二种术式治疗成人腹股沟疝的临床对比分析

目的 通过对比分析完全腹膜外疝修补术（TEP）与局部麻醉下无张力疝修补术治疗成人腹股沟疝的临床效果，了解TEP手术的优缺点。方法 回顾性分析2010年3月至2013年4月，南京中医药大学附属南京市中西医结合医院收治的腹股沟疝患者72例。随机分为TEP组（36例）和局部麻醉下无张力疝修补术组（36例），对比分析二组的临床效果。结果 TEP组在手术时间、术后下床活动时间、术后不适感持续时间、住院时间和治疗费用等方面与局部麻醉下无张力疝修补术组比较差异有统计学意义（t=16．2716、4．3816、-12．6182、6．3027、4．3924，P=0．001、0．002、0．005、0．001、0．002），而术后使用止痛药物情况、术后并发症和复发等方面比较差异无统计学意义（X^2=0．5416、2．6143、1．3016，P=0．3824、0．3026、0．1254）。结论 TEP与局部麻醉下开放式无张力疝修补术两种不同术式治疗成人腹股沟疝的临床效果相近，各有优势，临床医师需根据患者的具体情况选择最佳的治疗方式。

Comparative study of two different surgical procedures of adult inguinal herina repair

Objective To compare the clinical efficiency between totally extraperitoneal approach （TEP） and tension-free hernia repair under local anesthesia, and to summarize the advantages and disadvantages of TEP operation. Methods 72 cases of inguinal hernia admitted to Nanjing Intergrated Traditional Chinese and Western Medicine Hospital from March 2010 to April 2013, were enrolled and retrospectively analyzed. All of them were randomly divided into 2 groups. Each of the two groups （ TEP group,Tension-free hernia repair with local anesthesia, as Tension-free group） consisted of 36 cases, and the clinical effects in both groups were compared. Results The operating time, leave bed time, length of discomfort time, length of hospital stay and hospitalization cost were significantly different between two groups （t = 16. 271 6,4. 381 6, -12. 618 2,6. 302 7,4. 392 4,P =0. 001,0. 002,0. 005,0. 001,0. 002）. There were no statistically significant differences in terms of postoperative pain kiUer using, complications and recurrence （X^2 = 0. 541 6,2. 614 3,1. 301 6, P = 0. 382 4,0. 302 6,0. 125 4）. Conclusions TEP has similar clinical outcome with tension-free hernia repair under local anesthesia. However, the surgeon should choose the optimum treatment with specific conditions of individual patients.