腹腔镜下修补术与开放式无张力修补术在老年腹股沟疝的疗效比较
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摘要
目的对比分析腹腔镜下修补术与开放式无张力修补术在老年腹股沟疝中的效果及安全性。方法选取2015年7月至2017年1月,广州医科大学附属顺德医院收治的老年腹股沟疝患者118例,根据治疗方法不同分为研究组及对照组,每组患者59例。研究组行腹腔镜下疝修补术,对照组行开放式无张力疝修补术。分析2组手术状况、术后疼痛及并发症发生情况。结果研究组手术时间[(41.42±10.69)min比(48.75±11.62)min]、住院时间[(6.63±1.61)d比(7.28±1.53)d]及术后卧床时间[(2.45±1.06)d比(4.37±2.95)d]均显著短于对照组,术中出血量[(18.15±5.49)ml比(22.03±3.54)ml]少于对照组,但住院费用[(11 022.56±1 598.07)比(6 023.20±1 002.15)]高于对照组,差异均有统计学意义(P均<0.05);与术前比较,2组术后1、3、5 d视觉模拟评分(visual analogue scale,VAS)均显著下降,研究组各时间点VAS评分(3.65±0.72、2.56±1.49、1.70±0.13)均显著低于对照组(4.83±0.50、3.64±1.32、2.86±1.24),差异均有统计学意义(P均<0.05);术后研究组并发症发生率为6.67%,显著低于对照组的17.24%,差异有统计学意义(P<0.05)。结论与开放式无张力修补术相比,腹腔镜下修补术可有效减少出血、缩短手术时间、住院时间及卧床时间等,经济可行,安全性更好,且患者疼痛感更小。
Objective Compare the effect and safety of laparoscopic repair and open tension-free repair for inguinal hernia in elderly patients. Methods 118 cases of elderly patients with inguinal hernia in Shunde affiliated hospital of Guangzhou Medical University were selected and divided into study group and control group according to the different treatment methods, with 59 cases in each group. Study group was treated with laparoscopic repair, while control group was treated with open tension-free repair. The operation details, postoperative pain and complications of the 2 groups were analyzed. Results The operation time, length of hospital stay and postoperative bed time of study group were shorter than those of control group. The amount of bleeding during operation of study group was less than that of the control group, while the hospitalization cost was higher(P<0.05); Compared with preoperative pain, the VAS scores at 1 st, 3 th and 5 th day of 2 groups after surgery were significantly decreased, and the VAS scores of the study group were significantly lower than those of the control group at each time point(P<0.05); The postoperative complication rate of the study group was 6.67%, which was significantly lower than that of the control group(17.24%), the difference was statistically significant(P<0.05). Conclusion Compared with open tension-free repair, laparoscopic repair is feasible and safe, can reduce bleeding effectively and postoperative pain, shorten the operation time, length of hospital stay and postoperative bed time.
Objective Compare the effect and safety of laparoscopic repair and open tension-free repair for inguinal hernia in elderly patients. Methods 118 cases of elderly patients with inguinal hernia in Shunde affiliated hospital of Guangzhou Medical University were selected and divided into study group and control group according to the different treatment methods, with 59 cases in each group. Study group was treated with laparoscopic repair, while control group was treated with open tension-free repair. The operation details, postoperative pain and complications of the 2 groups were analyzed. Results The operation time, length of hospital stay and postoperative bed time of study group were shorter than those of control group. The amount of bleeding during operation of study group was less than that of the control group, while the hospitalization cost was higher(P<0.05); Compared with preoperative pain, the VAS scores at 1 st, 3 th and 5 th day of 2 groups after surgery were significantly decreased, and the VAS scores of the study group were significantly lower than those of the control group at each time point(P<0.05); The postoperative complication rate of the study group was 6.67%, which was significantly lower than that of the control group(17.24%), the difference was statistically significant(P<0.05). Conclusion Compared with open tension-free repair, laparoscopic repair is feasible and safe, can reduce bleeding effectively and postoperative pain, shorten the operation time, length of hospital stay and postoperative bed time.
引文
[1]李永智.腹膜外腹腔镜疝修补术治疗老年腹股沟疝的效果评价[J].中外医学研究,2016,14(26):140-141.
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[3]Mirza AA,Augustine AJ,Shibumon MM.Surgical Outcomes Open versus Laparoscopic Repair for Inguinal Hernia[J].Iosr J Dental Med Sci,2014,13(4):46-49.
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[6]Schiergens T S.Diagnosis of inguinal hernia[J].Mmw Fortschritte Der Medizin,2011,153(49-50):34-34.
[7]朱响,梅拥平,王馨,等.经腹腔镜与开放式腹膜外间隙无张力疝修补术治疗成人腹股沟斜疝的疗效分析[J].南京医科大学学报(自然科学版),2014,6(10):1412-1415.
[8]马天林.腹膜外腹腔镜疝修补术治疗老年腹股沟疝的效果评价[J].世界最新医学信息文摘,2016,16(21):25-26.
[9]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
[10]Reinpold W.Risk factors of chronic pain after inguinal hernia repair:a systematic review[J].Innov Surg Sci,2017,2(2):145-149.
[11]赵健,郭天康.腹腔镜与开放式无张力疝修补术治疗成人复发性腹股沟疝疗效Meta分析[J].中国实用外科杂志,2015,9(1):86-93.
[12]Sgourakis G,Dedemadi G,Gockel I,et al.Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence:a decision analysis based on net health benefits[J].Surg Endosc,2013,27(7):2526-2541.
[13]戴继平.腹腔镜手术治疗老年腹股沟疝患者的疗效及优势[J].实用临床医药杂志,2016,20(3):116-117.
[14]Bulus H,Dogan M,Tas A,et al.The effects of Lichtenstein tension-free mesh hernia repair on testicular arterial perfusion and sexual functions[J].Wien Klin Wochenschr,2013,125(3/4):96-99.
[2]刘郁,段绍斌,于亮.腹腔镜疝修补术与开放无张力疝修补术治疗老年复发性腹股沟斜疝的疗效分析[J].湖南师范大学学报(医学版),2013,3(1):63-65.
[3]Mirza AA,Augustine AJ,Shibumon MM.Surgical Outcomes Open versus Laparoscopic Repair for Inguinal Hernia[J].Iosr J Dental Med Sci,2014,13(4):46-49.
[4]Choi YY,Kim Z,Hur KY.Learning curve for laparoscopic totally extraperitoneal repair of inguinal hernia[J].Can J Surg,2012,55(1):33-36.
[5]孙广文,肖春林,周立新,等.腹腔镜与开放式无张力疝修补术治疗老年腹股沟斜疝的疗效对比[J].中国伤残医学,2015,4(23):74-76.
[6]Schiergens T S.Diagnosis of inguinal hernia[J].Mmw Fortschritte Der Medizin,2011,153(49-50):34-34.
[7]朱响,梅拥平,王馨,等.经腹腔镜与开放式腹膜外间隙无张力疝修补术治疗成人腹股沟斜疝的疗效分析[J].南京医科大学学报(自然科学版),2014,6(10):1412-1415.
[8]马天林.腹膜外腹腔镜疝修补术治疗老年腹股沟疝的效果评价[J].世界最新医学信息文摘,2016,16(21):25-26.
[9]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
[10]Reinpold W.Risk factors of chronic pain after inguinal hernia repair:a systematic review[J].Innov Surg Sci,2017,2(2):145-149.
[11]赵健,郭天康.腹腔镜与开放式无张力疝修补术治疗成人复发性腹股沟疝疗效Meta分析[J].中国实用外科杂志,2015,9(1):86-93.
[12]Sgourakis G,Dedemadi G,Gockel I,et al.Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence:a decision analysis based on net health benefits[J].Surg Endosc,2013,27(7):2526-2541.
[13]戴继平.腹腔镜手术治疗老年腹股沟疝患者的疗效及优势[J].实用临床医药杂志,2016,20(3):116-117.
[14]Bulus H,Dogan M,Tas A,et al.The effects of Lichtenstein tension-free mesh hernia repair on testicular arterial perfusion and sexual functions[J].Wien Klin Wochenschr,2013,125(3/4):96-99.