自固定补片对腹股沟疝患者TAPP术后术区疼痛及血清肿的影响
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摘要
目的与术中使用普通补片+医用胶固定比较,探讨术中使用自固定补片是否能减少腹股沟疝患者TAPP术后术区疼痛及血清肿的发生。方法回顾性分析遵义医科大学附属医院胃肠外科2016年6月至2017年12月期间行腹腔镜腹股沟疝修补术(TAPP)的患者共238例,按术中植入补片和固定方式的不同分为自固定补片组(观察组)和普通补片+医用胶组(对照组),其中观察组103例,对照组135例。比较两组患者年龄、性别、体重指数、疝类型、术前合并症、ASA分级等一般资料,手术时间、术中出血量、术后住院时间,术后血清肿、术后(3d、1月及6月)术区疼痛(VAS评分)等并发症,术后6月复发情况及住院费用。结果两组患者在年龄、性别、疝类型、体重指数、术前合并症、ASA分级、手术时间、术中出血量、术后住院时间差异无统计学意义(P>0.05);在术后并发症方面,两组均无戳孔感染、术区感染、肺部感染、术区血肿病例,尿潴留和戳孔渗血病例差异无统计学意义(P>0.05),术后血清肿的发生率观察组明显低于对照组(5.8%VS 16.3%,P=0.015),术后第3天、1月和6月后患者的术区疼痛VAS评分表明两组间、不同时间及时间与组别的交互作用均有明显统计学意义(P<0.001),观察组较对照组术后术区疼痛缓解明显;术后6月,两组均无复发病例;观察组住院费用(元)明显高于对照组(12 225.2±868.1VS 9 332.7±579.0,P<0.001)。结论与普通补片+医用胶固定组比较,术中使用自固定补片能减少腹股沟疝TAPP术后术区疼痛及血清肿的发生,但费用偏高。
Objective Comparing with the use of ordinary mesh + medical glue in the operation,to explore whether the use of self-gripping mesh during surgery can reduce the operation area pain and seroma after TAPP in patients with inguinal hernia.Methods A retrospective analysis was made of 238 patients who underwent laparoscopic inguinal hernia repair(TAPP) between June 2016 and December 2017 in the Department of Gastrointestinal Surgery,Affiliated Hospital of Zunyi Medical University.According to the differences of mesh implantation and fixation,the patients were divided into self-gripping mesh group(observation group,103 cases) and ordinary mesh + medical glue(control group,135 cases).The general data of age,gender,sputum type,BMI,ASA,preoperative comorbidities,operative time,intraoperative blood loss,postoperative hospital stay,complications such as seroma,postoperative pain in operation area(VAS score at 3 days,1 month and 6 months),recurrence after 6 months of surgery and hospitalization costs were all analyzed.Results There was no significant difference in age,gender,sputum type,BMI,ASA,preoperative comorbidities,operative time,intraoperative blood loss,and postoperative hospital stay between the two groups(P>0.05).And there was no difference in puncture infection,surgical infection,pulmonary infection,hematoma in the operation area,urine retention and puncture oozing cases(P>0.05).For the incidence of postoperative seroma,the observation group was significantly lower than the control group(5.8% vs 16.3%, P=0.015).The VAS scores of the patients in the operation area after 3 days,1 month and 6 months showed that there were significant differences between groups,time points and the interaction of group and time(P<0.001).In the observation group,the pain in the operation area was relieved.6 months after surgery,there was no recurrence case in both groups.The hospitalization expenses(yuan) were significantly higher in the observation group than in the control group(12 225.2±868.1 vs 9 332.7±579.0,P <0.001).Conclusion Compared with the ordinary mesh + medical glue,the use of self-gripping mesh can reduce the postoperative pain and seroma in the inguinal hernia after TAPP,but the cost is higher.
Objective Comparing with the use of ordinary mesh + medical glue in the operation,to explore whether the use of self-gripping mesh during surgery can reduce the operation area pain and seroma after TAPP in patients with inguinal hernia.Methods A retrospective analysis was made of 238 patients who underwent laparoscopic inguinal hernia repair(TAPP) between June 2016 and December 2017 in the Department of Gastrointestinal Surgery,Affiliated Hospital of Zunyi Medical University.According to the differences of mesh implantation and fixation,the patients were divided into self-gripping mesh group(observation group,103 cases) and ordinary mesh + medical glue(control group,135 cases).The general data of age,gender,sputum type,BMI,ASA,preoperative comorbidities,operative time,intraoperative blood loss,postoperative hospital stay,complications such as seroma,postoperative pain in operation area(VAS score at 3 days,1 month and 6 months),recurrence after 6 months of surgery and hospitalization costs were all analyzed.Results There was no significant difference in age,gender,sputum type,BMI,ASA,preoperative comorbidities,operative time,intraoperative blood loss,and postoperative hospital stay between the two groups(P>0.05).And there was no difference in puncture infection,surgical infection,pulmonary infection,hematoma in the operation area,urine retention and puncture oozing cases(P>0.05).For the incidence of postoperative seroma,the observation group was significantly lower than the control group(5.8% vs 16.3%, P=0.015).The VAS scores of the patients in the operation area after 3 days,1 month and 6 months showed that there were significant differences between groups,time points and the interaction of group and time(P<0.001).In the observation group,the pain in the operation area was relieved.6 months after surgery,there was no recurrence case in both groups.The hospitalization expenses(yuan) were significantly higher in the observation group than in the control group(12 225.2±868.1 vs 9 332.7±579.0,P <0.001).Conclusion Compared with the ordinary mesh + medical glue,the use of self-gripping mesh can reduce the postoperative pain and seroma in the inguinal hernia after TAPP,but the cost is higher.
引文
[1] 中华医学会外科学分会疝与腹壁外科学组,中国医师协会外科医师分会疝和腹壁外科医师委员会.成人腹股沟疝诊断和治疗指南(2018年版)[J].中华疝和腹壁外科杂志:电子版,2018,12(4):244-246.
[2] 谢飞.腹股沟疝开放式无张力修补术86例报告[J].遵义医学院学报,2010,33(5):489.
[3] Wei F X,Zhang Y C,Han W,et al.Transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) for laparoscopic hernia repair:A meta-analysis.[J].Surg Laparosc Endosc Percutan Tech,2015,25(5):375-383.
[4] K?ckerling F,Bittner R,Adolf D,et al.Seroma following transabdominal preperitoneal patch plasty (TAPP):incidence,risk factors,and preventive measures[J].Surgical Endoscopy,2018,32(5):2222-2231.
[5] Kosai N,Sutton P A,Evans J,et al.Laparoscopic preperitoneal mesh repair using a novel self-adhesive mesh[J].J Minim Access Surg,2011,7(3):192-194.
[6] 支修益,何建行,刘伦旭,等.多学科围手术期气道管理专家共识(2016年版)[J].中国胸心血管外科临床杂志,2016,3(7):641-645.
[7] 唐健雄,郑民华,陈杰,等.腹腔镜腹股沟疝手术操作指南(2017版)[J].中华疝和腹壁外科杂志:电子版,2017,22(6):1238-1242.
[8] 王平.腹腔镜腹部疝修补术后血清肿分型的解读[J].中华疝和腹壁外科杂志:电子版, 2013,7(2):107-108.
[9] Klobusicky P,Hoskovec D.Reduction of chronic post-herniotomy pain and recurrence rate.Use of the anatomical self-gripping ProGrip laparoscopic mesh in TAPP hernia repair.Preliminary results of a prospective study[J].Videosurgery & Other Miniinvasive Techniques,2015,10(3):373-381.
[10]Kumar A,Agrahari A,Pahwa H S,et al.A Prospective nonrandomized study of comparisonof perioperative and quality of life outcomes of endoscopic versus open inguinal hernia repair:Data from a developing country[J].Journal of Laparoendoscopic & Advanced Surgical Techniques Part A,2017,27(3):264-267.
[11]Balakrishnan S,Singhal T,Samdani T,et al.Laparoscopic inguinal hernia repair:Over a thousand convincing reasons to go on[J].Hernia,2008,12(5):493-498.
[12]Bittner R,Schwarz J.Inguinal hernia repair:Current surgical techniques[J].Langenbecks Arch Surg,2012,397(2):271-282.
[13]Gemma P,Sandra S,Marta R,et al.Cytotoxicity of cyanoacrylate-based tissue adhesivesand short-term preclinicalIn vivoBiocompatibility in abdominal hernia repair[J].Plos One,2016,11(6):e0157920.
[2] 谢飞.腹股沟疝开放式无张力修补术86例报告[J].遵义医学院学报,2010,33(5):489.
[3] Wei F X,Zhang Y C,Han W,et al.Transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) for laparoscopic hernia repair:A meta-analysis.[J].Surg Laparosc Endosc Percutan Tech,2015,25(5):375-383.
[4] K?ckerling F,Bittner R,Adolf D,et al.Seroma following transabdominal preperitoneal patch plasty (TAPP):incidence,risk factors,and preventive measures[J].Surgical Endoscopy,2018,32(5):2222-2231.
[5] Kosai N,Sutton P A,Evans J,et al.Laparoscopic preperitoneal mesh repair using a novel self-adhesive mesh[J].J Minim Access Surg,2011,7(3):192-194.
[6] 支修益,何建行,刘伦旭,等.多学科围手术期气道管理专家共识(2016年版)[J].中国胸心血管外科临床杂志,2016,3(7):641-645.
[7] 唐健雄,郑民华,陈杰,等.腹腔镜腹股沟疝手术操作指南(2017版)[J].中华疝和腹壁外科杂志:电子版,2017,22(6):1238-1242.
[8] 王平.腹腔镜腹部疝修补术后血清肿分型的解读[J].中华疝和腹壁外科杂志:电子版, 2013,7(2):107-108.
[9] Klobusicky P,Hoskovec D.Reduction of chronic post-herniotomy pain and recurrence rate.Use of the anatomical self-gripping ProGrip laparoscopic mesh in TAPP hernia repair.Preliminary results of a prospective study[J].Videosurgery & Other Miniinvasive Techniques,2015,10(3):373-381.
[10]Kumar A,Agrahari A,Pahwa H S,et al.A Prospective nonrandomized study of comparisonof perioperative and quality of life outcomes of endoscopic versus open inguinal hernia repair:Data from a developing country[J].Journal of Laparoendoscopic & Advanced Surgical Techniques Part A,2017,27(3):264-267.
[11]Balakrishnan S,Singhal T,Samdani T,et al.Laparoscopic inguinal hernia repair:Over a thousand convincing reasons to go on[J].Hernia,2008,12(5):493-498.
[12]Bittner R,Schwarz J.Inguinal hernia repair:Current surgical techniques[J].Langenbecks Arch Surg,2012,397(2):271-282.
[13]Gemma P,Sandra S,Marta R,et al.Cytotoxicity of cyanoacrylate-based tissue adhesivesand short-term preclinicalIn vivoBiocompatibility in abdominal hernia repair[J].Plos One,2016,11(6):e0157920.