腹腔镜经腹膜前、完全腹膜外和无张力疝修补术的前瞻性对照研究

目的通过对比研究腹腔镜经腹腹膜前补片植入术（TAPP）、完全腹膜外腹腔镜疝修补术（TEP）和开放无张力疝修补术，总结3种手术方法的优缺点。方法将124例腹股沟疝患者随机分为TAPP组44例、TEP组R40例及开放无张力修补组40例。分别行TAPP、TEP和无张力疝修补术（Lichtenstein修补），术后对患者进行随访，比较3组患者的手术相关参数。结果TAPP组与TEP组在手术时间、住院天数、住院费用、恢复工作时间、术后疼痛程度方面比较差异无统计学意义。两组与开放无张力修补组比较差异有高度统计学意义（P〈0．01）。3组在并发症方面的差异无统计学意义。TAPP组与TEP组术后各有1例因补片曲卷移位而复发。结论与开放无张力疝修补手术相比，TAPP及TEP较安全可行，且患者疼痛轻、恢复快。TAPP对于复发性疝、双侧疝及隐形疝的优势更加明显，随着修补材料的不断改进及手术熟练程度的提高，TAPP会有更广阔的前景。

Randomized comparative study on transabdominal preperitoneal, totally extraperitoneal prosthetic and open tension-free herniorrhaphy of groin hernia

Objective To compare the effect and superiority about transabdominal preperitoneal laparoscopic hernia repair （TAPP）, totally extraperitoneal laproscopic hernioplasty （TEP） and open tension-free hemiorrhaphy（OPEN） of groin hernia in a randomized research. Methods One hundred and twenty-four cases with adult inguinal hernia were randomized divided to three groups. Forty-four cases were received the laparoscopic repair with TAPP（TAPP group）. Forty cases were repaired with TEP（TEP group）. Forty cases were repaired with tension-free herniorrhaphy （Lichtenstein）. The patients were followed up postoperatively and compared the correlative parameter. Results The operation time, duration in hospital, hospital costs, reprocessing time and the degree of postoperative pain in TAPP, TEP were more satisfactory than those in Lichtenslein group（P〈0.01）, There was no significant diference between TAPP and TEP groups. There was one case recurred in TAPP group and TEP group for tissue patch displacement. Conclusions For patients with groin hernia, TAPP or TEP is a feasible, safe and has advantages over open tention-free repair in the postoperative recovery. TAPP is more advantageous in recurring hernia, occular hernia and bilateral hernia. With the patch material development and the improvement of surgical technic, TAPP will have a broader prospect.