腹腔镜和开放式无张力修补腹股沟疝251例对比分析

目的探讨腹股沟疝修补术的术式选择。方法回顾性分析2005—10～2008—11251例腹股沟疝修补术病例资料，对比分析各种手术方式的效果和并发症及其经济价值。结果腹腔镜和开放式无张力腹股沟疝修补术的手术时间：开放式为60．5±15．4min，TEP手术为80．2±25．0min，两组比较差异有统计学意义（P〈0．05，）；术后住院时间腹腔镜组（TEP为3．5±2．4d，P〈0．05）；术后恢复工作时间腹腔镜组（TEP为14．0±4．8d，P〈0．05）；医疗费用腹腔镜组（TEP为6506±325元，IPOM＋内环口结扎术为15733±2739元，P〈0．05）；两类手术并发症发生率相似（并发症为10％～21％，P〉0．05），但IPOM＋内环口结扎术组出现了4例严重并发症（肠瘘、长期腹股沟痛、长期腹股沟积液、死亡）；两类手术复发率相近（复发率为1．1％-3．4％，P〉0．05）。结论开放式无张力疝修补术是最常用腹股沟疝修补术式，尤其适合巨大疝。腹腔镜腹股沟疝修补术具有疼痛少、切口小、住院时间短、恢复时间早等优点；TEP适合年轻病人的腹股沟直疝；TAPP适合开放式修补术后复发疝；IPOM＋内环口结扎术费用高并且可能出现严重并发症。

Comparative analysis of repair of inginal hernia by laparoscopy or open approach

Objective To explore how to choose right approach of repair of inguinal hernia. Methods Two hundred and fifty - one cases undergone inguinal herniorrhaphy from Oct. 2005 to Nov. 2008 were collected, and the effectivness, complications and cost of varied approachs of inguinal hernia repair were analyzed comparatively and ret- rospectively. Results Operating time was different between laparoseopie approach and open approach （P 〈 0. 05 ） ; the patients with laparoscopic approach was earlier to be discharged and retun to work than that with open approaeh（P 〈 0. 05 ） ; cost of laparoseopic approach was higher than that of open approach （ P 〈 0. 05 ） ; the rate of complication and recurrence between two approaehs was similar, dispite there were 4 serious complications in IPOM. Conclusion Open tension - free inguinal herniorrhaphy is the most frequent approach of inguinal hernia repair, especially huge hernia. Iaparoseopie inguinal herniorrahphy has the advantages of slighter pain, smaller incision, short hospital stay and earlier return to work,TEP is suitable to direct inguinal hernia,TAPP to recurrent inguinal hernia,and IPOM ＋internal ring closing may occur severe complications.