Kugel和TAPP修补术治疗成人腹股沟疝的效果比较(1)
[摘要]目的 比较经疝环入路改良Kugel疝修补术(改良Kugel修补术)与腹腔镜经腹腹膜前疝修补术(TAPP修补术)治疗成人腹股沟疝的效果。方法 回顾性分析2015年1月～2017年3月我院收治的173例成人腹股沟疝的临床资料，其中行改良Kugel修补术78例;行TAPP术95例。比较两组手术指标[疝囊颈直径、手术时间、视觉模拟评分法(VAS)评分]，术后并发症(疼痛程度、血肿、积液、异物感)及术后2年复发情况。结果 两组的疝囊颈直径、手术时间、VAS评分比较，差异无统计学意义(P>0.05)。两组早期疼痛、慢性疼痛发生率和术后并发症发生率比较，差异无统计学意义(P>0.05)。随访2年，两组术后复发率比较，差异无统计学意义(P>0.05)。结论 改良Kugel修补术和TAPP修补术治疗成人腹股沟疝的效果相同，可根据适应证和患者情况选择治疗。
[关键词]改良Kugel修补术;腹腔镜经腹腹膜前疝修补术;腹股沟疝;腹膜前间隙;治疗效果
[中图分类号] R656.21 [文献标识码] A [文章编号] 1674-4721(2020)6(c)-0070-04
Effect comparison of Kugel and TAPP in the treatment of adults inguinal hernia
TAO Hong-fa XIAO Yong ZHAO Kun
Department of General Surgery， Shenzhen Songgang People′s Hospital， Guangdong Province， Shenzhen 518105， China
[Abstract] Objective To compare the clinic effect of modified-Kugel and transabdominal preperitoneal repair (TAPP) in the treatment of adults inguinal hernia. Methods The clinical data of 173 patients with inguinal hernia treated in our hospital from January 2015 to March 2017 were retrospectively analyzed. Patients were divided into modified-Kugel group (78 cases) and the TAPP group (95 cases). The differences in surgical indicators (diameter of hernia sac， operation time， visual analogue scale [VAS])， postoperative complications (pain degree， hematoma， effusion， foreign body sensation) and recurrence after 2 years were compared between the two groups. Results There were no significant differences in the diameter of hernia sac neck， operation time and VAS score between the two groups (P>0.05). There were no significant difference in the incidence rates of early pain， chronic pain and postoperative complications between the two groups (P>0.05). After 2 years follow-up， there was no significant difference in recurrence rate between the two groups (P>0.05). Conclusion Modified- Kugel repair and TAPP repair have the same effect treating adult inguinal hernia. Treatment can be selected according to the indication and the specific situation of the patient.
[Key words] Modified-Kugel; Transabdominal preperitoneal repair; Inguinal hernia; Preperitoneal space; Treatment effect
腹股溝疝是外科常见和多发病，发病率近年呈现逐年递增趋势，根据不完全统计，我国每年进行腹股沟疝修补患者有300多万人次[1]。腹股沟疝主要由于腹腔结构异常导致腹股沟区域结构变薄，或由于腹横筋膜缺损造成腹腔内组织或器宫突出体表的一种疾病，若治疗不当或不及时，极易诱发肠穿孔、肠坏死、肠梗阻等并发症[2]。腹膜前间隙和腹横筋膜薄弱是腹股沟疝发生的主要原因[3]。成人疝不可自愈，手术是唯一有效治疗方法。腹股沟疝修补术分为腹横筋膜前修补前入路和腹膜前间隙后入路术。前入路术主要包括传统组织修补术如Bassini法及无张力疝修补的平片无张力疝修补术(Lichtenstein手术)、疝环充填式Rutkow术、Millikan修补术等。后入路主要包括经疝环入路改良Kugel疝修补术(改良Kugel修补术)、Nyhus、巨大补片加强内囊术(Stoppa术)等，以及腹腔镜疝修补术如腹腔镜经腹腹膜前修补术(TAPP修补术)和腹腔镜完全腹膜外腹股沟疝修补术(totally extraperitoneal prosthesis，TEP)等[4]。对于缺损较大的腹股沟疝，后入路术后慢性疼痛和复发率低于前入路，而对较小的缺损，前和后入路治疗效果无明显差异[4]。临床选择何种手术方式治疗，是业内重点研究的问题。改良Kugel修补术和TAPP修补术都是后入路技术，两者治疗效果比较少见报道，为探讨两种方式治疗成人腹股沟疝的临床效果，现将我院收治的173例成人腹股沟疝患者随机分成两组进行对照研究，现报道如下。, http://www.100md.com(陶红发 肖勇 赵坤)
[关键词]改良Kugel修补术;腹腔镜经腹腹膜前疝修补术;腹股沟疝;腹膜前间隙;治疗效果
[中图分类号] R656.21 [文献标识码] A [文章编号] 1674-4721(2020)6(c)-0070-04
Effect comparison of Kugel and TAPP in the treatment of adults inguinal hernia
TAO Hong-fa XIAO Yong ZHAO Kun
Department of General Surgery， Shenzhen Songgang People′s Hospital， Guangdong Province， Shenzhen 518105， China
[Abstract] Objective To compare the clinic effect of modified-Kugel and transabdominal preperitoneal repair (TAPP) in the treatment of adults inguinal hernia. Methods The clinical data of 173 patients with inguinal hernia treated in our hospital from January 2015 to March 2017 were retrospectively analyzed. Patients were divided into modified-Kugel group (78 cases) and the TAPP group (95 cases). The differences in surgical indicators (diameter of hernia sac， operation time， visual analogue scale [VAS])， postoperative complications (pain degree， hematoma， effusion， foreign body sensation) and recurrence after 2 years were compared between the two groups. Results There were no significant differences in the diameter of hernia sac neck， operation time and VAS score between the two groups (P>0.05). There were no significant difference in the incidence rates of early pain， chronic pain and postoperative complications between the two groups (P>0.05). After 2 years follow-up， there was no significant difference in recurrence rate between the two groups (P>0.05). Conclusion Modified- Kugel repair and TAPP repair have the same effect treating adult inguinal hernia. Treatment can be selected according to the indication and the specific situation of the patient.
[Key words] Modified-Kugel; Transabdominal preperitoneal repair; Inguinal hernia; Preperitoneal space; Treatment effect
腹股溝疝是外科常见和多发病，发病率近年呈现逐年递增趋势，根据不完全统计，我国每年进行腹股沟疝修补患者有300多万人次[1]。腹股沟疝主要由于腹腔结构异常导致腹股沟区域结构变薄，或由于腹横筋膜缺损造成腹腔内组织或器宫突出体表的一种疾病，若治疗不当或不及时，极易诱发肠穿孔、肠坏死、肠梗阻等并发症[2]。腹膜前间隙和腹横筋膜薄弱是腹股沟疝发生的主要原因[3]。成人疝不可自愈，手术是唯一有效治疗方法。腹股沟疝修补术分为腹横筋膜前修补前入路和腹膜前间隙后入路术。前入路术主要包括传统组织修补术如Bassini法及无张力疝修补的平片无张力疝修补术(Lichtenstein手术)、疝环充填式Rutkow术、Millikan修补术等。后入路主要包括经疝环入路改良Kugel疝修补术(改良Kugel修补术)、Nyhus、巨大补片加强内囊术(Stoppa术)等，以及腹腔镜疝修补术如腹腔镜经腹腹膜前修补术(TAPP修补术)和腹腔镜完全腹膜外腹股沟疝修补术(totally extraperitoneal prosthesis，TEP)等[4]。对于缺损较大的腹股沟疝，后入路术后慢性疼痛和复发率低于前入路，而对较小的缺损，前和后入路治疗效果无明显差异[4]。临床选择何种手术方式治疗，是业内重点研究的问题。改良Kugel修补术和TAPP修补术都是后入路技术，两者治疗效果比较少见报道，为探讨两种方式治疗成人腹股沟疝的临床效果，现将我院收治的173例成人腹股沟疝患者随机分成两组进行对照研究，现报道如下。, http://www.100md.com(陶红发 肖勇 赵坤)