腹腔镜全腹膜外腹股沟疝修补术与无张力疝修补术的随机对照研究.DOCVIP

临床医学论文-腹腔镜全腹膜外腹股沟疝修补术与无张力疝修补术的随机对照研究 ??????????? 作者：汤治平　谭敏　张金成　丁纪伟　梁志宏　王立勋 【摘要】? 　　目的： 研究腹腔镜全腹膜外腹股沟疝修补术（totally extraperitoneal prosthetic,TEP）在临床应用中的价值。方法：71例成人腹股沟疝患者前瞻性随机分成两组，分别进行TEP和无张力疝修补术(Lichtenstein)。TEP组35例，Lichtenstein组36例。手术后1周和1年内对患者作出临床观察和评估，并在3个月和1年时进行电话及门诊随访。观察指标为：手术时间、使用镇痛药物的频率、下床活动时间、住院天数、并发症、暂时性神经感觉异常、正常活动时间、腹股沟疼痛持续时间、疝复发。将两组数据进行统计学处理和分析。结果：使用镇痛药物的频率、下床活动时间、住院天数、恢复正常活动时间、腹股沟疼痛持续时间、并发症方面TEP组优于Lichtenstein组，有显著性差异(Ｐ0.05)。手术时间、复发例数TEP组少于Lichtenstein组，但无统计学差异。结论：TEP对于复发疝、老年人疝以及双侧疝更加具有优势。但TEP手术费用较高、需要腹腔镜等设备、学习曲线较长，这些可能是目前TEP尚未广泛开展的主要原因。我们认为，缩短TEP学习曲线的关键在于掌握手术空间的建立，腹白线中隔是影响手术空间建立的主要因素，打开下方部分腹白线中隔是手术的要点。 【关键词】? 腹腔镜术；疝，腹股沟；疝修补术；随机对照研究 　　Randomized comparative study on totally extraperitoneal prosthetic and tensionfree herniorrhaphy ??? 　　【Abstract】Ｏbjective:To study the value of totaly extraperitaneal prosthetic(TEP)in the treatment of hernia.Methods:Seventyone cases with adult inguinal hernia were randomized in two groups.35 cases received the laparoscopic repair with TEP.36 cases were repaired with tensionfree herniorrhaphy（Lichtenstein）.The observe period was within 1 week to 1 year in two groups and the patients were followedup by telephone or consultation in outpatient clinic between 3 months and 1 year after operation.Results:The frequency of using analgesic drugs,duration in hospital,pain time in TEP was more satisfactory than those in the other group.There was a significant difference in two groups.There was no significant difference in two groups in operation time,complication and recurrence rate.Conclusions:Compared tensionfree heniorhaphy,the TEP is more advantageous in recurring hernia,hernia in aged people and hibateral.The key to shorten the period of learningcurve is to establish the effective operating space and master the technology. ??? 【Key words】Ｌaparoscopy;Hernia,inguinal;Ｈerniorrhaphy;Ｒandomized comparative study ??? 近20年来，无张力修补手术在发达国家已经成为治疗腹股沟疝的重要手术，我国亦迅速增加［1］。随着腹腔镜手术的发展，改变了传统腹股沟区手术的入路和修补部位，各种腹腔镜腹股沟疝修补术式亦相继出现，如完全腹膜外疝修补术（total