开放TEP与传统前入路无张力修补腹股沟疝的比较

目的比较传统前入路和开放式TEP无张力修补腹股沟疝方法的手术疗效。方法采用随机双盲对照方法,对165例腹股沟疝患者分别沿用传统前入路和开放式TEP术式行无张力修补方法,比较两组患者手术时间、住院天数、平均恢复正常活动时间、治疗费用以及近、远期并发症和术后不适等指标,以评价开放式TEP术式修补腹股沟疝的疗效。结果前入路组随访时间平均为(20.5±1.5)个月,开放TEP组(21.6±1.8)个月,完成随访率为98.79%。前入路3例1年后复发(3.66%),开放TEP组1例术后1年半后复发(1.20%),手术时间、平均住院天数、治疗费用、恢复正常活动时间、疝复发率和尿潴留发生率等均无明显差异(P0.05);术后腹股沟区疼痛、血清肿、阴囊水肿、切口感染、神经感觉异常和缺血性睾丸炎等近、远期并发症开放TEP组明显少于前入路组,两组间差异有显著意义(P0.05)结论开放TEP修补腹股沟疝可明显减少各种并发症和术后不适的发生率,疗效肯定,值得临床推广应用。

Comparison of opening total extraperitoneal herniorrhaphy and traditional anterior approach on tension-free repair of inguinal hernia

Objective To evaluate the effect of the two different operation ways,such as opening total extraperitoneal herniorrhaphy and traditional anterior approach on tension-free repair of inguinal hernia.Methods A randomized,double blind method,165 cases of inguinal hernia were treated either the anterior approach group（82 cases）or opening total extraperitoneal herniorrhaphy group（83 cases） to compare the two groups with operation time,admission day,the average time to resume normal activities,treatment cost and the recent/long-term operative complications and postoperative discomfort to evaluate the curative effect ofopening total extraperitoneal herniorrhaphy approach.Results The follow-up rate were 98.79 %,after（20.5±1.5） months in average followed-up in the anterior approach group and（21.6±1.8） months in the TEP group,no significant difference was founded between the two groups in the operation time,average admission day,treatment cost,time for returning to normal activities,and recurrence rate（3.66 % vs 1.20 %） and urinary retention（P0.05）,however,postoperative inguinal pain,serum swelling,scrotal edema,wound infection,sensory abnormalities and ischemic testitis in TEP group was significantly less than in the anterior group,the difference between the two groups was significant（P0.05）.Conclusions Open TEP inguinal hernia repair can significantly reduce the complications and the incidence of postoperative discomfort,being more effective,and worthwhile clinical use.