负压吸引固定技术应用在腹腔镜下腹膜前疝修补术中的价值研究

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　　 【摘要】 目的：探讨负压吸引固定技术应用在腹腔镜下腹膜前疝修补术（TAPP）中的临床价值。方法：60例行腹腔镜下TAPP治疗的腹股沟疝患者分为补片固定组（n=30例）和负压吸引组（n=30例），比较两组患者手术时间、术后首次下床活动时间、术后住院时间、术中出血量、住院治疗费用、并发症发生率及1年复发率。结果：两组患者手术时间、术中出血量、术后首次下床活动时间及术后住院时间比较，差异无统计学意义（P>0.05）。负压吸引组住院治疗费用明显低于补片固定组，差异有统计学意义（P<0.05）。两组患者1年复发率比较差异无统计学意义（P>0.05）。负压吸引组阴囊气肿、暂时性神经感觉异常、血肿、尿潴留及慢性神经性疼痛等术后并发症发生率（10.0%）明显低于补片固定组（26.7%），差异有统计学意义（P<0.05）。结论：腹腔镜下TAPP使用负压吸引固定术可降低术后并发症发生率，减少医疗费用支出，且治疗效果与补片固定无明显差异。
　　 【关键词】 负压吸引固定; 腹腔镜; 腹膜前疝修补术
　　 doi：10.14033/j.cnki.cfmr.2019.18.018 文献标识码 B 文章编号 1674-6805（2019）18-00-03
　　 【Abstract】 Objective：To investigate the application value of negative pressure suction fixation in laparoscopic transabdominal preperitoneal prosthesis（TAPP）.Method：60 cases of inguinal hernia treated by laparoscopic TAPP were divided into patch fixation group（n=30） and negative pressure suction group（n=30）.The operation time，first time out of bed after surgery，postoperative hospitalization time，intraoperative bleeding volume，hospitalization cost，complication rate and 1-year recurrence rate of the two groups were compared.Result：There was no significant difference in operation time，intraoperative bleeding volume，first time out of bed after surgery and postoperative hospitalization time between the two groups（P>0.05）.The hospitalization cost of negative pressure suction group was significantly lower than that of patch fixation group，the difference was statistically significant（P<0.05）.There was no significant difference in 1-year recurrence rate between the two groups（P>0.05）.The incidence of postoperative complications of postoperative complications such as scrotal emphysema，transient neurosensory abnormalities，hematoma，urinary retention and chronic neuropathic pain（10.0%） were significantly lower than those of the patch fixation group（26.7%），the differences were statistically significant（P<0.05）.Conclusion：Laparoscopic TAPP with negative pressure suction fixation can reduce the incidence of postoperative complications，reduce medical expenses，and there is no significant difference between the treatment effect and patch fixation.
　　 【Key words】 Negative pressure suction fixation; Laparoscopy; Transabdominal preperitoneal prosthesis
　　 First-author’s address：The Hospital of Wuhan University of Science and Technology，Wuhan 430065，China
　　 近些年我國腹股沟疝发生率呈逐渐升高的趋势，已受到越来越多医务人员的关注[1]。由于腹股沟疝形成后无法自愈，故外科修补手术是目前临床治疗此疾病的唯一措施[2]。腹腔镜疝修补术具有机体创伤程度轻、术后病情康复速度快、疾病复发率较低等优点，已逐渐应用于腹股沟疝患者治疗方面，根据手术入路方式不同分为腹腔镜下腹膜前疝修补术（transabdominal preperitoneal prosthesis，TAPP）和腹腔镜下全腹膜外疝修补术（totally extraperitoneal prosthesis，TEP），后者操作者需要学习较长时间方可掌握手术步骤，而TAPP手术过程中多需要钉合固定补片，术后患者慢性神经性疼痛发生率明显升高，且加重了患者医疗费用负担[3-4]。笔者所在医院外科将负压吸引固定技术应用在腹腔镜下TAPP治疗中，取得较好的治疗效果，现报道如下。
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