Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University, 374 Dianmian Road, Kunming, 650101, Yunnan Province, China.
Surg Endosc. 2017 Oct;31(10):4238-4243. doi: 10.1007/s00464-017-5485-1. Epub 2017 Mar 13.
The aim of this study was to compare the effect of transabdominal preperitoneal (TAPP) inguinal hernioplasty with or without mesh fixation on chronic pain and quality of life of patients.
One hundred patients with a simple oblique inguinal hernia were included and treated at the Second Affiliated Hospital of Kunming Medical University from July of 2015 to July of 2016. Patients were randomly assigned to TAPP inguinal hernioplasty with mesh fixation (fixation group, n = 50) or without mesh fixation (non-fixation group, n = 50). Observation indices such as mean operative time, time to ambulation, hospitalization expense, and complications were recorded. The visual analog scale (VAS) was adopted for pain evaluation 2 days, 3 months, and 6 months postoperatively. The 36-item short-form health survey (SF-36) was adopted for life quality scoring 3 months postoperatively.
No recurrence or incisional infections were observed during follow-up in either group. The mean operative time, time to ambulation, and hospitalization expense of the non-fixation group were all significantly reduced compared to those of the fixation group. The VAS score 2 days, 3 months, and 6 months postoperatively of the non-fixation group were significantly lower than in the fixation group. The physical function, role physical, bodily pain, and general health in the non-fixation group were each significantly higher than in the fixation group. In contrast, vitality, social function, role emotional, and mental health showed no significant differences across groups.
For patients with primary unilateral oblique inguinal hernia with a defect size less than 4.0 cm in diameter, TAPP inguinal hernioplasty without mesh fixation was safe and effective. Furthermore, this shortened the operative time, promoted early ambulation, decreased hospitalization expenses, alleviated postoperative pain, and improved quality of life.
本研究旨在比较经腹腹膜前（TAPP）腹股沟疝修补术联合或不联合网片固定对慢性疼痛和生活质量的影响。
选取 2015 年 7 月至 2016 年 7 月昆明医科大学第二附属医院收治的 100 例单纯性斜疝患者，随机分为 TAPP 腹股沟疝修补术联合网片固定组（固定组，n=50）和不联合网片固定组（非固定组，n=50）。记录两组患者的平均手术时间、下床活动时间、住院费用和并发症等观察指标。采用视觉模拟评分法（VAS）评估术后 2d、3 个月和 6 个月的疼痛，采用 36 项简明健康状况量表（SF-36）评估术后 3 个月的生活质量。
两组患者随访期间均未见复发或切口感染。非固定组的平均手术时间、下床活动时间和住院费用均明显低于固定组。非固定组术后 2d、3 个月和 6 个月的 VAS 评分明显低于固定组。非固定组的生理功能、躯体角色、躯体疼痛和总体健康评分明显高于固定组。而活力、社会功能、情绪角色和心理健康评分两组间无明显差异。
对于直径小于 4.0cm 的原发性单侧斜疝患者，不联合网片固定的 TAPP 腹股沟疝修补术安全有效，可缩短手术时间，促进早期下床活动，降低住院费用，减轻术后疼痛，提高生活质量。
