腹腔镜经腹腔腹膜前疝修补术与Lichtenstein无张力疝修补术治疗腹股沟疝临床对照研究
摘要
目的比较开放式前入路腹股沟疝无张力修补术(Lichtenstein术)与腹腔镜下经腹腔腹膜前间隙腹股沟疝无张力修补术(TAPP)在腹股沟疝手术中应用的临床疗效。方法回顾性分析中国医科大学第四医院普通外科自2015年1月至2016年2月收治的194例腹股沟疝患者的临床资料,其中,Lichtenstein术99例(A组),TAPP术95例(B组)。比较两组患者的手术时间、术后住院天数、血清肿发生率、皮下血肿发生率及术后下床活动时间等指标。结果 B组手术时间为(45.36±15.43)min,长于A组的(33.52±8.67)min,B组术后下床活动时间为(13.72±4.91)h,短于A组的(18.73±4.67)h,差异均有统计学意义(P<0.05);而两组术后住院时间、血清肿发生率、皮下血肿发生率比较,差异均无统计学意义(P>0.05)。结论 TAPP术与Lichtenstein术均是对于腹股沟疝疾病有效且安全的治疗方式。与Lichtenstein术比较,TAPP术具有恢复快的特点,但TAPP术的手术时间受术者腹腔镜技术,特别是镜下缝合技术影响较大,手术时长波动较大。
引文
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[12] Eriksen JR,Poornoroozy P,Jφ rgensen LN,et al.Pain,quality of life and recovery after laparoscopic ventral hernia repair[J].Hernia,2009,13(1):13-21.
[13] Snyder CW,Graham LA,Vick CC,et al.Patient satisfaction,chronic pain,and quality of life after elective incisional hernia repair:effects of recurrence and repair technique[J].Hernia,2011,15(2):123-129.
[14] Kleidari B,Mahmoudieh M,Yaribakht M,et al.Mesh fixation in TAPP laparoscopic hernia repair:introduction of a new method in a prospective randomized trial[J].Surg Endosc,2014,28(2):531-536.
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[2] 赵俊,张晓东.传统疝修补术与无张力腹股沟疝修补术后慢性疼痛原因分析及治疗[J].中国实用医药,2013,8(2):31-32.
[3] Miyaki A,Yamaguchi K,Kishibe S,et al.Diagnosis of inguinal hernia by prone-vs.supine-position computed tomography[J].Hernia,2017,21(5):705-713.
[4] 蒋会勇,李炳根,吴卫东,等.完全腹膜外修补术治疗切口疝临床效果观察[J].临床军医杂志,2019,47(3):255-257.
[5] Fadaee N,Mazer L,Sharma R,et al.Clinical value of hernia mesh pathology evaluation[J].J Am Coll Surg,2019,228(5):776-781.
[6] 段红亮,黄光宇.前入路腹膜前间隙无张力疝修补术对腹股沟疝患者血清基质金属蛋白酶、基质金属蛋白酶组织抑制剂的影响[J].实用临床医药杂志,2018,22(23):36-39.
[7] Zhu X,Cao H,Ma Y,et al.Totally extraperitoneal laparoscopic hernioplasty versus open extraperitoneal approach for inguinal hernia repair:a meta-analysis of outcomes of our current knowledge[J].Surgeon,2014,12(2):94-105.
[8] 杨惊雷,卞栋.开放式完全腹膜外疝修补术与无张力疝修补术治疗腹股沟疝的临床疗效比较[J].解放军预防医学杂志,2019,37(4):71-72.
[9] Patterson TJ,Beck J,Currie PJ,et al.Meta-analysis of patient-reported outcomes after laparoscopic versus open inguinal hernia repair[J].Br J Surg,2019,106(7):824-836.
[10] 李健文.腹腔镜腹股沟疝修补术[J].中国实用外科杂志,2018,38(8):954-957.
[11] Wang WJ,Chen JZ,Fang Q,et al.Comparison of the effects of laparoscopic hernia repair and Lichtenstein tension-free hernia repair[J].J Laparoendosc Adv Surg Tech A,2013,23(4):301-305.
[12] Eriksen JR,Poornoroozy P,Jφ rgensen LN,et al.Pain,quality of life and recovery after laparoscopic ventral hernia repair[J].Hernia,2009,13(1):13-21.
[13] Snyder CW,Graham LA,Vick CC,et al.Patient satisfaction,chronic pain,and quality of life after elective incisional hernia repair:effects of recurrence and repair technique[J].Hernia,2011,15(2):123-129.
[14] Kleidari B,Mahmoudieh M,Yaribakht M,et al.Mesh fixation in TAPP laparoscopic hernia repair:introduction of a new method in a prospective randomized trial[J].Surg Endosc,2014,28(2):531-536.
[15] 赵育,罗兵,吴华锋.复发性腹壁切口疝患者个体化手术分析[J].实用临床医药杂志,2018,22(19):94-97.