本文選題：腹股溝疝　切入點：腹腔鏡　出處：《瀘州醫(yī)學院》2014年碩士論文

【摘要】：目的：通過成人腹腔鏡腹股溝疝修補術（LIHR）和開放式腹股溝疝修補術的前瞻性隨機臨床研究，進一步明確腹腔鏡治療腹股溝疝的安全性及優(yōu)越性。方法：將宜賓市第一人民醫(yī)院普外科2012年1月～2013年1月收治的100例成人腹股溝疝患者按入院順序進行編號，隨機分為奇數(shù)組和偶數(shù)組，其中奇數(shù)組50例患者安排到腹腔鏡組，偶數(shù)組50例安排到開放組。腹腔鏡組患者給予全身麻醉，奇數(shù)組前25例患者施行完全腹膜外網片修補術（TEP）和奇數(shù)組后25例患者施行經腹腔腹膜前網片修補術（TAPP）；開放組50例患者全部接受雙層平片無張力疝修補術。100例病例進行長達1年的觀察隨訪（門診隨訪、電話隨訪或醫(yī)護人員上門隨訪的方式相結合），記錄患者術后恢復情況和并發(fā)癥的情況，建立統(tǒng)計資料。觀察和比較兩組患者的以下指標：包括手術時間、住院費用、術后并發(fā)癥、術后復發(fā)、術后使用鎮(zhèn)痛藥物例數(shù)、切口疼痛持續(xù)時間、術后下床活動時間、術后參加正常活動、患者對切口滿意程度進行統(tǒng)計分析。結果：兩組腹股溝疝患者在性別、年齡、疝的類型、發(fā)病部位、伴發(fā)病等臨床資料方面差異無顯著性（P0.05），兩組資料之間具有可比性。開放組50例患者，全部接受雙層平片無張力疝修補術。腹腔鏡組共50例，25例患者行TAPP治療，有1例中轉為開放無張力疝修補術；25例病例行TEP治療，其中僅有2例中轉為TAPP治療。腹腔鏡組手術時間59.11±14.1（5分），住院費用12540.3±2582.3（元），住院時間3.57±1.52（天）；開放組手術時間40.21±11.11（分），住院費用6709.6±1477.8（元），住院時間6.39±3.63（天）。腹腔鏡組手術時間長、住院費用高，與開放組比較統(tǒng)計學有顯著性差異（P=0.000,0.000）。腹腔鏡組住院時間明顯縮短，與開放組比較差異性顯著（P=0.047）。兩組術后并發(fā)癥方面（局部血腫，修補區(qū)域疼痛，陰囊腫脹，尿潴留，補片感染）比較差異無統(tǒng)計學意義（X2=0.65，P=0.275）；腹腔鏡組術后無復發(fā)，開放組術后復發(fā)1例，，兩組在術后復發(fā)統(tǒng)計學上無顯著性差異（P=0.484）。腹腔鏡組疝修補術后有3例患者使用了鎮(zhèn)痛藥物，而開放組疝修補術后為4例；兩組病例在術后下床活動時間（P=0.001）和切口疼痛持續(xù)時間（P=0.001）上差異有統(tǒng)計學意義；兩組病例在術后參加正常活動（P=0.230）和切口滿意程度（P=0.242）上統(tǒng)計學無顯著性差異。結論：腹腔鏡疝修補術手術時間較開放式疝修補術長，住院總費用高于開放組，但術中、術后的近期并發(fā)癥及遠期并發(fā)癥和復發(fā)率的發(fā)生概率均無明顯差別，而行腹腔鏡疝修補術的患者具有術后恢復快、開始工作的時間早、術后切口疼痛持續(xù)時間短、術后使用鎮(zhèn)痛藥物較少、等優(yōu)點；而且，腹腔鏡腹股溝疝修補術更符合人體的正常解剖生理結構，因此成人腹股溝疝的患者行腹腔鏡疝修補術是安全的、可行的，并在術后恢復方面腹腔鏡腹股溝疝修補術較開放式疝修補術有其獨特的優(yōu)勢。
[Abstract]:Objective: to investigate the prospective randomized clinical study of laparoscopic inguinal hernioplasty (LIHR) and open inguinal hernia repair (OGH) in adults. Methods: 100 adult patients with inguinal hernia treated by the first people's Hospital of Yibin from January 2012 to January 2013 were numbered according to the order of admission. They were randomly divided into odd number group and even number group, in which 50 patients in odd number group were assigned to laparoscopic group and 50 patients in even number group were assigned to open group. The first 25 patients with odd array underwent complete external peritoneal mesh repair (TEP) and 25 patients with odd-numbered group underwent transhepatic anterior peritoneal mesh repair (TAPPN), while 50 patients in the open group received tension-free hernioplasty with double-layer plain film. 100 patients were treated with transurethral repair of tension hernia. Follow up for up to one year (outpatient follow-up, The methods of telephone follow-up or on-site follow-up were used to record the patients' recovery and complications, and to establish statistical data. The following indexes were observed and compared between the two groups: operation time, hospitalization cost, Postoperative complications, postoperative recurrence, postoperative use of analgesic drugs, duration of incision pain, time to get out of bed after operation, normal activities after operation, Results: two groups of inguinal hernia patients in gender, age, type of hernia, location of the disease, There was no significant difference in clinical data between the two groups. 50 patients in the open group received tension-free hernioplasty with double-layer plain film, and 25 patients in the laparoscopic group were treated with TAPP. In one case, 25 cases underwent open tension-free hernioplasty, and 25 cases were treated with TEP. In the laparoscopic group, the operation time was 59.11 鹵14.1min, the hospitalization cost was 12540.3 鹵2582.3 yuan, the hospitalization time was 3.57 鹵1.52days, the open group operation time was 40.21 鹵11.11 (min), the hospitalization cost was 6709.6 鹵1477.8 yuan, the hospitalization time was 6.39 鹵3.63. The hospitalization cost was high, there was significant difference between the open group and the open group. The length of stay in the laparoscopy group was significantly shorter than that in the open group, and the difference was significant compared with the open group. The postoperative complications (local hematoma, pain in the repaired area, swelling of scrotum) in the two groups were significantly different from those in the open group. There was no significant difference in urinary retention and patch infection (P < 0. 275), but there was no recurrence in laparoscopy group, 1 case in open group, 1 case in open group, 1 case in laparoscopy group, 1 case in open group, 1 case in laparoscope group, 1 case in open group. There was no significant difference in postoperative recurrence between the two groups (P < 0. 484). In the laparoscopic group, 3 patients were treated with analgesic drugs after herniorrhaphy, while 4 patients in the open group were treated with analgesic drugs after herniorrhaphy. There was significant difference between the two groups in the time of getting out of bed and the duration of incision pain (P 0.001). There was no significant difference between the two groups in terms of normal activity (P < 0.230) and incision satisfaction (P < 0.242). Conclusion: laparoscopic herniorrhaphy is longer than open hernioplasty, and the total cost of hospitalization is higher than that of open group, but during operation, there is no significant difference between the two groups. There was no significant difference in the incidence of short-term complications, long-term complications and recurrence rates. The patients undergoing laparoscopic herniorrhaphy had the advantages of quick recovery, early start of work and short duration of postoperative incision pain. In addition, laparoscopic inguinal hernia repair is more in line with the normal anatomical and physiological structure of the human body, so it is safe and feasible for adult patients with inguinal hernia to perform laparoscopic herniorrhaphy. Laparoscopic inguinal hernia repair has its unique advantages over open hernia repair in postoperative recovery.
【學位授予單位】：瀘州醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R656.21

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相關期刊論文 前2條

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