Dirksen C D, Beets G L, Go P M, Geisler F E, Baeten C G, Kootstra G
Department of Surgery, University Hospital Maastricht, The Netherlands.
Eur J Surg. 1998 Jun;164(6):439-47. doi: 10.1080/110241598750004256.
To compare the effectiveness of open and laparoscopic primary inguinal hernia repair.
Randomised controlled trial.
University hospital, The Netherlands.
87 patients had 103 open repairs and 88 patients had 114 laparoscopic repairs between November 1993 and July 1995.
Laparoscopic repair by the transabdominal preperitoneal (TAPP) technique and open repair by the Bassini technique.
Recurrence, morbidity, pain, and duration of convalescence.
Operating time was longer for laparoscopy (mean (SD): 82 (28) compared with 45 (15) minutes p < 0.001). Patients in the Bassini group had higher postoperative pain scores (mean (SD)VAS: 2.9 (1.6) compared with 2.0 (1.6) p=0.002), used more analgesics (median total intake: 2 (0-54) compared with 0 tablets (0-42) p=0.008), and needed a longer convalescence time (mean (SD) time to return to work: 22 (12.6) compared with 14 (10.1) days p < 0.001; mean (SD) time to return to physical activities: 27 (12.6) compared with 17 (12.2) days p < 0.001). Mean follow up was 24 months. Recurrence rates were 21% (22/ 103) after Bassini and 6% (7/114) after laparoscopic repair (p=0.001).
Laparoscopic hernia repair is a safe operation, which has obvious advantages over the Bassini repair in terms of pain, use of analgesic drugs, resumption of activities, and recurrence. A disadvantage of the laparoscopic repair is the longer operating time.
比较开放式与腹腔镜下原发性腹股沟疝修补术的疗效。
随机对照试验。
荷兰的大学医院。
1993年11月至1995年7月期间，87例患者接受了开放修补术103次，88例患者接受了腹腔镜修补术114次。
经腹腹膜前（TAPP）腹腔镜修补术和Bassini开放式修补术。
复发率、发病率、疼痛及康复时间。
腹腔镜手术时间更长（平均值（标准差）：82（28）分钟，而开放式手术为45（15）分钟；p<0.001）。Bassini组患者术后疼痛评分更高（平均值（标准差）视觉模拟评分法（VAS）：2.9（1.6），而腹腔镜组为2.0（1.6）；p=0.002），使用更多镇痛药（中位数总摄入量：2（0-54）片，而腹腔镜组为0片（0-42）；p=0.008），康复时间更长（平均（标准差）恢复工作时间：22（12.6）天，而腹腔镜组为14（10.1）天；p<0.001；平均（标准差）恢复体力活动时间：27（12.6）天，而腹腔镜组为17（12.2）天；p<0.001）。平均随访时间为24个月。Bassini术后复发率为21%（22/103），腹腔镜修补术后复发率为6%（7/114）（p=0.001）。
腹腔镜疝修补术是一种安全的手术，在疼痛、镇痛药使用、活动恢复及复发方面比Bassini修补术具有明显优势。腹腔镜修补术的一个缺点是手术时间更长。
