TAPP术式中不同补片的使用效果和经验

目的 探究基层医院腹腔镜成人疝修补术运用于成人腹股沟手术的手术用时、手术费用及临床疗效的情况。方法 选择2015年3月至2017年3月腹股沟疝患者180例作为研究对象，分为对照组和观察组，各90例。对照组为使用3D补片、钉枪固定及间断缝合腹膜的常规TAPP术，观察组为使用国产平补片、胶水固定及连续缝合腹膜的改良TAPP术治疗。比较两组患者的手术成功率、1年内复发率，并比较患者术中指标：手术时间、术中出血量、下床活动时间、住院时间以及住院费，用VAS评分评价患者术后疼痛情况，观察记录并发症发生情况。 结果 两组手术成功率和1年内两组复发率无显著差异（P>0.05）；两组的术中出血量无显著差异（P>0.05）；两组的VAS评分、下床活动时间、住院时间无显著差异（P>0.05）；观察组的手术时间短于对照组（P<0.05），住院费用小于对照组（P<0.05）；两组并发症总发生率无显著差异（P>0.05）。 结论 改良后的TAPP术具有与常规TAPP术相似的临床效果，但是手术时间更短，操作更为简便，同时改良TAPP术具有更低的住院费用，值得在基层医院推广。

Clinical application research of laparoscopic transabdominal preperitoneal hernioplasty in primary hospitals

［Abstract］ Objective To analyze the effect and provide experience of different patches in TAPP operation. Methods From March 2015 to March 2017， 180 patients with inguinal hernia were selected as study objects and divided into control group and observation group， 90 cases each. The control group was treated with classical TAPP procedure with 3D patch， nail gun fixation and intermittent suture of peritoneum， while the observation group was treated with modified TAPP with domestic flat patch， glue fixation and continuous suture of peritoneum. The success rate of surgery and the recurrence rate within one year were compared between the two groups of patients. The intraoperative indexes were compared： operation time， intraoperative blood loss， ambulation time， hospitalization time， and hospitalization fee. VAS was used to evaluate postoperative pain. Observe and record the complications. Results There was no significant difference between the two groups in the success rate of surgery and the recurrence rate of the two groups within one year （P>0.05）. There was no significant difference in blood loss between the two groups （P>0.05）. There was no significant difference in VAS score， time of ambulation and hospital stay between the two groups （P>0.05）. The operation time of the observation group was significantly shorter than that of the control group （P<0.05）. The cost of hospitalization was significantly lower than that of the control group （P<0.05）|There was no significant difference in the total incidence of complications between the two groups （P>0.05）. Conclusion The modified TAPP procedure has similar clinical effects as the traditional TAPP procedure， but the operation time is shorter and the operation is easier， which promotes the patient′s postoperative recovery. At the same time， the modified TAPP procedure has lower surgical cost.