刘星 欧小勇 付波

【摘要】 目的：对比分析改良腹腔镜腹膜疝修补术（TAPP）与开放式疝修补术治疗急性嵌顿性腹股沟疝的临床效果。方法：选取2015年5月-2018年5月笔者所在医院收治的85例急性嵌顿性疝患者，其中40例采用改良TAPP手术治疗（观察组），45例采取传统开放式手术治疗（对照组），比较两组临床疗效。結果：观察组手术切口长度、术后首次下床活动时间、住院时间均优于对照组，差异均有统计学意义（P<0.05）。观察组切口感染、阴囊水肿、术后复发、补片异物感等术后并发症发生率均低于对照组，差异均有统计学意义（P<0.05）。结论：改良TAPP术探查便利，操作方便，与开放式手术相比可以安全、有效地应用于急性嵌顿性腹股沟疝患者。

【关键词】 疝 嵌顿疝 腹腔镜 基层医院

doi：10.14033/j.cnki.cfmr.2019.28.057 文献标识码 B 文章编号 1674-6805（2019）28-0-03

Comparative Study of Modified TAPP and Open Surgery in Acute Inguinal Incarcerated Hernia in Grass-roots Hospitals/LIU Xing， OU Xiaoyong， FU bo. //Chinese and Foreign Medical Research， 2019， 17（28）： -138

[Abstract] Objective： To analyze the acute incarcerated inguinal hernia underwent laparoscopic preperitoneal hernia repair （TAPP） clinical curative effect and open hernia repair. Method： A total of 85 patients with acute incarcerated hernia admitted to our hospital from May 2015 to May 2018 were selected as the research objects. Among them， 40 cases were treated with modified TAPP operation （the observation group） and 45 cases were treated with traditional open surgery （the control group）， and the efficacy of the two groups was compared and analyzed. Result： The length of incision， the time of getting out of bed for the first time after operation， and the hospitalization time of the observation group were better than those of the control group， the differences were statistically significant（P<0.05）. The incidence of postoperative complications such as incision infection， scrotum edema， postoperative recurrence and patch foreign body sensation were all lower in the observation group than those in the control group， the differences were statistically significant （P<0.05）. Conclusion： Exploration of TAPP operation convenience， can be safely and effectively applied to acute incarcerated inguinal hernia patients， suitable for promotion in the primary hospital.

[Key words] Hernia Incarcerated hernia Laparoscopy Primary hospital

First-authors address： The Peoples Hospital of Taihe， Taihe 236600， China.

腹股沟嵌顿疝是基层医院常见的急腹症之一，其发生率为0.3%～2.9%[1]，基层医院多为县市级医院，患者就诊意识稍差，嵌顿时间较长，一经确诊，需要立即进行手法复位，如果嵌顿时间较长，不能及时还纳，将导致疝嵌顿物绞窄、缺血坏死，引起非常严重后果[2]。开放式的嵌顿疝手术，手术时存在嵌顿后肠管生机的判断，肠管坏死后切口选择，嵌顿后组织水肿是否一期修补及手术创伤相对较大，等众多不便之处。经腹腹膜前腹腔镜疝修补术（TAPP）凭借其独特的优势，在腹股沟疝治疗中逐渐被认可，特别是在复发疝、嵌顿疝优点更加明显[3]，本次研究中选病例为笔者所在医院2015年5月-2018年5月收治的急性腹股沟嵌顿性疝患者，分别进行改良的TAPP手术和开放性疝修补手术，并进行比较，研究改良TAPP手术治疗急性腹股沟疝的安全性和可行性，具体如下。

1 资料与方法

1.1 一般资料

选取2015年5月-2018年5月笔者所在医院收治的85例急性嵌顿性疝患者（嵌顿时间小于48 h）。……