天津医药

天津医药 ›› 2025, Vol. 53 ›› Issue (10): 1033-1036.doi: 10.11958/20251780

• 临床研究 • 上一篇    下一篇

腹腔镜疝囊高位结扎联合IPOM与局麻李金斯坦修补术治疗男性全膀胱切除术后腹股沟疝

万方鑫1(), 刘宾1, 张皓程1, 张昌文2, 李宝玉1,△()   

  1. 1 天津医科大学第二医院胃肠外科（邮编 300211）
    2 天津医科大学第二医院泌尿外科（邮编 300211）
  • 收稿日期:2025-04-29 修回日期:2025-07-04 出版日期:2025-10-15 发布日期:2025-10-12
  • 通讯作者: △E-mail：libaoyu81@163.com
  • 作者简介:万方鑫（1994），男，医师，主要从事腹部疝方面研究。E-mail：dr_fangxinwan@163.com
  • 基金资助:
    天津市科技计划项目(24ZYCGCG00620)

Clinical study of laparoscopic high ligation of hernia sac combined with IPOM and local anesthesia Lichtenstein repair in the treatment of male patients with inguinal hernia after radical cystectomy

WAN Fangxin1(), LIU Bin1, ZHANG Haocheng1, ZHANG Changwen2, LI Baoyu1,△()   

  1. 1 Department of Gastrointestinal Surgery, the Second Hospital of Tianjin Medical University, Tianjin 300211, China
    2 Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin 300211, China
  • Received:2025-04-29 Revised:2025-07-04 Published:2025-10-15 Online:2025-10-12
  • Contact: △E-mail：libaoyu81@163.com

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摘要：

目的 比较腹腔镜疝囊高位结扎联合腹腔内补片植入修补术（IPOM）与局麻李金斯坦修补术治疗男性全膀胱切除术后腹股沟疝的临床疗效。方法 纳入59例男性全膀胱切除术后腹股沟疝患者并随机分为腹腔镜疝囊高位结扎联合IPOM组（IPOM组，30例）和局麻李金斯坦修补术组（局麻组，29例）。观察并比较2组患者的年龄、手术时间、术后下床活动时间、术后第1—3天及术后3个月的疼痛视觉模拟评分、术中出血量、住院时间、术后恢复日常活动时间、手术总费用、术后1年复发率及并发症等指标，并综合分析得出最佳手术方式。结果 IPOM组在手术时间、术后下床活动时间、术后第1—3天及术后3个月的疼痛视觉模拟评分、术中出血量、住院时间、术后恢复日常活动时间方面均优于局麻组（P<0.01），手术总费用高于局麻组（P<0.01）；2组术后并发症比较差异无统计学意义（P>0.05）；IPOM组术后1年复发情况优于局麻组（P<0.05）。结论 腹腔镜下疝囊高位结扎联合IPOM在减少术后疼痛和复发方面优于传统的李金斯坦修补术，在经济条件允许下应首选该术式。

关键词: 膀胱切除术, 疝, 腹股沟, 腹腔镜检查, 腹腔内补片植入修补术, 李金斯坦修补术, 疝囊高位结扎

Abstract:

Objective To compare the clinical efficacy of laparoscopic high ligation of the hernia sac combined with intraperitoneal onlay mesh (IPOM) and local anesthesia Lichtenstein repair for the treatment of inguinal hernia after total cystectomy in male patients. Methods A total of 59 male patients who underwent total cystectomy were included in this study and randomly divided into two groups: the laparoscopic high ligation of the hernia sac combined with IPOM group (IPOM group, 30 cases) and the local anesthesia Lichtenstein repair group (local anesthesia group, 29 cases). The patient age, surgical time, postoperative ambulation time, visual analogue scale score for pain on the 1st to 3rd days and 3 months after operation, time to first mobilization post-operation, pain scores on postoperative day 1, 2 and 3, pain scores at 3 months post-operation were observed and compared between the two groups. Data of intraoperative blood loss, hospital stay, time to return to daily activities, total surgery costs, recurrence rates at 1 year after operation and complications were also observed and compared in two groups of patients. The results were analyzed to determine the optimal surgical method. Results The IPOM group demonstrated better outcomes in terms of surgical time, time to first mobilization, pain scores on postoperative days 1, 2 and 3, pain scores at 3 months, intraoperative blood loss, hospital stay and time to return to daily activities compared to those of the local anesthesia group (P<0.01). However, the total cost of the operation was higher in the IPOM group than those of the local anesthesia group (P<0.01). There were no significant differences in postoperative complications between the two groups (P>0.05). The recurrence rate of the IPOM group one year after surgery was better than that of the local anesthesia group (P<0.05). Conclusion Laparoscopic IPOM with high ligation of the hernia sac is superior to the traditional Lichtenstein repair in reducing postoperative pain and recurrence rates. This surgical method should be the first choice when economic conditions permit.

Key words: cystectomy, hernia, inguinal, laparoscopy, intraperitoneal onlay mesh, Lichtenstein repair, high ligation of the hernia sac

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