腹腔鏡和開放無張力疝修補(bǔ)術(shù)臨床研究
發(fā)布時間：2019-06-20 21:52
【摘要】：目的:通過對腹腔鏡疝修補(bǔ)網(wǎng)片固定術(shù)組、腹腔鏡疝修補(bǔ)網(wǎng)片免固定術(shù)組和開放式無張力疝修補(bǔ)術(shù)組,3組患者的手術(shù)治療結(jié)果對比研究,探討3組不同的腹股溝疝修補(bǔ)方法臨床效果的優(yōu)劣,得到適宜于臨床推廣應(yīng)用疝修補(bǔ)手術(shù)方法。方法:回顧性分析,曲阜市中醫(yī)院2012年1月至2015年1月,同期126例腹股溝疝修補(bǔ)術(shù)患者的臨床資料,按照手術(shù)方式的不同分為腹腔鏡疝修補(bǔ)網(wǎng)片固定術(shù)組(A組,41例)、腹腔鏡疝修補(bǔ)網(wǎng)片免固定術(shù)組(B組,46例)和開放式無張力疝修補(bǔ)術(shù)組(C組,39例),比較3組患者的手術(shù)時間、術(shù)中出血量、術(shù)后疼痛、術(shù)后慢性疼痛、術(shù)后下床活動時間、術(shù)后進(jìn)食時間、住院時間、住院費(fèi)用、切口感染、切口血腫、血清腫、尿潴留、腸粘連、疝復(fù)發(fā)等情況,術(shù)后隨訪1-2年觀察患者近、遠(yuǎn)期并發(fā)癥。統(tǒng)計分析患者的手術(shù)時間、術(shù)中出血量、術(shù)后疼痛、術(shù)后慢性疼痛、術(shù)后下床活動時間、術(shù)后進(jìn)食時間、住院時間、住院費(fèi)用、切口感染、切口血腫、血清腫、尿潴留、腸粘連、疝復(fù)發(fā)的差異以及對比三種術(shù)式的手術(shù)效果,用t檢驗與x2檢驗進(jìn)行統(tǒng)計分析。結(jié)果:腹腔鏡疝修補(bǔ)網(wǎng)片固定術(shù)組(A組,41例)、腹腔鏡疝修補(bǔ)網(wǎng)片免固定術(shù)組(B組,46例)和開放式無張力疝修補(bǔ)術(shù)組(C組,39例)3組患者手術(shù)均得到較好的療效,3組患者年齡、性別、患病類型等一般資料比較,差異均無統(tǒng)計學(xué)意義。B組患者在手術(shù)時間、術(shù)中出血量、術(shù)后進(jìn)食時間、術(shù)后下床時間、住院時間明顯小于A組,差異無統(tǒng)計學(xué)意義。B組患者住院費(fèi)用明顯少于A組差異有統(tǒng)計學(xué)意義(P0.05)。A組患者在術(shù)中出血量、術(shù)后進(jìn)食時間、術(shù)后下床時間、住院時間明顯小于C組,差異有統(tǒng)計學(xué)意義(P0.01),C組患者在住院費(fèi)用明顯少于A組差異有統(tǒng)計學(xué)意義(P0.05),手術(shù)時間差異無統(tǒng)計學(xué)意義。B組患者在術(shù)中出血量、術(shù)后進(jìn)食時間、術(shù)后下床時間、住院時間明顯小于C組差異有統(tǒng)計學(xué)意義(P0.01),B、C組患者在住院費(fèi)用、手術(shù)時間差異無統(tǒng)計學(xué)意義。A組、B組患者的并發(fā)癥和復(fù)發(fā)情況比較治療效果無明顯差異。但分別于與C組比較差異均有統(tǒng)計學(xué)意義。A組在切口感染、切口血腫、血清腫、尿潴留、術(shù)后慢性疼痛、腸粘連、復(fù)發(fā)和C組比較治療效果差異無統(tǒng)計學(xué)意義。A組患者在術(shù)后疼痛明顯少于C組差異有統(tǒng)計學(xué)意義(P0.05)。B組在切口感染、切口血腫、血清腫、尿潴留、術(shù)后慢性疼痛、腸粘連、復(fù)發(fā)和C組比較治療效果差異無統(tǒng)計學(xué)意義。B組患者在術(shù)后疼痛明顯少于C組差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:腹腔鏡和開放式無張力腹股溝疝修補(bǔ)術(shù)均是安全有效的術(shù)式,腹腔鏡優(yōu)于開放無張力疝修補(bǔ)術(shù)。腹腔鏡腹股溝疝修補(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)生率三組差異均無統(tǒng)計學(xué)意義。腹腔鏡網(wǎng)片免固定疝修補(bǔ)術(shù)式操作簡單、臨床實用、并發(fā)癥少、費(fèi)用低、易于推廣應(yīng)用。
[Abstract]:Objective: to compare the surgical results of laparoscopic hernia repair mesh fixation group, laparoscopic hernia repair mesh free fixation group and open tension-free hernia repair group, and to explore the advantages and disadvantages of different inguinal hernia repair methods in the three groups, so as to obtain a suitable method for clinical application of hernia repair. Methods: the clinical data of 126 patients undergoing inguinal hernia repair from January 2012 to January 2015 in Qufu Hospital of traditional Chinese Medicine were analyzed retrospectively. according to the different surgical methods, the patients in group A (41 cases), group B (46 cases) and group C (39 cases) were divided into three groups: group A (41 cases), group B (46 cases) and group C (39 cases). The amount of intraoperative bleeding, postoperative pain, postoperative chronic pain, postoperative time of getting out of bed, postoperative eating time, hospitalization expenses, incision infection, incision hematomas, serum swelling, urinary retention, intestinal adhesion, hernia recurrence, etc., were followed up for 1-2 years to observe the short-term and long-term complications of the patients. The differences of operation time, intraoperative bleeding volume, postoperative pain, postoperative chronic pain, postoperative time of getting out of bed, postoperative eating time, hospitalization expenses, incision infection, incision hematomas, serum swelling, urinary retention, intestinal adhesion and recurrence of hernia were statistically analyzed. T test and x2 test were used for statistical analysis. Results: laparoscopic hernia repair mesh fixation group (group A, 41 cases), laparoscopic hernia repair mesh free fixation group (group B, 46 cases) and open tension-free hernia repair group (group C, 39 cases) had better curative effect. There was no significant difference in age, sex, disease type and other general data among the three groups. The time of getting out of bed after operation was significantly smaller than that of group A, and the difference was not statistically significant. The hospitalization expenses of group B were significantly lower than those of group A (P 0.05). The amount of bleeding during operation, the time of eating after operation, the time of getting out of bed and the time of hospitalization in group). A were significantly lower than those in group C, the difference was statistically significant (P 0.01). The hospitalization expenses of group C were significantly lower than those of group A (P 0.05), but there was no significant difference in operation time. The amount of bleeding during operation, the time of eating after operation, the time of getting out of bed and the time of hospitalization in group B were significantly lower than those in group C (P 0.01). There was no significant difference in hospitalization expenses and operation time in group B. there was no significant difference in hospitalization expenses and operation time in group A. there was no significant difference in the amount of bleeding during operation, the time of eating after operation, the time of getting out of bed after operation. There was no significant difference in the treatment effect between complications and recurrence in group B. However, there was significant difference between group A and group C. there was no significant difference in incision infection, incision hematomas, serum swelling, urinary retention, postoperative chronic pain, intestinal adhesion and recurrence between group A and group C. there was significant difference in postoperative pain between group A and group C (P 0.05). B group, chronic pain, intestinal adhesion, chronic pain and intestinal adhesion). There was no significant difference in postoperative pain between group B and group C. there was significant difference in postoperative pain between group B and group C (P 0.05). Conclusion: laparoscopic and open tension-free inguinal hernia repair are safe and effective, and laparoscopy is superior to open tension-free hernia repair. Laparoscopic inguinal hernia repair patch can still achieve the effect of nailing after nailing without nailing. There is no significant difference in the total complications and the incidence of complications among the three groups. Laparoscopic mesh free hernia repair has the advantages of simple operation, clinical practice, less complications and low cost, so it is easy to be popularized and applied.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R656.21
本文編號：2503535
[Abstract]:Objective: to compare the surgical results of laparoscopic hernia repair mesh fixation group, laparoscopic hernia repair mesh free fixation group and open tension-free hernia repair group, and to explore the advantages and disadvantages of different inguinal hernia repair methods in the three groups, so as to obtain a suitable method for clinical application of hernia repair. Methods: the clinical data of 126 patients undergoing inguinal hernia repair from January 2012 to January 2015 in Qufu Hospital of traditional Chinese Medicine were analyzed retrospectively. according to the different surgical methods, the patients in group A (41 cases), group B (46 cases) and group C (39 cases) were divided into three groups: group A (41 cases), group B (46 cases) and group C (39 cases). The amount of intraoperative bleeding, postoperative pain, postoperative chronic pain, postoperative time of getting out of bed, postoperative eating time, hospitalization expenses, incision infection, incision hematomas, serum swelling, urinary retention, intestinal adhesion, hernia recurrence, etc., were followed up for 1-2 years to observe the short-term and long-term complications of the patients. The differences of operation time, intraoperative bleeding volume, postoperative pain, postoperative chronic pain, postoperative time of getting out of bed, postoperative eating time, hospitalization expenses, incision infection, incision hematomas, serum swelling, urinary retention, intestinal adhesion and recurrence of hernia were statistically analyzed. T test and x2 test were used for statistical analysis. Results: laparoscopic hernia repair mesh fixation group (group A, 41 cases), laparoscopic hernia repair mesh free fixation group (group B, 46 cases) and open tension-free hernia repair group (group C, 39 cases) had better curative effect. There was no significant difference in age, sex, disease type and other general data among the three groups. The time of getting out of bed after operation was significantly smaller than that of group A, and the difference was not statistically significant. The hospitalization expenses of group B were significantly lower than those of group A (P 0.05). The amount of bleeding during operation, the time of eating after operation, the time of getting out of bed and the time of hospitalization in group). A were significantly lower than those in group C, the difference was statistically significant (P 0.01). The hospitalization expenses of group C were significantly lower than those of group A (P 0.05), but there was no significant difference in operation time. The amount of bleeding during operation, the time of eating after operation, the time of getting out of bed and the time of hospitalization in group B were significantly lower than those in group C (P 0.01). There was no significant difference in hospitalization expenses and operation time in group B. there was no significant difference in hospitalization expenses and operation time in group A. there was no significant difference in the amount of bleeding during operation, the time of eating after operation, the time of getting out of bed after operation. There was no significant difference in the treatment effect between complications and recurrence in group B. However, there was significant difference between group A and group C. there was no significant difference in incision infection, incision hematomas, serum swelling, urinary retention, postoperative chronic pain, intestinal adhesion and recurrence between group A and group C. there was significant difference in postoperative pain between group A and group C (P 0.05). B group, chronic pain, intestinal adhesion, chronic pain and intestinal adhesion). There was no significant difference in postoperative pain between group B and group C. there was significant difference in postoperative pain between group B and group C (P 0.05). Conclusion: laparoscopic and open tension-free inguinal hernia repair are safe and effective, and laparoscopy is superior to open tension-free hernia repair. Laparoscopic inguinal hernia repair patch can still achieve the effect of nailing after nailing without nailing. There is no significant difference in the total complications and the incidence of complications among the three groups. Laparoscopic mesh free hernia repair has the advantages of simple operation, clinical practice, less complications and low cost, so it is easy to be popularized and applied.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R656.21
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