[1]杨传振.斜疝巨大疝囊TAPP中不同疝囊处理策略的应用研究[J].医学信息,2021,34(08):98-102.[doi:10.3969/j.issn.1006-1959.2021.08.025]
　YANG Chuan-zhen.Application Study of Different Hernia Sac Management Strategies in Indirect Hernia Giant Hernia Sac TAPP[J].Medical Information,2021,34(08):98-102.[doi:10.3969/j.issn.1006-1959.2021.08.025]
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斜疝巨大疝囊TAPP中不同疝囊处理策略的应用研究()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
34卷
期数:
2021年08期
页码:
98-102
栏目:
论著
出版日期:
2021-04-15

文章信息/Info

Title:
Application Study of Different Hernia Sac Management Strategies in Indirect Hernia Giant Hernia Sac TAPP
文章编号:
1006-1959（2021）08-0098-05
作者:
杨传振
（天津市东丽区东丽医院普外科，天津 300300）
Author(s):
YANG Chuan-zhen
(General Surgery,Dongli Hospital,Dongli District,Tianjin 300300,China)
关键词:
斜疝; 巨大疝囊; 腹腔镜; 经腹腔腹膜前疝修补术; 炎性反应; 氧化应激
Keywords:
Indirect hernia; Giant hernia sac; Laparoscopic; Transabdominal preperitoneal hernia repair; Inflammatory response; Oxidative stress
分类号:
R656.2
DOI:
10.3969/j.issn.1006-1959.2021.08.025
文献标志码:
A
摘要:
目的 探讨斜疝巨大疝囊腹腔镜下经腹腔腹膜前疝修补术（TAPP）中不同疝囊处理策略的应用效果及对创伤应激、术后恢复、并发症的影响。方法 选取2018年10月~2020年2月我院斜疝巨大疝囊拟行TAPP治疗患者102例，依据随机数字表法分为研究组与对照组，各51例。两组均行TAPP，术中对照组常规游离疝囊，研究组采取T型切开疝囊、向两侧游离。比较两组围术期情况、并发症发生率、手术前后疼痛评分（VAS）、炎性反应指标[C反应蛋白（CRP）、白细胞介素6（IL-6）、肿瘤坏死因子-α（TNF-α）]、氧化应激指标[还原型谷胱甘肽过氧化物酶（GSH-Px）、丙二醛（MDA）、超氧化物歧化酶（SOD）]水平，随访6个月统计疾病复发率。结果 研究组手术时间、疝囊游离时间、下床活动时间短于对照组，术中失血量少于对照组（P＜0.05）；术后12、24、48 h研究组VAS评分均低于对照组（P＜0.05）；术后第1、3 天两组血清CRP、IL-6、TNF-α、MDA水平较术前增高，GSH-Px、SOD水平较术前降低，但研究组血清CRP、IL-6、TNF-α、MDA水平低于对照组，GSH-Px、SOD水平高于对照组（P＜0.05）；研究组并发症发生率（3.92%）低于对照组（15.69%）（P＜0.05）；术后1、3、6个月研究组疾病复发率与对照组比较，差异无统计学意义（P＞0.05）。结论 与常规游离疝囊相比，斜疝巨大疝囊患者行TAPP中采取T型切开疝囊、向两侧游离，可有效缩短手术时间、疝囊游离时间及下床活动时间，减少术中失血量，降低疼痛程度及并发症发生率，减轻炎性及氧化应激，且不增加术后疾病复发风险。
Abstract:
Objective To investigate the application effect of different hernia sac management strategies in transperitoneal preperitoneal hernia repair (TAPP) under laparoscopic large hernia sac of indirect hernia and their influence on trauma stress, postoperative recovery, and complications.Methods From October 2018 to February 2020, 102 patients with indirect hernia and giant hernia sacs in our hospital were selected for TAPP treatment. According to the random number table method, they were divided into study group and control group, with 51 cases in each group.Both groups underwent TAPP, the control group was routinely freed the hernia sac during the operation, and the study group was opened with T-shaped hernia sac and freed to both sides.The perioperative situation, complication rate, pre- and post-operative pain score (VAS), inflammatory response index [C-reactive protein (CRP), interleukin 6 (IL-6),Tumor necrosis factor-α (TNF-α)], oxidative stress indicators [reduced glutathione peroxidase (GSH-Px), malondialdehyde (MDA), superoxide dismutase (SOD)] levels,follow up for 6 months and count the disease recurrence rate.Results The study group’s operation time, hernia sac free time, and time to get out of bed were shorter than those of the control group, and the blood loss during the operation was less than that of the control group (P＜0.05);The VAS scores of the study group were lower than those of the control group at 12, 24, and 48 h after operation (P＜0.05);The levels of serum CRP, IL-6, TNF-α, and MDA in the two groups were higher than those before the operation on the first and third days after the operation, while the levels of GSH-Px and SOD were lower than those before the operation.However, the serum CRP, IL-6, TNF-α, and MDA levels of the study group were lower than those of the control group, and the levels of GSH-Px and SOD were higher than those of the control group (P＜0.05);The incidence of complications in the study group (3.92%) was lower than that in the control group (15.69%) (P＜0.05);There was no significant difference in the disease recurrence rate between the study group and the control group at 1, 3, and 6 months after surgery (P＞0.05).Conclusion Compared with conventional free hernia sacs, in TAPP patients with huge hernia sacs with indirect hernia, the T-shaped incision of the hernia sac and the freeing to both sides can effectively shorten the operation time, the free time of the hernia sac and the time of getting out of bed, and reduce the intraoperative time. Blood loss, reduce the degree of pain and the incidence of complications, reduce inflammatory and oxidative stress, and do not increase the risk of postoperative disease recurrence.

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更新日期/Last Update: 1900-01-01