开放式与腹腔镜全腹膜外疝修补术的对照研究

目的比较开放式和腹腔镜全腹膜外疝修补术（TEP）的临床效果。方法回顾性分析2012年1月至2013年7月期间我科收治的148例成人腹股沟疝或股疝的临床资料,根据手术方式的不同分为2组,74例行开放式TEP术（开放式TEP组）,74例行腹腔镜TEP术（腹腔镜TEP组）。结果 2组患者均顺利完成手术。开放式TEP组手术时间为（50.65±30.98）min,术中出血量为（14.97±6.70）m L,术后排气时间为（19.73±3.64）h,住院时间为（6.34±3.80）d,住院费用为（6 361±1 330）元;腹腔镜TEP组手术时间为（70.51±30.07）min,术中出血量为（17.39±4.84）m L,术后排气时间为（19.19±3.65）h,住院时间为（5.35±2.49）d,住院费用为（8 532±777）元。与腹腔镜TEP组相比,开放式TEP组手术时间短,术中出血量少,住院费用低,差异均有统计学意义（P〈0.05）;而术后排气时间和住院时间2组间比较差异无统计学意义（P〉0.05）。开放式TEP组和腹腔镜TEP组术后并发症发生率（8.11%比4.05%）比较差异无统计学意义（P〉0.05）。2组患者随访3~19个月,均无复发病例。结论开放式TEP与腹腔镜TEP的复发率相当,开放式TEP操作相对容易,手术时间短,术中出血量少,且无需腹腔镜设备,住院费用低,适合在基层医院开展。

Comparison Study of Total Extraperitoneal Inguinal Herniorrhaphy with Open and Laparoscopic Technique

Objective To compare the clinical effect of total extraperitoneal inguinal herniorrhaphy （TEP） with open and laparoscopic technique. Methods The clinical data of 148 patients with inguinal hernia or femoral hernia in this hospital from January 2012 to July 2013 were analyzed retrospectively, in which 74 patients received TEP with open technique （open TEP group）, 74 patients received TEP with laparoscopic technique （laparoscopic TEP group）. Results All the operations were successfully completed. Compared with the laparoscopic TEP group, the operative time, intra- operative bleeding, and hospitalization expenses were significantly decreased in the open TEP group （P〈0. 05）. The post- operative exhaust time, postoperative hospital stay, and the postoperative complications rate had no significant differences between the open TEP group and the laparoseopic TEP group （P〉0. 05）. All the patients were followed up, no recurr- ence occurred during a 3-19 months of following-up. Conclusions TEP with open and laparoscopic technique are both safe and efficient. The open technique has the advantages of shorter operative time, lower cost, so it is worth being widely used for primary hospital.