腹腔镜下全腹膜外腹股沟疝修补术与经正中线切口腹膜前腹股沟疝修补术的比较研究  

Comparative Analysis of Laparoscopic Total Extraperitoneal Repair Versus Preperitoneal Inguinal Hernia Repair via Midline Incision

作　　者：王桐生[1] 丁磊[1] 赵爱民[1] 许开宇[1] 高宏[1] 张能维[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院普通外科,北京100038

出　　处：《中国微创外科杂志》2016年第2期118-121,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：北京市卫生和计划生育委员会"北京市卫生系统高层次卫生技术人员培养计划"(项目编号:Z201412201712)

摘　　要：目的比较腹腔镜下全腹膜外腹股沟疝修补术（totalextraperitonealrepair，TEP）与经正中线切口腹膜前腹股沟疝修补术治疗成人腹股沟疝的效果。方法2011年1月～2014年12月，94例成人腹股沟疝采用腹腔镜下完全腹膜外游离腹膜前间隙，放置补片（TEP组），83例成人腹股沟疝采用下腹正中小切口游离腹膜前间隙，放置补片（开放组），比较2组手术时间、住院时间、住院费用、术后应用止痛药物情况、血清肿与切口裂开情况等。结果TEP组手术时间（76±14）min，明旺长于开放组（47±8）min（t=16．623，P=0．000）；住院费用（9568．95±1422．23）元，明显高于开放组（5327．75±662．76）元（t=24．88，P=0．000）；开放组术后应用镇痛剂（15例vs．6例，X2=5．760，P=0．016）、切口脂肪液化裂开（4例VS．0例，P=0．046，）例数均明显高于TEP组；TEP组住院时间（4．9±0．6）d，与开放组（5．0±0．5）d无统计学差异（t=-1．195，P=0．234）；2组血清肿无统计学差异（6例VS．1例，X2=2．937，P=0．087）。177例随访3～12个月，平均7．4月，2组均无疝复发、补片感染、慢性疼痛、睾丸萎缩等并发症发生。结论开放手术在手术时间和住院费用上较TEP有明短优势，但术后疼痛、切口并发症高于TEP组，更适合双侧疝及复发疝，对单侧初发疝的治疗无明显优势。Objective To compare curative effects of laparoseopic total extraperitoneal repair （TEP） versus preperitoneal inguinal hernia repair via midline incision. Methods From January 2011 to December 2014, the TEP operation was conducted in 94 patients （TEP group） , during which the mesh was placed under total laparoscopie extraperitoneal approach, while the open operation was carried out in 83 patients （open group） , during which the mesh was placed into after preperitoneal space exposure via a midline incision. The operation time, length of hospital stay, cost of hospitalization, application of analgesics, seroroa, fat liquefaction and incision split were compared between the two groups. Results The operation time was significantly longer in the TEP group lhan that in the open group [ （ 76 ± 14） min vs. （47 ± 8 ） rain, t = 16. 623, P = 0. 000 ]. The cost of hospitalization was significantly higher in the TEPgroup than that in the open group [（9568.95 ±1422,23） yuan vs. （5327.75±662.76） yuan, t=24.881, P=0.O00]. The application rate of analgesics and incidence of fat liquefaction and incision split were significantly higher in the open group than those in the TEP group [ 15 vs. 6, X2 = 5. 760, P = 0.016 ; 4 vs, 0, P = 0. 046 ]. There was no significant difference between the TEP group and fhe open group in the postoperative hospital stay （4.9±0.6 days vs. 5.0±0.5 days, t = - 1. 195, P=0.234） and the incidence of seroma （ 6 vs. 1 , X2 = 2. 937, P = 0. 087 ） . All the 177 cases were followed up for 3 - 12 months （ mean, 7.4 months）. No severe postoperative complication was encountered in both groups, such as recurrence, mesh infection, chronic pain after hernia repair, or testicle atrophy. Conclusions Open surgery is superior to TEP in operation time and cost of hospitalization hut has higher incidence of postoperative pain and incision complications, being suitable for bilateral hernia and recurrent hernia. It has no significant advantages for incipient unilateral inguinal h

关 键 词：腹股沟疝 疝修补术 正中切口 腹膜前 腹腔镜 

分 类 号：R656.21[医药卫生—外科学]