腹腔镜下完全腹膜外疝修补术与腹腔镜经腹膜前疝修补术治疗成人腹股沟疝的效果比较
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摘要
目的比较腹腔镜下完全腹膜外疝修补术(TEP)与经腹腔腹膜前疝修补术(TAPP)治疗成人腹股沟疝患者的效果。方法选取本院2016年1月～2017年5月收治的126例腹股沟疝患者作为研究对象,根据手术方式不同将其分为TEP组(64例)和TAPP组(62例)。TEP组患者采用TEP治疗,TAPP组患者采用TAPP治疗。观察比较两组患者的手术指标、复发状况。结果 TEP组患者的手术时间及住院时间均长于TAPP组,失血量多于TAPP组,差异有统计学意义(P<0.05);TEP组患者的创口直径、术后止痛药使用次数、疼痛评分、睡眠质量评分及治疗费用均低于TAPP组,差异有统计学意义(P<0.05)。两组患者的并发症总发生率比较,差异无统计学意义(P>0.05)。两组患者的术后复发率比较,差异无统计学意义(P>0.05)。结论 TEP与TAPP对成人腹股沟疝均有较好的治疗效果,且安全、有效,临床上可根据患者的具体情况选择合适的治疗方式。
Objective To compare the effect of laparoscopic totally extraperitoneal herniorrhaphy(TEP) and transperitoneal preperitoneal herniorrhaphy(TAPP) in the treatment of adult patients with inguinal hernia. Methods A total of126 cases of patients with inguinal hernia in our hospital from January 2016 to May 2017 were selected as the study objects, and they were divided into the TEP group(64 cases) and the TAPP group(62 cases) according to different operative methods. The TEP group was treated with TEP, and the TAPP group was treated with TAPP. The operation indexes and recurrence status of the two groups were observed and compared. Results The operation time and hospitalization time in the TEP group were longer than those in the TAPP group, the blood loss in the TEP group was more than that in the TAPP group, and the differences were statistically significant(P<0.05). The wound diameter, the times of painkillers used, pain score, sleep quality score and treatment cost in the TAPP group were lower than those in the TAPP group, and the differences were statistically significant(P<0.05). There was no significant difference in the total incidence rate of complications between the two groups(P>0.05). There was no significant difference in the recurrence rate between the two groups(P>0.05). Conclusion TEP and TAPP both have good therapeutic effect on adults with inguinal hernia, which are safe and effective. The appropriate treatment can be chosen according to the situation of patients in clinic.
Objective To compare the effect of laparoscopic totally extraperitoneal herniorrhaphy(TEP) and transperitoneal preperitoneal herniorrhaphy(TAPP) in the treatment of adult patients with inguinal hernia. Methods A total of126 cases of patients with inguinal hernia in our hospital from January 2016 to May 2017 were selected as the study objects, and they were divided into the TEP group(64 cases) and the TAPP group(62 cases) according to different operative methods. The TEP group was treated with TEP, and the TAPP group was treated with TAPP. The operation indexes and recurrence status of the two groups were observed and compared. Results The operation time and hospitalization time in the TEP group were longer than those in the TAPP group, the blood loss in the TEP group was more than that in the TAPP group, and the differences were statistically significant(P<0.05). The wound diameter, the times of painkillers used, pain score, sleep quality score and treatment cost in the TAPP group were lower than those in the TAPP group, and the differences were statistically significant(P<0.05). There was no significant difference in the total incidence rate of complications between the two groups(P>0.05). There was no significant difference in the recurrence rate between the two groups(P>0.05). Conclusion TEP and TAPP both have good therapeutic effect on adults with inguinal hernia, which are safe and effective. The appropriate treatment can be chosen according to the situation of patients in clinic.
引文
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[13]马超.腹腔镜腹股沟疝修补术与腹腔镜完全腹膜外疝修补术的手术疗效比较[J].中国社区医师,2018,34(21):33-34.
[14]夏联山,罗靖,古少东,等.腹腔镜腹股沟疝修补术与腹腔镜完全腹膜外疝修补术手术疗效的对比[J].中华疝和腹壁外科杂志(电子版),2017,11(2):137-139.
[15]汪磊,李宏.全腹膜外腹腔镜疝修补术与经腹膜前腹腔镜疝修补术治疗成人腹股沟疝的疗效比较[J].现代实用医学,2016,28(2):183-184.
[16]Chen LS,Chen WC,Kang YN,et al.Effects of transabdominal preperitoneal and totally extraperitoneal inguinal hernia repair:an update systematic review and meta-analysis of randomized controlled trials[J].Surg Endosc,2018,16(9):1-11.
[17]任士贵.经腹腔腹膜前修补术与全腹膜外修补术治疗成人腹股沟疝疗效比较[J].中国冶金工业医学杂志,2015,32(1):73-74.
[18]罗乐.经腹腔膜前修补术和完全腹膜外疝修补术治疗腹股沟疝的疗效对比[J].医学信息,2016,29(33):75-76.
[2]张礼.老年腹股沟斜疝无张力疝修补术临床治疗分析[J].临床合理用药杂志,2017,10(35):167-168.
[3]Wakasugi M,Tei M,Anno K,et al.Single-incision to tally extraperitoneal inguinal hernia repair as a teaching procedure:one center′s experience of more than 300 procedures[J].Surg Today,2015,46(9):1-6.
[4]包汉康,李英儒.腹腔镜经腹腹膜前腹股沟疝修补术在广东基层医院应用体会[J].岭南现代临床外科,2015,15(4):436-439.
[5]中国医师协会外科医师分会疝和腹壁外科医师委员会.成人腹股沟疝诊疗指南(2014年版)[J].中华外科杂志,2014,52(7):484-486.
[6]严广斌.视觉模拟评分法[J].中华关节外科杂志(电子版),2014,15(2):34.
[7]Smyth C.The pittsburgh sleep quality index(PSQI)[J].Medsurg Nurs,2003,12(4):261-262.
[8]卢仲烨,赵正东.腹膜外腹腔镜疝气修补术与传统疝修补术治疗腹股沟疝效果比较[J].中国现代药物应用,2016,10(4):46-47.
[9]Gao D,Wei S,Zhai C,et al.Clinical research of preperitoneal drainage after endoscopic totally extraperitoneal inguinal hernia repair[J].Hernia,2015,19(5):789-794.
[10]管华琴.腹腔镜下全腹膜外疝修补术的围术期护理[J].实用临床医药杂志,2016,20(16):205-206.
[11]Mitura K,Garnysz K,Wyrzykowska D,et al.The change in groin pain perception after transabdominal preperitoneal inguinal hernia repair with glue fixation:a prospective trial of a single surgeon′s experience[J].Surg Endosc,2018,32(10):4284-4289.
[12]周华友,杨超,龙雪艳,等.TAPP与开放式腹膜前间隙腹股沟疝无张力修补术的临床效果比较[J].医学综述,2016,22(15):3087-3089.
[13]马超.腹腔镜腹股沟疝修补术与腹腔镜完全腹膜外疝修补术的手术疗效比较[J].中国社区医师,2018,34(21):33-34.
[14]夏联山,罗靖,古少东,等.腹腔镜腹股沟疝修补术与腹腔镜完全腹膜外疝修补术手术疗效的对比[J].中华疝和腹壁外科杂志(电子版),2017,11(2):137-139.
[15]汪磊,李宏.全腹膜外腹腔镜疝修补术与经腹膜前腹腔镜疝修补术治疗成人腹股沟疝的疗效比较[J].现代实用医学,2016,28(2):183-184.
[16]Chen LS,Chen WC,Kang YN,et al.Effects of transabdominal preperitoneal and totally extraperitoneal inguinal hernia repair:an update systematic review and meta-analysis of randomized controlled trials[J].Surg Endosc,2018,16(9):1-11.
[17]任士贵.经腹腔腹膜前修补术与全腹膜外修补术治疗成人腹股沟疝疗效比较[J].中国冶金工业医学杂志,2015,32(1):73-74.
[18]罗乐.经腹腔膜前修补术和完全腹膜外疝修补术治疗腹股沟疝的疗效对比[J].医学信息,2016,29(33):75-76.