摘要
目的探讨腹股沟疝日间手术腹腔镜全腹膜外疝修补术(TEP)与Lichtenstein术的临床疗效和优缺点。方法采用回顾性病例对照研究方法,分析绍兴市人民医院2019年2月至2020年4月收治的原发单侧腹股沟疝日间手术患者300例临床资料,按手术方式分为TEP组(采用TEP手术)和开放组(采用Lichtenstein手术),各150例。观察2组手术时间、出血量、住院时间及费用、术后下床时间、术后24 h内疼痛评分及超敏C反应蛋白变化,随访术后疼痛程度及持续时间、术后并发症、复发率等情况。结果TEP组的平均手术时间、住院时间明显少于开放组[(35.3±11)min vs(44.5±12)min,(16.8±1.8)h vs(17.2±1.5)h],差异均有统计学意义(P<0.05)。2组患者的出血量、住院费用比较,差异无统计学意义(P>0.05)。TEP组术后下床时间(4.3±1.1)h、术后24 h疼痛VAS评分(3.45±0.2)分及超敏C反应蛋白(12.73±2.09)mg/L明显优于开放组[(6.5±1.2)h、(4.86±0.3)分和(27.46±4.63)mg/L],差异均有统计学意义(P<0.05)。2组患者均获随访,无失访病例。开放组术后疼痛VAS评分高于TEP组,且2组患者术后疼痛程度均随时间推移逐渐减轻,差异有统计学意义(F_(时间)=10.09,P_(时间)<0.001;F_(组间)=1.35,P_(组间)=0.018;F_(交互)=9.37,P_(交互)<0.001)。TEP组患者尿潴留发生率低于开放组,皮下气肿发生率高于对照组,差异均有统计学意义(P<0.05)。2组患者阴囊水肿和(或)阴囊积液、切口血肿发生率、疝复发率差异无统计学意义(P>0.05)。TEP组并发症总发生率低于开放组(9.33%vs 12.67%),差异有统计学意义(P<0.05)。结论TEP与Lichtenstein术治疗成人腹股沟疝疗效相当,但是TEP具有创伤小、术后恢复快等优点,更适合于日间手术的开展。
Objective To explore the clinical efficacy,advantages and disadvantages of two surgical methods(TEP and Lichtenstein surgery)for day surgery for inguinal hernia.Methods A retrospective case-control study method was used to analyze 300 patients with primary unilateral inguinal hernia day surgery in People's Hospital of Shaoxing from February 2019 to April 2020.They were divided into a laparoscopic total extraperitoneal hernia repair group(TEP group)and a Lichtenstein surgery group(open group)according to the surgical method,with 150 cases in each group.The operation time,blood loss,hospitalization time and cost,postoperative ambulation time,24 h postoperative pain visual analogue scale(VAS)score and changes in highly sensitive C-reactive protein(hsCRP)of the two groups were observed.The pain level and duration,postoperative complications,recurrence rate of the two groups were followed up.Results Compared with the open group,the average operative time and hospital stay were shorter in the TEP group[(35.3±11)min vs(44.5±12)min,(16.8±1.8)h vs(17.2±1.5)h],with statistical significance(P<0.05).The blood loss and hospital costs showed no statistically significant differences between the two groups(P>0.05).Compared to the open group,the TEP group showed statistically significant differences in postoperative ambulation time and 24 h postoperatively pain VAS score,changes in hsCRP[(4.3±1.1)h,(3.45±0.2)scores,(12.73±2.09)mg/L vs.(6.5±1.2)h,(4.86±0.3)scores,(27.46±4.63)mg/L].All patients were followed up,with no missing cases.The VAS score of postoperative pain in the open group was higher than that in the TEP group,and the level of postoperative pain gradually decreased over time in both groups,with statistical significance(F=10.09,P<0.001;F=1.35,P=0.018;F=9.37,P<0.001,in time,group,and interaction).Compared with the open group,the incidence of urinary retention was lower,and subcutaneous emphysema was higher in the TEP group,with statistical significance(P<0.05).There were no statistically significant differences in the incidence of scrotal edema and/or hydrocele,incision hematoma,and recurrence rate between the two groups of patients(P>0.05).The overall complication rate in the TEP group was lower than in the open group(9.33%vs 12.67%),with a statistically significant difference(P<0.05).Conclusion TEP and Lichtenstein surgery are equally effective in treating adult inguinal hernia,but TEP has the advantages of less trauma and faster postoperative recovery,making it more suitable for day surgery.
作者
徐妙军
唐黎明
孙一峰
Xu Miaojun;Tang Liming;Sun Yifeng(Department of Hernia and Abdominal Wall Surgery,People's Hospital of Shaoxing,Shaoxing 312000,Zhejiang,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2024年第1期56-60,共5页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
基金
绍兴市科技计划项目(2018C30089)。
关键词
疝
腹股沟
腹腔镜
疝修补术
日间手术
Hernia,inguinal
Laparoscopy
Hernia repair
Day surgery
