腹腔镜腹股沟疝无张力修补术的临床和实验研究外科学普外科专业论文.docxVIP

症率差异无统计学意义：两组在C02气腹过程中其血压、心率、呼吸、 症率差异无统计学意义：两组在C02气腹过程中其血压、心率、呼吸、 Na+、Ca2+、IIb、Hot、TC02、P02和S02值变化差异没有统计学意义； 两组的呼气末C02分压(PETC02)、K+、PC02值随手术时间的延长而增 高，拔管后恢复到气腹前水平；两组的PH值和HC03-值在气腹建立后逐 渐下降，在拔管后恢复到气腹前水平，各种病理生理学变化在两组之间差 异没有统计学意义。③n—TEP组和S-TEP组在术后的B超显象相似；两组 在术后补片的挛缩度差异无统计学意义；n．TEP组的住院费用低于s-TEP 组(P=0．000)；n—TEP组在术后第1天咳嗽时的疼痛分数低于S-TEP组 (P=O．05)，两组在术后其他各时期静卧和咳嗽时的疼痛分数差异没有统 计学意义。④甲组大鼠在术后腹腔有粘连，乙组和丙组无腹腔粘连。三组 大鼠在术后各个时间段修复区域的腹壁抗张强度和补片挛缩度差异无统 计学意义。三组大鼠的组织细胞学变化基本一致。 结论：TAPP和TEP都是安全有效的无张力修补方式，手术效果及术式选择取决 于术者的临床经验：选择性的应用n-TEPN获得最佳的临床和卫生经济学 效益。 【关键词】 腹腔镜 腹股沟疝 外科手术 Clinical Clinical and laboratory research of laparoscopic inguinal hernia repair Abstract objective To evaluate the clinical safety,efficiency and cost—effectiveness of laparoscopic inguinal hemia repair(LIHR)；to evaluate the pathophysi0109ical influence of“C02 pneumo—preperitoneum”；to observe the tensile strength and histological reaction in the region repaired in rats；and to discuss the indications and approach of laparoscopic repair for inguinal hernias． Methods OA non·randomized concurrent control study was performed including 25 1 LIHR，9 1 Lichtenstein repair and 1 46 conventional hernia repair during Jan．2003 and Oct．2005．②A non．randomized concurrent control study was carried out in 144 TEP and 1 07 TAPP,and a case control study with 1 0 selective TEP and 1 0 TAPP was prospectively designed to evaluate the safety of CO：pneumo—preperitoneum．③A clinical randomized control trial(RCT)Was carried out in 20 non stapling TEP (n—TEP)and 20 stapling TEP(s—TEP)from Aug．2004 to Mar．2005．④75 SD rats with abdominal wall defect models were randomly divided into 3 groups：TAPP model with incomplete peritoneum(group A)，s—TEP model(group B)and n—TEP model(group C)．The rats were respectively killed at 7m，1 4“，30“，60th，90‘“day postoperatively for haematoxylin and eosin(HE)histological examination． Results①There was no significant difference in operating time between LIHR， Lichtenstein and conventional procedures．The postopera