腹腔镜完全腹膜外补片植入术与Lichtenstein无张力疝修补术治疗腹股沟疝的疗效对比研究  

Efficacy comparison of the laparoscopic total extraperitoneal prosthetic and the Lichtenstein herniorrhaphy for inguinal hernia

作　　者：李义亮[1] 王志[1] 克力木[1] 苏福增[1] 张成[1] 李慧灵[1] 杜智[1] 祝志开 李松[1] 

机构地区：[1]新疆维吾尔自治区人民医院微创、疝和腹壁外科,乌鲁木齐830001

出　　处：《中华胃肠外科杂志》2017年第8期928-931,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的 比较腹腔镜完全腹膜外补片植入术（TEP）与Lichtenstein无张力疝修补术治疗腹股沟疝的临床疗效和安全性。方法 回顾性分析2015年10月至2016年10月间新疆维吾尔自治区人民医院收治的158例腹股沟疝患者的病历资料，其中85例患者行TEP术（TEP组），73例患者行Lichtenstein无张力疝修补术（Lichtenstein组）。TEP组全身麻醉，分离耻骨膀胱间隙和髂窝间隙，术中注意保护精索，避免对其过分分离；放置补片时，内侧超过对侧的耻骨结节，外侧至髂前上棘，上缘与联合肌腱至少有2 cm的重叠，下缘内侧插入耻骨膀胱间隙（Retzius间隙），下缘外侧至少距内环口6 cm。Lichtenstein组局部麻醉或连续硬膜外麻醉，行常规Lichtenstein无张力疝修补术。比较两组手术时间、术后情况及复发情况。结果 158例腹股沟疝患者中男129例，女29例，年龄26~75（中位数42）岁，TEP组与Lichtenstein组患者基线资料的差异无统计学意义（均P 〉 0.05）。两组手术时间相近[（47.6 ± 5.4）min比（48.9 ± 6.3）min，t= 0.238，P= 1.024]，但在术中出血量[（7.5 ± 2.3）ml比（11.4 ± 4.5）ml，t= 5.783，P= 0.032]、术后自主下床活动时间[（1.25 ± 0.32）d比（2.83 ± 0.52）d，t= 5.294，P= 0.041]、术后住院天数[（2.38 ± 1.14）d比（3.46 ± 1.81）d，t= 5.482，P= 0.037]、术后第1天疼痛评分（1.27 ± 0.47比3.42 ± 1.93，t= 5.639，P= 0.034）方面，TEP组均优于Lichtenstein组。术后TEP组和Lichtenstein组各有1例出现切口感染；分别有2例和3例术后发生阴囊或大阴唇水肿；分别有1例和2例出现慢性疼痛。术后随访5~16（中位数10）月，两组有1例复发。结论 腹腔镜完全腹膜外补片植入术治疗腹股沟疝安全有效，与Lichtenstein无张力疝修补术对比，具有术后恢复快、创伤小、舒适度高的优点，值得临床推广。Objective To compare the efficacy and safety between laparoscopic total extraperitoneal prosthetic （TEP） and Lichtenstein herniorrhaphy in the treatment of inguinal hernia （IH） . Methods Clinical data of 158 IH patients at our hospital from October 2015 to October 2016 were retrospectively analyzed. Among 158 patients, 85 patients underwent TEP （TEP group） , and 73 underwent Lichtenstein herniorrhaphy （Lichtenstein group） . Patients of TEP group received general anesthesia. The space between suprapubic space and iliac fossa was separated with attention to protect the spermatic cord during the operation so as to avoid excessive separation. When the patch was placed, the internal margin exceeded the contralateral pubic tubercle, the lateral margin reached the anterior superior iliac spine, there was at least 2 cm overlap between the superior margin and the joint tendon, the lower margin was inserted into the suprapubic bladder space （Retzius space） , and the lateral lower margin was at least 6 cm to internal ring. Lichtenstein group received local anesthesia or continuous epidural anesthesia and all underwent routine Lichtenstein herniorrhaphy. Operative time, postoperative conditions and recurrence were compared between two groups.Results Among these 158 patients, 129 were male and 29 were female, with an age ranging from 26 to 75 years （median 42 years） . Baseline data were not significantly different between two groups （all P 〉 0.05） . There was no perioperative death and serious complications in two groups. The difference was not statistically significant in operative time[ （47.6 ± 5.4） minutes vs. （48.9 ± 6.3） minutes, t= 0.238, P= 1.024]. But TEP group was better than Lichtenstein group in terms of intraoperative blood loss[ （7.53 ± 2.31） ml vs. （11.41 ± 4.49） ml, t= 5.783, P=0.032], postoperative bedtime[ （1.25 ± 0.32） days vs. （2.83 ± 0.52） days, t= 5.294, P= 0.041], postoperative hospital stay[ （2.38 ± 1.14） days vs. （3.46 ± 1.81） days,

关 键 词：腹股沟疝 腹腔镜完全腹膜外补片植入术 Liehtenstein无张力疝修补术 

分 类 号：R656.21[医药卫生—外科学]