腹腔镜经腹腹膜前疝修补术与腹腔镜完全腹膜外疝修补术的对比研究
|
摘要
目的比较腹腔镜经腹腹膜前疝修补术(laparoscopic trans-abdominal preperitoneal hernia repair,TAPP)与腹腔镜完全腹膜外疝修补术(laparoscopic totally extra-peritoneal,TEP)治疗腹股沟疝的手术疗效。方法回顾性分析2013年1月至2017年12月,广西医科大学第四附属医院柳州市工人医院行腹腔镜手术治疗的380例单侧腹股沟疝患者的临床资料。其中TAPP组患者233例,TEP组患者147例,分析2组的手术时间、住院时间、住院费用、手术并发症、复发率等,比较2组患者的手术疗效。结果所有患者术后恢复顺利,2组患者的手术时间、住院时间比较,差异无统计学意义(P>0.05);TAPP在探查隐匿疝方面较TEP有优势,差异有统计学意义(P<0.05),但TAPP组血清肿的发生率较高,差异有统计学意义(12%vs 4.7%,P<0.05),2组总体并发症的发生率比较,差异无统计学意义(P>0.05)。结论TAPP与TEP治疗腹股沟疝手术疗效无差异,手术方式的选择根据外科医师的经验选择。
Objective To compare the outcomes of laparoscopic transabdominal preperitneal hernia repair(TAPP) and totally extrapreperitoneal hernia repair(TEP). Methods A Retrospective analysis was conducted on 380 patients with unilateral inguinal hernia from January 2013 to December2017. All the patients who met the inclusion criteria were divided into TAPP group(n=233) and TEP group(n=147). The operative time, hospitalization, costs, complications and recurrence rate were observed.Results All the patients recovered well. There was no significantly difference in operation time and hospitalization(P>0.05). TAPP had an advantage in detecting occult hernias(P<0.05), but the incidence of seroma was higher than TEP(12% vs 4.7%, P<0.05). There was no significant difference in the rate of overall complications(P>0.05). Conclusions The efficacy of TAPP and TEP are comparable. The choice of the operation is depend on surgeon's experience.
Objective To compare the outcomes of laparoscopic transabdominal preperitneal hernia repair(TAPP) and totally extrapreperitoneal hernia repair(TEP). Methods A Retrospective analysis was conducted on 380 patients with unilateral inguinal hernia from January 2013 to December2017. All the patients who met the inclusion criteria were divided into TAPP group(n=233) and TEP group(n=147). The operative time, hospitalization, costs, complications and recurrence rate were observed.Results All the patients recovered well. There was no significantly difference in operation time and hospitalization(P>0.05). TAPP had an advantage in detecting occult hernias(P<0.05), but the incidence of seroma was higher than TEP(12% vs 4.7%, P<0.05). There was no significant difference in the rate of overall complications(P>0.05). Conclusions The efficacy of TAPP and TEP are comparable. The choice of the operation is depend on surgeon's experience.
引文
[1]Arregui ME,Davis CJ,Yucel O,Nagan RF.Laproscopic mesh repair of inguinal hernia using a preperitoneal approach:a preliminary report[J].Surg Laparosc Endosc,1992,2(1):53-58.
[2]Mc Kernan JB,Laws HL.Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J].Surg Endosc,1993,7(1):26-28.
[3]James J,Wu Joshua A,Way Guy D,Eslick Michael R Cox.Transabdominal pre-peritoneal versus open repair for primary unilateral inguinal hernia:a Meta-analysis[J].World J Surg,2018(42):1304-1311.
[4]王家兴,张杰.腹腔镜完全腹膜外修补术与经腹腹膜前修补术优缺点对比分析[J].创伤与急危重病医学,2017,5(3):172-176.
[5]Kockerling F,Bittner R,Jacob DA,et al.TEP versus TAPP:comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia[J].Surg Endosc,2015,29(12):3750-3760.
[6]牛天峰,罗靖,刘斌,等.腹股沟疝TAPP与TEP手术疗效的对比[J/CD].中华疝和腹壁外科杂志(电子版),2017,11(4):287-289.
[7]Bringman S,Blomqvist P.Intestinal obstruction after inguinal and femoral hernia repair:a study of 33275 operations during 1992-2000in Sweden[J].Hernia,2005,9(2):178-183.
[8]Krishna A,Misra MC,Bansal VK,et al.Laparoscopic inguinal hernia repair:transabdominal preperitoneal(TAPP)versus totally extraperitoneal(TEP)approach:a prospective randomized controlled trial[J].Surg Endosc,2012,26(3):639-649.
[9]Sajid MS,Ladwa N,Kalra L,et al.A meta-analysis examining the use of tacker mesh fixation versus glue mesh fixation in laparoscopic inguinal hernia repair[J].Am J Surg,2013,206(1):103-111.
[10]刘嘉欣,李汝红,于海东,等.TAPP与TEP对腹股沟疝术后慢性疼痛的影响[J/CD].中华腔镜外科杂志(电子版),2016,9(2):121-123.
[11]吴耀华.腹腔镜下两种术式治疗成人腹股沟疝的临床疗效及心理观察[J/CD].中华疝和腹壁外科杂志(电子版),2015,9(2):43-46.
[12]柳青婷,崔明,王世清,等.完全腹膜外疝修补术与经腹腹膜前疝修补术的临床疗效对比[J/CD].中华疝和腹壁外科杂志(电子版),2014,8(3):230-232.
[13]汪想忠,孙喜太.腹腔镜经腹腹膜前疝修补术与完全腹膜外疝修补术术式选择和安全性讨论[J/CD].中华疝和腹壁外科杂志(电子版),2017,11(6):413-415.
[2]Mc Kernan JB,Laws HL.Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach[J].Surg Endosc,1993,7(1):26-28.
[3]James J,Wu Joshua A,Way Guy D,Eslick Michael R Cox.Transabdominal pre-peritoneal versus open repair for primary unilateral inguinal hernia:a Meta-analysis[J].World J Surg,2018(42):1304-1311.
[4]王家兴,张杰.腹腔镜完全腹膜外修补术与经腹腹膜前修补术优缺点对比分析[J].创伤与急危重病医学,2017,5(3):172-176.
[5]Kockerling F,Bittner R,Jacob DA,et al.TEP versus TAPP:comparison of the perioperative outcome in 17,587 patients with a primary unilateral inguinal hernia[J].Surg Endosc,2015,29(12):3750-3760.
[6]牛天峰,罗靖,刘斌,等.腹股沟疝TAPP与TEP手术疗效的对比[J/CD].中华疝和腹壁外科杂志(电子版),2017,11(4):287-289.
[7]Bringman S,Blomqvist P.Intestinal obstruction after inguinal and femoral hernia repair:a study of 33275 operations during 1992-2000in Sweden[J].Hernia,2005,9(2):178-183.
[8]Krishna A,Misra MC,Bansal VK,et al.Laparoscopic inguinal hernia repair:transabdominal preperitoneal(TAPP)versus totally extraperitoneal(TEP)approach:a prospective randomized controlled trial[J].Surg Endosc,2012,26(3):639-649.
[9]Sajid MS,Ladwa N,Kalra L,et al.A meta-analysis examining the use of tacker mesh fixation versus glue mesh fixation in laparoscopic inguinal hernia repair[J].Am J Surg,2013,206(1):103-111.
[10]刘嘉欣,李汝红,于海东,等.TAPP与TEP对腹股沟疝术后慢性疼痛的影响[J/CD].中华腔镜外科杂志(电子版),2016,9(2):121-123.
[11]吴耀华.腹腔镜下两种术式治疗成人腹股沟疝的临床疗效及心理观察[J/CD].中华疝和腹壁外科杂志(电子版),2015,9(2):43-46.
[12]柳青婷,崔明,王世清,等.完全腹膜外疝修补术与经腹腹膜前疝修补术的临床疗效对比[J/CD].中华疝和腹壁外科杂志(电子版),2014,8(3):230-232.
[13]汪想忠,孙喜太.腹腔镜经腹腹膜前疝修补术与完全腹膜外疝修补术术式选择和安全性讨论[J/CD].中华疝和腹壁外科杂志(电子版),2017,11(6):413-415.