腹腔镜下不同术式与开放手术疝修补术治疗腹股沟疝的疗效

目的比较腹腔镜下经腹腔腹膜前疝修补法（TAPP）、完全腹膜外疝修补法（TEP）与开放式无张力疝修补术（Lichtenstein）治疗腹股沟疝的疗效及安全性。 方法选择2015年3月至2017年8月就诊于松滋市人民医院的150例腹股沟疝患者，按照随机数字表法分为3组，Lichtenstein组、TAPP组、TEP组，各50例。对比3组手术相关指标、并发症及术后6个月复发率，并观察围手术期患者应激反应[皮质醇（Cor）、去甲肾上腺素（NE）、醛固酮（ALD）]变化。 结果3组手术时间、术后并发症发生率比较，差异均无统计学意义（P>0.05）；Lichtenstein组术中出血量、术后12 h疼痛数字评分（NRS）、术后下床活动时间及住院时间均比TAPP组和TEP组高，住院费用比TAPP组和TEP组低，差异有统计学意义（P<0.05）；TEP组术后12 h NRS评分、术后下床活动时间及住院费用比TAPP组低，差异有统计学意义（P<0.05）；Lichtenstein组术后3 d Cor、NE及ALD水平，复发率比TAPP组和TEP组高，差异均有统计学意义（P<0.05）。 结论Lichtenstein术治疗腹股沟疝操作相对简单、费用低，腹腔镜下TAPP、TEP术具有应激创伤小、疼痛轻、并发症少、复发率低等特点，临床应结合患者具体病情选择适宜的手术修补方式。

Comparison of efficacy and safety of different laparoscopic procedures and open herniorrhaphy in treatment of inguinal hernia

ObjectiveTo compare the clinical efficacy and safety of laparoscopic transabdominal preperitoneal hernia repair (TAPP), totally extraperitoneal hernia repair (TEP), open tension-free herniorrhaphy (Lichtenstein surgery) in treatment of inguinal hernia. Methods150 cases of patients with inguinal hernia admitted to the Songzi People's hospital from March 2015 to August 2017 were selected as the research object. All the patients were divided into Lichtenstein group, TAPP group and TEP group according to random number table method, with 50 cases in each group. The surgical indexes, complications, postoperative 6-month recurrence rate were compared among the three groups. The changes of stress response [cortisol (Cor), norepinephrine (NE), aldosterone (ALD)] of perioperative patients were observed. ResultsThere was no statistical difference in the operation time and the incidence of postoperative complications among the three groups (P>0.05); The intraoperative bleeding volume, postoperative 12 h NRS score, postoperative leaving bed time, hospital stays in Lichtenstein group were higher than those in TAPP group and TEP group, while the hospitalization expense of Lichtenstein group was lower than that of TAPP group and TEP group, and the difference was statistically significant (P<0.05); The postoperative 3 d Cor, NE, ALD levels, recurrence rate in Lichtenstein group were higher than those in TAPP group and TEP group, and the difference was statistically significant (P<0.05). ConclusionLichtenstein surgery in treatment of inguinal hernia is easy operation and has low expense, while laparoscopic TAPP and TEP have characteristics of small trauma, slight pain, less complications and low recurrence rate. Therefore, it is necessary to select suitable surgical procedure according to patients' specific conditions.