普通平片联合α氰基丙烯酸酯医用胶在TAPP治疗腹股沟疝手术中的效果观察
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摘要
目的观察普通平片联合α氰基丙烯酸酯医用胶在经腹腹膜前修补术(TAPP)治疗腹股沟疝的可行性及经济性。方法将90例单侧腹股沟疝患者随机分为普通平片组及3D补片组,前者使用普通平片联合α氰基丙烯酸酯医用胶行TAPP手术,后者使用3D成型补片,比较二者在手术时间、住院时间、术后疼痛、术后并发症、术后慢性腹股沟区不适、术后复发及平均住院费用的差异。结果普通平片组的住院费用为(8 385.9±882.9)元,低于3D补片组的(9 340.1±1 180.9)元;手术时间为(74.1±11.3) min,稍长于3D补片组的(67.1±9.8) min,差异均有统计学意义(均P<0.01);而两组的住院时间、术后疼痛、术后并发症、术后慢性腹股沟区不适及复发情况差异无统计学意义(P>0.05)。结论在TAPP治疗腹股沟疝手术中,使用普通平片联合α氰基丙烯酸酯医用胶安全可行、价格低廉。
Objective To explore the feasibility and economical efficiency of plain film combined with alpha cyanoacrylate medical adhesive in transabdominal preperitoneal prosthesis(TAPP) for inguinal hernia. Methods A total of 90 patients with unilateral inguinal hernia were randomly divided into Plain Film Group and 3 D Patch Group. The former underwent TAPP using plain film combined with alpha cyanoacrylate medical adhesive while the latter underwent TAPP using3 D patch. The two groups were compared in terms of operation duration, hospital stay, postoperative pain, postoperative complications, postoperative chronic groin discomfort, postoperative hernia recurrence and average hospitalization cost.Results The Plain Film Group had a hospitalization cost of(8 385.9±882.9) yuan, which was less than that of the 3 D Patch Group(9 340.1±1 180.9) yuan; and had an operation duration of(74.1±11.3) min, which was slightly longer than that of the3 D Patch Group(67.1±9.8) min, and the differences were statistically significant(P<0.01). However, there was no significant difference in hospital stay, postoperative pain, postoperative complications, postoperative chronic inguinal discomfort and recurrence between the two groups(P>0.05). Conclusion In the TAPP for inguinal hernia, the plain film combined with alpha cyanoacrylate adhesive is safe, feasible and less expensive.
Objective To explore the feasibility and economical efficiency of plain film combined with alpha cyanoacrylate medical adhesive in transabdominal preperitoneal prosthesis(TAPP) for inguinal hernia. Methods A total of 90 patients with unilateral inguinal hernia were randomly divided into Plain Film Group and 3 D Patch Group. The former underwent TAPP using plain film combined with alpha cyanoacrylate medical adhesive while the latter underwent TAPP using3 D patch. The two groups were compared in terms of operation duration, hospital stay, postoperative pain, postoperative complications, postoperative chronic groin discomfort, postoperative hernia recurrence and average hospitalization cost.Results The Plain Film Group had a hospitalization cost of(8 385.9±882.9) yuan, which was less than that of the 3 D Patch Group(9 340.1±1 180.9) yuan; and had an operation duration of(74.1±11.3) min, which was slightly longer than that of the3 D Patch Group(67.1±9.8) min, and the differences were statistically significant(P<0.01). However, there was no significant difference in hospital stay, postoperative pain, postoperative complications, postoperative chronic inguinal discomfort and recurrence between the two groups(P>0.05). Conclusion In the TAPP for inguinal hernia, the plain film combined with alpha cyanoacrylate adhesive is safe, feasible and less expensive.
引文
[1]中华医学会外科学会疝和腹壁外科学组.成人腹股沟疝股疝手术治疗方案(修订稿)[J].腹部外科,2004,17(1):126-126.
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[3]张宇.视觉模拟评分法对腹股沟疝无张力修补术中患者疼痛的评估[J].湖南中医药大学学报,2012,32(8):37-38.
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[6]孙少川,孙中伟.腔镜腹股沟疝术式选择:TAPP vs.TEP[J].腹腔镜外科杂志,2016(2):85-87.
[7]曾毅克,王存川,黎绍基,等.治疗成人腹股沟疝选择腹腔镜或开放Lichtenstein修补术--随机对照研究的Meta分析[J].腹腔镜外科杂志,2007,12(1):27-31.
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[9]付鸿江.自固定轻量补片在腹腔镜下腹股沟疝修补中的应用[J/CD].中华疝和腹壁外科杂志:电子版,2014,8(1):60-62.
[10]陈建发,杨雪丰,傅明,等.经腹直肌切口的Ⅰ期腹膜前无张力疝修补治疗嵌顿性腹股沟疝[J].广东医学院学报,2014,32(4):477-478.
[11]赵同民,王建辉,冯国强.轻质量聚丙烯编织补片皱缩率对照研究[J].中华疝和腹壁外科杂志(电子版),2013,7(3):23-25.
[12]KUKLETA J F,FREYTAG C,WEBER M.Efficiency and safety of mesh fixation in laparoscopic inguinal hernia repair using n-butyl cyanoacrylate:long-term biocompatibility in over 1,300 mesh fixations[J].Hernia,2012,16(2):153-162.
[13]SHAH N S,BANDARA A I,SHEEN A J.Clinical outcome and quality of life in 100 consecutive laparoscopic totally extra-peritoneal(TEP)groin hernia repairs using fibrin glue(Tisseel?):a United Kingdom experience[J].Hernia,2012,16(6):647-653.
[14]BYRD J F,AGEE N,SWAN R Z,et al.Evaluation of absorbable and permanent mesh fixation devices:adhesion formation and mechanical strength[J].Hernia,2011,15(5):553-558.
[15]KHALEAL F,BERNEY C.The role of fibrin glue in decreasing chronic pain in laparoscopic totally extraperitoneal(TEP)inguinal hernia repair:a single surgeon's experience[J].Anz J Surg,2011,81(3):154.
[16]BEETS G L,VAN G D,BAETEN C G,et al.Long-term results of giant prosthetic reinforcement of the visceral sac for complex recurrent inguinal hernia[J].Br J Surg,1996,83(6):203-206.
[17]SCHUMPELICK V,CONZE J,KLINGE U.Preperitoneal mesh-plasty in incisional hernia repair:a comparative retrospective study of 272 operated incisional hernias[J].Chirurg,1996,67:1028-1035.
[18]JENSEN K K,MUNIM K,KJAER M,et al.Abdominal wall reconstruction for incisional hernia optimizes truncal function and quality of life:a prospective controlled study[J].Ann Surg,2017,265(6):1235.
[19]张志刚,李俊生,嵇振岭.聚丙烯3D补片与平片补片在经腹腔腹膜前疝修补术中的对比研究[J].中华疝和腹壁外科杂志(电子版),2012,6(3):865-867.
[20]STELZNER F.Function of the abdominal wall and development and therapy of hernias(among others:the para-colostomy hernia)[J].Langenbecks Arch Chir,1994,379(2):109-119.
[2]李健文,王明刚,唐健雄,等.腹股沟疝腹腔镜手术规范化操作指南[J].腹腔镜外科杂志,2013,33(10):566-570.
[3]张宇.视觉模拟评分法对腹股沟疝无张力修补术中患者疼痛的评估[J].湖南中医药大学学报,2012,32(8):37-38.
[4]赵瑾,孙小亮,朱太阳,等.局部麻醉下无张力腹股沟疝修补术后早期疼痛的多因素分析[J].中华疝和腹壁外科杂志:电子版,2015(4):290-294.
[5]BRACALE U,MELILLO P,PIGNATA G,et al.Which is the best laparoscopic approach for inguinal hernia repair:TEP or TAPP?A systematic review of the literature with a network meta-analysis[J].Surgical Endoscopy,2012,26(12):3355-3366.
[6]孙少川,孙中伟.腔镜腹股沟疝术式选择:TAPP vs.TEP[J].腹腔镜外科杂志,2016(2):85-87.
[7]曾毅克,王存川,黎绍基,等.治疗成人腹股沟疝选择腹腔镜或开放Lichtenstein修补术--随机对照研究的Meta分析[J].腹腔镜外科杂志,2007,12(1):27-31.
[8]K?CKERLING F,BITTNER R,JACOB DA,et al.TEPversus TAPP:comparison of the perioperative outcome in17,587 patients with a primary unilateral inguinal hernia[J].Surgical Endoscopy,2015,29(12):3750-3760.
[9]付鸿江.自固定轻量补片在腹腔镜下腹股沟疝修补中的应用[J/CD].中华疝和腹壁外科杂志:电子版,2014,8(1):60-62.
[10]陈建发,杨雪丰,傅明,等.经腹直肌切口的Ⅰ期腹膜前无张力疝修补治疗嵌顿性腹股沟疝[J].广东医学院学报,2014,32(4):477-478.
[11]赵同民,王建辉,冯国强.轻质量聚丙烯编织补片皱缩率对照研究[J].中华疝和腹壁外科杂志(电子版),2013,7(3):23-25.
[12]KUKLETA J F,FREYTAG C,WEBER M.Efficiency and safety of mesh fixation in laparoscopic inguinal hernia repair using n-butyl cyanoacrylate:long-term biocompatibility in over 1,300 mesh fixations[J].Hernia,2012,16(2):153-162.
[13]SHAH N S,BANDARA A I,SHEEN A J.Clinical outcome and quality of life in 100 consecutive laparoscopic totally extra-peritoneal(TEP)groin hernia repairs using fibrin glue(Tisseel?):a United Kingdom experience[J].Hernia,2012,16(6):647-653.
[14]BYRD J F,AGEE N,SWAN R Z,et al.Evaluation of absorbable and permanent mesh fixation devices:adhesion formation and mechanical strength[J].Hernia,2011,15(5):553-558.
[15]KHALEAL F,BERNEY C.The role of fibrin glue in decreasing chronic pain in laparoscopic totally extraperitoneal(TEP)inguinal hernia repair:a single surgeon's experience[J].Anz J Surg,2011,81(3):154.
[16]BEETS G L,VAN G D,BAETEN C G,et al.Long-term results of giant prosthetic reinforcement of the visceral sac for complex recurrent inguinal hernia[J].Br J Surg,1996,83(6):203-206.
[17]SCHUMPELICK V,CONZE J,KLINGE U.Preperitoneal mesh-plasty in incisional hernia repair:a comparative retrospective study of 272 operated incisional hernias[J].Chirurg,1996,67:1028-1035.
[18]JENSEN K K,MUNIM K,KJAER M,et al.Abdominal wall reconstruction for incisional hernia optimizes truncal function and quality of life:a prospective controlled study[J].Ann Surg,2017,265(6):1235.
[19]张志刚,李俊生,嵇振岭.聚丙烯3D补片与平片补片在经腹腔腹膜前疝修补术中的对比研究[J].中华疝和腹壁外科杂志(电子版),2012,6(3):865-867.
[20]STELZNER F.Function of the abdominal wall and development and therapy of hernias(among others:the para-colostomy hernia)[J].Langenbecks Arch Chir,1994,379(2):109-119.