基于膜解剖指导的成人腹股沟疝腔镜腹膜前与开放腹膜前修补术疗效分析  

Analysis of the therapeutic effect of laparoscopic and open preperitoneal repair for adult patients with groin hernia guided by the principle of membrane anatomy

作　　者：付平 刘怡菁 谢云 黄亮 严卫忠 李东 冯学艺 汤睿 Fu Ping;Liu Yijing;Xie Yun;Huang Liang;Yan Weizhong;Li Dong;Feng Xueyi;Tang Rui(Shanghai Oriental Clinical Medical College,Nanjing Medical University,Nanjing 211166,China;Department of General Surgery,Anting Hospital,Jiading District,Shanghai,Shanghai 201805,China;Department of General Surgery,Lu'an Hospital,Anhui Medical University,Anhui 237001,China;Department of Hernia and Abdominal Wall Surgery,Shanghai East Hospital,Tongji University,Shanghai 200120,China)

机构地区：[1]南京医科大学上海东方临床医学院,211166 [2]上海市嘉定区安亭医院普外科,201805 [3]安徽医科大学附属六安医院普外科,237001 [4]同济大学附属上海市东方医院疝与腹壁外科,200120

出　　处：《中华疝和腹壁外科杂志(电子版)》2025年第1期83-87,共5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和采用超普网片的开放腹膜前修补术(UHS组)治疗成人腹股沟疝的临床疗效及膜解剖指导手术的意义。方法回顾性分析2022年1月至2023年10月,上海市嘉定区安亭医院普外科手术治疗的163例成人腹股沟疝患者的临床资料,依据手术方法分为TAPP组(采用腹腔镜经腹腹膜前手术)92例及UHS组(行开放腹膜前修补术)71例,分析2组患者的基线资料、手术情况、术后疼痛视觉模拟评分法(VAS)评分、住院时间、住院费用、以及术后并发症与复发情况。结果UHS组患者的年龄、美国麻醉医师协会分级高于TAPP组,2组患者疝分类、分型差异有统计学意义(P<0.001);2组患者的手术时间差异无统计学意义,与UHS组比较,TAPP组术后疼痛VAS评分更低、住院时间更短,但住院费用更高,差异均有统计学意义(P<0.001,P=0.001,P<0.001);2组术后并发症总体差异无统计学意义,但TAPP组无Clavien-DindoⅠ级以上并发症、UHS组有2例Ⅱ级和1例Ⅲ级并发症。结论基于膜解剖理念的TAPP和UHS腹膜前修补术治疗成人腹股沟疝均安全有效;TAPP具有腔镜视野优势、创伤更小、术后疼痛轻、恢复快;开放腹膜前术式的优势在于有多种麻醉方式选项,适用患者更广。Objective To compare the clinical efficacy of laparoscopic transabdominal preperitoneal repair(TAPP group)and open preperitoneal repair with Ultrapro Hernia System(UHS group)in the treatment of adult patients with groin hernia,and to explore the significance of membrane anatomy principle in guiding the surgical procedure.Methods The clinical data of 163 adult patients with groin hernia from January 2022 to October 2023 treated by general surgery in Anting Hospital,Jiading District,Shanghai were analyzed retrospectively.According to the surgical method,patients were divided into TAPP group(laparoscopic TAPP surgery,92 cases)and UHS group(open preperitoneal repair,71 cases).The baseline data,operative data,postoperative visual analogue scale(VAS)scores,length of hospital stay,total cost,postoperative complications and recurrence of the two groups was compared.Results The age,ASA grade of the patients in UHS group were higher than those in TAPP group.There were significant differences in hernia classification and type between the two groups(P<0.001).No significant difference in operation time were observed between two groups.Compared with the UHS group,the TAPP group had lower postoperative pain VAS scores and shorter hospital stays,but higher hospitalization costs,with statistically significant differences(P<0.001,P=0.001,P<0.001).There was no significant difference in the overall postoperative complications between the two groups.There was no Clavien-Dindo grade I or above complications in the TAPP group,and 2 cases of Clavien-Dindo gradeⅡand 1 case of gradeⅢcomplications in UHS group.Conclusion Both TAPP and open preperitoneal repair with UHS guided by the concept of membrane anatomy are safe and effective in the treatment of adult patients with groin hernia.TAPP has the advantages of better visual field with endoscopy,less trauma,less postoperative pain and faster recovery.The advantage of open preperitoneal surgery is that it provides a variety of anesthesia options,which means it can be performed for a wid

关 键 词：腹股沟疝 疝修补术 腹腔镜 治疗结果 膜解剖 

分 类 号：R65[医药卫生—外科学]