标题：男性原发性腹股沟斜疝患者TAPP术中改良残端疝囊处理方式的应用效果研究

      作者：杨志勇，刘悦，胡碧玲，郑丽燕    东莞市东南部中心医院普通外科，广东 东莞 523710

      卷次： 2023年34卷1期

      【摘要】 目的 研究改良残端疝囊处理方式在男性原发性腹股沟斜疝患者腹腔镜经腹膜前法(TAPP)术中的应用效果。方法 选取2017年1月至2019年12月东莞市东南部中心医院收治的50例男性原发性腹股沟斜疝患者展开研究，按照随机数表法将患者分为观察组和对照组各25例。两组患者均行TAPP手术治疗，观察组患者给予改良残端疝囊处理方式(疝囊免剥离法)，对照组患者给予常规残端疝囊处理方式(疝囊剥离法)。比较两组患者的手术情况、术后1 d、术后3 d的视觉模拟评分法(VAS)评分情况，比较两组患者手术前后1 d的应激指标[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)]变化情况，比较两组患者术后1周并发症发生率及随访3个月后复发率。结果 观察组患者的手术时间、住院时间、下床活动时间分别为(33.57±4.62) min、(3.46±0.83) d、(7.06±1.23) h，明显短于对照组的(42.38±6.35) min、(4.38±1.04) d、(7.97±1.72) h，术中出血量为(3.21±0.68) mL，明显少于对照组的(4.68±0.84) mL，差异均有统计学意义(P<0.05)；两组患者术后3 d的VAS评分明显低于术后1 d，差异均有统计学意义(P<0.05)，但术后1 d、3 d，两组患者的VAS评分比较差异均无统计学意义(P>0.05)；两组患者术前 1 d的应激指标 SOD、MDA、GSH-Px比较差异均无统计学意义(P>0.05)，但观察组患者术后 1 d时的 SOD、GSH-Px分别为(128.28±10.06) U/mL、(1.87±0.52) U/mL，明显高于对照组的(100.12±8.24) U/mL、(0.91±0.23) U/mL，MDA为(4.16±0.84) U/mL，明显低于对照组的(6.01±1.28) U/mL，差异均有统计学意义(P<0.05)；观察组患者术后 1周的并发症总发生率为 8.00%，明显低于对照组的 32.00%，差异有统计学意义(P<0.05)，但两组患者术后3个月的复发率比较差异无统计学意义(P>0.05)。结论 男性原发性腹股沟斜疝患者TAPP术中，通过改良残端疝囊处理方式可促进患者术后恢复，减少并发症发生率，改善预后，值得推广应用。
      【关键词】 原发性腹股沟斜疝；腹腔镜经腹膜前法；残端疝囊；效果；并发症
      【中图分类号】 R656.2+1 【文献标识码】 A 【文章编号】 1003—6350（2023）01—0038—04

Application effect of improved residual hernia sac treatment in transabdominal preperitoneal prosthesis for malepatients with primary indirect inguinal hernia.
YANG Zhi-yong, LIU Yue, HU Bi-ling, ZHENG Li-yan. Department ofGeneral Surgery, Dongguan Southeast Central Hospital, Dongguan 523710, Guangdong, CHINA
【Abstract】 Objective To analyze the application of improved residual hernia sac treatment in transabdominalpreperitoneal prosthesis (TAPP) for male patients with primary indirect inguinal hernia. Methods Fifty male patientswith primary indirect inguinal hernia in Dongguan Southeast Central Hospital from January 2017 to December 2019were selected for the study. According to the random number table method, the patients were divided into two groups,with 25 cases in each group. Based on TAPP, the patients in the observation group were given improved residual herniasac treatment (hernial sac dissection-free method), and those in the control group were given conventional residual her-nia sac treatment (hernial sac dissection method). The surgical conditions, Visual Analogue Scale (VAS) scores at 1 dand 3 d after surgery were compared between the two groups, and the changes of stress indicators [reduced glutathioneperoxidase (GSH-Px), malondialdehyde (MDA), superoxide dismutase (SOD)] in the two groups before and after sur-gery were compared. The incidence of complications at 1 week after operation and the recurrence rate after three monthsof follow-up were compared between the two groups. Results The operation time, the postoperative hospital stay, thetime of getting out of bed in the observation group were (33.57±4.62) min, (3. 46±0.83) d, (7.06±1.23) h, which weresignificantly shorter than (42.38±6.35) min, (4.38±1.04) d, (7.97±1.72) h in the control group; the intraoperative bloodloss in the observation group was (3.21±0.68) mL, which was significantly less than (4.68±0.84) mL in the controlgroup; the differences were statistically significant (P<0.05). VAS score of the two groups was significantly lower on the3rd day after operation than on the 1st day after operation (P<0.05), but there was no statistically significant difference be-tween the two groups on the 1st day and the 3rd day after operation (P>0.05). There was no significant difference in thestress indexes SOD, MDA, and GSH PX between the two groups one day before operation (P>0.05); the SOD and GSHPX of the observation group were (128.28±10.06) U/mL and (1.87±0.52) U/mL, respectively, which were significantly