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经腹腹腔镜疝修补术当前技术的早期并发症及结果,并与传统开放手术方法进行比较。

Early complications and outcomes of the current technique of transperitoneal laparoscopic herniorrhaphy and a comparison to the traditional open approach.

作者信息

Cornell R B, Kerlakian G M

机构信息

Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio 45220.

出版信息

Am J Surg. 1994 Sep;168(3):275-9. doi: 10.1016/s0002-9610(05)80201-6.

DOI:10.1016/s0002-9610(05)80201-6
PMID:8080067
Abstract

We conducted a prospective study to evaluate early complications and complaints of 60 patients who underwent laparoscopic transperitoneal hernia repair at our institution. Average follow-up was 9 months. Patients graded levels and duration of postoperative pain subjectively. Nine patients (15%) had complications of anterior/medial thigh numbness, 4 (6.7%) scrotal swelling, 4 (6.7%) scrotal ecchymosis, 3 (5%) hematoma, 2 (3.3%) prolonged sensation of tightness/pressure, 1 (1.7%) seroma, 1 (1.7%) urinary retention, and 1 (1.7%) pain with intercourse. Twenty-six (43%) had no postoperative complaints. Overall, 57 (95%) stated they were satisfied with their repair and would recommend the laparoscopic technique. Fifty-five patients (92%) returned to basic activities of daily living in less than 2 weeks. Thirty-five (73%) of the 48 patients who were employed returned to work within 3 weeks. In comparison, only 7 (29%) of 24 patients in an open hernia repair group resumed normal activity during the first 2 postoperative weeks, and only 3 (14%) of the 21 employed patients in this group returned to work at 3 weeks. The laparoscopic and traditional open herniorrhaphy methods were compared in terms of operating room time and cost. The average unilateral laparoscopic repair (n = 51) cost $3,094 and lasted 81 minutes. Bilateral laparoscopy procedures (n = 9) averaged $3,774 and 110 minutes. Unilateral traditional hernia repairs (n = 24) had an average cost of $1,990 and duration of 69 minutes. In follow-up ranging from 2 to 28 months, there has been only 1 recurrence to report in the laparoscopic group (1.7%). All patients continue to be followed to determine long-term recurrence risks.

摘要

我们进行了一项前瞻性研究,以评估在我们机构接受腹腔镜经腹疝修补术的60例患者的早期并发症及不适情况。平均随访时间为9个月。患者对术后疼痛程度及持续时间进行主观分级。9例患者(15%)出现大腿前内侧麻木并发症,4例(6.7%)阴囊肿胀,4例(6.7%)阴囊瘀斑,3例(5%)血肿,2例(3.3%)有持续的紧绷/压迫感,1例(1.7%)血清肿,1例(1.7%)尿潴留,1例(1.7%)性交疼痛。26例(43%)无术后不适。总体而言,57例(95%)表示对修补手术满意,并会推荐腹腔镜技术。55例患者(92%)在不到2周内恢复了日常生活的基本活动。48例就业患者中有35例(73%)在3周内重返工作岗位。相比之下,开放疝修补组24例患者中只有7例(29%)在术后前2周恢复正常活动,该组21例就业患者中只有3例(14%)在3周时重返工作岗位。对腹腔镜和传统开放疝修补方法在手术时间和费用方面进行了比较。单侧腹腔镜修补术平均费用为3094美元(n = 51),持续时间为81分钟。双侧腹腔镜手术平均费用为3774美元(n = 9),持续时间为110分钟。单侧传统疝修补术平均费用为1990美元,持续时间为69分钟。在2至28个月的随访中,腹腔镜组仅报告1例复发(1.7%)。所有患者仍在继续随访,以确定长期复发风险。

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