腹腔镜经腹腹膜前疝修补术治疗同侧复发性腹股沟疝的可行性分析

目的分析腹腔镜经腹腹膜前疝修补术治疗同侧复发性腹股沟疝的可行性。方法选取2015年2月至2017年2月126例在上海交通大学医学院附属新华医院崇明分院普外科就诊的同侧复发性腹股沟疝126例患者。依据患者选择的手术方式将其分为腔镜组(79例)与开放组(47例)。腔镜组行腹腔镜经腹腹膜前疝修补术治疗,开放组用采用Lichtenstein修补术。观察2组患者的围手术期指标、术后疼痛情况、术后复发率及并发症。结果126例患者的手术均顺利,无中转开放手术,未见重要组织器官损伤,腔镜组术中出血量为(14.87±3.47)ml、下床活动时间为(21.97±6.18)h、住院时间为(4.51±1.21)d,均低于开放组(21.11±5.48)ml、(26.81±7.32)h及(5.81±1.31)d,差异有统计学意义(t=6.121,3.987,5.149;P<0.05);术后6 h、24 h、1周、1个月、3个月,腔镜组视觉模拟评分显著低于开放组,差异有统计学意义(t=4.312,7.561,11.236,10.231,2.654;P<0.05);腔镜组并发症发生率低于开放组,差异有统计学意义(χ²=6.147,P<0.05)。结论腹腔镜经腹腹膜前疝修补术术中出血量少,术后恢复时间短,术后疼痛轻,并发症少,治疗同侧复发性腹股沟疝安全可行。

Feasibility analysis of laparoscopic transabdominal preperitoneal repair for ipsilateral recurrent inguinal hernia

Objective To analyze the feasibility of laparoscopic transabdominal preperitoneal repair in the treatment of ipsilateral recurrent inguinal hernia.Methods 126 patients with ipsilateral recurrent inguinal hernia who were treated in Xinhua hospital Chongming branch from February 2015 to February 2017 were selected and divided into the endoscopic group(79 cases)and the open group(47 cases).The observation group was treated with laparoscopic transabdominal preperitoneal repair,and the control group was treated with Lichtenstein repair.The perioperative indicators,postoperative pain,postoperative recurrence rate and complications were observed in the two groups.Results The operations in both groups were successfully completed.There was no transfer to open surgery.No major tissue or organ damage was seen.In the endoscopy group,intraoperative blood loss was(14.87±3.47)ml,time to get out of bed was(21.97±6.18)hours,and hospital stay was(4.51±1.21)days,which were lower than those in Lichtenstein group,and the differences were statistically significant(P<0.05);At 6 hours,24 hours,1 week,1 month,and 3 months after surgery,the VAS score of the endoscopy group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05);the complication rate of the endoscopy group was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Laparoscopic transabdominal preperitoneal repair has less blood loss,short postoperative recovery time,less postoperative pain and fewer complications.It is safe and feasible to treat ipsilateral recurrent inguinal hernia.