低温芒硝序贯疗法预防TAPP术后血清肿发生的疗效观察

目的 探讨低温芒硝序贯疗法在预防腹腔镜下经腹腔腹膜前疝修补术（TAPP）后血清肿发生的治疗效果。方法 收集2019年3月至2022年3月在万安县人民医院普外科和中山大学附属第六医院胃肠、疝与腹壁外科收治的120例行TAPP患者的临床资料，利用电脑随机数字表分为试验组与对照组，每组各60例。试验组予以腹股沟区创面200 m L 4℃生理盐水冲洗+术后腹股沟区冰敷2 h+术后芒硝外敷2 d的3种联合措施，对照组仅予以TAPP术后常规处理；主要观察指标为两组患者术后血清肿发生率，次要观察指标包括手术时间、下床活动时间、住院天数、住院费用、切口疼痛、VAS评分、恶性呕吐、尿潴留及肠梗阻发生率和远期随访指标包括慢性疼痛、补片感染、疝复发等。结果 试验组和对照组患者血清肿发生率分别为1.7%(1/60)、16.7%(10/60)，差异有统计学意义（P<0.05），试验组1例属于Ⅰ型；对照组10例中，Ⅰ型6例、Ⅱ型2例、Ⅳ型2例；Ⅳ型血清肿予以B超引导下穿刺抽吸后逐渐缓解，Ⅰ型、Ⅱ型血清肿予以芒硝外敷处理后均好转。试验组患者术后切口疼痛、恶心呕吐、尿潴留发生率分别是5.0%、3.3%、3.3%...

Effect of sequential therapy of low temperature and glauber salt to prevent the occurrence of seroma after TAPP

Objective To investigate the effect of sequential therapy of low temperature and glauber salt in preventing seroma after laparoscopic transperitoneal preperitoneal hernia repair （TAPP）. Methods Clinical data of 120 TAPP patients admitted to the General Surgery Department of Wan′an County People′s Hospital and Department of Gastrointestinal Surgery and Hernia Center of the Sixth Affiliated Hospital of Sun Yat-sen University from March 2019 to March 2022 were collected and divided into the study group and the control group with 60 patients in each group by using a computer random number table. In the study group, 200 mL 4℃ saline irrigation was applied to the inguinal area, ice packs compress two hour postoperatively in the inguinal area and two day external application of glauber salt after surgery. In the control group, conventional TAPP postoperative treatment was performed. The main outcome indicators were the incidence of postoperative seroma in two groups, while the secondary outcome indicators included operation time, out-of-bed activity time, length of stay, hospitalization cost, incision pain, VAS score, incidence of malignant vomiting, urinary retention and intestinal obstruction, and long-term follow-up indicators included chronic pain, mesh infection and hernia recurrence. Results The incidence of seroma in study group and control group was 1.7% （1/60） and 16.7% （10/60）, respectively, and the difference was statistically significant （P<; 0.05）, 1 in the study group belonged to type ⅰ. In the control group, 6 cases were type ⅰ, 2 cases were type ⅱ and 2 cases were type ⅳ. Type ⅳ seroma was gradually relieved after puncture and aspiration guided by B-ultrasound, while type ⅰ and ⅱ seroma were improved after glauber salt external application. The incidence of postoperative incision pain, nausea and vomiting and urinary retention in the study group were 5.0%, 3.3% and 3.3%, respectively, lower than 16.7%, 13.3% and 15.0% in the control group, and the difference was statistically significant （P<; 0.05）. VAS score （3.1±; 0.6） points, out-of-bed activity time （8.5±; 2.3） h, and length of stay （3.5±; 0.6） d in the study group were all lower than those in the control group （4.8±; 0.8） points, （13.1±; 1.7） h, and （4.5±; 1.0） d, all of which were statistically significant （P<; 0.05）. There were no statistically significant differences between the two groups in terms of operation time, chronic pain in the inguinal region, mesh infection, intestinal obstruction, hospital expenses, and hernia recurrence. Conclusion The sequential therapy of low temperature and glauber salt can effectively prevent the occurrence of seroma after TAPP, with fewer complications, significantly reduce the postoperative pain of patients,promote rapid recovery, and do not increase the economic burden of patients, which is worthy of clinical application and promotion.