腹腔镜经腹腹膜前疝修补术与开放式腹膜前疝修补术治疗股疝的疗效比较

目的比较腹腔镜经腹腹膜前疝修补术（TAPP）与开放式腹膜前疝修补术治疗股疝的手术结果和对生活质量的影响。 方法回顾性分析2014年1月至2019年12月新疆医科大学第一附属医院收治的58例股疝患者的临床资料，根据手术方式不同分为TAPP组和开放式腹膜前疝修补术组（开放组），TAPP组31例，开放组27例。比较两组手术指标，采用卡罗来纳舒适量表（CCS）评估并比较两组患者术前及术后1、6、12和24个月的生活质量。 结果TAPP组在手术时间、术中出血量、术后住院天数及术后并发症发生率等方面和开放组相比差异无统计学意义（P>0.05）；TAPP组在术后24 h疼痛视觉模拟评分及术后镇痛药使用率方面明显优于开放组（P<0.05）；TAPP组术后离床时间及术后首次进食时间长于开放组（P<0.05）；2组患者术后随访24个月，均无复发病例。两种术式均能有效改善患者术前的疼痛、运动受限及总体生活质量（P<0.05）；TAPP组患者术后1个月疼痛及总体生活质量优于开放组（P<0.05）。 结论TAPP与开放式腹膜前疝修补术均可有效治疗股疝。TAPP可作为无全身麻醉禁忌股疝患者的首选治疗方法。股疝的治疗应依据患者的自身情况和手术医师的技术掌握程度制定个体化治疗方案。

Comparison of surgical outcomes and quality of life of TAPP versus open preperitoneal hernia repair for the treatment of femoral hernia

ObjectiveTo compare the surgical outcomes and quality of life between TAPP and open preperitoneal repair for the treatment of femoral hernia. MethodsFrom January 2014 to December 2019, the clinical data of 58 patients with femoral hernia treated at Xinjiang Medical University's First Affiliated Hospital were retrospectively analyzed. Patients were divided into the TAPP group (n=31) and the open group (n=27) according to different surgical methods. The surgical outcomes were recorded and compared between the two groups. In addition, the quality of life of the two groups was evaluated and compared before surgery and 1, 6, 12 and 24 months after surgery using the Carolinas Comfort Scale (CCS). ResultsThere was no significant difference in terms of operation time, intraoperative blood loss, postoperative hospital stay and incidence of postoperative complications between the TAPP group and the open group (P>0.05). The VAS score at 24 h after surgery and the utilization rate of postoperative analgesics in the TAPP group were significantly lower than those in the open group (P<0.05). The postoperative ambulation time and the first postoperative feeding time in the TAPP group were significantly longer than those in the open group (P<0.05). After 24 months of follow-up, there were no recurrences in the TAPP group or the open group. Both TAPP and open preperitoneal repair could effectively improve the preoperative pain, movement limitation and overall quality of life of patients (P<0.05). The pain and overall quality of life in TAPP group were better than those in open group one month after surgery (P<0.05). ConclusionTAPP and open preperitoneal hernia repair can effectively treat femoral hernia. TAPP can be used as the preferred treatment for patients with femoral hernia without general anesthesia contraindication.The appropriate surgical method for femoral hernia should be individualized according to the patient's own situation and the surgical skill level of the surgeon.