【摘要】 目的 研究腹腔镜经腹膜前疝修补术(TAPP术)和开放式无张力疝修补术在腹股沟疝治疗中的应用价值。方法 选择西安市北方医院2018年6月至2020年11月诊治的125例成人腹股沟疝患者为研究对象,按照随机数字表法分为A组(63例)和B组(62例),其中前者给予TAPP术,后者给予开放式无张力疝修补术治疗。比较两组患者术后股静脉血流状态、疼痛情况和胶原蛋白代谢情况,并比较手术前后男性睾丸血流动力学指标和生育功能变化。结果 术前两组患者股静脉血流速度、血流量、睾丸血流动力学指标、精液量、精子密度、精子存活率、胶原蛋白代谢酶比较,差异无统计学意义(P>0.05);术后A组股静脉血流速度、睾丸动脉舒张期流速快于B组,股静脉血流量、精液量明显大于B组,不同时间点疼痛评分低于B组,金属蛋白酶组织抑制因子-2(TIMP-2)水平明显高于B组,基质金属蛋白酶(MMP)-2、MMP-9水平明显低于B组,差异有统计学意义(P<0.05)。结论 相比于无张力疝修补术,TAPP术应用于成人腹股沟疝优势更大,对于患者股静脉血流状态和男性生殖功能影响更小,同时可减轻术后疼痛,改善胶原蛋白代谢水平。更多还原

【Abstract】 Objective To study the application value of laparoscopic transabdominal preperitoneal herniorrhaphy(TAPP) and open tension-free hernia repair in the treatment of inguinal hernia.Methods Totally 125 adults with inguinal hernia admitted to the North Hospital of Xi’an City were enrolled in this study from June 2018 to November 2020.The patients were divided into group A(63 cases) and group B(62 cases) by random number table method.Group A was treated with TAPP,group B was treated with open tension-free hernia repair.The postoperative femoral vein blood flow velocity,pain and collagen metabolism in the two groups were compared.Changes in male testicular hemodynamics indexes and fertility function before and after surgery were analyzed.Results Before surgery,there was no significant difference on femoral vein blood flow velocity,blood flow,testicular hemodynamic index,semen volume,sperm density, sperm survival rate,collagen metobolizing enzyme(P>0.05).Postoperative femoral vein blood flow velocity and diastolic flow rate in group A were significant faster than those in group B,femoral vein blood flow,semen volume in group A were significant more than those in group B pain score at different time points in group A was lower than group B,TIMP-2 in group A was significantly higher than that in group B,while MMP-2 and MMP-9 levels were significantly lower than those in group B,with statistical significance(P<0.05).Conclusion Compared with tension-free hernia repair,TAPP has more advantages in the treatment of adult inguinal hernia,and it has less influence on femoral vein blood flow and male fertility function.Meanwhile,it could reduce postoperative pain and improve collagen metabolism.更多还原