摘要
目的:探讨腹腔镜疝修补术中不同入路治疗腹股沟疝康复效果及安全性。方法:回顾性分析2018年1月至2020年5月合肥市第一人民医院蜀山分院132例腹股沟疝患者的临床资料。患者均行腹腔镜疝修补术治疗,其中采用经腹腔腹膜前修补术(TAPP)46例(TAPP组),采用全腹膜外修补术(TEP)86例(TEP组)。比较两组患者手术相关指标、气腹对机体病理生理的影响指标、炎性指标、疼痛评分和术后并发症。结果:两组术中出血量、肠功能恢复时间、住院时间和非手术费用比较差异无统计学意义( P>0.05);TEP组手术时间、下床活动时间和手术费用明显低于TAPP组[(45.08 ± 4.92)min比(51.03 ± 5.62)min、(20.93 ± 2.64)h比(22.98 ± 2.01)h和(6 887 ± 603)元比(8 276 ± 813)元],差异有统计学意义( P<0.01)。两组气腹前、气腹后10 min和拔管后二氧化碳总量(TCO 2)、动脉血二氧化碳分压(PaCO 2)、动脉血氧分压(PaO 2)和碳酸氢根比较差异无统计学意义( P>0.05)。两组手术前后白细胞介素(IL)-6、IL-10和C反应蛋白(CRP)比较差异无统计学意义( P>0.05)。两组术后1、3和7 d疼痛视觉模拟评分(VAS)比较差异无统计学意义( P>0.05)。两组总并发症发生率比较差异无统计学意义( P>0.05)。 结论:TAPP和TEP均是腹股沟疝治疗的安全有效方式,其中TEP手术费用相对较低、手术时间较短、患者术后可更快下床活动,临床术式的选择应以术者经验及患者个体化特征为原则。
Objective To explore the rehabilitation effect and safety of laparoscopic herniorrhaphy through different approaches in the treatment of inguinal hernia.Methods The clinical data of 132 patients with inguinal hernia in Shushan Branch of Hefei First People′s Hospital from January 2018 to May 2020 were retrospectively analyzed.Laparoscopic herniorrhaphy was performed in all patients.The 46 patients who were treated with transabdominal preperitoneal patch(TAPP)repair were included in TAPP group,while another 86 patients who were treated with totally extraperitoneal patch implantation(TEP)were included in TEP group.The surgery-related indexes,influencing indexes of pneumoperitoneum on pathophysiology,inflammation indexes,pain score and postoperative complications were compared between 2 groups.Results There were no significant differences in intraoperative blood loss,recovery time of gastrointestinal function,hospitalization time and non-surgery cost between 2 groups(P>0.05).The operation time,leaving bed time and surgery cost in TEP group were significantly lower than those in TAPP group:(45.08±4.92)min vs.(51.03±5.62)min,(20.93±2.64)h vs.(22.98±2.01)h and(6887±603)yuan vs.(8276±813)yuan,and there were statistical differences(P<0.01).Before pneumoperitoneum,at 10 min after pneumoperitoneum and after extubation,there were no significant differences in levels of total carbon dioxide(TCO2),partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2)and bicarbonate radical between 2 groups(P>0.05).Before and after surgery,there were no significant differences in interleukin(IL)-6,IL-10 and C-reactive protein(CRP)between 2 groups(P>0.05).At 1,3 and 7 d after surgery,there were no significant differences in visual analogue scale(VAS)between 2 groups(P>0.05).There was no significant difference in the total incidence of complications between 2 groups(P>0.05).Conclusions Both TAPP and TEP are safe and effective in the treatment of inguinal hernia.The surgical cost of TEP is relatively lower,and operatio
作者
蒋厚记
冯宏俊
刘玮玮
Jiang Houji;Feng Hongjun;Liu Weiwei(Department of General Surgery,Shushan Branch of Hefei First People′s Hospital,Hefei 230000,China)
出处
《中国医师进修杂志》
2021年第1期53-57,共5页
Chinese Journal of Postgraduates of Medicine
关键词
疝
腹股沟
腹腔镜
治疗结果
疝修补术
Hernia,inguinal
Laparoscopes
Treatment outcome
Herniorrhaphy
