目的：对比分析腹腔镜下腹股沟前间隙疝修补术、无张力疝修补术与传统疝修补术的临床疗效。方法2001年1月－2004年3月共42例患者采用传统方法修复腹股沟疝（传统组），2004年4月－2014年12月有39例患者行疝环充填式无张力疝修补术（无张力组），行腹腔镜疝修补术26例（腹腔镜组）。观察3组患者的手术时间、离床时间、住院时间。出院后记录并发症发生情况及复发率。采用视觉模拟评分法 VAS 法对3组患者术后1、3 d 及1 a 随访时疼痛程度进行观察。结果3组手术时间比较差异有统计学意义，腹腔镜组手术时间明显短于传统组（P ＜0．05），但与无张力组比较无差异。3组住院时间、下床活动时间比较差异有统计学意义，腹腔镜组和无张力组住院时间及下床时间明显短于传统组（P ＜0．05），腹腔镜组住院时间短于无张力组，差异有统计学意义（P ＜0．05），腹腔镜组和无张力组下床时间比较差异无统计学意义（P ＞0．05）。腹腔镜组及无张力组术后均未使用镇痛药或肌注止痛针，传统组有14例术后需服用止痛药或肌注止痛针。传统组镇痛药使用率均高于腹腔镜组及无张力组，差异有统计学意义。腹腔镜组术后2例病人发生相关并发症，并发症发生率明显低于传统组及无张力组，差异有统计学意义。3组术后1、3 d VAS 评分比较差异有统计学意义，术后1 a VAS 评分差异无统计学意义。腹腔镜组术后1、3 d 时 VAS 评分明显低于传统组及无张力组，差异有统计学意义。传统组平均复发率为6．8％，1、3年复发率分别为7．1％（3／39）、5．9％（2／34）。无张力组平均复发率为5．8％，1、3年复发率分别为8．3％（3／36）、3．3％（1／30）。腹腔镜组术后随访3 a 仅1例复发，复发率为4．3％（1／23）。结论无张力疝修补术和腹腔镜疝修补术治疗腹股沟疝均取得较好的临床效果，2种术式同样安全有效，又各自有优势。腹腔镜疝修补术在手术创伤、术后疼痛及术后恢复较前2种术式具有明显的优势。疝的修补术应遵循个体化、规范化的原则，根据患者具体情况来决定手术方式，充分考虑疝分型，是否复发，患者的经济条件、年龄、基础疾病等。%Objective To compare clinical effect of laparoscopic inguinal hetniorrhapy,the tension-free het-niorrhapy and traditional hetniorrhapy.Methods A total of 42 patients from January 2001 to March 2004 inguinal hernia were used conventional hetniorrhapy.From Apr.to Dec.2004,39 patients were underwent tension-free hetniorrhapy,26 cases were used laparoscopic hetniorrhapy.Operative time,ambulation time, hospital stay of 3 groups were observed.Complications occurrence and recurrence rate were observed.Vis-ual analogue scale (VAS)method was used to evaluate the postoperative pain level 1,3 d after operation, the scores were also evaluated at 1-year follow-up.Results The operative time of the three groups were statistically significant (P < 0.05).The operative time of laparoscopic surgery group was significantly shorter than the conventional group,the difference was statistically significant (P <0.05).But there was no difference between laparoscopic surgery group and ension-free group.Hospital stay,ambulation time of 3 groups were statistically significant.Hospitalization and ambulation time of laparoscopic group and ten-sion-free group were significantly shorter than the traditional group (P <0.05),the difference was statisti-cally significant P <0.05).But ambulation time of laparoscopic group and tension-free group was not sig-nificant differences.Patients of laparoscopic group and tension-free group used no analgesics or intramus-cular injection to ease the pain.In the traditional group,14 cases of patients needed to take painkillers or intramuscular injection to ease the pain,the three groups were statistically significant differences (P <0.05).Analgesic use ratio of traditional group were higher than which in the laparoscopic group and ten-sion-free group,the difference was statistically significant.The complication rate of laparoscopic surgery group was significantly lower than the traditional group and tension-free group,the difference was statisti-cally significant.1,3 d VAS score difference was statistically significant among 3 groups,after 1 year′s fol-low-up,VAS score difference was not statistically significant.VAS scores in the laparoscopic group was significantly lower than the traditional group and tension-free group at the time of 1,3 d postoperative,the difference was statistically significant.Average recurrence rate of traditional group was 6.8%,1-year and 3-year recurrence rate was 77.1%(3/39),5.9%(2/34),respectively.In tension-free group,the average re-currence rate was 5.8%,1-year and 3-year follow-up recurrence rate was 8.3%(3/36),3.3%(1/30),re-spectively.In laparoscopic group,there was only one case of postoperative with recurrence of 4.3%(1/23). Conclusion Traditional hernia hetniorrhapy was not fitted for inguinal hernia hetniorrhapy.Tension-free hernia hetniorrhapy and laparoscopic hetniorrhapy for inguinal hernia have achieved better clinical results, the two procedures equally safe and effective,but also have their own advantages.Laparoscopic hernia het-niorrhapy has obvious advantages in surgical trauma, postoperative pain and postoperative recovery. Hernia repair should be individualized according to the specific circumstances of the patient to determine the surgical approach.We should fullly considerate hernia type,recurrence,the economic conditions of the patient,age and underlying disease.
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