目的 探讨腹腔镜下经腹腹膜前疝修补术(TAPP)与疝环充填式无张力疝修补术(Mesh-Plug)在腹股沟疝治疗中的应用及临床疗效比较.方法 选取采用TAPP和Mesh-Plug治疗的77例成年腹股沟疝患者的临床病历资料.根据手术方式不同分为TAPP组(37例)和Mesh-Plug组(40例),其中TAPP组采用腹腔镜下经腹腹膜前疝修补术手术治疗,Mesh-Plug组采用开放式疝环充填式无张力疝修补术手术治疗,观察对比两组患者临床治疗效果及在手术时间、住院时间、住院费用、术后并发症(血肿、疼痛等)、近中期复发率等方面的差异.结果 两组患者均获得临床治愈;Mesh-Plug组平均手术时间为(50.25 ±11.36)min,TAPP组平均手术时间为(48.68 ±10.23)min;Mesh-Plug组平均住院时间为(10.69 ±2.36)d,TAPP组平均住院时间为(7.61 ±2.11)d;Mesh-Plug组出现围术期并发症7例,TAPP组为1例;两组间在手术时间方面差异无统计学意义(P>0.05);在平均住院日、围手术期并发症等组间比较均差异有统计学意义(P<0.05);住院费用:TAPP组为(1.25 ±0.24)万元,Mesh-Plug组为(0.84 ±0.22)万元,TAPP组费用高于开放组,差异有统计学意义(P<0.05).术后随访3~24个月,TAPP组复发0例,Mesh-Plug组复发1例,差异无统计学意义(P>0.05).结论 TAPP和Mesh-Plug在治疗成年腹股沟疝中均具有良好治疗效果,但TAPP较Mesh-Plug具有住院时间短、恢复快、围术期并发症低、慢性疼痛不适感轻等方面的优势,因而在临床应用中更具优势.%Objective To explore the application and clinical effect of laparoscopic abdominal preperitoneal hernia repair(TAPP)and hernia ring filling tension-free hernia repair(Mesh-Plug)in the treatment of inguinal hernia. Methods Seventy-seven cases of adult inguinal hernia with laparoscopic hernia repair and tension -free hernia repair were selected.They were divided into TAPP group(37 cases)and Mesh-Plug group(40 cases)according to the differ-ent ways of operation,laparoscopic transabdominal preperitoneal hernia repair surgery was used in TAPP group and open tension-free hernia repair treatment was used in the Mesh-Plug group.The clinical curative effect,operation time,hospi-talization time,hospitalization expenses,postoperative complications(hematoma,pain,etc.),recurrence rate of the short term of two groups were observed and compared.Results Patients of two groups all obtained clinically cure.The aver-age operation time of Mesh-Plug group,and TAPP group were(50.25 ±11.36)min,(48.68 ±10.23)min respectively. The average hospitalization time was(10.69 ±2.36)d,(7.61 ±2.11)d respectively.Mesh-Plug group perioperative complications appeared in 7 cases,1 cases in group TAPP.There were no significant differences between the two groups in operative time(P>0.05).There were significant differences between the two groups in the average hospitalization days,perioperative complications(P<0.05).The hospitalization expenses of TAPP group and Mesh-Plug group were (12.5 ±2.4)thousands yuan,(8.4 ±2.2)thousands yuan respectively,the cost of TAPP group was higher than the open group,the difference was statistically significant(P<0.05).There was 0 cases recurred in group TAPP and 1 cases recurred in Mesh-Plug group after 3-24 months follow-up,there was no significant difference(P>0.05).Conclusion TAPP and Mesh-Plug has a good therapeutic effect for adult abdominal preperitoneal inguinal hernia,but TAPP had shor-ter hospitalization time,rapid recovery,lower perioperative complications,chronic pain and discomfort,so it has more ad-vantages in clinical application.
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