作者：胡楠，谢红，余淼，王邓超，魏健，杨玉辉，张陈

单位：四川省自贡市第四人民医院 普通外科，四川 自贡 643000

Authors:  HU Nan, XIE Hong, YU Miao, WANG Dengchao, YANG Yuhui, WEI Jian, ZHANG Chen

Unit:  NO.4 People's Hospital of ZiGong, ZiGong 64300, Sichuan, China

摘要：

目的   探讨自固定补片在成人腹腔镜完全腹膜外无张力疝修补术的临床优势。方法  回顾性分析2017年1月至2018年6月我院收治的156例进行腹腔镜全腹膜外修补术患者的临床资料,根据使用的补片不同,将患者分为自固定补片组(n=82)和聚丙烯平片组(n=74)。采用t检验、χ2检验比较不同组别患者手术之后的疼痛评分、手术时间、住院时间、术后并发症及复发情况。结果  两组腹股沟疝患者均顺利完成手术,自固定补片组和聚丙烯平片组术后1天疼痛评分分别为(2.2±0.75)分、(2.3±0.8)分,术后7天疼痛评分分别为(1.3±0.8)分、(1.9±0.8)分,术后1月疼痛评分分别为(0.3±0.5)分、(1.0±0.9)分,术后3月疼痛评分分别为(0.2±0.4)分、(0.9±0.9)分,术后半年疼痛评分分别为(0.1±0.3)分、(0.4±0.5)分；自固定补片组异物感发生例数为0,聚丙烯平片组异物感发生例数为4；自固定补片组出现阴囊积液例数为4,聚丙烯平片组阴囊积液例数为3；两组患者术中及术后均未发生血清肿、腹壁下血管损伤、复发。结论  自固定补片应用于腹腔镜完全腹膜外无张力疝修补术与钉合固定补片相比,能显著减轻患者术后疼痛,值得临床推广使用。

关键词： 腹股沟疝； 腹腔镜； 自固定补片； 完全腹膜外

Abstract：

Objective  To explore the clinical advantages of self-fixed patch in adult laparoscopic total extraperitoneal hernia repair. Methods  A total of 156 patients with inguinal hernia between January 2017 to June 2018 in our hospital were randomly divided into two groups depend on the different patch used, the patients were divided into self-fixed patch group (n=82) and common polypropylene mesh group (n= 74), postoperative pain scores, operative time, hospital stay, postoperative complications and recurrence were compared through t test and χ2 test between the two groups. Result  Both groups of inguinal hernia were successfully operated, the pain scores of one day after surgery of the self-fixed patch group and polypropylene group were (2.2±0.75) and (2.3±0.8) respectively, the pain scores of seven days after surgery were (1.3±0.8) and (1.9±0.8) respectively, the pain scores of 1 month after surgery were (0.3±0.5) and (1.0±0.9) respectively, the pain scores of three months after surgery were(0.2±0.4) and(0.9±0.9) respectively, the pain scores of six months after surgery were(0.1±0.3) and(0.4±0.5) respectively. The number of cases of foreign body sensation in self-fixed patch group was 0, there were 4 cases of foreign body sensation in polypropylene group. There were 4 cases of scrotal effusion in self -fixed patch group, 3 cases of scrotal effusion in polypropylene group. Two groups of patients were no serum swelling, abdominal vascular injury, recurrence in intraoperative and postoperative. Conclusion  The self-gripping mesh has more significant advantages than fixation with staples in reducing postoperative pain, worthy of promotion.

Key Words:  Inguinal hernia; Laparoscopes; Herniorrhaphy; Totally extraperoneal