本文選題：腹股溝疝　切入點(diǎn)：腹腔鏡　出處：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：通過成人腹腔鏡腹股溝疝修補(bǔ)術(shù)（LIHR）和開放式腹股溝疝修補(bǔ)術(shù)的前瞻性隨機(jī)臨床研究，進(jìn)一步明確腹腔鏡治療腹股溝疝的安全性及優(yōu)越性。方法：將宜賓市第一人民醫(yī)院普外科2012年1月～2013年1月收治的100例成人腹股溝疝患者按入院順序進(jìn)行編號(hào)，隨機(jī)分為奇數(shù)組和偶數(shù)組，其中奇數(shù)組50例患者安排到腹腔鏡組，偶數(shù)組50例安排到開放組。腹腔鏡組患者給予全身麻醉，奇數(shù)組前25例患者施行完全腹膜外網(wǎng)片修補(bǔ)術(shù)（TEP）和奇數(shù)組后25例患者施行經(jīng)腹腔腹膜前網(wǎng)片修補(bǔ)術(shù)（TAPP）；開放組50例患者全部接受雙層平片無張力疝修補(bǔ)術(shù)。100例病例進(jìn)行長(zhǎng)達(dá)1年的觀察隨訪（門診隨訪、電話隨訪或醫(yī)護(hù)人員上門隨訪的方式相結(jié)合），記錄患者術(shù)后恢復(fù)情況和并發(fā)癥的情況，建立統(tǒng)計(jì)資料。觀察和比較兩組患者的以下指標(biāo)：包括手術(shù)時(shí)間、住院費(fèi)用、術(shù)后并發(fā)癥、術(shù)后復(fù)發(fā)、術(shù)后使用鎮(zhèn)痛藥物例數(shù)、切口疼痛持續(xù)時(shí)間、術(shù)后下床活動(dòng)時(shí)間、術(shù)后參加正�；顒�(dòng)、患者對(duì)切口滿意程度進(jìn)行統(tǒng)計(jì)分析。結(jié)果：兩組腹股溝疝患者在性別、年齡、疝的類型、發(fā)病部位、伴發(fā)病等臨床資料方面差異無顯著性（P0.05），兩組資料之間具有可比性。開放組50例患者，全部接受雙層平片無張力疝修補(bǔ)術(shù)。腹腔鏡組共50例，25例患者行TAPP治療，有1例中轉(zhuǎn)為開放無張力疝修補(bǔ)術(shù)；25例病例行TEP治療，其中僅有2例中轉(zhuǎn)為TAPP治療。腹腔鏡組手術(shù)時(shí)間59.11±14.1（5分），住院費(fèi)用12540.3±2582.3（元），住院時(shí)間3.57±1.52（天）；開放組手術(shù)時(shí)間40.21±11.11（分），住院費(fèi)用6709.6±1477.8（元），住院時(shí)間6.39±3.63（天）。腹腔鏡組手術(shù)時(shí)間長(zhǎng)、住院費(fèi)用高，與開放組比較統(tǒng)計(jì)學(xué)有顯著性差異（P=0.000,0.000）。腹腔鏡組住院時(shí)間明顯縮短，與開放組比較差異性顯著（P=0.047）。兩組術(shù)后并發(fā)癥方面（局部血腫，修補(bǔ)區(qū)域疼痛，陰囊腫脹，尿潴留，補(bǔ)片感染）比較差異無統(tǒng)計(jì)學(xué)意義（X2=0.65，P=0.275）；腹腔鏡組術(shù)后無復(fù)發(fā)，開放組術(shù)后復(fù)發(fā)1例，，兩組在術(shù)后復(fù)發(fā)統(tǒng)計(jì)學(xué)上無顯著性差異（P=0.484）。腹腔鏡組疝修補(bǔ)術(shù)后有3例患者使用了鎮(zhèn)痛藥物，而開放組疝修補(bǔ)術(shù)后為4例；兩組病例在術(shù)后下床活動(dòng)時(shí)間（P=0.001）和切口疼痛持續(xù)時(shí)間（P=0.001）上差異有統(tǒng)計(jì)學(xué)意義；兩組病例在術(shù)后參加正�；顒�(dòng)（P=0.230）和切口滿意程度（P=0.242）上統(tǒng)計(jì)學(xué)無顯著性差異。結(jié)論：腹腔鏡疝修補(bǔ)術(shù)手術(shù)時(shí)間較開放式疝修補(bǔ)術(shù)長(zhǎng)，住院總費(fèi)用高于開放組，但術(shù)中、術(shù)后的近期并發(fā)癥及遠(yuǎn)期并發(fā)癥和復(fù)發(fā)率的發(fā)生概率均無明顯差別，而行腹腔鏡疝修補(bǔ)術(shù)的患者具有術(shù)后恢復(fù)快、開始工作的時(shí)間早、術(shù)后切口疼痛持續(xù)時(shí)間短、術(shù)后使用鎮(zhèn)痛藥物較少、等優(yōu)點(diǎn)；而且，腹腔鏡腹股溝疝修補(bǔ)術(shù)更符合人體的正常解剖生理結(jié)構(gòu)，因此成人腹股溝疝的患者行腹腔鏡疝修補(bǔ)術(shù)是安全的、可行的，并在術(shù)后恢復(fù)方面腹腔鏡腹股溝疝修補(bǔ)術(shù)較開放式疝修補(bǔ)術(shù)有其獨(dú)特的優(yōu)勢(shì)。
[Abstract]:Objective: to investigate the prospective randomized clinical study of laparoscopic inguinal hernioplasty (LIHR) and open inguinal hernia repair (OGH) in adults. Methods: 100 adult patients with inguinal hernia treated by the first people's Hospital of Yibin from January 2012 to January 2013 were numbered according to the order of admission. They were randomly divided into odd number group and even number group, in which 50 patients in odd number group were assigned to laparoscopic group and 50 patients in even number group were assigned to open group. The first 25 patients with odd array underwent complete external peritoneal mesh repair (TEP) and 25 patients with odd-numbered group underwent transhepatic anterior peritoneal mesh repair (TAPPN), while 50 patients in the open group received tension-free hernioplasty with double-layer plain film. 100 patients were treated with transurethral repair of tension hernia. Follow up for up to one year (outpatient follow-up, The methods of telephone follow-up or on-site follow-up were used to record the patients' recovery and complications, and to establish statistical data. The following indexes were observed and compared between the two groups: operation time, hospitalization cost, Postoperative complications, postoperative recurrence, postoperative use of analgesic drugs, duration of incision pain, time to get out of bed after operation, normal activities after operation, Results: two groups of inguinal hernia patients in gender, age, type of hernia, location of the disease, There was no significant difference in clinical data between the two groups. 50 patients in the open group received tension-free hernioplasty with double-layer plain film, and 25 patients in the laparoscopic group were treated with TAPP. In one case, 25 cases underwent open tension-free hernioplasty, and 25 cases were treated with TEP. In the laparoscopic group, the operation time was 59.11 鹵14.1min, the hospitalization cost was 12540.3 鹵2582.3 yuan, the hospitalization time was 3.57 鹵1.52days, the open group operation time was 40.21 鹵11.11 (min), the hospitalization cost was 6709.6 鹵1477.8 yuan, the hospitalization time was 6.39 鹵3.63. The hospitalization cost was high, there was significant difference between the open group and the open group. The length of stay in the laparoscopy group was significantly shorter than that in the open group, and the difference was significant compared with the open group. The postoperative complications (local hematoma, pain in the repaired area, swelling of scrotum) in the two groups were significantly different from those in the open group. There was no significant difference in urinary retention and patch infection (P < 0. 275), but there was no recurrence in laparoscopy group, 1 case in open group, 1 case in open group, 1 case in laparoscopy group, 1 case in open group, 1 case in laparoscope group, 1 case in open group. There was no significant difference in postoperative recurrence between the two groups (P < 0. 484). In the laparoscopic group, 3 patients were treated with analgesic drugs after herniorrhaphy, while 4 patients in the open group were treated with analgesic drugs after herniorrhaphy. There was significant difference between the two groups in the time of getting out of bed and the duration of incision pain (P 0.001). There was no significant difference between the two groups in terms of normal activity (P < 0.230) and incision satisfaction (P < 0.242). Conclusion: laparoscopic herniorrhaphy is longer than open hernioplasty, and the total cost of hospitalization is higher than that of open group, but during operation, there is no significant difference between the two groups. There was no significant difference in the incidence of short-term complications, long-term complications and recurrence rates. The patients undergoing laparoscopic herniorrhaphy had the advantages of quick recovery, early start of work and short duration of postoperative incision pain. In addition, laparoscopic inguinal hernia repair is more in line with the normal anatomical and physiological structure of the human body, so it is safe and feasible for adult patients with inguinal hernia to perform laparoscopic herniorrhaphy. Laparoscopic inguinal hernia repair has its unique advantages over open hernia repair in postoperative recovery.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R656.21

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 鄭民華,李健文;腹腔鏡腹股溝疝修補(bǔ)術(shù)中的若干問題探討[J];腹部外科;2004年01期

2 曾毅克;王存川;黎紹基;徐以浩;;治療成人腹股溝疝選擇腹腔鏡或開放Lichtenstein修補(bǔ)術(shù)——隨機(jī)對(duì)照研究的Meta分析[J];腹腔鏡外科雜志;2007年01期

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