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李金斯坦手术与腹腔镜经腹腹膜前疝修补术治疗复发性腹股沟疝的疗效比较

A Comparison of Outcomes between Lichtenstein and Laparoscopic Transabdominal Preperitoneal Hernioplasty for Recurrent Inguinal Hernia.

作者信息

Yang Bin, Zhou Shengning, Li Yingru, Tan Jianan, Chen Shuang, Han Fanghai

出版信息

Am Surg. 2018 Nov 1;84(11):1774-1780.

Abstract

There remain concerns about the optimal technique for repairing recurrent inguinal hernias because of the high risks of complications and recurrence. The aim of this study was to compare Lichtenstein hernioplasty with the transabdominal preperitoneal (TAPP) laparoscopic technique in the treatment of recurrent inguinal hernias. One hundred twenty-two patients who underwent surgery for recurrent inguinal hernia were prospectively randomized to receive either Lichtenstein (n = 63) or TAPP (n = 59) hernioplasty between January 2010 and December 2014. Baseline characteristics, intraoperative complications, and short- and long-term postoperative factors were evaluated. Preoperative factors were comparable between the two groups. The average follow-up period was 46.2 ± 8.5 months. The two groups had similar intraoperative and short-term postoperative complication rates, whereas the rate of long-term postoperative complications was lower for the TAPP group than the Lichtenstein group (6.8% 23.8%, respectively, = 0.012). The TAPP group had significantly lower visual analogue scale scores, fewer analgesics consumption, and faster recovery than the Lichtenstein group ( < 0.05). Chronic pain was more prevalent in the Lichtenstein group than the TAPP group (15.9% 3.4%, respectively, = 0.031). The recurrence rate was 4.8 per cent for the Lichtenstein group and 1.7 per cent for the TAPP group, with no significant difference ( = 0.62). Both the Lichtenstein and TAPP procedures are safe and effective methods for repairing recurrent inguinal hernia with low incidence rates of life-threatening complications and recurrence. The TAPP procedure is superior to the Lichtenstein repair in terms of reduced postoperative pain, shorter sick leave, faster recovery, and better cosmetic results. Careful selection of the surgical procedures and implementation of technical essentials are necessary.

摘要

由于复发性腹股沟疝修补术并发症和复发风险较高,因此对于其最佳技术仍存在担忧。本研究的目的是比较Lichtenstein疝修补术与经腹腹膜前(TAPP)腹腔镜技术治疗复发性腹股沟疝的效果。2010年1月至2014年12月期间,122例行复发性腹股沟疝手术的患者被前瞻性随机分为接受Lichtenstein手术(n = 63)或TAPP手术(n = 59)两组。评估了基线特征、术中并发症以及术后短期和长期因素。两组术前因素具有可比性。平均随访期为46.2±8.5个月。两组术中及术后短期并发症发生率相似,而TAPP组术后长期并发症发生率低于Lichtenstein组(分别为6.8%和23.8%,P = 0.012)。TAPP组视觉模拟评分显著低于Lichtenstein组,镇痛药物使用量更少,恢复更快(P < 0.05)。Lichtenstein组慢性疼痛比TAPP组更普遍(分别为15.9%和3.4%,P = 0.031)。Lichtenstein组复发率为4.8%,TAPP组为1.7%,差异无统计学意义(P = 0.62)。Lichtenstein手术和TAPP手术都是修复复发性腹股沟疝的安全有效方法,危及生命的并发症和复发发生率较低。TAPP手术在减轻术后疼痛、缩短病假、加快恢复和改善美容效果方面优于Lichtenstein修补术。仔细选择手术方法并落实技术要点很有必要。

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