Mussack T, Ladurner R, Vogel T, Lienemann A, Eder-Willwohl A, Hallfeldt K K
Department of Surgery Innenstadt, Klinikum der Universität München, Nussbaumstrasse 20, 80336 Munich, Germany.
Surg Endosc. 2006 Mar;20(3):410-3. doi: 10.1007/s00464-005-0440-y. Epub 2006 Jan 19.
The objective of this matched control study in patients suffering from incisional hernia was to compare laparoscopic open repair (LHR) with open hernia repair (OHR) in terms of long-term health-related quality of life (HRQL) according to the SF-36 Health Survey.
Twenty-four consecutive patients (18 male, six female; mean age, 55 years) prospectively underwent LHR using expanded polytetrafluoroethylene mesh. The second group, which was matched for age and gender, was subjected to OHR using large pore-sized, low-weight polypropylene meshes. Before and after surgery, HRQL was assessed by the SF-36 Health Survey, which measures eight different health-quality domains, and the SF-36 Physical (PCS) and Mental Component Summary (MCS) score. The SF-36 values were compared to the scores of age-stratified German population controls.
The patients were reevaluated 16 months (range, 12-25) after LHR and 28 months (range, 18-52) after OHR, respectively. Before surgery, all of the eight health-quality domains as well as the PCS and MCS scores of both study groups were significantly lower than the corresponding scores of the age-stratified healthy German population. However, the OHR patients had significantly higher physical functioning and vitality scores than the LHR patients. After LHR and OHR, the scores for all eight SF-36 domains significantly increased but were still lower than those of the controls. The LHR patients were still worse than the norm population on both PCS and MCS scores, whereas OHR patients were worse only on PCS but not on MCS. In the long-term follow-up, none of the SF-36 Health Survey domains or the PCS and the MCS scores revealed significant differences between LHR and OHR patients.
LHR was not different from OHR for selected indications that measure long-term outcome and HRQL. SF-36 appears to be an appropriate instrument to measure postoperative HRQL, showing responsiveness to changes in objective outcome measures.
本项针对切口疝患者的配对对照研究的目的是，根据SF-36健康调查，比较腹腔镜开放修补术（LHR）与开放疝修补术（OHR）在长期健康相关生活质量（HRQL）方面的差异。
连续24例患者（18例男性，6例女性；平均年龄55岁）前瞻性地接受了使用膨体聚四氟乙烯补片的LHR。第二组在年龄和性别上与之匹配，接受了使用大孔径、低重量聚丙烯补片的OHR。手术前后，通过SF-36健康调查评估HRQL，该调查测量八个不同的健康质量领域以及SF-36身体（PCS）和精神成分总结（MCS）得分。将SF-36值与按年龄分层的德国人群对照组的得分进行比较。
LHR术后16个月（范围12 - 25个月）和OHR术后28个月（范围18 - 52个月）分别对患者进行了重新评估。手术前，两个研究组的所有八个健康质量领域以及PCS和MCS得分均显著低于按年龄分层的健康德国人群的相应得分。然而，OHR患者的身体功能和活力得分显著高于LHR患者。LHR和OHR术后，所有八个SF-36领域的得分均显著增加，但仍低于对照组。LHR患者的PCS和MCS得分仍低于正常人群，而OHR患者仅PCS得分低于正常人群，MCS得分则不然。在长期随访中，LHR和OHR患者在SF-36健康调查领域或PCS和MCS得分方面均未显示出显著差异。
对于测量长期结局和HRQL的特定适应症，LHR与OHR并无差异。SF-36似乎是测量术后HRQL的合适工具，对客观结局指标的变化具有反应性。
