县级医院开放式无张力疝修补术与腹腔镜疝修补术的临床研究

目的探讨开放无张力修补术与腹腔镜疝修补术在县级医院应用中的临床效果。 方法回顾性分析2016年1月至2017年12月，清河县中心医院连续收治的行成人腹股沟疝手术218例患者的临床资料，分为开放组（Lichtenstein无张力疝修补术）102例，腹腔镜下腹股沟疝修补术（laparoscopic trans-abdominal preperitoneal hernia repair，TAPP）组116例。统计2组患者一般资料、手术资料、术后并发症等方面数据，并进行对比分析。 结果患者中位数随访时间为651 d，开放组和TAPP组均未出现感染或复发的病例。开放组与TAPP组尿潴留发生率分别为7例（6.9%）、8例（6.9%），差异无统计学意义（P=0.799）；开放组术后出现血清肿情况12例（11.8%）、TAPP组25例（21.6%），差异有统计学意义（P=0.042）；开放组应用止痛药物情况25例（24.5%）、TAPP组4例（3.4%），差异有统计学意义（P=0.009）；恢复日常活动中位数时间均为4 d，差异有统计学意义（P=0.026）；开放组中位数手术时间为50 min、TAPP组70 min，差异有统计学意义（P<0.001）；开放组住院中位数花费为4 225元、TAPP组为7 425元，差异有统计学意义（P<0.001）；开放组无慢性疼痛发生，TAPP组发生慢性疼痛2例（2.0%），差异有统计学意义（P=0.001）。 结论开放手术和腹腔镜下腹股沟疝修补术在县级医院开展均能取得较好临床效果，但开展腹腔镜疝修补应经过专业培训的基础上，加强同上级医院的联系，谨慎开展。

Retrospective study of effect between open tension-free inguinal hernia repair and laparoscopic inguinal hernia repair in country-level hospital

ObjectiveTo compare clinical effect between open inguinal hernia repair and laparoscopic inguinal hernia repair in country-level hospital. MethodsA total number of 218 consecutive adult cases with inguinal hernia were analyzed retrospectively from January 2016 to December 2017. The patients were divided into open group performed with Lichtenstein repair (n=102) and laparoscopic group performed with laparoscopic trans-abdominal preperitoneal hernia repair (TAPP, n=116). The clinical data, operation data and complications incidence were analyzed. ResultsThe median follow-up time was 651 days. No recurrence or infection case was observed in both 2 groups. The outcome between open group and TAPP group is as follows: postoperative uroschesis occurred in 7 cases (6.9%) and 8 cases (6.9%) respectively without significant difference (P=0.799); seroma occurred in 12 cases (11.8%) and 25 cases (21.5%) with significant difference (P=0.042); analgesics was used in 25 cases (24.5%) and 4 cases (3.4%) with significant difference (P=0.009); the median return-to-work time was both 4 days but with significant difference (P=0.026), the median operation time was 50 and 70 minutes with significant difference (P<0.001); hospital cost was 4 425 and 7 425 yuan with significant difference (P<0.001); chronic pain occurred in 0 and 2 cases (2.0%) with significant difference (P=0.001). ConclusionAn equal effect between open group and TAPP group was observed. Whereas, it is necessary to undergo professional training and build connection with superior hospital during the initial period.