腹腔镜腹膜前补片修复还是无张力补片塞技术?471例543例腹股沟疝的前瞻性研究。

Emmanouil Pikoulis, Christos Tsigris, Theodoros Diamantis, Spiros Delis, Panayiotis Tsatsoulis, Sotiris Georgopoulos, Emmanouil Pavlakis, Ari K Leppäniemi, Elias Bastounis, Stilianos Mantonakis
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引用次数: 13

摘要

目的:比较两种现代“无张力”疝修补术、腹腔镜修补术和网塞修补术。设计:前瞻性、非随机研究。环境:希腊两个主要的医疗中心。研究对象:471例腹股沟疝543例。干预:进入研究的患者在两个主要医疗中心接受治疗,要么在A医院接受全麻下的腹腔镜修复(n = 237),要么在b医院接受监测局部麻醉、硬膜外麻醉或脊髓麻醉下插入网塞(n = 234)。已知双侧腹股沟疝、股疝以及同时患有腹股沟疝和胆石症的患者被鼓励接受腹腔镜修复。主要观察指标:手术时间、住院死亡率、发病率和住院时间、费用、重返工作岗位时间和复发率。结果:腹腔镜修复的中位手术时间明显更长(57分钟比33分钟,p < 0.001)。腹腔镜修复更昂贵(1200美元比500美元),技术上比插入网塞要求更高。两组患者的中位术后住院时间、麻醉性镇痛药的使用、恢复完全工作和繁重活动的时间相似,而轻度活动在塞子修复后开始得更早[5.4(2.4)小时比3.4(1.5)小时,p < 0.0001]。腹腔镜组6例复发,栓塞组1例复发。结论:网状塞的插入速度更快,成本更低,技术上更容易,不需要全身麻醉,适合由外科医生和初级外科医生在没有特殊器械的情况下作为全科手术的一部分进行。术后短期或长期并发症少,复发率低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Laparoscopic preperitoneal mesh repair or tension-free mesh plug technique? A prospective study of 471 patients with 543 inguinal hernias.

Objective: To compare two modem mesh-based "tension free" hernioplasties, laparoscopic repair and mesh plug technique.

Design: Prospective, non-randomised study.

Setting: Two major medical centres, Greece.

Subjects: 471 patients with 543 inguinal hernias.

Intervention: Patients entering the study were treated in two major medical centres either by laparoscopic repair under general anaesthesia (n = 237) in hospital A, or by insertion of a mesh plug under monitored local, epidural, or spinal anaesthesia (n = 234) in hospital B. Patients with known bilateral inguinal hernias, femoral hernias, and those with both inguinal hernias and cholelithiasis were encouraged to undergo laparoscopic repair.

Main outcome measures: Operative time, hospital mortality, morbidity and length of stay, costs, time to return to work, and recurrence rate.

Results: The median operative time for laparoscopic repair was significantly longer (57 compared with 33 minutes, p < 0.001). Laparoscopic repair was more costly (1,200 US dollars compared with 500), and technically more demanding than insertion of a mesh plug. The median postoperative hospital stay, consumption of narcotic analgesics, and return to full work and heavy activities were similar in the two groups, whereas light activities were started earlier after plug repair [5.4 (2.4) compared with 3.4 (1.5) hours, p < 0.0001]. There were 6 recurrences in the laparoscopic group and 1 in the plug group.

Conclusions: Mesh plug insertion is faster, cheaper, technically easier, does not require general anaesthesia, and is suitable to be done by surgeons as part of their general practice without special instruments and by junior surgeons. Plug repair resulted in fewer short or long term complications and reduced the recurrence rate.

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