单侧腹股沟疝患者行腹腔镜下腹膜前腹股沟疝补片植入修补术的疼痛、生活质量及补片感染因素分析

Pain, quality of life, and factors influencing mesh infection in patients with unilateral inguinal hernia undergoing laparoscopic transabdominal preperitoneal inguinal hernia mesh repair

摘要:

目的 探讨腹腔镜下腹膜前腹股沟疝补片植入修补术（TAPP）对单侧腹股沟疝患者疼痛、生活质量的影响，及其补片感染的影响因素。方法 选取2019年1月—2023年2月宿州市第一人民医院接收的100例单侧腹股沟疝患者，采用随机数字表法分为对照组和观察组，每组50例。对照组予以无张力疝修补手术治疗，观察组予以腹腔镜下TAPP治疗，比较两组的临床指标、术后1 d、1个月、3个月的疼痛程度［疼痛视觉模拟评分（VAS）］、手术前后的生活质量［生活质量量表（GQOL-74）］，并根据术后是否发生补片感染将患者分为感染组（7例）与未感染组（93例），采用多因素一般Logistic回归模型分析补片感染的影响因素。结果 观察组手术时间长于对照组（P <0.05），下床活动时间、住院时间短于对照组（P <0.05），术中出血量少于对照组（P <0.05）。观察组与对照组术后1 d、1个月和3个月的VAS评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（F =731.639，P =0.000）；②观察组与对照组VAS评分比较，差异有统计学意义（F =89.116，P =0.000），观察组VAS评分较低，相对镇痛效果较好；③两组VAS评分变化趋势比较，差异有统计学意义（F =28.414，P =0.000）。观察组治疗前后GQOL-74评分（心理功能、物质生活、躯体功能、社会功能）的差值均高于对照组（P <0.05）。感染组与未感染组手术时间、2型糖尿病、营养不良、补片类型比较，差异均有统计学意义（P <0.05）。多因素一般Logistic回归分析结果显示：手术时间≥ 1 h ［O^R=9.631（95% CI：1.255，73.894）］、合并2型糖尿病［O^R=12.036（95% CI：1.508，96.097）］、营养不良［O^R=14.090（95% CI：1.385，143.343）］、使用聚四氟乙烯补片［O^R=27.999（95% CI：2.136，366.955）］均是术后补片感染的影响因素（P <0.05）。结论 腹腔镜下TAPP相比传统方法，能有效减轻术后疼痛，缩短恢复时间，提高生活质量。补片感染的主要影响因素包括手术时间> 1 h、合并2型糖尿病、营养不良和使用聚四氟乙烯补片。

Abstract:

Objective To explore the impact of laparoscopic transabdominal preperitoneal inguinal hernia mesh repair on pain and quality of life in patients with unilateral inguinal hernia, and to analyze the factors influencing mesh infection.Methods The study included 100 patients with unilateral inguinal hernia treated in the First People's Hospital of Suzhou City from January 2019 to February 2023. They were randomly divided into a control group and an observation group, with 50 cases in each group. The control group underwent tension-free hernia repair, while the observation group received laparoscopic transabdominal preperitoneal inguinal hernia mesh repair. Clinical indicators, pain at 1 day, 1 month, and 3 months after surgery [via the Visual Analogue Scale (VAS) ], and quality of life before and after surgery [via the Generic Quality of Life Inventory-74 (GQOL-74) ] were compared between the two groups. Patients were divided into an infection group (7 cases) and a non-infection group (93 cases) based on postoperative mesh infection, and multivariable Logistic regression analysis was conducted to determine the influencing factors for mesh infection.Results Compared with the control group, the operative duration was longer (P < 0.05), the time to off-bed activities and the length of hospital stay were shorter (P < 0.05), and intraoperative blood loss was less in the observation group (P < 0.05). The comparison of VAS scores at 1 day, 1 month, and 3 months after surgery showed that they were different among the time points (F = 731.639, P = 0.000) and between the groups (F = 89.116, P = 0.000), where the VAS score in the observation group was lower than that in the control group, indicating better analgesic effects. The change trends of the VAS scores were also different between the groups (F = 28.414, P = 0.000). The differences of the GQOL-74 scores (psychological function, physical life, physical function, and social function) before and after the treatment in the observation group were higher than those in the control group (P < 0.05). Significant differences were observed in the operative duration, proportions of patients with type 2 diabetes mellitus and malnutrition, and the mesh type between the infection group and the non-infection group (P < 0.05). Multivariable Logistic regression analysis indicated that the operative duration ≥ 1 h [O^R = 9.631 (95% CI: 1.255, 73.894) ], presence of type 2 diabetes mellitus [O^R = 12.036 (95% CI: 1.508, 96.097) ], malnutrition [O^R = 14.090 (95% CI: 1.385, 143.343) ], and the use of polytetrafluoroethylene mesh [O^R = 27.999 (95% CI: 2.136, 366.955) ] were factors influencing the postoperative mesh infection (P < 0.05).Conclusion Laparoscopic transabdominal preperitoneal inguinal hernia mesh repair, compared to traditional approaches, can effectively reduce postoperative pain, shorten recovery time, and improve quality of life. The main influencing factors for mesh infection include the operative duration exceeding 1 hour, comorbid type 2 diabetes mellitus, malnutrition, and the use of polytetrafluoroethylene mesh.