CAJ | 학술논문

目的：比较腹腔镜经腹腹膜前疝修补术（ transabdominal preperitoneal ，TAPP）与Lichtenstein无张力疝修补术治疗腹股沟复发疝的效果。方法采用前瞻性对照研究将2006年3月～2013年6月65例成人腹股沟复发疝按患者意愿分为TAPP组（n＝34）和Lichtenstein组（n＝31），比较2组手术时间、术中出血量、术后疼痛评分、术后肛门排气时间、术后住院时间、术后并发症发生率、住院费用以及术后复发率等。结果65例手术均顺利完成，TAPP组手术时间（44．8±9．7） min明显少于Lichtenstein组（68．1±18．6）min（t＝-6．413，P＝0．000）；术中出血量中位数10 ml（5～50 ml）明显少于Lichtenstein组中位数30 ml（10～150 ml）（Z＝-4．349，P＝0．000）；术后疼痛评分（2．2±1．5）分明显小于Lichtenstein组（5．5±1．1）分（t＝-10．032，P＝0．000）；术后住院时间（4．2±1．3）d，明显短于Lichtenstein组（5．6±1．9）d（t＝-3．493，P＝0．001）；术后复发0例，明显少于Lichtenstein组4例（Fisher’s检验，P＝0．049）；住院费用（10676．8±2018．9）元，明显高于Lichtenstein 组（8060.0±990．5）元（t＝6．532，P＝0．000）；术后肛门排气时间（2．1±0．8）d，明显长于Lichtenstein组（1．5±0．6）d（t＝3．394， P＝0．001）。结论 TAPP治疗腹股沟复发疝安全可行，在手术时间、术中出血量、术后疼痛评分、术后住院时间、术后复发方面要明显优于Lichtenstein术式，但手术费用较高，手术难度较大，难以广泛开展。
목적：비교복강경경복복막전산수보술（ transabdominal preperitoneal ，TAPP）여Lichtenstein무장력산수보술치료복고구복발산적효과。방법채용전첨성대조연구장2006년3월～2013년6월65례성인복고구복발산안환자의원분위TAPP조（n＝34）화Lichtenstein조（n＝31），비교2조수술시간、술중출혈량、술후동통평분、술후항문배기시간、술후주원시간、술후병발증발생솔、주원비용이급술후복발솔등。결과65례수술균순리완성，TAPP조수술시간（44．8±9．7） min명현소우Lichtenstein조（68．1±18．6）min（t＝-6．413，P＝0．000）；술중출혈량중위수10 ml（5～50 ml）명현소우Lichtenstein조중위수30 ml（10～150 ml）（Z＝-4．349，P＝0．000）；술후동통평분（2．2±1．5）분명현소우Lichtenstein조（5．5±1．1）분（t＝-10．032，P＝0．000）；술후주원시간（4．2±1．3）d，명현단우Lichtenstein조（5．6±1．9）d（t＝-3．493，P＝0．001）；술후복발0례，명현소우Lichtenstein조4례（Fisher’s검험，P＝0．049）；주원비용（10676．8±2018．9）원，명현고우Lichtenstein 조（8060.0±990．5）원（t＝6．532，P＝0．000）；술후항문배기시간（2．1±0．8）d，명현장우Lichtenstein조（1．5±0．6）d（t＝3．394， P＝0．001）。결론 TAPP치료복고구복발산안전가행，재수술시간、술중출혈량、술후동통평분、술후주원시간、술후복발방면요명현우우Lichtenstein술식，단수술비용교고，수술난도교대，난이엄범개전。
Objective To compare the effect of laparoscopic transabdominal preperitoneal herniorrhaphy with Lichtenstein tension-free repair for recurrent inguinal hernia . Methods A total of 65 patients were involved in this study and received tension-free inguinal hernia repair from March 2006 to June 2013, with 34 patients in TAPP group and 31 patients in Lichtenstein group .The operative time, intraoperative blood loss , postoperative pain scores , postoperative exhaust time , postoperative hospital stay , postoperative complications , hospital cost and recurrence rate were compared between the two groups . Results All the 65 operations were successfully completed.The TAPP group had shorter operative time, less blood loss, lower postoperative pain scores, shorter postoperative hospital stay, and lower recurrence rate than those of the Lichtenstein group [ (44.8 ±9.7) min vs.(68.1 ±18.6) min, t=-6.413,P=0.000);10 ml (median) vs.30 ml (median), Z=-4.349,P=0.000;(2.2 ±1.5)points vs.(5.5 ±1.1) points, t=-10.032,P=0.000;(4.2 ±1.3) d vs.(5.6 ±1.9) d, t=-3.493,P=0.001;0 vs.4, P=0.049];hospital cost in the TAPP group was significantly higher than that of the Lichtenstein group [(10 676.8 ±2018.9) yuan vs.(8060.0 ±990.5) yuan, t=6.532, P=0.000];exhaust time in the TAPP group was longer than that of the Lichteastein group [(2.1 ±0.8) d vs.(1.5 ± 0.6) d, t=3.394,P=0.001]. Conclusions TAPP is a safe and feasible procedure for recurrent inguinal hernia repair .Compared with Lichtenstein procedure , TAPP is superior in operative time , intraoperative blood loss , postoperative pain scores , postoperative hospital stay and postoperative recurrence .However, the relatively high cost and complicated procedures might be reasons for its postponed popularization .