摘要目的 比较开放式腹膜前间隙修补术和Lichtenstein无张力修补术治疗腹股沟疝的安全性和有效性.方法 回顾性分析2008年10月至2013年12月收治的249例腹股沟疝患者的临床资料.根据手术方式分为开放式腹膜前间隙修补组(腹膜前组)和Lichtenstein无张力修补术组(对照组).腹膜前组83例,男性76例,女性7例,平均年龄(70±10)岁;对照组173例,男性162例,女性11例,平均年龄(60±16)岁.比较两组围手术期结果、术后并发症发生率及复发率.结果 手术时间腹膜前组为(60±11) min,对照组为(63±8) min;术后下地活动时间腹膜前组为(6.2±1.8)h,对照组为(15.0±2.8)h;术后24 h视觉模拟评分法疼痛评分腹膜前组为4.0±0.9,对照组为4.6±1.4;差异均有统计学意义(t=-2.16、-13.2、-4.11,P=0.032、0.000、0.000).两组患者的手术费用、总住院费用无明显差异(P＞0.05).两组患者随访6 ～ 36个月,均无一例复发.腹膜前组出现1例切口感染(1.2％),对照组出现4例切口脂肪液化(2.3％)和1例补片排斥(0.6％).并发症发生率两组无明显差异(P＞0.05).结论 开放式腹膜前间隙修补术在修补的有效性和安全性方面均与传统Lichtenstein修补法无明显差异,并可以用于复发性和股疝的修补.

abstractsObjectives To evaluate the safety and effectiveness of open preperitoneal herniorraphy comparing with traditional Lichtenstein tension-free herniorraphy on the surgical treatment of inguinal hernia.Methods The clinical data of 249 patients with inguinal hernia admitted from October 2008 to December 2013 were reviewed retrospectively.Eighty-three patients received preperitoneal herniorraphy (preperitoneal group),there were 76 male and 7 female patients with a mean age of (70 ± 10) years.One hundred and seventy-three patients underwent Lichtenstein procedure (Lichtenstein group),there were 162 male and 11 femal patients with a mean age of (60 ± 16) years.The peri-operative performance,recurrence rate and postoperative morbidities of the patients underwent preperitoneal herniorraphy and traditional Lichtenstein herniorraphy were analyzed.Results The operation time of the preperitoneal group (60 ± 11) minutes was significantly shorter than the Lichtenstein group (63 ± 8) minutes (t =-2.16,P =0.032).The preperitoneal group showed significantly earlier out-of-bed activity ((6.2 ± 1.8) hours) than the Lichtenstein group ((15.0 ± 2.8) hours) (t =-13.2,P =0.000).The visual analogue scale score on 24 hours postoperative was also lower in the preperitoneal group (4.0 ± 0.9) than in the Lichtenstein group (4.6 ± 1.4) (t =-4.11,P =0.000).The two groups had no significant difference on the cost.There was one incision infection in preperitoneal group (1.20％).Four fat liquefaction (2.31％) and one patch rejection (0.58％) were found in Lichtenstein group.The incidence of complication of the two groups had no significant difference (P ＞ 0.05).All the patients were followed up for 6 to 36 months,and there was no recurrence among all these patients.Conclusions There is no significant difference on the safety and effectiveness between preperitoneal herniorraphy and traditional Lichtenstein procedure on inguinal hernia.Open preperitoneal herniorraphy and can be applied for surgical treatment of recurrent or femoral hernia.