完整剥离和横断疝囊在单侧腹股沟斜疝经腹腹膜前修补术中的疗效比较

目的探讨完整剥离疝囊和横断疝囊在单侧腹股沟斜疝腹腔镜经腹腹膜前修补术（TAPP）中的疗效。 方法选取2020年3月至2021年3月南京医科大学附属江宁医院85例行TAPP的腹股沟斜疝患者作为研究对象，根据入院单双号分为横断组（43例）和剥离组（42例），其中横断组术中横断疝囊，剥离组完整剥离疝囊。比较2组一般手术情况，疼痛视觉模拟评分（VAS），氧化应激指标中生长激素、胰岛素、血糖和总抗氧化能力（T-AOC），血清免疫指标和术后并发症情况。 结果横断组手术时间、腹股沟区积液、术中出血量及住院时间均显著优于剥离组（P<0.05）；横断组术后1 d、3 d和1周VAS评分显著低于剥离组（P<0.05）；横断组生长激素、胰岛素和T-AOC水平均显著高于剥离组（P<0.05），血糖水平显著低于剥离组（P<0.05）；2组血清基质金属蛋白酶-2（MMP-2）、MMP-9、基质金属蛋白酶抑制剂-1（TIMP-1）和TIMP-2水平均较术前显著降低（P<0.05），2组术后血清免疫水平比较差异均无统计学意义（P>0.05）；2组患者术后血清肿、神经感觉异常和尿潴留等情况比较差异无统计学意义（P>0.05）。 结论完全剥离和横断疝囊在治疗单侧腹股沟斜疝中均具有良好的效果，但横断疝囊方式在减少手术时间，减轻患者疼痛及应激反应，加快康复方面具有更积极的作用。

The efficacy of complete dissection of hernia sac and transection of hernia sac in laparoscopic transabdominal preperitoneal repair for unilateral indirect inguinal hernia

ObjectiveTo investigate the efficacy of complete stripping of the hernia sac and transection of hernia sac in laparoscopic transabdominal preperitoneal repair (TAPP) for unilateral indirect inguinal hernia. MethodsFrom March 2020 to March 2021, 85 patients with indirect inguinal hernia who underwent TAPP in Jiangning Hospital Affiliated with Nanjing Medical University were selected as the research subjects. According to the odd and even numbers of admissions, they were divided into a transection group (43 cases) and a dissection group (42 cases). The general surgical conditions, pain indexes, oxidative stress indexes such as growth hormone (GH), insulin (InS), blood sugar (BS) and total antioxidant capacity (T-AOC), serum immune indexes and postoperative complications were compared between the two groups. ResultsThe operation time, inguinal effusion, intraoperative blood loss and hospitalization time in the transection group were significantly better than those in the dissection group (P<0.05); The degree of pain in the transection group 1 d, 3 d and 1 week after the operation was significantly lower than that in the dissection group (P<0.05); The levels of GH, InS and T-AOC in the transection group were significantly higher than those in the dissection group (P<0.05), and the level of BS was significantly lower than that in the dissection group (P<0.05); Serum levels of matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) and TIMP-2 in the two groups significantly decreased compared with those before the operation (P<0.05), and there was no significant difference in serum levels between the two groups after the surgery (P>0.05); There were no significant differences in postoperative seroma, neuroparesthesia and urinary retention between 2 groups (P>0.05). ConclusionBoth complete dissection and transection of the hernia sac have good efficacy in the treatment of unilateral inguinal hernia, but transection of the hernia sac plays a more positive role in reducing the operation time, alleviating the pain of patients, alleviating the stress response, and expediting the recovery of patients.