腹腔镜下关闭Ⅲ型腹股沟斜疝内环联合补片修补的临床疗效  

Clinical efficacy of laparoscopic closure of internal ring combined with mesh repair for typeⅢindirect inguinal hernia

作　　者：罗彬予 张肖 郭庆 喻晶 张大权 李权林[1] 周冬兵[1] 田云鸿[1] 任明扬[1] Binyu Luo;Xiao Zhang;Qing Guo;Jing Yu;Daquan Zhang;Quanlin Li;Dongbing Zhou;Yunhong Tian;Mingyang Ren(Department of Gastrointestinal Surgery,Affiliated Nanchong Central Hospital&The Second Clinical Medical College of North Sichuan Medical College,Nanchong 637000,Sichuan Province,China)

机构地区：[1]川北医学院第二临床医学院·南充市中心医院胃肠疝外科,四川637000

出　　处：《中华疝和腹壁外科杂志（电子版）》2024年第2期197-201,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜下关闭Ⅲ型腹股沟斜疝内环联合补片修补手术的临床疗效。方法采用前瞻性随机对照研究方式,将2020年5月至2021年12月,川北医学院附属南充市中心医院收治的193例Ⅲ型腹股沟斜疝患者随机分为内环关闭试验组(93例)和未关闭对照组(100例),比较2组患者手术时间、术后住院时间、术后疼痛视觉模拟评分(VAS)、血清肿及血清肿积液量、住院费用、并发症及复发情况等。结果试验组在术后7 d[32(34.4%)比63(63.0%)]、14 d[16(17.2%)比35(35.0%)]、21 d[6(6.5%)比20(20.0%)]血清肿发生比率低于对照组,差异均有统计学意义(P<0.01);对照组在术后7 d[(36.44±16.57)ml比(45.44±15.27)ml]、14 d[(23.88±9.20)ml比(32.23±8.87)ml]出现血清肿积液量高于试验组,差异均有统计学意义(P<0.05)。对照组在术后7 d[39(41.9%)比60(60.0%)]、14 d[17(18.2%)比33(33.0%)]、21 d[6(6.4%)比22(22.0%)]疼痛患者例数占比明显高于试验组,差异均有统计学意义(P<0.05);对照组在术后7 d[(1.95±0.71)分比(2.37±0.62)分]、14 d[(1.65±0.49)分比(2.12±0.49)分]VAS评分高于试验组,差异均有统计学意义(P<0.05);试验组手术时间长于对照组[(64.1±12.1)min比(54.9±9.7)min],差异有统计学意义(P<0.05);2组住院时间、总住院费用及术后并发症(尿潴留、肠梗阻、恶心、呕吐、出血及感染)发生率比较,差异均无统计学意义(P>0.05)。术后随访时间3~20个月,2组患者随访期间均未出现慢性疼痛及复发。结论腹腔镜下缝合关闭Ⅲ型斜疝内环缺损是安全并有效的,可显著减少术后血清肿发生率,并进一步减轻术后疼痛,且不增加术后感染、复发等风险。Objective To investigate the clinical efficacy of laparoscopic closure of internal ring combined with mesh repair for typeⅢindirect inguinal hernia.Methods In this prospective randomized controlled study,193 patients with typeⅢindirect inguinal hernia admitted to Nanchong Central Hospital Affiliated to North Sichuan Medical College from May 2020 to December 2021 were randomly divided into the experimental group(close internal ring,93 cases)and the control group(not close internal ring,100 cases).The operation time,postoperative hospital stays,postoperative pain visual analogue scale(VAS)score,seroma and seroma fluid volume,hospitalization cost,complications and recurrence were compared between the two groups.Results The incidence of seroma in the experimental group was lower than that in the control group on the 7 d[32(34.4%)vs 63(63.0%)],14 d[16(17.2%)vs 35(35.0%)],21 d[6(6.5%)vs 20(20.0%)]after operation,and the difference was statistically significant(P<0.01).The seroma fluid volume in the control group was higher than that in the experimental group on the 7 d[(36.44±16.57)ml vs(45.44±15.27)ml]and 14 d[(23.88±9.20)ml vs(32.23±8.87)ml]days after operation,and the difference was statistically significant(P<0.05).The number of patients with pain in the control group was significantly higher than that in the experimental group at 7 d[39(41.9%)vs 60(60.0%)]、14 d[17(18.2%)vs 33(33.0%)]、21 d[6(6.4%)vs 22(22.0%)]after operation,and the difference between the two groups was statistically significant(P<0.05).The VAS score in the control group was higher than that in the experimental group at 7 d[(1.95±0.71)points vs(2.37±0.62)points]and 14 d[(1.65±0.49)points vs(2.12±0.49)points]after operation,and the difference between the two groups was statistically significant(P<0.05).The operation time in the experimental group was longer than that in the control group[(64.1±12.1)min vs(54.9±9.7)min],and the difference was statistically significant(P<0.05).There was no significant difference between the two group

关 键 词：腹腔镜 Ⅲ型腹股沟斜疝 补片 关闭疝环 血清肿 术后疼痛 

分 类 号：R656.21[医药卫生—外科学]