CAJ | 학술논문

目的：探讨腹腔镜全腹膜外疝修补术(totally extraperitoneal prosthesis，TEP)术中经腹壁外穿刺带线结扎固定补片与疝钉枪固定补片的效果。方法将56例择期行TEP术患者按随机数字表法分为A、B 2组，每组28例。2组均行TEP手术治疗，A组采用经腹壁外穿刺带线结扎固定补片；B组采用疝钉枪固定补片。比较2组手术时间、术中出血量、术后下床活动时间、术后住院时间、住院费用及术后并发症（血清肿、切口感染、疼痛、阴囊气肿、复发）发生率。结果所有病例均在腹腔镜下成功完成手术，术后随访6个月～3年，未发现有疝气复发病例。2组手术时间、术中出血量、术后下床活动时间、术后住院时间及术后并发症发生率比较差异均无统计学意义（P＞0.05）；但B组住院费用显著高于A组（P＜0.05）。结论 TEP术中经腹壁外穿刺带线结扎固定补片是一种可行、安全、有效的方法，不仅能有效防止补片移位和卷曲，避免疝复发，而且治疗费用低廉，值得在基层医院推广使用。
목적：탐토복강경전복막외산수보술(totally extraperitoneal prosthesis，TEP)술중경복벽외천자대선결찰고정보편여산정창고정보편적효과。방법장56례택기행TEP술환자안수궤수자표법분위A、B 2조，매조28례。2조균행TEP수술치료，A조채용경복벽외천자대선결찰고정보편；B조채용산정창고정보편。비교2조수술시간、술중출혈량、술후하상활동시간、술후주원시간、주원비용급술후병발증（혈청종、절구감염、동통、음낭기종、복발）발생솔。결과소유병례균재복강경하성공완성수술，술후수방6개월～3년，미발현유산기복발병례。2조수술시간、술중출혈량、술후하상활동시간、술후주원시간급술후병발증발생솔비교차이균무통계학의의（P＞0.05）；단B조주원비용현저고우A조（P＜0.05）。결론 TEP술중경복벽외천자대선결찰고정보편시일충가행、안전、유효적방법，불부능유효방지보편이위화권곡，피면산복발，이차치료비용저렴，치득재기층의원추엄사용。
Objective To investigate the efficacies of extraperitoneal puncture with suture ligation and hernia nail gun for mesh fixation in totally extraperitoneal prosthesis (TEP ). Methods Fifty-six patients undergoing elective TEP were randomly assigned to receive mesh fixation with either extraperitoneal puncture and suture ligation(group A, n=28)or hernia nail gun(group B, n=28). Oper-ation time, intraoperatve blood loss, time to out-of-bed activity, hospital stay, hospital costs and postoperative complications (seroma, incision infection, pain, scrotal emphysema and hernia recurrence) were compared between the two groups. Results The operation was completed successfully under laparoscope in all patients. After 6-36 months of follow-up, no hernia recurrence was found in both groups. There were no significant differences in operation time, intraoperatve blood loss, time to out-of-bed activity , hospital stay , and incidence of postoperative complications between the two groups ( P>0.05). Compared with group A, hospital costs significantly increased in group B(P<0.05). Conclusion The extraperitoneal puncture with suture ligation is feasible, safe, effective and economical for mesh fixation in TEP, and can prevent mesh shift and curl and avoid hernia recurrence. Therefore, this method is worthy of popularization in basic-level hospitals.