腹腔镜全腹膜外腹股沟疝修补术与无张力疝修补术的随机对照研究

目的：研究腹腔镜全腹膜外腹股沟疝修补术（totally extraperitoneal prosthetic,TEP）在临床应用中的价值。方法：71例成人腹股沟疝患者前瞻性随机分成两组,分别进行TEP和无张力疝修补术（Lichtenstein）。TEP组35例,Lichtenstein组36例。手术后1周和1年内对患者作出临床观察和评估,并在3个月和1年时进行电话及门诊随访。观察指标为：手术时间、使用镇痛药物的频率、下床活动时间、住院天数、并发症、暂时性神经感觉异常、正常活动时间、腹股沟疼痛持续时间、疝复发。将两组数据进行统计学处理和分析。结果：使用镇痛药物的频率、下床活动时间、住院天数、恢复正常活动时间、腹股沟疼痛持续时间、并发症方面TEP组优于Lichtenstein组,有显著性差异（P〈0.05）。手术时间、复发例数TEP组少于Lichtenstein组,但无统计学差异。结论：TEP对于复发疝、老年人疝以及双侧疝更加具有优势。但TEP手术费用较高、需要腹腔镜等设备、学习曲线较长,这些可能是目前TEP尚未广泛开展的主要原因。我们认为,缩短TEP学习曲线的关键在于掌握手术空间的建立,腹白线中隔是影响手术空间建立的主要因素,打开下方部分腹白线中隔是手术的要点。

Randomized comparative study on totally extraperitoneal prosthetic and tension-free herniorrhaphy

Objective:To study the value of totaly extraperitaneal prosthetic(TEP)in the treatment of hernia.Methods:Seventy-one cases with adult inguinal hernia were randomized in two groups.35 cases received the laparoscopic repair with TEP.36 cases were repaired with tension-free herniorrhaphy(Lichtenstein).The observe period was within 1 week to 1 year in two groups and the patients were followed-up by telephone or consultation in out-patient clinic between 3 months and 1 year after operation.Results:The frequency of using analgesic drugs,duration in hospital,pain time in TEP was more satisfactory than those in the other group.There was a significant difference in two groups.There was no significant difference in two groups in operation time,complication and recurrence rate.Conclusions:Compared tension-free heniorhaphy,the TEP is more advantageous in recurring hernia,hernia in aged people and hibateral.The key to shorten the period of learning-curve is to establish the effective operating space and master the technology.