【摘要】 目的比较腹腔镜下全腹膜外腹股沟疝修补术(total extraperitoneal repair,TEP)与经正中线切口腹膜前腹股沟疝修补术治疗成人腹股沟疝的效果。方法 2011年1月~2014年12月,94例成人腹股沟疝采用腹腔镜下完全腹膜外游离腹膜前间隙,放置补片(TEP组),83例成人腹股沟疝采用下腹正中小切口游离腹膜前间隙,放置补片(开放组),比较2组手术时间、住院时间、住院费用、术后应用止痛药物情况、血清肿与切口裂开情况等。结果 TEP组手术时间(76±14)min,明显长于开放组(47±8)min(t=16.623,P=0.000);住院费用(9568.95±1422.23)元,明显高于开放组(5327.75±662.76)元(t=24.881,P=0.000);开放组术后应用镇痛剂(15例vs.6例,χ2=5.760,P=0.016)、切口脂肪液化裂开(4例vs.0例,P=0.046,)例数均明显高于TEP组;TEP组住院时间(4.9±0.6)d,与开放组(5.0±0.5)d无统计学差异(t=-1.195,P=0.234);2组血清肿无统计学差异(6例vs.1例,χ2=2.937,P=0.087)。177例随访3~12个月,平均7.4月,2组均无疝复发、补片感染、慢性疼痛、睾丸萎缩等并发症发生。结论开放手术在手术时间和住院费用上较TEP有明显优势,但术后疼痛、切口并发症高于TEP组,更适合双侧疝及复发疝,对单侧初发疝的治疗无明显优势。更多还原

【Abstract】 Objective To compare curative effects of laparoscopic total extraperitoneal repair( TEP) versus preperitoneal inguinal hernia repair via midline incision. Methods From January 2011 to December 2014,the TEP operation was conducted in 94patients( TEP group),during which the mesh was placed under total laparoscopic extraperitoneal approach,while the open operation was carried out in 83 patients( open group),during which the mesh was placed into after preperitoneal space exposure via a midline incision. The operation time,length of hospital stay,cost of hospitalization,application of analgesics,seroma,fat liquefaction and incision split were compared between the two groups. Results The operation time was significantly longer in the TEP group than that in the open group [( 76 ± 14) min vs.( 47 ± 8) min,t = 16. 623,P = 0. 000]. The cost of hospitalization was significantly higher in the TEP group than that in the open group [( 9568. 95 ± 1422,23) yuan vs.( 5327. 75 ± 662. 76) yuan,t = 24. 881,P = 0. 000].The application rate of analgesics and incidence of fat liquefaction and incision split were significantly higher in the open group than those in the TEP group [15 vs. 6,χ2= 5. 760,P = 0. 016; 4 vs. 0,P = 0. 046]. There was no significant difference between the TEP group and the open group in the postoperative hospital stay( 4. 9 ± 0. 6 days vs. 5. 0 ± 0. 5 days,t =- 1. 195,P = 0. 234) and the incidence of seroma( 6 vs. 1,χ2= 2. 937,P = 0. 087). All the 177 cases were followed up for 3- 12 months( mean,7. 4 months).No severe postoperative complication was encountered in both groups,such as recurrence,mesh infection,chronic pain after hernia repair,or testicle atrophy. Conclusions Open surgery is superior to TEP in operation time and cost of hospitalization but has higher incidence of postoperative pain and incision complications,being suitable for bilateral hernia and recurrent hernia. It has no significant advantages for incipient unilateral inguinal hernia.更多还原