、2.388 6、2.0520,P=0.001 7、0.0000、0.0180、0.0417）。术后4 h、术后1、2、3 d,TPIPOM组CRP均低于TAPP组,差异均有统计学意义（t=4.852 0、3.057 8、3.695 8、3.299 0,P=0.000 0、0.0026、0.000 3、0.0012）。术后4 h、术后1、2、3 d,TPIPOM组IL-6均低于TAPP组,差异均有统计学意义（t=8.190 5、6.4618、4.8054、2.485 9,P=0.0000、0.0000、0.0000、0.0139）。术后随访24-48个月,二组均未发现肠粘连、肠梗阻以及疝复发。结论 TPIPOM具有手术操作简单、手术时间短、疼痛轻、恢复快、住院时间短、住院费用低、不易复发、微创等优势;适宜在基层医院推广。Objective To investigate the advantages and disadvantages between laparoscopic total peritoneum intraperitoneal onlay mesh（ TPIPOM） with median umbilicusfold（ or medial umbilical fold） and transabdominal preperitonealrepair（ TAPP） for inguinal hernia. Methods The clinical data of patients who received TPIPOM or TAPP operations in Guangdong No. 2 Provincial People＇s Hospital from January 2010 to January 2012 was retrospective analyzed. The comparative indexes as follows： operative time,postoperativehospital stay,out-of-bed activity time,durante dolors after operation,use of painkillers,white blood cell count（ WBC）,C-reactive protein（ CRP） and interleukin-6（ IL-6）（ at preoperative 1th day,postoperative 4 hours,1th,2th and 3th day）,hospitalization cost,follow-up information and so on. Results96 cases in TPIPOM group and 72 cases in TAPP group were successfully completed. Operative time,postoperative hospital stay,out-of-bed activity time,durante dolors after operation,average hospitalization cost and cases of using analgesic in TPIPOM team were significantly less than those in TAPP group（ t =20. 760 5,3. 774 8,6. 177 8,5. 598 9,15. 244 4,χ^2= 4. 495 9,P = 0. 000 0,0. 000 2,0. 000 0,0. 000 0,0. 000 0,0. 034 0）. WBC,CRP and IL-6 at 1 th day before the operation had no differences in both groups（ t = 1. 484 6,1. 023 3,1. 284 2,P = 0. 139 5,0. 307 7,0. 200 8）. Postoperatively,WBC in TPIPOM group which were tested at 4 hours,1 th,2 th and 3 th day were respectively lower than those in TAPP group（ t =3. 181 6,7. 147 8,2. 388 6,2. 052 0,P = 0. 001 7,0. 000 0,0. 018 0,0. 041 7）. CRP in TPIPOM group which were tested at 4 hours,1th,2th and 3th day were respectively lower than those in TAPP group（ t =4. 852 0,3. 057 8,3. 695 8,3. 299 0,P = 0. 000 0,0. 002 6,0. 000 3,0. 001 2）. IL-6 in TPIPOM group which were tested at 4 hours,1th,2th and 3th days were respectively lower than those in TAPP group（ t =8. 190 5,6. 461 8,4. 805 4,2. 485 9,P = 0. 000 0,0. 000 0,0. 000 0,0. 013 9）

关 键 词：疝 腹股沟 疝修补术 腹腔镜 对比研究 

分 类 号：R656.21[医药卫生—外科学]