腹腔镜经腹腹膜前疝修补术中各种补片固定方法的疗效观察

目的探讨医用胶粘合、钉枪钉合及可吸收线缝合固定补片在腹腔镜经腹腹膜前疝修补术（TAPP）中的疗效差别及对并发症的影响。 方法2017年9月至2018年12月，对北京市垂杨柳医院90例初发腹股沟疝患者进行TAPP手术治疗。术中分别采用医用胶粘合、钉枪钉合及可吸收线缝合固定补片，每组患者30例。术后随访6～12个月。 结果各组患者均无复发，医用胶粘合组术后局部血清肿0例，钉枪钉合组1例，可吸收线缝合组1例；医用胶粘合组术后未发生慢性疼痛，钉枪钉合组1例，可吸收线缝合组1例。医用胶粘合、钉枪钉合及可吸收线缝合固定补片各组的手术时间分别为（47.5±7.3）min、（36.4±6.5）min，及（69.2±6.6）min，两两比较，差异均有统计学意义（P<0.05）。医用胶粘合、钉枪钉合及可吸收线缝合固定补片组术后住院时间分别为（3.1±0.7）d、（3.2±0.6）d及（3.2±0.7）d，两两比较，差异均有统计学意义（P>0.05）。钉枪钉合组住院费用[（13 325±645）元]显著高于医用胶组[（9629±646）元]及可吸收线缝合组[（9617±429）元]，差异均有统计学意义（P<0.05）；医用胶粘合组住院费用与可吸收线缝合组比较，差异无统计学意义（P>0.05）。术后l、3、5、7、14 d疼痛视觉模拟评分（VAS），钉枪钉合组及可吸收线缝合组显著高于医用胶组，差异均有统计学意义（P<0.05）。可吸收线缝合组与可吸收线缝合组术后1 d、7 d VAS评分比较，差异无统计学意义（P>0.05）；术后3 d、5 d、14 d VAS评分比较，差异均有统计学意义（P<0.05）。 结论TAPP术中各种补片固定方法均安全有效，均未有补片移位甚至导致复发发生；钉枪钉合是手术时间最短的固定方法；医用胶粘合及可吸收线缝合固定相对便宜；医用胶粘合可减低术后疼痛和减低血肿的发生。

Therapeutic effect of laparoscopic transabdominal preperitoneal hernia repair (TAPP) in various methods of mesh fixation

ObjectiveTo investigate the difference of curative effect and complications of the mesh fixation of laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) with medical adhesive, auto-suture tacks or absorbable suture. Methods90 cases of primary inguinal hernia treated by the TAPP in Beijing Chuiyangliu Hospital during September 2017 to December 2018 were reviewed. In our control studies, 90 patients were divided into three groups using medical adhesive, auto-suture tacks or absorbable suture, respectively. And they were followed up for 6 to 12 months. ResultsThere was no recurrence in all groups. There were 0 case of local seroma in the medical adhesive group, 1 case in the auto-suture tacks group, and 1 case in the absorbable suture group; No chronic pain occurred in the medical adhesive group. But one case of auto-suture tacks group was happened, and one case in the absorbable suture group. The operative times in each groups of medical adhesive, auto-suture tacks and absorbable suture were (47.5±7.3) minutes, (36.4±6.5) minutes, and (69.2±6.6) minutes. The time of auto-suture tacks group was significantly shorter than the medical adhesive group and the absorbable suture group (P<0.05); And the medical adhesive group was shorter than the absorbable suture group (P<0.05); The postoperative lengths of stay were (3.1±0.7) days, (3.2±0.6) days and (3.2±0.7) days, respectively, and there was no significant difference between the groups (P>0.05). The hospitalization expenses of auto-suture tacks group were (13,325±645) yuan. This expense was apparently higher than the medical adhesive group [(9629±646) yuan, P<0.05] and absorbable suture group [(9617±429) yuan, P<0.05]; There was no significant difference between the medical adhesive group and the absorbable suture group (P>0.05). The postoperative pain scores at 1, 3, 5, 7, and 14 days after operation in the auto-suture tacks group and in the absorbable suture group were apparently higher than in the medical adhesive group (P<0.05). The pain scores of the absorbable suture group was generally lower than that of the auto-suture tacks group. ConclusionVarious methods of mesh fixation in TAPP are safe and effective, and there is no meshes displacement or even recurrence. In comparison, the fixation by auto-suture tacks is the fastest method; medical adhesive and absorbable suture fixation is relatively inexpensive; the fixation by medical adhesive can reduce postoperative pain and decrease the occurrence of hematoma.