腹腔镜经腹腹膜前修补术与Lichtenstein手术对腹股沟疝患者术后早期疼痛和行动力的影响

Effects of laparoscopic transabdominal preperitoneal repair and Lichtenstein surgery on post-operative early pain and mobility in patients with inguinal hernia

  • 摘要:
    目的 探讨腹腔镜经腹腹膜前修补术(TAPP)与Lichtenstein手术对腹股沟疝患者术后早期疼痛和行动力的影响。
    方法 采用回顾性队列研究方法。收集2021年6月至2022年12月陕西省人民医院收治的184例单侧腹股沟疝患者的临床资料;男152例,女32例;年龄为(64±8)岁。184例患者中,92例行TAPP,设为TAPP组;92例行Lichtenstein手术,设为Lichtenstein组。观察指标:(1)手术情况。(2)术后疼痛情况。(3)术后行动力。正态分布的计量资料组间比较采用独立样本t检验;同组自身前后对照采用配对样本t检验。偏态分布的计量资料组间比较采用Mann⁃Whitney U检验。计数资料组间比较采用χ²检验。
    结果 (1)手术情况。TAPP组和Lichtenstein组患者总住院时间分别为1.70(1.00,2.00)d和2.12(2.00,3.00)d、术后住院时间分别为1.00(1.00,1.00)d和1.42(1.00,2.00)d、住院费用分别为14 808(14 385,15 292)元和10 590(9 802,11 362)元,两组患者上述指标比较,差异均有统计学意义(Z=-3.23、-4.07、-11.72,P<0.05)。(2)术后疼痛情况。TAPP组和Lichtenstein组患者术前口述分级评分分别为(1.36±0.75)分和(1.34±0.80)分、术后20~22 h口述分级评分分别为(3.22±0.66)分和(3.42±0.80)分,两组患者组内术前及术后20~22 h口述分级评分比较,差异均有统计学意义(t=-29.15、-31.46,P<0.05)。(3)术后行动力。TAPP组和Lichtenstein组患者术前起床至站立床旁时间分别为(5.47±1.08)s和(5.87±1.13)s、术后20~22 h起床至站立床旁时间分别为(7.94±2.23)s和(11.59±1.88)s,两组患者组间术后20~22 h、两组组内术前及术后20~22 h起床至站立床旁时间比较,差异均有统计学意义(t=-11.99、-15.64、-27.26,P<0.05)。TAPP组和Lichtenstein组患者术前屈膝屈髋90°时间分别为(0.74±0.32)s和(0.81±0.19)s、术后20~22 h屈膝屈髋90°时间分别为(1.23±0.54)s和(1.97±0.69)s,两组患者组间术后20~22 h、两组组内术前及术后20~22 h屈膝屈髋90°时间比较,差异均有统计学意义(t=-8.11、-16.53、-17.81,P<0.05)。TAPP组和Lichtenstein组患者术前步行10 m时间分别为(10.30±1.53)s和(10.38±1.35)s、术后20~22 h步行10 m时间分别为(12.80±1.67)s和(18.35±1.69)s,两组患者组间术后20~22 h、两组组内术前及术后20~22 h步行10 m时间比较,差异均有统计学意义(t=-22.44、-33.66、-32.46,P<0.05)。TAPP组和Lichtenstein组患者术前步行20 m时间分别为(17.87±2.89)s和(18.02±2.82)s、术后20~22 h步行20 m时间分别为(24.16±2.54)s和(32.64±2.56)s,两组患者组间术后20~22 h、两组组内术前及术后20~22 h步行20 m时间比较,差异均有统计学意义(t=-22.55、-38.75、-34.59,P<0.05)。
    结论 与Lichtenstein手术比较,TAPP后患者行动力恢复更快,出院更早,住院费用更高。

     

    Abstract:
    Objective To investigate the effects of laparoscopic transabdominal preperitoneal repair (TAPP) and Lichtenstein surgery on postoperative early pain and mobility in patients with inguinal hernia.
    Methods The retrospective cohort study was conducted. The clinical data of 184 pati-ents with unilateral inguinal hernia who were admitted to Shaanxi Provincial People's Hospital from June 2021 to December 2022 were collected. There were 152 males and 32 females, aged (64±8)years. Of the 184 patients, 92 cases undergoing TAPP were divided into the TAPP group, and 92 cases under-going Lichtenstein surgery were divided into the Lichtenstein group. Observation indicators: (1) surgical situations; (2) postoperative pain; (3) postoperative mobility. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Paired sample t test was used for comparison within group before and after surgery. Comparison of measurement data with skewed distribution between groups was conducted using the Mann⁃Whitney U test. Comparison of count data between groups was conducted using the chi-square test.
    Results (1) Surgical situations. Total duration of hospital stay, duration of postoperative hospital stay, expense of hospitalization were 1.70(1.00,2.00)days, 1.00(1.00,1.00)days, 14 808(14 385,15 292)yuan in the TAPP group, versus 2.12(2.00,3.00)days, 1.42(1.00,2.00)days, 10 590(9802,11 362)yuan in the Lichtenstein group, showing significant differences in the above indicators between the two groups (Z=-3.23, -4.07, -11.72, P<0.05). (2) Postoperative pain. Score of verbal rating scale (VRS) were 1.36±0.75 and 3.22±0.66 before surgery and at 20-22 hours after surgery in the TAPP group, versus 1.34±0.80 and 3.42±0.80 in the Lichtenstein group, showing significant differences within the two groups (t=-29.15, -31.46, P<0.05). (3) Postoperative mobility. The time from getting up to standing bedside of patients before surgery and at 20-22 hours after surgery were (5.47±1.08)seconds and (7.94±2.23)seconds in the TAPP group, versus (5.87±1.13)seconds and (11.59±1.88)seconds in the Lichtenstein group, showing a significant difference at 20-22 hours after surgery between the two groups and significant differences within the two groups (t=-11.99, -15.64, -27.26, P<0.05). The time for hip flexion 90° of patients before surgery and at 20-22 hours after surgery were (0.74±0.32)seconds and (1.23±0.54)seconds in the TAPP group, versus (0.81±0.19)seconds and (1.97±0.69)seconds in the Lichtenstein group, showing a significant difference at 20-22 hours after surgery between the two groups and significant differences within the two groups (t=-8.11, -16.53, -17.81, P<0.05). The time for walking 10 meters of patients before surgery and at 20-22 hours after surgery were (10.30±1.53)seconds and (12.80±1.67)seconds in the TAPP group, versus (10.38±1.35)seconds and (18.35±1.69)seconds in the Lichtenstein group, showing a significant difference at 20-22 hours after surgery between the two groups and significant differences within the two groups (t=-22.44, -33.66, -32.46, P<0.05). The time for walking 20 meters of patients before surgery and at 20-22 hours after surgery were (17.87±2.89)seconds and (24.16±2.54)seconds in the TAPP group, versus (18.02±2.82)seconds and (32.64±2.56)seconds in the Lichtenstein group, showing a significant difference at 20-22 hours after surgery between the two groups and significant differences within the two groups (t=-22.55, -38.75, -34.59, P<0.05).
    Conclusion Compared to Lichtenstein surgery, patients with TAPP experience faster recovery of mobility, earlier discharge, and higher expense of hospitalization.

     

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