不同术式在腹股沟疝治疗中的应用分析及对患者生活质量的对比研究
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摘要
目的探讨腹腔镜经腹腹膜前疝修补术(laparoscopictrans-abdominalpreperitoneal hernia repair,TAPP)和开放无张力疝修补术在腹股沟疝治疗中的效果及对患者生活质量的影响。方法选取2014年2月至2018年2月,江苏省南京市溧水区人民医院接受治疗的腹股沟疝患者60例,根据治疗方法不同分为TAPP组(26例)及开放手术组(34例)。随访3个月,比较2组手术指标、并发症发生情况及复发情况及生活质量评分差异。结果 TAPP组术中出血量及术后平均最高体温较开放手术组降低,下床活动时间、术后排气时间及住院时间较开放手术组缩短,但住院费用较开放手术组升高,差异均有统计学意义(P<0.05);2组手术时间、术后复发率比较,差异无统计学意义(P>0.05)。TAPP组总并发症发生率低于开放手术组,简明健康测量量表(short form-36 health surveyquestionmaire,SF-36)、改良Rankin量表(ModifiedRankinScale,m RS)和巴塞尔指数(Barthelindex,BI)评分均显著高于开放手术组,差异均有统计学意义(P<0.05)。结论 TAPP治疗腹股沟疝可加速患者预后恢复,降低并发症发生率,提高患者生活质量,但手术时间较长,费用较高。
Objective To investigate the effect of transabdominal preperitoneal repair(TAPP and open tension-free hernia repair in inguinal hernia treatment and intervention on patients' quality of life.Methods 60 cases of inguinal hernia patients treated in Lishui District People's hospital were selected and divided into two groups: TAPP group(n=26) and open operation group(n=34) according to the different treatment methods. The surgical indexes, complications and recurrence were compared between the two groups. All were followed up for 3 months, and the difference of quality of life score between the two groups was compared. Results The intraoperative bleeding volume and average maximum body temperature in TAPP group were lower than those in open operation group(P<0.01), the time of getting out of bed, exhaust after operation and hospitalization were shorter than those of open operation group(P<0.01), but the cost of hospitalization increased compared with the open operation group(P<0.01), there were no significant differences in the operation time and recurrence rate between the two groups(P>0.05). The incidence of total complications in TAPP group was lower than that in open operation group(P<0.01) and the scores of SF-36,m RS and BI in TAPP group were significantly higher than those in open operation group(P<0.01).Conclusion TAPP in the treatment of inguinal hernia can accelerate the recovery of prognosis, reduce the incidence of complications and improve the quality of life, but the operation time is longer and cost is higher.
Objective To investigate the effect of transabdominal preperitoneal repair(TAPP and open tension-free hernia repair in inguinal hernia treatment and intervention on patients' quality of life.Methods 60 cases of inguinal hernia patients treated in Lishui District People's hospital were selected and divided into two groups: TAPP group(n=26) and open operation group(n=34) according to the different treatment methods. The surgical indexes, complications and recurrence were compared between the two groups. All were followed up for 3 months, and the difference of quality of life score between the two groups was compared. Results The intraoperative bleeding volume and average maximum body temperature in TAPP group were lower than those in open operation group(P<0.01), the time of getting out of bed, exhaust after operation and hospitalization were shorter than those of open operation group(P<0.01), but the cost of hospitalization increased compared with the open operation group(P<0.01), there were no significant differences in the operation time and recurrence rate between the two groups(P>0.05). The incidence of total complications in TAPP group was lower than that in open operation group(P<0.01) and the scores of SF-36,m RS and BI in TAPP group were significantly higher than those in open operation group(P<0.01).Conclusion TAPP in the treatment of inguinal hernia can accelerate the recovery of prognosis, reduce the incidence of complications and improve the quality of life, but the operation time is longer and cost is higher.
引文
[1]张云,郝晓晖,李健文,等.腹腔镜腹股沟疝修补术治疗老年腹股沟疝的临床疗效[J].中华消化外科杂志,2016,15(10):967-971.
[2]Patterson A L,Thomas B,Franklin A,et al.Transabdominal Preperitoneal Repair of Spigelian Hernia[J].Am Surg,2016,82(1):18-19.
[3]中华医学会外科学分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.
[4]Muschalla F,Schwarz J,Bittner R.Effectivity of laparoscopic inguinal hernia repair(TAPP)in daily clinical practice:early and long-term result[J].Surg Endosc,2016,30(11):1-10.
[5]叶小勇,张帆,陈新岐,等.腹腔镜无张力疝修补术治疗老年双侧腹股沟疝32例分析[J].贵州医药,2015,39(7):609-610.
[6]杨栋,吴晓明,刘丰,等.腹股沟疝腹腔镜下修补术与无张力修补术应用于老年患者的综合疗效研究[J].现代生物医学进展,2016,16(18):3492-3495.
[7]Sarakatsianou C,Georgopoulou S,Baloyiannis I,et al.Spinal versus general anesthesia for transabdominal preperitoneal(TAPP)repair of inguinal hernia:Interim analysis of a controlled randomized trial[J].Am J Surg,2017,214(2):239-245.
[8]Ielpo B,Duran H,Diaz E,et al.A Randomized clinical trial of laparoscopic trans-abdominal preperitoneal(TAPP)vs open lichtenstein repair for bilateral inguinal hernias[J].J Am Colof Surg,2016,223(4):18-18.
[9]Tokumura H,Nomura R,Saijo F,et al.Tumescent TAPP:laparoscopic inguinal hernia repair after the preperitoneal tumescent injection of diluted lidocaine and epinephrine saline solution and carbon dioxide gas[J].Surg Today,2017,47(1):52-57.
[10]Simons MP,Aufenacker T,Baynielsen M,et al.European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J].Hernia,2014,13(4):151-163.
[2]Patterson A L,Thomas B,Franklin A,et al.Transabdominal Preperitoneal Repair of Spigelian Hernia[J].Am Surg,2016,82(1):18-19.
[3]中华医学会外科学分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.
[4]Muschalla F,Schwarz J,Bittner R.Effectivity of laparoscopic inguinal hernia repair(TAPP)in daily clinical practice:early and long-term result[J].Surg Endosc,2016,30(11):1-10.
[5]叶小勇,张帆,陈新岐,等.腹腔镜无张力疝修补术治疗老年双侧腹股沟疝32例分析[J].贵州医药,2015,39(7):609-610.
[6]杨栋,吴晓明,刘丰,等.腹股沟疝腹腔镜下修补术与无张力修补术应用于老年患者的综合疗效研究[J].现代生物医学进展,2016,16(18):3492-3495.
[7]Sarakatsianou C,Georgopoulou S,Baloyiannis I,et al.Spinal versus general anesthesia for transabdominal preperitoneal(TAPP)repair of inguinal hernia:Interim analysis of a controlled randomized trial[J].Am J Surg,2017,214(2):239-245.
[8]Ielpo B,Duran H,Diaz E,et al.A Randomized clinical trial of laparoscopic trans-abdominal preperitoneal(TAPP)vs open lichtenstein repair for bilateral inguinal hernias[J].J Am Colof Surg,2016,223(4):18-18.
[9]Tokumura H,Nomura R,Saijo F,et al.Tumescent TAPP:laparoscopic inguinal hernia repair after the preperitoneal tumescent injection of diluted lidocaine and epinephrine saline solution and carbon dioxide gas[J].Surg Today,2017,47(1):52-57.
[10]Simons MP,Aufenacker T,Baynielsen M,et al.European Hernia Society guidelines on the treatment of inguinal hernia in adult patients[J].Hernia,2014,13(4):151-163.