腹腔镜下经腹腹膜前疝修补术与完全腹膜外疝修补术的比较及疼痛的影响因素分析  

Comparison of laparoscopic transabdominal preperitoneal repair and total extraperitoneal repair and analysis of influencing factors of pain

作　　者：翟岱垠 刘波 任晋蒙[1] 周宗起[1] 

机构地区：[1]山东省泰安市中医医院外二科,271000

出　　处：《中华疝和腹壁外科杂志（电子版）》2017年第6期448-451,共4页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜经腹腹膜前疝修补术(TAPP)与完全腹膜外修补术(TEP)的疗效差异,并对术后影响疼痛的因素进行研究。方法选取2015年8月至2016年1月,山东省泰安市中医医院接受治疗的腹股沟疝患者178例,根据治疗方法不同分为TAPP组(97例)及TEP组(81例),分别进行腹腔镜下TAPP和TEP治疗。比较2组手术指标及并发症发生情况,评估患者术后急慢性疼痛情况,并分析其影响因素;术后随访12个月,统计2组复发比例。结果 TAPP组手术时间较TEP延长(P<0.05),2组术中出血量、术后排气时间及住院时间无明显差异(P>0.05);术后12个月随访期间,2组均无复发病例。术后TAPP组并发症发生率12.37%,TEP组为12.35%,2组间比较,差异无统计学意义(P>0.05)。2组术后NRS评分及IPQ评分比较,差异无统计学意义(P>0.05);年龄<65岁患者术后第2 d NRS评分明显高于≥65岁患者,差异有统计学意义(P<0.05)。结论腹腔镜下TAPP与TEP治疗腹股沟疝均是有效及可行的,应根据患者具体情况选择术式;同时,随着时间的延长,患者急慢性疼痛感有所缓解,对于年轻患者可于术后早期给予适当止痛治疗。Objective To investigate the difference of laparoscopic transabdominal preperitoneal repair （TAPP） and total extraperitoneal repair （TEP）, and to study the factors that affect the postoperative pain. Methods A total of 178 patients with inguinal hernia treated in Taian Traditional Chinese Medicine Hospital from August 2015 to January 2016 were selected and divided into TAPP group （ n = 97 ） and TEP group （ n = 81 ） according to the different treatment methods, laparoscopic TAPP and TEP were performed respectively. The operation indexes and complications of the 2 groups were compared. The incidence of postoperative acute and chronic pain were assessed and the influencing factors were analyzed. The patients were followed-up for 12 months, the recurrence rates of the 2 groups were statistically analyzed. Results The operation time of TAPP group was longer than that of the TEP group （ P 〈 0. 05 ） , there were no significant differences between the 2 groups in the amount of bleeding, the time of postoperative exhaust and the length of stay （P 〉 0.05 ） , there was no recurrence in the 2 groups after 12 months followed-up. The postoperative complication rate of the TAPP group was 12.37% , and which was 12.35% in the TEP group, there was no significant difference between the 2 groups （ P 〉 0.05 ） and the NRS, IPQ scores between the 2 groups had no significant difference （P 〈 0.05）. The NRS score of patients at the age of 〈 65 at 2rd days after postoperative was higher than that of i〉 65 years old patients （ P 〈 0.05 ）. Conclusion Laparoscopic TAPP and TEP are effective and feasible for the treatment of inguinal hernia. The procedure should be selected according to the specific condition of the patients. Meanwhile, with the prolongation of time, the acute and chronic pain of the patients is relieved. For young patients, adequate pain relief therapy can be performed early after surgery.

关 键 词：疝 腹股沟 疝修补术 腹腔镜 疼痛 

分 类 号：R656.21[医药卫生—外科学]