Lichtenstein和腹腔镜经腹腹膜前疝修补术在腹股沟阴囊疝患者中的临床应用

目的比较腹腔镜经腹腹膜前疝修补术（TAPP）与开放Lichtenstein手术，在腹股沟阴囊疝治疗中的疗效，并探讨其可行性及术后并发症的发生率。 方法选择2016年1月至2018年12月，南京市高淳人民医院阴囊疝患者48例。按照术式不同分为TAPP组（20例）和Lichtenstein组（28例）。比较2组术中及术后并发症，包括手术时间、术中出血、术后疼痛、伤口及网片感染和术后复发等。 结果本组患者均顺利完成手术。Lichtenstein组手术时间（59±12）min，TAPP组手术时间（56±9）min，差异无统计学意义（P>0.05）；Lichtenstein组术中出血量（30.0±10.5）ml，TAPP组为（10.0±5.1）ml，差异有统计学意义（P<0.05）。Lichtenstein组住院时间（9.0±5.2）d，TAPP组（3.0±2.4）d，差异有统计学意义（P<0.05）。Lichtenstein组术后疼痛VAS评分（术后1周）为（4.0±1.4）分，TAPP组（2.0±1.2）分，差异有统计学意义（P<0.05）。2组患者在随访期间均无补片感染、复发及慢性疼痛发生。Lichtenstein组切口并发症（浅表感染及血肿，渗血，渗液）6例，阴囊积液6例；TAPP组切口并发症0例，阴囊积液7例。均经过换药或者保守治疗，均治愈出院。 结论TAPP可以进行腹股沟阴囊疝修补术，其疗效与腹股沟疝开放修补术相当，TAPP具有术后疼痛轻、伤口并发症少，住院时间较短的优点。

Comparison of TAPP and Lichtenstein in inguinoscrotal hernia repair

ObjectiveTo compare the effect of the laparoscopic trans-abdominal preperitoneal (TAPP) approach and Lichtenstein approach in the treatment of scrotal inguinal hernia, and our results were focusing on the feasibility of the technique and the incidence of postoperative complications. MethodsBetween January 2016 and December 2018, a total of 48 scrotal hernia patients underwent either TAPP repair or Lichtenstein repair. And the intraoperative and postoperative complications were compared, including operative time, intraoperative bleeding, postoperative pain, wound and mesh infection, and recurrence. ResultsAll procedures were performed successfully, and the overall mean operative time for TAPP was (56±9) minutes, for Lichtenstein was (59±12) minutes, the difference was not statistically significant P>0.05]. The intraoperative bleeding was more for Lichtenstein than TAPP (30.0±10.5) ml vs (10.0±5.1) ml, (P<0.05), the hospital stay was shorter in TAPP group compared with Lichtenstein group (9.0±5.2) days vs (3.0±2.4) days, P<0.05] and postoperative pain at 1 week after operation was less in TAPP (3.0±2.4), as compared with Lichtenstein (4.0±1.4), the difference was statistically significant (P<0.05). During the follow-up period, there was no mesh infection, recurrence and chronic pain in the two groups. In the Lichtenstein group, there were 6 cases of wound complications (superficial infection and hematoma, blood oozing, and exudation), 6 cases of scrotal effusion. While there were no wound complications, 7 cases of scrotal effusion in the TAPP group. All patients were cured and discharged after dressing change or conservative treatment. ConclusionThe TAPP can be performed for inguinoscrotal hernia repair with an efficiency comparable to that of open inguinal hernia repair, and the TAPP procedure was associated with less pain, wound complications, and short hospital stay.