本文選題：腹股溝疝　切入點(diǎn)：腔鏡下疝修補(bǔ)　出處：《青島大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:對(duì)比分析腹腔鏡完全腹膜外腹股溝疝修補(bǔ)術(shù)中補(bǔ)片應(yīng)用疝釘固定與不用疝釘固定2種手術(shù)方式,探討腹腔鏡完全腹膜外腹股溝疝修補(bǔ)術(shù)中免釘合器技術(shù)的安全性及可靠性。方法:統(tǒng)計(jì)分析青島大學(xué)附屬醫(yī)院自2014年9月至2016年6月收治的腹股溝疝患者120例,按照治療方法的不同分為觀察組60例和對(duì)照組60例,觀察組采用免釘合腹腔鏡完全腹膜外疝修補(bǔ)術(shù),對(duì)照組采用釘合腹腔鏡完全腹膜外疝修補(bǔ)術(shù),術(shù)后隨訪一年左右。統(tǒng)計(jì)分析患者的年齡,術(shù)中、術(shù)后并發(fā)癥,術(shù)后復(fù)發(fā)率的差異以及對(duì)比兩種術(shù)式的手術(shù)效果,用t檢驗(yàn)與x2檢驗(yàn)進(jìn)行統(tǒng)計(jì)分析。結(jié)果:(1)免釘合組病人平均年齡42.47±16.51歲,釘合組病人平均年齡43.03±17.55歲,兩組年齡之間沒有統(tǒng)計(jì)學(xué)差異P=0.753(P0.05)。(2)免釘合組病人術(shù)后疼痛等級(jí)為II級(jí)及以上者1例,釘合組病人術(shù)后疼痛等級(jí)為II級(jí)及以上者5例,兩組術(shù)式的術(shù)后疼痛程度之間有統(tǒng)計(jì)學(xué)差異P=0.035(P0.05),免釘合的方法可以有效減輕術(shù)后疼痛程度。(3)免釘合組病人出現(xiàn)1例術(shù)后慢性疼痛,釘合組病人出現(xiàn)6例術(shù)后慢性疼痛,兩組術(shù)式的術(shù)后慢性疼痛之間有統(tǒng)計(jì)學(xué)差異P=0.029(P0.05),免釘合的方法可以有效減少術(shù)后慢性疼痛的發(fā)生。(4)免釘合組手術(shù)時(shí)間平均59.36±15.7min,釘合組手術(shù)時(shí)間平均78.44±15.6min,兩組手術(shù)時(shí)間之間沒有統(tǒng)計(jì)學(xué)差異p=0.618(P0.05);(5)免釘合組平均術(shù)中出血量16.08±6.28ml,釘合組平均術(shù)中出血量17.03±6.01ml,兩組術(shù)中出血量之間沒有統(tǒng)計(jì)學(xué)差異P=0.821(P0.05)。(6)免釘合組患者術(shù)后出現(xiàn)2例腹股溝區(qū)血清腫,釘合組患者術(shù)后出現(xiàn)3例腹股溝區(qū)血清腫,兩組之間無統(tǒng)計(jì)學(xué)差異P=0.648(P0.05)。(7)免釘合組患者術(shù)后未出現(xiàn)尿潴留及補(bǔ)片排異等并發(fā)癥,釘合組患者術(shù)后出現(xiàn)1例尿潴留,兩者之間沒有統(tǒng)計(jì)學(xué)差異p=0.681(P0.05)。(8)免釘合組患者術(shù)后住院時(shí)間2.23±1.15天,釘合組患者術(shù)后住院時(shí)間2.42±1.07天,兩組術(shù)后住院時(shí)間無統(tǒng)計(jì)學(xué)差異P=0.171(P0.05)。(9)免釘合組患者術(shù)后未見疝復(fù)發(fā),釘合組患者術(shù)后出現(xiàn)1例疝復(fù)發(fā),兩組術(shù)后疝復(fù)發(fā)率無統(tǒng)計(jì)學(xué)差異P=0.981(P0.05)。(10)免釘合組住院費(fèi)用13565.65±2356.78元,釘合組住院費(fèi)用16396.35±2124.12元,雖然釘合組平均費(fèi)用要比免釘合組費(fèi)用高,但是沒有統(tǒng)計(jì)學(xué)差異P=0.065(P0.05)。結(jié)論:腹腔鏡完全腹膜外腹股溝疝修補(bǔ)術(shù)中補(bǔ)片在不用釘合器釘合的情況下仍能達(dá)到應(yīng)用釘合器釘合后相的手術(shù)效果,總并發(fā)癥以及各并發(fā)癥的發(fā)生率兩組差異均無統(tǒng)計(jì)學(xué)意義。而且免釘合器的情況下患者術(shù)后疼痛程度及慢性疼痛的情況較應(yīng)用釘合器釘合要更好一些,并且可以減輕患者的經(jīng)濟(jì)負(fù)擔(dān)。
[Abstract]:Objective: to compare and analyze two operative methods of complete extraperitoneal inguinal herniorrhaphy by laparoscope, using hernia nail fixation and without herniation nail fixation. To investigate the safety and reliability of the nail-free technique in laparoscopic total extraperitoneal inguinal hernia repair methods: 120 cases of inguinal hernia treated in Qingdao University affiliated Hospital from September 2014 to June 2016 were analyzed statistically. According to the different treatment methods, 60 cases were divided into the observation group (n = 60) and the control group (n = 60). The observation group was treated with nail-free laparoscopic complete extraperitoneal hernia repair, and the control group was treated with nailing laparoscopic complete extraperitoneal hernia repair. All patients were followed up for about one year. The differences in age, intraoperative, postoperative complications, postoperative recurrence rate, and comparison between the two surgical procedures were statistically analyzed. Results the mean age of the patients in the nail-free group was 42.47 鹵16.51 years old, and that in the nail group was 43.03 鹵17.55 years old. There was no significant difference in age between the two groups (P _ (0.753) P _ (0.05) P _ (0.05)) there was no significant difference between the two groups (P _ (0.753) P _ (0.05)) there was one case of postoperative pain grade II or above in the nail free group, and 5 cases in the nail group. There was significant difference between the two groups in the degree of postoperative pain. The nailing free method could effectively reduce the postoperative pain degree of 1 patient in the nail free group, and 6 patients in the nail group, and there were 6 cases of postoperative chronic pain in the nail free group, and there was a significant difference between the two groups in the degree of postoperative pain, and there was a significant difference in the degree of postoperative pain between the two groups. There was a significant difference in postoperative chronic pain between the two groups. The nailing free method could effectively reduce the occurrence of postoperative chronic pain. The mean time of operation was 59.36 鹵15.7min in the no-nail group and 78.44 鹵15.6min in the nail group. The operative time of the two groups was 78.44 鹵15.6min. There was no statistical difference between the two groups (p _ (0.618) P _ (0.05)) the mean intraoperative blood loss was 16.08 鹵6.28 ml in the nail free group, and 17.03 鹵6.01 ml in the nail group. There was no statistical difference between the two groups in the intraoperative bleeding volume (P _ (0.821) P _ (0.05)). In the nail free group, there were no postoperative complications such as urinary retention and patch rejection, and one patient in the nail group had urinary retention after operation, and there was no significant difference between the two groups in blood serum swelling in the inguinal area. The patients in the nail free group had no complications such as urinary retention and patch rejection. The patients in the nail group had one case of urinary retention after the operation, and there was no significant difference between the two groups. There was no significant difference between the two groups (P < 0. 681, P 0. 05, P < 0. 05)) the postoperative hospitalization time of the patients in the nail-free group was 2. 23 鹵1.15 days, and that in the nail-free group was 2. 42 鹵1. 07 days. There was no significant difference between the two groups in the postoperative hospitalization time (P 0. 171, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P < 0. 9). There was no recurrence of hernia in the nail-free group. There was no significant difference in the recurrence rate of hernia between the two groups. The hospitalization cost of the nail free group was 13565.65 鹵2356.78 yuan, and the hospitalization cost of the nail group was 16396.35 鹵2124.12 yuan, although the average cost of the nail group was higher than that of the non-nail group. But there was no statistical difference between P0. 065 and P0. 05. Conclusion: the patch during laparoscopic total extraperitoneal inguinal herniorrhaphy can still achieve the effect of nailing after nailing without nailing. There was no significant difference in the total complications and the incidence of each complication between the two groups. And can reduce the patient's economic burden.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R656.21

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李健文;王明剛;唐健雄;鄭民華;;腹股溝疝腹腔鏡手術(shù)規(guī)范化操作指南[J];中國實(shí)用外科雜志;2013年07期

2 湯治平;蘇遠(yuǎn)航;陳雙;;主動(dòng)腹膜切開在完全腹膜外疝修補(bǔ)術(shù)中的應(yīng)用[J];中華疝和腹壁外科雜志(電子版);2013年03期

3 李健文;陳鑫;;進(jìn)一步評(píng)價(jià)腹腔鏡技術(shù)在腹股溝疝手術(shù)中的應(yīng)用[J];外科理論與實(shí)踐;2013年03期

4 陳雙;唐健雄;馬頌章;;成人腹股溝疝診療指南[J];中國實(shí)用外科雜志;2012年10期

5 胡偉;虞正鑫;許海周;;局麻下免氣囊分離器無釘合完全腹膜外腹腔鏡疝修補(bǔ)術(shù)的臨床應(yīng)用(附26例報(bào)告)[J];中國微創(chuàng)外科雜志;2011年04期

6 李虹;張正炎;楊庚生;張國柱;;改良完全腹膜外腹腔鏡腹股溝疝修補(bǔ)術(shù)68例報(bào)告[J];醫(yī)學(xué)信息(上旬刊);2011年04期

7 吳國賢;羅衡桂;楊應(yīng)林;胡月明;戴江峰;張愛民;;免氣囊分離器無釘合完全腹膜外腹腔鏡腹股溝疝修補(bǔ)術(shù)246例報(bào)告[J];中國微創(chuàng)外科雜志;2010年08期

8 張燕忠;張_g;田志宏;常毅剛;黃博;馮變喜;;腹腔鏡下完全腹膜外疝修補(bǔ)術(shù)10例分析[J];山西醫(yī)藥雜志(下半月刊);2009年10期

9 楊喜光;向國安;;腹腔鏡腹股溝疝修補(bǔ)術(shù)的研究進(jìn)展[J];中華臨床醫(yī)師雜志(電子版);2009年06期

10 吳相柏;杜小宜;魏亞元;吳利達(dá);宋文軍;陶凱雄;;經(jīng)濟(jì)型完全腹膜外腹腔鏡腹股溝疝修補(bǔ)術(shù)[J];中華疝和腹壁外科雜志(電子版);2008年03期

，

本文編號(hào)：1571788