【摘要】：目的：通過比較腹腔鏡完全腹膜外腹股溝疝修補術(shù)(Totally Extraperitoneal Prosthetic, TEP)與局麻下開放式無張力疝修補術(shù)治療成人腹股溝疝的臨床療效,探求哪一種成人腹股溝疝修補術(shù)更加高效、合理、經(jīng)濟。方法：收集北京大學(xué)深圳醫(yī)院2012年10月至2014年10月所進行的60例TEP術(shù)(TEP組)和60例局麻下開放式無張力疝修補術(shù)(局麻開放組)進行同期非隨機對照研究。術(shù)后通過門診和電話聯(lián)系的方式對兩組患者進行隨訪,比較兩組患者術(shù)前、術(shù)中、術(shù)后的相關(guān)參數(shù)。結(jié)果：TEP組對比局麻開放組,手術(shù)時間長[(71±9.8)min VS (48±15.6)min (P 0.01)];術(shù)中出血量多[(16±8.8)ml VS(11±4.5)ml(P0.01)]；術(shù)后初次下床活動時間短[(7±6.4)h VS(13±7.2)h(P0.01)]；術(shù)后第1天VAS疼痛評分低[(2±0.6)VS(4±0.7),(P0.01)]；術(shù)后住院時間長[(4±0.8)d VS(3±1.2)d(P0.05)]；住院費用高[(8755±329)元VS(5462±298)元(P0.01)]；術(shù)后使用止痛藥例數(shù)差異無統(tǒng)計學(xué)意義[6.7%(4/60)VS 10%(6/60)(P0.05)]。術(shù)后隨訪周期在2-24個月,中位隨訪時間為16個月。TEP組術(shù)后的總并發(fā)癥為7例,分別為：陰囊積液者3例,尿潴留者2例,腸梗阻者1例,復(fù)發(fā)者1例；局麻開放組術(shù)后的總并發(fā)癥7例,分別為：陰囊積液2例,尿潴留1例,切口血腫1例,慢性疼痛1例,射精痛1例,復(fù)發(fā)1例。兩組總并發(fā)癥發(fā)生率差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論：TEP是眾多腹腔鏡疝修補手術(shù)中較為理想的術(shù)式,安全有效,而局麻下開放式無張力疝修補術(shù)同樣具有TEP無法比擬的優(yōu)勢。兩種術(shù)式各有特點,在臨床應(yīng)用上具有互補性,均值得臨床推薦使用。在具體的手術(shù)方式選擇上,醫(yī)師應(yīng)該根據(jù)患者的具體情況,為其制定個性化的治療方案,這樣才能達到最佳的臨床效果和衛(wèi)生經(jīng)濟學(xué)效益。
[Abstract]:Objective: to compare the clinical effects of laparoscopic total extraperitoneal inguinal hernia repair (Totally Extraperitoneal Prosthetic, TEP) and open tension-free hernia repair under local anesthesia in adult inguinal hernia and to find out which adult inguinal hernia repair is more effective. Reasonable, economical. Methods: 60 cases of TEP (TEP group) and 60 cases of open tension-free herniorrhaphy under local anesthesia (open group) were collected from October 2012 to October 2014 in Shenzhen Hospital of Peking University. The two groups were followed up by outpatient service and telephone contact after operation, and the parameters before, during and after operation were compared. Results: compared with the open local anesthesia group, the operation time of TEP group was longer (71 鹵9.8) min VS (48 鹵15.6) min (P 0.01), and the amount of intraoperative bleeding was more (16 鹵8.8) ml VS (11 鹵4.5) ml (P 0.01). The first time of getting out of bed was short (7 鹵6.4) h VS (13 鹵7.2) h (P0.01), the VAS pain score was low on the first day after operation [(2 鹵0.6) VS (4 鹵0.7), (P0.01)]. The postoperative hospitalization time was long [(4 鹵0.8) d VS () 3 鹵1.2) d (P0.05], the hospitalization cost was high [(8755 鹵329) yuan VS (5462 鹵29.8) yuan (P0.01)]; There was no significant difference in the number of painkillers used after operation [6.7% (4 / 60) VS 10% (6 / 60) (P0.05)]. The postoperative follow-up period was 2-24 months and the median follow-up time was 16 months. In TEP group, the total postoperative complications were: scrotal effusion in 3 cases, urinary retention in 2 cases, intestinal obstruction in 1 case, recurrence in 1 case; In the open local anesthesia group, the total complications were scrotum effusion (2 cases), urinary retention (1 case), incision hematoma (1 case), chronic pain (1 case), ejaculation (1 case) and recurrence (1 case). There was no significant difference in the incidence of total complications between the two groups (P0.05). Conclusion: TEP is an ideal technique for laparoscopic herniorrhaphy, which is safe and effective, and open tension-free hernia repair under local anesthesia is also superior to TEP. The two types of operation have their own characteristics and complementary in clinical application, which are worthy of clinical recommendation. In the selection of specific surgical methods, doctors should make individualized treatment plans for patients according to their specific conditions, so as to achieve the best clinical effect and health economic benefits.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R656.2

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