改良TEP、TAPP与Rutkow术式治疗腹股沟疝的疗效及安全性分析  

Analysis of the efficacy and safety of improved TEP,TAPP and Rutkow operation in the treatment of inguinal hernia.

作　　者：牛斌 仇明洋 李强 NIU Bin;QIU Ming-yang;LI Qiang(Department of General Surgery,Xinhua Hospital,Huainan Xinhua Medical Group,Huainan Anhui 232000,China.)

机构地区：[1]淮南新华医疗集团新华医院普外科,安徽淮南232000

出　　处：《临床和实验医学杂志》2021年第10期1098-1101,共4页Journal of Clinical and Experimental Medicine

基　　金：安徽省科学技术基金项目(编号:2013-3026)。

摘　　要：目的探讨改良完全腹膜外腹腔镜腹股沟疝修补术(TEP)、经腹腔腹膜前腹腔镜疝修补术(TAPP)与Rutkow术式治疗腹股沟疝的疗效及安全性。方法回顾性分析2018年8月至2010年10月淮南新华医疗集团新华医院诊治的150例腹股沟疝患者临床资料。按照治疗方法的不同分为3组,分别为A组(予以改良TEP术式治疗)、B组(予以TAPP术式治疗)、C组(予以Rutkow术式),各50例。对比手术时间、术后恢复正常活动时间、住院时间、住院费用、精索静脉管径、精索静脉血流速度、术后疼痛评分及并发症情况。结果A组与B组患者的手术时间[(52.11±5.62)、(53.05±5.78)min]长于C组[(43.52±3.85)min],而术后肛门排气时间[(4.21±1.02)、(4.32±1.25)d]、住院时间[(7.65±1.25)、(7.78±1.32)h]短于对照组[(6.78±1.45)d、(10.45±2.65)h],而住院费用[(10254.32±415.45)、(11351.04±542.11)元]高于C组[(5084.65±212.33)元],差异均有统计学意义(P<0.05)。术后4周,A组患者精索静脉管径[(1.98±0.56)mm]低于B、C组[(2.14±0.69)、(2.19±0.75)mm],但差异无统计学意义(P>0.05),A组精索静脉血流速度[(1.85±0.21)cm/s]高于B、C组[(1.72±0.14)、(1.64±0.10)cm/s],差异均有统计学意义(P<0.05)。术后12、24、48 h,A组的视觉模拟量表(VAS)评分[(2.45±0.24)、(1.82±0.18)、(1.12±0.10)分]低于B、C组[(3.48±0.52)、(3.11±0.41)、(2.14±0.28)分,(4.25±0.72)、(3.95±0.61)、(2.89±0.41)分],差异均有统计学意义(P<0.05)。A组患者的并发症发生率(2.00%)低于B组(6.00%),但差异无统计学意义(P>0.05),显著低于C组(22.00%),差异有统计学意义(P<0.05)。A组患者复发率(0)低于B、C组(2.00%、6.00%),但差异无统计学意义(P>0.05)。结论改良TEP、TAPP术与Rutkow术式治疗腹股沟疝均具有明显疗效,但第一种术式安全性性更高,对患者创伤小及术后恢复快。Objective To explore the improvement of the efficacy and safety of total extraperitoneal laparoscopic inguinal hernia repair(TEP),transabdominal preper-itoneal hernia repair(TAPP)and Rutkow in the treatment of inguinal hernia.Methods The clinical data of 150 patients with inguinal hernia diagnosed and treated by Xinhua Hospital,Huainan Xinhua Medical Group from August 2018 to October 2010 were retrospectively analyzed.They were divided into three groups according to the different treatment methods,namely group A(improved TEP treatment),group B(treated with TAPP operation),group C(treated with Rutkow operation),50 cases in each group.The operation time,the time to resume normal activities after the operation,the length of hospitalization,the cost of hospitalization,the diameter of the spermatic vein,the blood flow velocity of the spermatic vein,the postoperative pain score and the complications were compared.Results The operation time of group A and group B patients[(52.11±5.62),(53.05±5.78)min]was longer than that of group C[(43.52±3.85)min],and the postoperative anal exhaust time[(4.21±1.02),(4.32±1.25)d],hospitalization time[(7.65±1.25),(7.78±1.32)h]was shorter than that of control group[(6.78±1.45)d,(10.45±2.65)h],and hospitalization expenses[(10254.32±415.45),(11351.04±542.11)yuan]were higher than those of group C[(5084.65±212.33)yuan],the differences were statistically significant(P<0.05).At 4 weeks postoperatively,the diameter of the spermatic vein[(1.98±0.56)mm]in group A was lower than that in groups B and C[(2.14±0.69),(2.19±0.75)mm],but the difference was not statistically significant(P>0.05),the blood flow velocity of the spermatic vein in group A[(1.85±0.21)cm/s]was higher than that in groups B and C[(1.72±0.14),(1.64±0.10)cm/s],the difference was statistically significant significance(P<0.05).At 12,24,and 48 h after surgery,the visual analogue scale(VAS)scores of group A[(2.45±0.24),(1.82±0.18),(1.12±0.10)points]were lower than those of groups B and C[(3.48±0.52),(3.11±0.41),(2

关 键 词：腹股沟疝 改良完全腹膜外腹腔镜腹股沟疝修补术 经腹腔腹膜前腹腔镜疝修补术 Rutkow术式 安全性 

分 类 号：R656.21[医药卫生—外科学]