腹腔镜经腹腹膜前疝修补术和腹腔镜完全腹膜外疝修补术对成人腹股沟疝治疗效果及预后分析  

Analysis of laparoscopic trans-abdominal preperitoneal hernia repair and laparoscopic totally extra-peritoneal hernia repair on efficacy and prognosis of inguinal hernia in adults

作　　者：于新峰 曾琦 后强 徐浩 操谢芳 Yu Xinfeng;Zeng Qi;Hou Qiang;Xu Hao;Cao Xiefang(General Treatment Center,Deyu Medical Maanshan General Hospital,Ma'anshan 243000,Anhui Province,China;General Surgery Department,Shiyan City Maternal and Child Health Care Hospital,Shiyan 442000,Hubei Propvince,China)

机构地区：[1]德驭医疗马鞍山总医院普外诊疗中心,安徽243000 [2]十堰市妇幼保健院普外科,湖北442000

出　　处：《中华疝和腹壁外科杂志(电子版)》2024年第6期681-686,共6页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

基　　金：十堰市科技局科研基金项(22Y50)。

摘　　要：目的探究腹腔镜经腹腹膜前疝修补术(TAPP)和完全腹膜外疝修补术(TEP)对成人腹股沟疝的疗效及预后。方法回顾性分析2021年6月至2022年11月德驭医疗马鞍山总医院普外科收治的腹股沟疝患者的临床资料,根据接受术式不同,将其分为TAPP组(接受TAPP术治疗)与TEP组(接受TEP术治疗),通过倾向性匹配评分法(卡钳值设置0.02)排除基线资料混杂因素影响,最终2组各获得患者60例。对比2组围手术期指标、并发症,术前及术后6、12、24 h视觉模拟评分(VAS),术前、术后24 h应激指标,术前、术后4周男性患者精索静脉情况(精索静脉管径及精索静脉血流速度),以及术后12个月复发率。结果TEP组术中出血量、创口直径、手术时间、下床活动时间少于TAPP组(P<0.05),而2组住院时间差异无统计学意义(P>0.05);TEP组并发症总发生率为3.33%(2/60),TAPP组并发症总发生率为6.67%(4/60),差异无统计学意义(P>0.05);组间与时间对TEP组与TAPP组患者的VAS评分存在交互作用(P<0.05),组间、时间对VAS主效应显著(P<0.05);术后24 h,2组患者皮质醇(Cor)、醛固酮(ALD)、去甲肾上腺素(NE)水平高于术前(P<0.05),TEP组术后24 h Cor、ALD、NE水平低于TAPP组(P<0.05);术后4周,2组男性患者精索静脉管径高于术前(P<0.05),TEP组男性患者精索静脉管径低于TAPP组(P<0.05),2组男性患者精索静脉血流速度低于术前(P<0.05),TEP组男性患者精索静脉血流速度高于TAPP组(P<0.05);术后12个月,TEP组总复发率(5.00%,3/60)与TAPP组(1.67%,1/60)比较,差异无统计学意义(P>0.05)。结论腹腔镜TAPP术与TEP术均可有效治疗腹股沟疝,并发症较少,但TEP术创伤更小、恢复更快、对男性患者精索静脉影响更小,可酌情选择合适术式。Objective To explore the influence of laparoscopic trans-abdominal preperitoneal hernia repair(TAPP)and laparoscopic totally extra-peritoneal hernia repair(TEP)on the efficacy and prognosis of adults with inguinal hernia.Methods Data of patients with inguinal hernia admitted to department of general surgery of Deyu Medical Ma&apos;anshan General Hospital from June 2021 to November 2022 were retrospectively analyzed.According to different surgical methods,they were divided into TAPP group(TAPP treatment)and TEP group(TEP treatment).The propensity matching score method(caliper value=0.02)was used to exclude the influence of confounding factors of baseline data.Finally,60 patients were obtained in each group(P>0.05).The perioperative indicators,complications,visual analogue scale(VAS)scores before surgery and at 6,12 and 24 h after surgery,stress indicators before surgery and at 24 h after surgery,spermatic vein in male patients(spermatic vein diameter and spermatic vein blood flow velocity)before surgery and at 4 w after surgery,and recurrence rate within 1 year were compared between the two groups.Results The intraoperative blood loss,wound diameter,surgical time,ambulation time in TEP group were significantly less or shorter than those in TAPP group(P<0.05).There was no significant difference in hospital stay between the two groups(P>0.05).There was no statistical significance in the incidence of complications between TEP group(3.33%,2/60)and TAPP group(6.67%,4/60)(P>0.05).There was interaction between groups and time on VAS scores in TEP group and TAPP group(P<0.05).The main effect between groups and time on VAS was significant(P<0.05).The levels of cortisol(Cor),aldosterone(ALD)and norepinephrine(NE)in both groups were significantly increased at 24 h after surgery than those before surgery(P<0.05),but the levels of Cor,ALD and NE were significantly lower in TEP group than those in TAPP group after surgery(P<0.05).At 4 w after surgery,the spermatic vein diameter of male patients in the two groups was significant

关 键 词：疝 腹股沟 疝修补术 腹腔镜 

分 类 号：R65[医药卫生—外科学]