摘要目的 对比腹腔镜经腹腹膜前疝修补术(TAPP)与经疝环入路改良Kugel疝修补术(简称改良Kugel手术)的临床疗效.方法 回顾分析2015年1月至2016年12月收治的202例腹股沟疝患者的临床资料,其中行TAPP的患者85例,设为TAPP组;行改良Kugel手术的患者117例,设为改良Kugel组.对比分析两组患者术中、术后情况及并发症发生情况.结果 TAPP组术中出血量、术后24hVAS评分、下床活动时间、术后住院时间分别为(14.84±6.95) ml、(2.27±0.97)分、(10.05±2.54)h、(3.92±1.18)d,均优于改良Kugel组(18.46±8.45)ml、(2.56±1.03)分、(20.74±4.39)h、(5.14±1.42)d,手术时间、住院费用分别为(80.94±20.54) min、(12.44±0.74)千元,均高于改良Kugel组(59.79±14.63)min、(7.25±0.58)千元,差异均有统计学意义(均P＜0.05);TAPP组尿潴留、切口感染、阴囊水肿、异物感、慢性疼痛发生率与改良Kugel组比较,差异均无统计学意义(均P＞0.05),但血清肿发生率12.94％(11/85),高于改良Kugel组3.42％ (4/117),差异有统计学意义(P＜0.05);术后随访1年,两组均无复发病例.结论 2种手术方式对治疗腹股沟疝均是安全、有效的.TAPP具有术后疼痛轻、恢复快等优点,但住院费用较高.外科医师可根据患者的意愿、经济状况以及术者经验等综合选择最佳的手术方式.

abstractsObjective To compare the clinical effects oflaparoscopic transabdominal preperitoneal hernia repair(TAPP) and modified-Kugel hemioplasty via hernia ring approach (Modified-Kugel hernioplasty).Methods The clinical data of 202 patients with inguinal hernia treated at our hospital from January,2015 to December,2016 were retrospectively analyzed.Of the 202 patients,85 underwent TAPP (a TAPP group),and 117 ModifiedKugel hernioplasty (a Modified-Kugel group).The intra-and post-operative situations as well as the occurrence of complications were compared between the two groups.Results The intraoperative bleeding volume,VAS score 24 h after operation,time for off-bed activity,and hospital stay after surgery were better in the TAPP group than in the Modified-Kugel group [(14.84±6.95) ml vs.(18.46±8.45) ml,(2.27±0.97) vs.(2.56±1.03),(10.05±2.54) h vs.(20.74±4.39) h,and (3.92±1.18) d vs.(5.14±1.42) d],with statistical differences (all P ＜ 0.05).The operation time was longer and the hospitalization cost was higher in the TAPP group than in the Modified-Kugel group [(80.94±20.54) min vs.(59.79±14.63) min and (12.440±0.74) yuan vs.(7.25±0.58) yuan,both P ＜ 0.05].There were no statistical differences in the incidences of uroschesis,incisional infection,hydrocele,foreign body sensation,and chronic pain between the two groups (all P ＞ 0.05).However,the incidence of seroma was higher in the TAPP group than in the Modified-Kugel group [12.94％(11/85) vs.3.42％ (4/117),P ＜ 0.05].All the patients were followed up 1 year,and no recurrence happened.Conclusions Both operations for inguinal hernia are safe and effective.TAPP has the advantages of less postoperative pain and faster recovery,but high hospitalization cost.The surgeon can choose the optimum treatment on the basis of intention and economic conditions of patients,as well as experience of surgeons.