摘要
目的 分析腹腔镜完全腹膜外疝修补术(TEP)治疗腹股沟疝的疗效及对炎症介质、氧化应激、疼痛介质的影响.方法 前瞻性选取2020年7月至2023年6月于海军军医大学第一附属医院行手术治疗的腹股沟疝患者100例作为研究对象,依据随机数字表法将其分为开放组(n=50)与TEP组(n=50).开放组行开放疝修补术,TEP组行TEP.比较两组的临床疗效,观察两组术中出血量、手术时间、术后下地时间、术后住院时间及胃肠功能恢复时间等围手术期指标.观察并比较两组手术后1 d血清炎症介质[肿瘤坏死因子-a(TNF-a)、白细胞介素(IL)-6、IL-1β]、氧化应激介质[人类软骨糖蛋白(YKL-40)、超氧化物歧化酶(SOD)、还原型谷胱甘肽过氧化物酶(GSH-Px)]、疼痛介质[β-内啡肽(β-EP)、P物质、5-羟色胺]水平,以及术后并发症发生情况.结果 TEP组总有效率为94.00％,高于开放组(76.00％),差异有统计学意义(P＜0.05).TEP组术中出血量、下地时间、术后住院时间、胃肠功能恢复时间为(14.28±1.70)mL、(14.62±1.68)h、(4.38±0.46)d、(14.76±1.72)d,均低(短)于开放组[(23.96±2.63)mL、(18.29±2.15)h、(7.64±0.79)d、(16.89±1.91)d],手术时间为(70.18±7.32)min,长于开放组[(53.86±5.64)min],差异均有统计学意义(P＜0.05).手术后1 d,TEP组的血清TNF-a、IL-6、IL-1 β、YKL-40、P物质、5-羟色胺水平分别为[(1.93±0.20)ng/mL、(4.67±0.49)pg/mL、(2.63±0.29)pg/mL、(124.64±14.08)pg/mL、(89.96± 9.24)pg/mL、(229.75±24.69)nmol/L],均低于开放组[(2.87±0.31)ng/mL、(6.14±0.64)pg/mL、(3.89±0.40)pg/mL、(158.93±18.94)pg/mL、(106.83±12.09)pg/mL、(297.68±31.71)nmol/L],血清 SOD、GSH-Px、β-EP 水平分别为(122.97±14.86)U/mL、(2.25±0.24)U/mL、(104.65±12.94)ng/mL,均高于开放组[(103.75±12.93)U/mL、(1.67±0.18)U/mL、(81.09±8.32)ng/mL],差异均有统计学意义(P＜0.05).TEP组术后总并发症率为4.00％,低于开放组18.00％(P＜0.05).结论 TEP治疗腹股沟疝具有创伤小,术后恢复快,并发症少,对炎症介质、氧化应激、疼痛介质的影响小的优点,优于开放手术.
Abstract
Objective To investigate the efficacy of laparoscopic complete extraperitoneal hernia repair(TEP)in the treatment of ingui-nal hernia and effect on inflammatory mediators,oxidative stress and pain mediators.Methods A total of 100 patients with inguinal hernia who underwent surgical treatment in First Affiliated Hospital of Naval Medical University from July 2020 to June 2023 were prospective selection and di-vided into the open group(n=50)and the TEP group(n=50)according to random number table method.The open group underwent open hernia repair surgery,while the TEP group underwent TEP.The clinical efficacy of two groups was compared.The perioperative indexes,such as the amount of blood loss,operation time,time on the ground,postoperative hospitalization time and gastrointestinal function recovery time were ob-served.The levels of serum inflammatory mediators[tumor necrosis factor-a(TNF-a),interleukin(IL)-6,IL-1 β],oxidative stress media-tors[human cartilage glycoprotein(YKL-40),superoxide dismutase(SOD),glutathione peroxidase(GSH-Px)],pain mediators[β-endor-phin(β-EP),substance P and 5-hydroxytryptamine]before and 1 d after surgery,and the occurrence of postoperative complications were ob-served and compared between the two groups.Results The total effective rate of TEP group was 94.00％,which was higher than that of open group(76.00％),and the difference was statistically significant(P＜0.05).The amount of blood loss,time on the ground,postoperative hos-pitalization time and gastrointestinal function recovery time in TEP group were(14.28±1.70)mL,(14.62±1.68)h,(4.38±0.46)d,(14.76 ±1.72)d,respectively,which were less(shorter)than those in the open group[(23.96±2.63)mL,(18.29±2.15)h,(7.64±0.79)d,(16.89±1.91)d],the operative time of TEP group was(70.18±7.32)min,which was longer than that that of open group[(53.86±5.64)min],and the differences were statistically significant(P＜0.05).One day after the surgery,the levels of serum TNF-alpha,IL-6,IL-1 β,YKL-40,substance P and 5-hydroxytryptamine in TEP group were[(1.93±0.20)ng/mL,(4.67±0.49)pg/mL,(2.63±0.29)pg/mL,(124.64±14.08)pg/mL,(89.96±9.24)pg/mL,(229.75±24.69)nmol/L,respectively,which were lower than those in the open group[(2.87±0.31)ng/mL,(6.14±0.64)pg/mL,(3.89±0.40)pg/mL,(158.93±18.94)pg/mL,(106.83±12.09)pg/mL,(297.68± 31.7 1)nmol/L],the levels of serum SOD,GSH-Px and β-EP in TEP group were[(122.97±14.86)U/mL,(2.25±0.24)U/mL and(104.65±12.94)ng/mL,respectively,which were higher than those in the open group[(103.75±12.93)U/mL,(1.67±0.18)U/mL,(81.09±8.32)ng/mL],and the differences were statistically significant(P＜0.05).The occurrence of postoperative complications in TEP group was 4.00％,which was lower than that in open group(18.00％),and the difference was statistically significant(P＜0.05).Conclusion TEP treatment of inguinal hernia has less trauma,faster postoperative recovery,fewer complications,and less influence on inflammatory mediators,oxidative stress and pain mediators.It is superior to open surgery.
维普
万方数据