中国实用外科杂志

中国实用外科杂志

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腹腔镜经腹腔腹膜前修补术和经内环入路Kugel手术治疗腹股沟疝疗效比较研究

王    琪，黄鹤光，陈燕昌，陆逢春，林贤超，林荣贵，杨媛媛，方海宗   

  1. 福建医科大学附属协和医院基本外科，福建福州 350001
  • 出版日期:2017-11-01 发布日期:2017-11-01

  • Online:2017-11-01 Published:2017-11-01

摘要：

目的    比较腹腔镜经腹腔腹膜前疝修补术（TAPP）和经内环入路Kugel手术（以下简称Kugel手术）治疗成人腹股沟疝的临床疗效及优缺点。方法    回顾性分析2015年1月至 2016年10月于福建医科大学附属协和医院基本外科行手术治疗的458例（594侧）腹股沟疝病人临床资料，依其所行手术类型分为TAPP组（203例，275侧）和Kugel组（255例，319侧）。结果    TAPP组单侧手术时间较Kugel组长［（65.5±14.5）min vs. （57.5±18.1）min，P<0.05］，双侧手术时间两组差异无统计学意义［（107.4±25.3）min vs.（112.1±29.1）min，P>0.05］。TAPP组术后24 h视觉模拟疼痛评分（VAS）优于Kugel组［单侧（2.0±0.5）vs.（2.5±0.5），P<0.01；双侧（2.4±0.6） vs. （2.8±0.7），P<0.01］。Kugel组总住院费用［单侧（9882.9±1112.1）元 vs. （12177.1±1701.3）元，双侧（14706.6±4706.5）元 vs. （16952.4±2245.6）元) ］低于TAPP组，P均<0.01。此外，TAPP组有31例（占双侧腹股沟疝的43%，31/72）在术中经探查发现对侧隐匿疝，予同期修补。随访时间为3～24个月（中位时间13个月）。随访率分别为96.6%（TAPP组，196例）和97.3%（Kugel组，248例）；TAPP组及Kugel组各有7例病人失访。随访期内无复发病例。Kugel组术后血清肿发生率低于TAPP组（0.8% vs. 6.1%，P<0.01）。两组在术后2周恢复日常活动率、慢性疼痛、异物感及总并发症发生率方面差异无统计学意义（P均>0.05）。结论    TAPP和Kugel手术均安全且疗效显著，前者在减轻术后疼痛、瘢痕美观及发现隐匿疝方面更具优势，后者则更为简便经济且适用于各种麻醉方式。

关键词: 腹股沟疝, 腹腔镜, 腹膜前疝修补术, 并发症

Abstract:

Comparison of aparoscopic transabdominal preperitoneal hernia repair and herniorrhaphy via internal ring approach (Kugel patch) for inguinal hernias        WANG Qi, HUANG He-guang, CHEN Yan-chang, et al. Department of General Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China
Corresponding author：HUANG He-guang, E-mail:heguanghuang2@163.com
Abstract    Objective    To compare the effect between transabdominal preperitoneal hernia repair(TAPP) and herniorrhaphy via internal ring approach (Kugel patch)in treating adult inguinal hernia．Methods    Patients(458 cases,594 sides) who were admitted to Department of General Surgery from Jan. 2015 to Oct. 2016 were divided into two groups depending on the surgical style. TAPP group included 203 patients (275 sides) and Kugel group included 255 patients(319 sides). The data of patients were analyzed retrospectively to compare the clinical effect between two groups. Results  For unilateral inguinal hernia, the operation time of TAPP group was longer than that of Kugel group (65.5±14.5)min vs.(57.5±18.1)min，P<0.05, while the operation time of bilateral inguinal hernia was not significant statistically between two groups(107.4±25.3)min vs (112.1±29.1)min，P>0.05. TAPP group is superior to Kugel group in postoperative VAS score，unilateral (2.0±0.5) vs. (2.5±0.5)，bilateral (2.4±0.6) vs. (2.8±0.7), P<0.01. Total hospitalization costs in Kugel group was lower than that in TAPP group,unilateral (9882.9±1112.1) yuan vs. (12177.1±1701.3) yuan, bilateral (14706.6±4706.5)yuan vs. (16952.4±2245.6) yuan, P<0.01. In addition, there were 31 cases (43% of its bilateral inguinal hernia patients) in TAPP group found the lateral occlusion hernia on the other side by intraoperative examination, which were repaired at the same time. The follow-up period ranged from 3 to 24 months (median 13 months).Follow-up rate was 96.6% (TAPP group, 196 cases) and 97.3% (Kugel group, 248 cases),each group missed 7 patients.All patients were cured, recurrent case was not found within the follow-up period . Kugel group had lower incidence of postoperative seroma（0.8% vs 6.1%, P<0.01）.No significant difference was found between the two groups in the rate of returning to daily activities within 2 weeks ,chronic pain, foreign body sensation and total postoperative complications(P>0.05).  Conclusion    Both TAPP and Kugel are safe and effective. TAPP has the advantage of reducing postoperative pain, minimizing scarring and discovering occult hernia. The Kugel is more economical and suitable for all types of anesthesia.

Key words: inguinal hernia, laparoscope, preperitoneal herniorrhaphy, complication