【摘要】：研究目的既往與腹腔鏡腹股溝疝修補(bǔ)術(shù)(TAPP或TEP)相比較的研究中,開放手術(shù)多采用李金斯坦術(shù)式。然而,與腹腔鏡疝修補(bǔ)術(shù)不同的是,李金斯坦術(shù)式操作位置為肌前,補(bǔ)片也放置于肌前,而非腹膜前。理想的情況下,為減少偏倚的發(fā)生,在比較開放疝修補(bǔ)術(shù)和腹腔鏡疝修補(bǔ)術(shù)的區(qū)別時(shí),兩者的補(bǔ)片放置位置應(yīng)該一致。該歷史性隊(duì)列研究中的目的在于,采用一種開放腹膜前腹股溝疝修補(bǔ)術(shù)--即改良Kugel(MK)術(shù)式作為對照,回顧性比較分析開放與腹腔鏡腹膜前腹股溝疝修補(bǔ)術(shù)的術(shù)后療效,進(jìn)一步明確開放與腹腔鏡腹股溝疝修補(bǔ)術(shù)的差異。研究方法納入上海市“疝與腹壁外科疾病診治中心”的兩所醫(yī)院,即上海交通大學(xué)醫(yī)學(xué)院附屬第九人民醫(yī)院和附屬瑞金醫(yī)院在2008年01月至2010年12月3年期間行開放MK腹股溝疝修補(bǔ)術(shù)或腹腔鏡腹股溝修補(bǔ)術(shù)的18周歲以上的腹股溝疝患者。根據(jù)手術(shù)方式分為開放組(MK術(shù)式)和腹腔鏡組(TEP/TAPP術(shù)式),收集兩組患者的基線資料、復(fù)發(fā)率,以及術(shù)中、術(shù)后短期并發(fā)癥和術(shù)后長期并發(fā)癥等并進(jìn)行統(tǒng)計(jì)分析。研究結(jié)果該回顧性隊(duì)列研究共納入1760名患者(530例開放,1230例腔鏡),其中96.08%的患者完成隨訪(24-60個(gè)月)。開放組患者平均年齡高于腹腔鏡組(p0.001)。91.45%的雙側(cè)腹股溝疝及82.12%的復(fù)發(fā)疝患者行腹腔鏡疝修補(bǔ)術(shù)�？傮w復(fù)發(fā)率為0.71%,兩組之間無統(tǒng)計(jì)學(xué)差異(p=0.227)。腹腔鏡組總并發(fā)癥發(fā)生率低于開放組(14.47%vs.19.25%,p=0.012),但是威脅生命的并發(fā)癥發(fā)生率相近(1.51%vs.0.98%,p=0.332)。腹腔鏡組患者的傷口感染及慢性疼痛發(fā)生率顯著低于開放組(分別為p=0.016和p0.001),并且腔鏡組平均手術(shù)時(shí)間短,疼痛評分低,恢復(fù)快(p0.001)。結(jié)論作為腹膜前腹股溝疝修補(bǔ)術(shù),開放MK腹股溝疝修補(bǔ)術(shù)和腹腔鏡(TEP/TAPP)腹股溝疝修補(bǔ)術(shù)均安全有效,威脅生命的并發(fā)癥及復(fù)發(fā)率均較低。腔鏡疝修補(bǔ)術(shù)后感染及慢性疼痛的發(fā)生率低,并且手術(shù)時(shí)間短,術(shù)后患者恢復(fù)快;但前提是要選擇合適的操作途徑(TAPP或TEP)并貫徹好技術(shù)細(xì)節(jié)。
[Abstract]:Objective to compare the previous studies with laparoscopic inguinal hernia repair (TAPP or TEP). However, unlike laparoscopic hernia repair, Li Kintan is operated in front of the muscle, and the patch is also placed in front of the muscle, not in front of the abdomen. In order to reduce the occurrence of bias, the position of patch placement should be the same when comparing the difference between open hernia repair and laparoscopic hernia repair. The purpose of this historic cohort study was to compare and analyze the postoperative efficacy of open and laparoscopic anterior inguinal hernia repair with modified Kugel (MK) as control, and to further clarify the difference between open inguinal hernia repair and laparoscopic inguinal hernia repair. Methods the patients over 18 years old who underwent open MK inguinal hernia repair or laparoscopic inguinal hernia repair were included in two hospitals of Shanghai Center for diagnosis and treatment of hernia and abdominal Wall Surgical Diseases, namely, the Ninth people's Hospital and Ruijin Hospital, affiliated to the Medical College of Shanghai Jiaotong University, who underwent open inguinal hernia repair or laparoscopic inguinal repair from January 2008 to December 2010. According to the operation mode, the patients were divided into open group (MK operation) and laparoscopy group (TEP/TAPP operation). The baseline data, recurrence rate, intraoperative, postoperative short-term and long-term complications were collected and analyzed statistically. Results A total of 1760 patients (530 open, 1230 endoscopic) were included in the retrospective cohort study, of which 96.08% completed follow-up (24 脳 60 months). The average age of the patients in the open group was higher than that in the laparoscopy group (p0.001). Laparoscopic hernia repair was performed in 91.45% of the patients with bilateral inguinal hernia and 82.12% of the patients with recurrent hernia. The overall recurrence rate was 0.71%, and there was no significant difference between the two groups (p 鈮，

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