腹腔镜经腹膜前疝修补术与疝环充填式无张力修补术治疗成人腹股沟疝的临床预后对比分析
吕承刚 刘良超▲ 王亚东 程欣 屠佳
安徽省芜湖市中医医院普通外科,安徽芜湖 241000
Comparative analysis of laparoscopic transperitoneal hernia repair between hernia ring filling tension-free repair in adults with inguinal hernia
LYU Chenggang LIU Liangchao▲ WANG Yadong CHENG Xin TU Jia
Department of General Surgery, Traditional Chinese Medical Hospital of Wuhu City, Anhui Province, Wuhu 241000, China
摘要 目的 比较分析腹腔镜经腹膜前疝修补术(TAPP)和疝环充填式无张力修补术两种手术方式在治疗腹股沟疝的临床预后。 方法 选取2017年1月至2020年4月在安徽省芜湖市中医医院接受手术的腹股沟疝患者170例,根据在院施行手术方案分为疝环充填式无张力修补术(对照组,84例)和TAPP(观察组,86例)。比较两组患者手术时间、术后疼痛评分、恢复正常活动时间、术后住院时间、住院费用及并发症总发生率情况。 结果 两组并发症总发生率比较,差异无统计学意义(P > 0.05)。两组手术时间比较,差异无统计学意义(P > 0.05)。观察组术后疼痛评分低于对照组、术后恢复正常活动时间、术后住院时间及住院费用均短于对照组,差异均有统计学意义(P < 0.05),但观察组住院费用高于对照组,差异有统计学意义(P < 0.05)。 结论 TAPP在成人腹股沟疝的应用中较安全,且具备术后疼痛减轻、患者恢复快等优势,可推广应用于临床。
关键词 :
腹腔镜 ,
腹膜前疝修补 ,
疝环充填 ,
无张力疝修补术
Abstract :Objective To compare and study the prognosis between different surgical ways of laparoscopic transabdominal preperitoneal (TAPP) hernia repair and mesh plug tension-free hernioplasty. Methods A total of 170 cases of inguinal hernia patients who underwent surgery in Traditional Chinese Medical Hospital of Wuhu City from January 2017 to April 2020 were selected. According to the surgical plan performed in the hospital, they were divided into hernia ring filling tension-free repair (control group, 84 cases) and TAPP (observation group, 86 cases). The operation time, postoperative pain score, time to return to normal activities, postoperative hospital stays, hospitalization expenses and total incidence of complications were compared between two groups. Results There was no significant difference in total incidence of complications between the two groups (P > 0.05). There was no significant difference in operation time between two groups (P > 0.05). The postoperative pain score of the observation group was lower than that of the control group, and the postoperative recovery time to normal activities, postoperative hospital stays and hospitalization expenses were shorter than those of the control group, the differences were statistically significant (P < 0.05), but the hospitalization expenses of the observation group was higher than that of the control group, the difference was statistically significant (P < 0.05). Conclusion TAPP is safer in application of adult inguinal hernia, and has the advantages of postoperative pain reduction and faster recovery of patients, and can be promoted and applied in clinical practice.
Key words :
Laparoscopic
Inguinal hernia repair
Mesh plug
Tension-free hernia repair
基金资助: 安徽省科技攻关计划项目(1607a0202076)。
通讯作者:
▲通讯作者
作者简介 : 吕承刚(1982.3-),男,硕士;研究方向:胃肠外科,疝与腹壁外科。
引用本文:
吕承刚 刘良超▲ 王亚东 程欣 屠佳. 腹腔镜经腹膜前疝修补术与疝环充填式无张力修补术治疗成人腹股沟疝的临床预后对比分析[J]. 中国医药导报, 2021, 18(26): 121-124.
LYU Chenggang LIU Liangchao▲ WANG Yadong CHENG Xin TU Jia . Comparative analysis of laparoscopic transperitoneal hernia repair between hernia ring filling tension-free repair in adults with inguinal hernia. 中国医药导报, 2021, 18(26): 121-124.
链接本文:
https://www.yiyaodaobao.com.cn/CN/ 或 https://www.yiyaodaobao.com.cn/CN/Y2021/V18/I26/121
[1] 李胜君,祁燕红.腹腔镜经腹腹膜前疝修补术与完全腹膜外疝修补术的疗效对比[J].中华疝和腹壁外科杂志:电子版,2018,12(3):207-210.
[2] 欧阳剑波,黄耿文,何文,等.多学科合作快速康复外科理念在腹腔镜腹股沟疝修补术围手术期的应用[J].中国普通外科杂志,2017,26(4):506-513.
[3] 史桂宝,黄其根,赵华,等.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治疗成人腹股沟疝的疗效[J].中华疝和腹壁外科杂志:电子版,2020,14(3):254-256.
[4] 王宁华.疼痛定量评定的进展[J].中国临床康复,2000,6(18):2739-2738.
[5] Usmani F,Wijerathne S,Malik S,et al. Effect of direct defect closure during laparoscopic inguinal hernia repair(“TEP/TAPP plus” technique) on post-operative outcomes [J]. Hernia,2020,24(1):167-171.
[6] 王明刚,申英末,陈杰,等.腹腔镜经腹腔腹膜前疝修补技术治疗复发性腹股沟疝的疗效观察[J].中华医学杂志,2016,96(20):1588-1590.
[7] 王卫军,陈军政,方钱,等.腹腔镜腹股沟疝修补术与Lichtenstein无张力疝修补术的前瞻性随机对照研究[J].中国微创外科杂志,2012,12(8):692-695.
[8] 李瑞斌,吴攀,万智恒,等.经腹腹膜前腹腔镜腹股沟疝修补术在腹股沟疝无张力修补中的应用[J].中国普通外科杂志,2020,29(10):1275-1279.
[9] 刘景平,万智恒,李瑞斌,等.腹腔镜经腹腹膜前疝修补术与开放无张力疝修补术治疗腹股沟疝的疗效比较[J].中华疝和腹壁外科杂志:电子版,2020,14(5):485-488.
[10] 王钢普,李海,代国锋,等.腹腔镜经腹腹膜前腹股沟疝修补术的学习曲线[J].腹腔镜外科杂志,2019,24(12):929-932.
[11] 陈昕,徐露,殷骏,等.腹腔镜经腹腹膜前疝修补术的临床疗效及术后并发症危险因素分析[J].中华消化外科杂志,2017,16(9):920.
[12] 王祥龙.腹腔镜腹膜前疝修补术与Lichtenstein平片疝修补术治疗腹股沟疝的疗效比较[J].中国普通外科杂志,2016,25(4):587.
[13] 梁国栋,徐壮,杨玉波,等.腹腔镜经腹腹膜前疝修补术和李金斯坦手术对老年腹股沟疝患者的临床疗效[J].中华疝和腹壁外科杂志:电子版,2019,13(6):589-592.
[14] 马宁,于洪燕,汤福鑫,等.加速康复外科模式在腹腔镜经腹腹膜前腹股沟疝修补术中的应用[J].中华普通外科学文献:电子版,2019,13(4):291-295.
[15] Wormer BA,Ross SW,Walters AL,et al. Bladder Fill after Laparoscopic Inguinal Hernia Repair Reduces Time to Discharge [J]. The American Surgeon,2017,83(4):385-389.
[16] 贾传新,吕亮宏,吕忠船,等.腹腔镜经腹腹膜前疝修补术与李金斯坦术治疗成人腹股沟疝的临床对比研究[J].腹腔镜外科杂志,2020,25(5):386-388.
[17] 荀江.Lichtenstein和腹腔镜经腹腹膜前疝修补术在腹股沟阴囊疝患者中的临床应用[J].中华疝和腹壁外科杂志:电子版,2020,14(4):363-365.
[18] Dhawan N,Goyal KS,Sodhi TPS,et al. Comparative study of laparoscopic and conventional (Lichtenstein tension free) inguinal hernia repair in a tertiary care institute [J]. International Surgery Journal,2019,6(10):3739-3743.
[19] Peitsch WK. A modified laparoscopic hernioplasty (TAPP) is the standard procedure for inguinal and femoral hernias: a retrospective 17-year analysis with 1,123 hernia repairs [J]. Surg Endosc,2014,28(2):671-682.
[20] 王梦桥,徐宇飞,黄河,等.腹腔镜腹膜前间隙疝修补术疝囊剥离与横断处理的临床分析[J].中华疝和腹壁外科杂志:电子版,2016,10(2):98-100.
[21] 成晓舟,屈坤鹏,景恩义,等.腹腔镜经腹腹膜前疝修补术中采用疝囊剥离与横断处理治疗Ⅲ型腹股沟疝的对比研究[J].腹腔镜外科杂志,2016,2l(10):780-782.
[22] 李英儒,甘文昌,曾兵,等.腹腔镜经腹腹膜前修补术治疗巨大阴囊疝5例分析[J].中国实用外科杂志,2020, 40(11):1320-1323.
[23] 王磊,王文耀,周正方,等.两种手术方法治疗老年复发性腹股沟疝的临床效果[J].中华疝和腹壁外科杂志:电子版,2019,13(5):429-432.
[24] 邓朝东,和勇.腹腔镜TAPP与开放式无张力疝修补术治疗双侧腹股沟疝的疗效对比[J].临床医学研究与实践,2018,3(12):83-84.
[25] 朱红,何钱章,康雅琴,等.腹腔镜下不同术式与开放手术疝修补术治疗腹股沟疝的疗效[J].中华疝和腹壁外科杂志:电子版,2020,14(1):43-46.
[26] 阮华,夏青萍,李劲平,等.腹腔镜经腹腹膜前疝修补术对患者术后应激反应及疼痛的影响[J].中华疝和腹壁外科杂志:电子版,2020,14(6):629-632.
[27] 罗剑波,张国然,李小腾.腹腔镜经腹腹膜前疝修补术治疗腹股沟疝的临床研究[J].中国现代医生,2020,58(28):67-69,73.
[28] 刘鹏,缪小飞,高世平,等.腹腔镜经腹腔腹膜前疝修补术的效果分析[J].中国医药科学,2020,10(24):185-187.
[29] 傅厚丰,符敏,杨河,等.腹腔镜下经腹腹膜前疝无张力修补术与传统术式治疗腹股沟疝患者近期效果比较[J].中国医药,2019,14(12):1851-1853.
[30] Ross SW,Groene SA,Prasad T,et al. Does peritoneal flap closure technique following transabdominal preperitoneal (TAPP) inguinal hernia repair make a difference in postoperative pain? A long-term quality of life comparison [J]. Surgical endoscopy,2017,31(6):2548-2559.
[1]
张晓林 雷茹茹 张燕茹 陈怀安. 输尿管尿路上皮癌行完全腹腔镜下肾输尿管全长切除、膀胱袖状切除术的治疗效果 [J]. 中国医药导报, 2021, 18(9): 81-85.
[2]
谢玮 俞敏▲. 腹腔镜输卵管切除术对异位妊娠患者的血清β-HCG、血常规及C反应蛋白水平和生育结局的影响 [J]. 中国医药导报, 2021, 18(9): 126-129.
[3]
张作君 彭涛. 超声内镜下辅助腹腔镜切除治疗胃肠道黏膜下肿瘤的临床效果 [J]. 中国医药导报, 2021, 18(7): 148-151.
[4]
董烨1 张昕宁1 周毅1 张紫昭1 黄浩1 魏志刚2▲. 动脉优先入路在开腹及微创胰十二指肠切除术运用的研究进展 [J]. 中国医药导报, 2021, 18(6): 54-58.
[5]
赵昌1 周琼2. 结直肠癌患者腹腔镜术后切口感染的影响因素分析 [J]. 中国医药导报, 2021, 18(26): 104-106,120.
[6]
叶聪 徐凤娟▲. 加速康复外科临床路径用于腹腔镜全子宫切除术患者的效果 [J]. 中国医药导报, 2021, 18(24): 96-98,131.
[7]
时婕 花庶庆 陈云 李昕 汪伟. 微创根治术中预防性回肠末端造口对直肠癌患者临床疗效及肛门功能的影响 [J]. 中国医药导报, 2021, 18(20): 91-95.
[8]
周义志1 姚粮2. 腹腔镜胆囊切除术与开腹手术治疗胆结石的效果比较 [J]. 中国医药导报, 2021, 18(2): 106-109.
[9]
李斯博 黄澜▲. 快速康复外科理念对腹腔镜胃癌根治术患者术后康复及围术期应激指标的影响 [J]. 中国医药导报, 2021, 18(2): 90-93,97.
[10]
王倩1 陈炎2 陈红梅1. 腹腔镜下广泛子宫切除术联合盆腔淋巴结切除治疗早期宫颈癌的预后效果及对盆底肌功能的影响 [J]. 中国医药导报, 2021, 18(18): 103-106.
[11]
徐梓恒 孙磊 胡伟. 不同手术时机运用腹腔镜治疗胆囊结石所致急性胰腺炎的效果及安全性分析 [J]. 中国医药导报, 2021, 18(13): 76-79.
[12]
包宇. 全身麻醉联合硬膜外麻醉对腹腔镜直肠癌切除术患者血流动力学及临床效果分析 [J]. 中国医药导报, 2021, 18(1): 123-126.
[13]
颜冰1 孙毅海2 何文军3 黄恒前3. 炎性因子检测与肾盂输尿管连接部梗阻手术治疗的临床研究 [J]. 中国医药导报, 2020, 17(9): 65-68.
[14]
陈龙 李现令 刘婷婷. 儿童腹腔镜阑尾切除术后肠梗阻的临床特点 [J]. 中国医药导报, 2020, 17(35): 96-98,103.
[15]
蒋旭 曹海明 吴冠伟 董壮 马学平 杨学贞. 腹膜后神经鞘瘤1例 [J]. 中国医药导报, 2020, 17(3): 159-163,180.