TEP与改良Kugel术治疗双侧腹股沟疝的临床效果

目的分析比较TEP与改良Kugel术治疗双侧腹股沟疝的临床效果及患者生活质量。 方法选取2012年1月至2017年1月在上海交通大学医学院附属第九人民医院接受手术治疗双侧腹股沟疝患者157例。按照手术方式分为腹腔镜组（TEP组）和开放组（改良Kugel）组。其中,TEP组71例,改良Kugel组86例。分析比较包括2组患者的手术时间、术中出血量、住院时间、术后并发症、术后早期疼痛、慢性疼痛、复发情况和生活质量。采用SPSS 20.0统计学软件进行数据分析。 结果TEP组手术时间（93.5±10.9）min,改良Kugel组（102.6±9.8）min,差异有统计学意义（P<0.05）。TEP组住院时间（1.05±0.21）d,改良Kugel组（1.52±0.69）d,差异有统计学意义（P<0.05）。TEP组术中出血量（22.1±7.1）ml,改良Kugel组（23.4±6.8）ml,差异无统计学意义（P>0.05）。TEP组术后恢复正常活动时间（8.67±2.32）d,改良Kugel组（9.14±2.40）d,差异无统计学意义（P>0.05）。TEP组术后并发症5（7%）,改良Kugel组10例（11.6%）,差异无统计学意义（P>0.05）。并发症患者中身体质量指数>27 kg/m²,TEP组1例（20%）,改良Kugel组6例（60%）,差异无统计学意义（P>0.05）。TEP组慢性疼痛3例（4.2%）,改良Kugel组14例（16%）,差异有统计学意义（P<0.05）。截止至随访结束,TEP组术后复发0例,改良Kugel组术后复发1例,占约1%;2组无明显差异（P>0.05）。术后1及7 d,2组疼痛视觉模拟评分比较,差异有统计学意义（P<0.05）;术前、术后及12个月比较,差异无统计学意义（P>0.05）。术前、术后1、2、6及12个月2组生活质量量表评分比较,差异均无统计学意义（P>0.05）。 结论通过TEP治疗双侧腹股沟疝能有效地减少患者的手术时间、住院时间、术后疼痛。

Laparoscopic totally extraperitoneal herniorrhaphy versus modified Kugel repair for bilateral inguinal hernias: A comparative study

ObjectiveThe aim of this study is to compare the modified Kugel (M-Kugel) repair with laparoscopic totally extraperitoneal herniorrhaphy (TEP) in patients undergoing surgery for bilateral inguinal hernia. MethodsClinical data of 157 patients (71 cases in TEP group and 86 cases in M-Kugel group) undergoing herniorrhaphy in Ninth People's Hospital of Shanghai Jiaotong University School of Medicine were analyzed. Outcome parameters included hospital stay, operation time, intraoperative bleeding volume, postoperative complications, immediate postoperative pain and chronic pain, recurrence and quality of life. The SPSS20.0 statistical software was used for data analysis. ResultsThe operation time was (93.5±10.9) minutes in the TEP group and (102.6±9.8) minutes in the modified Kugel group, the difference was statistically significant (P<0.05). The length of stay in the TEP group was (1.05±0.21) days, and it was (1.52±0.69) dayd in the modified Kugel group, the difference was statistically significant (P<0.05). Intraoperative blood loss was (22.1±7.1) ml in the TEP group and (23.4±6.8) ml in the modified Kugel group, the difference was not statistically significant (P>0.05). The time to return normal activities after operation was (8.67±2.32) days in the TEP group and (9.14±2.40) days in the modified Kugel group, and there was no significant difference (P>0.05). Postoperative complications were 5 cases (7%) in the TEP group and 10 cases (11.6%) in the modified Kugel group. The difference was not statistically significant (P>0.05). Among the patients with complications, the body mass index was more than 27 kg/m², there was 1 case (20%) in the TEP group and 6 cases (60%) in the modified Kugel group. The difference was not statistically significant (P>0.05). There were 3 cases of chronic pain (4.2%) in the TEP group and 14 cases (16%) in the modified Kugel group. The difference was statistically significant (P<0.05). As of the end of the follow-up, there was no recurrence in the TEP group and 1 recurrence in the modified Kugel group (about 1%); there was no significant difference between the two groups (P>0.05). There was a statistically significant difference in the visual analogue scores of pain between the two groups at 1 and 7 days after surgery (P<0.05); the difference was not statistically significant (P>0.05) between preoperative, postoperative and 12 months. There was no significant difference in the scores of the quality of life scale between the two groups before operation, at 1, 2, 6 and 12 months after operation (P>0.05). ConclusionTEP procedure for bilateral inguinal hernia effectively reduces operation time, early postoperative pain, and hospital stay.