开放TEP与传统前入路无张力修补腹股沟疝的比较

目的 比较传统前入路和开放式TEP无张力修补复发性腹股沟疝方法的手术疗效.方法 采用随机双盲对照方法,对165例腹股沟疝分别沿用传统前入路和开放式TEP术式行无张力修补方法,比较两组患者手术耗时、住院天数、平均恢复正常活动时间、治疗费用以及近/远期并发症和术后不适等指标,以评价开放式TEP术式修补腹股沟疝的疗效. 结果前入路组随访时间平均为(20.52±1.54)月,开放TEP组(21.63±1.76)月,完成随访率为98.79%.前入路3例1年后复发(3.66%),开放TEP组1例术后1年半后复发(1.22%),手术耗时、尿潴留率、平均住院天数、治疗费用、恢复正常活动时间和疝复发率均无显著性差异(P>0.05);术后腹股沟区疼痛、血清肿、阴囊水肿、切口感染、神经感觉异常和缺血性睾丸炎等近远期并发症开放TEP组明显少于前入路组,两组间差异有统计学意义(P<0.05). 结论开放TEP修补腹股沟疝可明显减少各种并发症和术后不适的发生率,疗效肯定,值得临床推广应用.

A comparison between opening total extraperitoneal herniorrhaphy and traditional anterior approach on tension-free repair of inguinal hernia

Objective To evaluate the effects of the two different operations, such as open total extraperitoneal herniorrhaphy or traditional anterior approachs on tension-free repair of inguinal hernia. Methods In a prospective randomized controlled study, 165 cases with inguinal hernia were allocated randomly to either the anterior approach group (82 cases)or open total extraperitoneal herniorrhaphy group( 83 cases ).The index including the operation time, hospital stay, mean expense, time for returning to normal activity,and the recent or long-term operative complications and recurrence rate, were observed to evaluate the curative effect of open total extraperitoneal herniorrhaphy approach. Results The follow-up rate were 98.79% ,after (20.52 ± 1.54) months in average follow-up in the anterior approach group and (21.63 ± 1.76) months in the TEP group, and no significant differences were recorded between the two groups in the operation time, hospital stay, time for returning to normal activity, recurrence rate(3.66% vs 1.22% ) and urinary retention ( P > 0. 05 ), but operative complications in TEP group were significantly less than that in anterior approach group (P< 0.05). Conclusions The operative complications or postoperative unwell decrease significantly through the open total extraperitoneal herniorrhaphy approach in repairing inguinal hernias. Its curative effect was confirmed and deserves to be clinically popularized.