CAJ | 학술논문

目的：研究局麻、硬膜外麻下开放式无张力疝修补术与腹腔镜全腹膜外疝修补术（TEP）治疗成人腹股沟疝的疗效对比。方法：回顾性分析本院2009年8月-2014年3月诊治的87例成人腹股沟疝患者的临床资料，根据患者的经济情况和病情等选择不同术式，其中23例行局麻下疝修补的患者作为局麻组，36例硬膜外麻下行无张力疝修补术的患者作为硬膜外麻组，28例行腹腔镜全腹膜外疝修补的患者作为腹腔镜组。观察比较三组患者的手术时间、术后下床时间、总住院时间、术后疼痛时间、住院费用、术后并发症和术后复发率等指标。结果：三组患者手术均成功。手术时间以硬膜外麻组时间最短，腹腔镜组时间最长（P<0.05）；术后下床活动时间以局麻组最短，硬膜外麻组最长（P<0.05）；总住院时间以腹腔镜组最短，局麻组最长（P<0.05）；术后疼痛时间以腹腔镜组最短，局麻组最长（P<0.05）；住院费用以腹腔镜组最高，局麻组最低（P<0.05）；三组的术后并发症发生率比较差异无统计学意义（P>0.05）；三组均无近期复发病例。结论：三种术式各有最佳适应证和优缺点，应个体化选择疝修补术，腹腔镜腹股沟疝修补术有良好的发展前景。
목적：연구국마、경막외마하개방식무장력산수보술여복강경전복막외산수보술（TEP）치료성인복고구산적료효대비。방법：회고성분석본원2009년8월-2014년3월진치적87례성인복고구산환자적림상자료，근거환자적경제정황화병정등선택불동술식，기중23례행국마하산수보적환자작위국마조，36례경막외마하행무장력산수보술적환자작위경막외마조，28례행복강경전복막외산수보적환자작위복강경조。관찰비교삼조환자적수술시간、술후하상시간、총주원시간、술후동통시간、주원비용、술후병발증화술후복발솔등지표。결과：삼조환자수술균성공。수술시간이경막외마조시간최단，복강경조시간최장（P<0.05）；술후하상활동시간이국마조최단，경막외마조최장（P<0.05）；총주원시간이복강경조최단，국마조최장（P<0.05）；술후동통시간이복강경조최단，국마조최장（P<0.05）；주원비용이복강경조최고，국마조최저（P<0.05）；삼조적술후병발증발생솔비교차이무통계학의의（P>0.05）；삼조균무근기복발병례。결론：삼충술식각유최가괄응증화우결점，응개체화선택산수보술，복강경복고구산수보술유량호적발전전경。
To study the contrast effect of local anesthesia,epidural anesthesia for open tension-free hernia repair and laparoscopic total extraperitoneal hernia repair(TEP)in the treatment of adult inguinal hernia. Method:The clinical data of 87 patients with adult inguinal hernia in our hospital from August 2009 to March 2014 were retrospectively analyzed,selected different surgery according to the patient’s economic conditions and disease,23 patients with hernia repair under local anesthesia were selected as local anesthesia group,36 patients with tension-free hernia repair under epidural anesthesia were selected as epidural anesthesia group,28 patients with laparoscopic total extraperitoneal hernia repair were selected as the laparoscopic group.The operation time,postoperative ambulation time, hospitalization time,postoperative pain,hospitalization expenses,postoperative complications and recurrence rate of the three groups were observed and compared.Result:Three groups of patients with operation were successful.The operation time of epidural anesthesia group was the shortest,the laparoscopic group was the longest(P<0.05).The postoperative ambulation time of local anesthesia group was the shortest,epidural anesthesia group was the longest(P<0.05).The hospitalization time of the laparoscopic group was the shortest,local anesthesia group was the longest(P<0.05).The postoperative pain of the laparoscopic group was the shortest,local anesthesia group was the longest(P<0.05).The hospitalization expenses of the laparoscopic group was the highest,local anesthesia group was the lowest(P<0.05).The postoperative complication rate of three groups had no significant differences(P>0.05);the three groups had no relapse in the near future.Conclusion:Three procedures have the best indication,advantages and disadvantages,should be individualized selection of hernia repair,laparoscopic inguinal hernia repair has a good development prospect.