摘要
目的探讨腹腔镜经腹腹膜前疝修补术(TAPP)对腹股沟疝患者术后恢复、凝血功能及预后复发率的影响。方法选取2018年2月至2020年4月邯郸市中心医院腹股沟疝患者116例,依据治疗术式分为TAPP组和传统组,每组58例。TAPP组予以TAPP,传统组予以传统无张力疝修补术。比较2组手术有关指标、术前、术后1 d、术后3 d凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、纤维蛋白原(FIB)]水平,统计术后并发症发生情况、术后6个月瘢痕美观度与复发率、术前、术后3个月、6个月性功能指标(睾丸体积与睾丸最大血流速度)。结果TAPP组手术时间虽长于传统组,但术后下床活动时间、住院时间较传统组短,术中出血量较传统组低(P<0.05);2组术后1、3 d的血清APTT、PT水平较术前缩短,FIB水平较术前升高(P<0.05),但组间比较,差异无统计学意义(P>0.05);术后并发症发生率TAPP组较传统组低(P<0.05);术后6个月TAPP组瘢痕美观度较传统组高(P<0.05),术后6个月TAPP组复发率更低(P<0.05);2组术后3、6个月的睾丸体积及睾丸最大血流速度均较本组术前下降,但TAPP组高于传统组(P<0.05)。结论TAPP治疗腹股沟疝患者,具有创伤小、出血少、术后恢复快、并发症少、瘢痕美观度高、复发率低等优势,可改善瘢痕美观度,减轻对男性患者性功能的影响,但手术时间延长,术中应注意气腹对凝血功能的影响。
Objective To investigate the effect of laparoscopic trans-abdominal preperitoneal hernia repair(TAPP)repair on postoperative recovery,coagulation function and prognostic recurrence rate of patients with inguinal hernia.Methods A total of 116 patients with inguinal hernia in Handan Central Hospital from February 2018 to April 2020 were selected,and they were divided into TAPP group(n=58)and traditional group(n=58)according to the treatment method.The TAPP group received TAPP repair,and the traditional group received traditional tension-free hernia repair.To compare the levels of coagulation function indexes[activated partial thromboplastin time(APTT),prothrombin time(PT),fibrinogen(FIB)]before operation,1 days after operation,and 3 days after operation in the two groups.The incidence of postoperative complications,recurrence rate and scars aesthetics at 6 months after operation,and the sexual function indexes(testicular volume and maximum blood flow velocity of testis)before operation,3 months and 6 months after operation were also calculated.Results Although the operation time of the TAPP group was longer than that of the traditional group,the postoperative time of getting out of bed and hospital stay were shorter than those of the traditional group,and the intraoperative blood loss was lower than that of the traditional group(P<0.05).The serum APTT and PT levels of the two groups at 1 d and 3 d after operation were shorter than those before operation,and the FIB level was higher than before operation(P<0.05),but there was no significant difference between the groups(P>0.05).The incidence of postoperative complications in the TAPP group was lower than that in the traditional group(P<0.05).The scars aesthetics in the TAPP group at 6 months after surgery was better than that in the traditional group(P<0.05),and the recurrence rate in TAPP group at 6 months after surgery was lower(P<0.05).The testicular volume and maximum blood flow velocity at 3 and 6 months after surgery in both groups were lower than those before surgery,but those in TAPP group were higher than those in traditional group(P<0.05).Conclusion TAPP in the treatment of inguinal hernia patients has the advantages of less trauma,less bleeding,quick postoperative recovery,fewer complications,better scar aesthetics and low recurrence rate.It can improve the appearance of scar and reduce the impact on the sexual function of male patients.However,the operation time is prolonged,and attention should be paid to the effect of pneumoperitoneum on the coagulation function during the operation.
作者
张美英
Zhang Meiying(Endoscopy Center,Handan Central Hospital,Handan 056001,China)
出处
《中华疝和腹壁外科杂志（电子版）》
2021年第3期228-232,共5页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
关键词
疝
腹股沟
腹腔镜
疝修补术
凝血功能
复发率
Hernia,inguinal
Laparoscopes
Herniorrhaphy
Coagulation function
Recurrence rate
