三种局部麻醉小切口术式治疗腹股沟疝的疗效及舒适度对比

目的综合比较Lichtenstein术（常规平片）、Lichtenstein术（自粘式补片）及腹膜前间隙修补术治疗腹股沟疝的效果。 方法选择2018年3月至2019年12月中日友好医院收治的473例腹股沟疝患者，依据修补方式将其分为A组（Lichtenstein术，使用常规平片，175例）、B组（Lichtenstein术，使用自粘式补片，109例）、C组（腹膜前间隙修补术，189例）。对比3组围手术期及长期随访情况，分析3组术后不同时刻疼痛程度和手术前后舒适状况，并比较近远期并发症发生率以探讨三种术式的安全性。 结果B组手术持续时间短于A组和C组（P<0.05），A组和C组手术持续时间比较无显著差异（P>0.05）；术中失血量3组间分别比较有统计学差异，B组失血量最少（P<0.01）；B组住院费用高于A组和C组（P<0.05），A组和C组住院费用比较无明显差异（P>0.05）；术后12、24 h，C组的视觉模拟评分（VAS）显著低于A组和B组（P<0.05），3组的VAS评分随时间推移均逐渐降低（P<0.05）；术后美国舒适状况量表躯体维度评分3组间两两比较，差异均有统计学意义，C组最高（P<0.001）；C组异物感发生率略低于A组和B组，但3组异物感发生率方面并无统计学差异（P>0.05）；3组的复发率、局部积液、切口感染、发热及24 h尿潴留发生率等并发症发生率无显著差异（P>0.05）。 结论Lichtenstein术（常规平片）、Lichtenstein术（自粘式补片）、腹膜前间隙修补术均能有效治疗腹股沟疝且都很安全，三种术式在围手术期情况、术后疼痛感及舒适感、远期疗效方面均有不同程度的差异性，因此对具体术式的选择仍需要根据患者情况具体分析。

Comparison of the curative effect and comfort of three surgical treatments with local anesthesia and small incision for inguinal hernia

ObjectiveTo compare the effect of the three surgical methods(Lichtenstein operation (conventional patch), Lichtenstein operation (self-adhesive mesh), preperitoneal repair on inguinal hernia. MethodsA total of 473 patients with inguinal hernia admitted to the hospital from March, 2018 to December, 2019 were divided into the group A (Lichtenstein operation with conventional patch, n=175), group B (Lichtenstein operation with self-adhesive mesh, n=109), and group C (Preperitoneal hernia repair operation, n=189). The perioperative period (operative time, blood loss volume, length of stays and hospitalization costs), the visual analogue scale (VAS) score at different times after operation, the General Comfort Questionnaire (GCQ) score and long-term follow-up (recurrence rate, foreign body sensation, local effusion, infection, fever and uroschesis) of three groups were compared. ResultsThe operation duration in group B were shorter than those in groups A and C (P<0.05), and there were no differences in operation duration in group A and C (P>0.05).Intraoperative blood loss volume was different among the three groups with statistical differences (P<0.01), and the group B was the least. The hospitalization cost in group B were higher than that of groups A and C (P<0.05), and there were no differences in operation cost between group A and C (P>0.05); The VAS score of group C was lower than that of groups B and A at 12 and 24 hours after surgery (P<0.05); VAS scores of the three groups decreased gradually over time (P<0.05). After the operation, the physical dimension score of the GCQ was different among the three groups with statistical differences (P<0.001), and the group C was the highest. The incidence of foreign body sensation in group C was slightly lower than that in group A and B but here was no significant difference in the incidence of foreign body sensation among the three groups (P>0.05); There were no significant differences in the incidence of complications such as recurrence rate, local effusion, fever, and 24-hour uroschesis (P>0.05). ConclusionLichtenstein operation (conventional patch), Lichtenstein operation (Self-adhesive mesh), preperitoneal hernia repair are all effective in the treatment of inguinal hernias, and the three methods have certain safety. The three types of surgery have varying degrees of difference in perioperative conditions, postoperative pain, comfortability, and long-term efficacy. Therefore, the selection of specific surgical methods still needs to be analyzed according to the specific situation of patients.