腹腔镜经腹腹膜前疝修补术对患者术后应激反应及疼痛的影响

目的探讨腹腔镜经腹腹膜前疝修补术（TAPP）对患者术后并发症及疼痛的影响。 方法收集2018年4~11月收治的128例腹股沟斜疝患者，随机数表法分为TAPP组（64例）和对照组无张力疝修补术（64例）。比较2组临床指标、应激激素水平、疼痛情况和并发症。 结果TAPP组术后下床时间、术后疼痛持续时间和平均住院时间均低于对照组（P<0.05），2组患者的术后进食时间无明显统计学差异（P>0.05）。与术前比较，术后3 d 2组皮质醇（Cor）和醛固酮（ALD）水平均升高（P<0.05），对照组去甲肾上腺素（NE）水平显著升高（P<0.05）。术后3 d，TAPP组Cor、NE和ALD水平低于对照组，差异具有统计学意义（P<0.05）。与术后24 h比较，术后72 h 2组简式疼痛问卷表（SF-MPQ）评分和视觉模拟评分（VAS）均降低（P<0.05），且TAPP组VAS评分和SF-MPQ评分低于对照组（P<0.05）。 结论TAPP手术是治疗腹股沟疝的有效手段，与无张力疝修补术相比在减少术后疼痛和并发症方面具有明显优势，术后应激反应较低。

Effect of laparoscopic transabdominal preperitoneal hernia repair on postoperative stress response and pain

ObjectiveTo explore the effect of laparoscopic transabdominal preperitoneal hernia repair (TAPP) on postoperative complications and pain. Methods128 patients with inguinal hernia were divided into the TAPP group (n=64, TAPP) and the control group (n=64, tension-free hernia repair) by Random number table. The clinical indexes, levels of stress hormone, pain and complications were compared between the two groups. ResultsThe time of getting out of bed, pain duration and average hospital stay in the TAPP group were lower than those in the control group (P<0.05). There was no statistically significant difference in postoperative feeding time between the two groups (P>0.05). Compared with before operation, the levels of cortisol (Cor) and aldosterone (ALD) in the two groups increased at 3 days after operation (P<0.05), while the levels of norepinephrine (NE) in the control group increased significantly (P<0.05). At 3 days after operation, the levels of Cor, NE and ALD in the TAPP group were lower than those in the control group, with statistical differences (P<0.05). Compared with those at 24 hours after operation, the scores of SF-MPQ and VAS in the two groups decreased at 72 hours after operation (P<0.05), and the scores of SF-MPQ and VAS in the TAPP group were lower than those in the control group (P<0.05). ConclusionTAPP is an effective method to treat inguinal hernia. Compared with tension-free hernia repair, TAPP has obvious advantages in reducing postoperative pain and complications, and has lower postoperative stress response.