免氣囊、免固定完全腹膜外腹腔鏡腹股溝疝修補術(shù)（TEP）的臨床研究
發(fā)布時間：2019-04-01 12:00
【摘要】：目的:進行免氣囊、免固定完全腹膜外腹腔鏡腹股溝疝修補術(shù)(TEP)和開放性無張力疝修補術(shù)臨床療效的對比性研究,以探討免氣囊、免固定TEP的臨床可行性。方法:選擇包頭醫(yī)學院第一附屬醫(yī)院普外一科自2012年02月至2013年10月期間收治的46例腹股溝疝患者進行回顧性分析。其中23例行開放性無張力疝修補術(shù)(開放組),采用連續(xù)硬膜外麻醉。23例行免氣囊、免固定TEP術(shù)(TEP組),采用全身麻醉。觀察并記錄兩種術(shù)式的手術(shù)時間、術(shù)中出血量、術(shù)后住院天數(shù)、術(shù)后并發(fā)癥的發(fā)生情況、術(shù)后使用鎮(zhèn)痛劑情況、住院費用等指標。結(jié)果:手術(shù)時間:開放組為(54.6±10.0)min,TEP組為(45.4±5.8)min,(P0.05),有統(tǒng)計學意義;術(shù)中出血量:開放組為(37.0±10.6)ml,TEP組為(19.6±7.7)ml,(P0.05),有統(tǒng)計學意義;術(shù)后住院天數(shù):開放組為(5.3±1.7)d,TEP組為(2.4±0.5)d,(P0.05),有統(tǒng)計學意義;住院費用:開放組為(9952.7±2180.6)元,TEP組為(7570.8±1388.7)元,(P0.05),無統(tǒng)計學意義;術(shù)后使用鎮(zhèn)痛劑情況:開放組有14例,TEP組有2例;開放組術(shù)后總的并發(fā)癥有6例,分別為:陰囊血腫3例,切口血腫2例,睪丸扭曲1例。TEP組術(shù)后總的并發(fā)癥2例,均為陰囊血腫。兩組患者比較,(P0.05),術(shù)后各種并發(fā)癥和總的并發(fā)癥發(fā)生率差異無統(tǒng)計學意義。并且兩組術(shù)后隨訪2-24個月,隨訪期間內(nèi)均未發(fā)現(xiàn)復發(fā)病例。結(jié)論:進行免氣囊、免固定TEP術(shù)在手術(shù)時間、術(shù)中出血量、術(shù)后住院天數(shù)等方面明顯優(yōu)于開放性無張力疝修補術(shù),而兩者術(shù)后并發(fā)癥、住院費用等方面差異不明顯。由此可以顯示免氣囊、免固定TEP和傳統(tǒng)疝修補術(shù)均能治愈腹股溝疝,但TEP較傳統(tǒng)疝修補術(shù)更具有優(yōu)越性;免氣囊、免固定TEP手術(shù)是一種微創(chuàng),安全可行的手術(shù),特別適合在貧困的邊遠地區(qū)展開及推廣。
[Abstract]:Aim: to compare the clinical effects of open tension-free hernia repair (TEP) and open tension-free hernioplasty (TEP) without balloon-free fixation and complete extraperitoneal laparoscopic inguinal hernia repair in order to explore the clinical feasibility of free-balloon and fixed-free TEP. Methods: 46 patients with inguinal hernia admitted to the first affiliated Hospital of Baotou Medical College from February 2012 to October 2013 were analyzed retrospectively. Open tension-free herniorrhaphy (open group) was performed in 23 cases, continuous epidural anesthesia was performed in 23 cases, airbag-free and fixed-free Tepp (TEP group) were performed in 23 cases, and general anesthesia was used in 23 cases. The time of operation, the amount of bleeding during the operation, the days of hospitalization, the occurrence of postoperative complications, the use of analgesic after operation, the cost of hospitalization and so on were observed and recorded. Results: the operation time was (54.6 鹵10.0) min,TEP in the open group, (45.4 鹵5.8) min, () in the open group, and there was significant difference between the open group and the open group (P < 0.05). Intraoperative bleeding volume: the open group was (37.0 鹵10.6) ml,TEP group was (19.6 鹵7.7) ml, (P0.05), there was statistical significance; The postoperative hospitalization days were (5.3 鹵1.7) days in the open group and (2.4 鹵0.5) d, () days in the TEP group (P 0.05). The hospitalization cost was (9952.7 鹵2180.6) yuan in the open group and (7570.8 鹵1388.7) yuan in the TEP group (P0.05), and there was no statistical significance in the use of analgesic after operation: 14 cases in the open group and 2 cases in the TEP group; The total complications of open group were 3 cases of scrotum hematoma, 2 cases of incision hematoma and 1 case of testicular distortion. The total complications of TEP group were scrotum hematoma in 2 cases, scrotal hematoma in 3 cases, incision hematoma in 2 cases and testicular distortion in 1 case. Compared with the two groups, there was no significant difference in the incidence of complications and total complications between the two groups (P0.05). The two groups were followed up for 2 months and 24 months, and no recurrence was found during the follow-up period. Conclusion: TEP is superior to open tension-free herniorrhaphy in terms of operation time, intraoperative bleeding, postoperative hospitalization days and so on. However, there is no significant difference in postoperative complications and hospitalization cost between the two groups. It can be shown that balloon-free, fixed-free TEP and traditional herniorrhaphy can cure inguinal hernia, but TEP has more advantages than traditional herniorrhaphy. Balloon-free, fixed-free TEP surgery is a minimally invasive, safe and feasible operation, especially suitable for deployment and promotion in poor remote areas.
【學位授予單位】：內(nèi)蒙古科技大學包頭醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R656.21
本文編號：2451539
[Abstract]:Aim: to compare the clinical effects of open tension-free hernia repair (TEP) and open tension-free hernioplasty (TEP) without balloon-free fixation and complete extraperitoneal laparoscopic inguinal hernia repair in order to explore the clinical feasibility of free-balloon and fixed-free TEP. Methods: 46 patients with inguinal hernia admitted to the first affiliated Hospital of Baotou Medical College from February 2012 to October 2013 were analyzed retrospectively. Open tension-free herniorrhaphy (open group) was performed in 23 cases, continuous epidural anesthesia was performed in 23 cases, airbag-free and fixed-free Tepp (TEP group) were performed in 23 cases, and general anesthesia was used in 23 cases. The time of operation, the amount of bleeding during the operation, the days of hospitalization, the occurrence of postoperative complications, the use of analgesic after operation, the cost of hospitalization and so on were observed and recorded. Results: the operation time was (54.6 鹵10.0) min,TEP in the open group, (45.4 鹵5.8) min, () in the open group, and there was significant difference between the open group and the open group (P < 0.05). Intraoperative bleeding volume: the open group was (37.0 鹵10.6) ml,TEP group was (19.6 鹵7.7) ml, (P0.05), there was statistical significance; The postoperative hospitalization days were (5.3 鹵1.7) days in the open group and (2.4 鹵0.5) d, () days in the TEP group (P 0.05). The hospitalization cost was (9952.7 鹵2180.6) yuan in the open group and (7570.8 鹵1388.7) yuan in the TEP group (P0.05), and there was no statistical significance in the use of analgesic after operation: 14 cases in the open group and 2 cases in the TEP group; The total complications of open group were 3 cases of scrotum hematoma, 2 cases of incision hematoma and 1 case of testicular distortion. The total complications of TEP group were scrotum hematoma in 2 cases, scrotal hematoma in 3 cases, incision hematoma in 2 cases and testicular distortion in 1 case. Compared with the two groups, there was no significant difference in the incidence of complications and total complications between the two groups (P0.05). The two groups were followed up for 2 months and 24 months, and no recurrence was found during the follow-up period. Conclusion: TEP is superior to open tension-free herniorrhaphy in terms of operation time, intraoperative bleeding, postoperative hospitalization days and so on. However, there is no significant difference in postoperative complications and hospitalization cost between the two groups. It can be shown that balloon-free, fixed-free TEP and traditional herniorrhaphy can cure inguinal hernia, but TEP has more advantages than traditional herniorrhaphy. Balloon-free, fixed-free TEP surgery is a minimally invasive, safe and feasible operation, especially suitable for deployment and promotion in poor remote areas.
【學位授予單位】：內(nèi)蒙古科技大學包頭醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R656.21
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