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Objective To compare the clinical efficacy of laparoscopic repair of laparoscopic transabdominal preperitoneal(TAPP)and Lichtenstein tension-free repair herniorrhaphy in the treatment of recurrent inguinal hernia in adults,and to explore the clinical advantages of TAPP in the treatment of recurrent inguinal hernia.Methods A retrospective analysis was conducted in 54 adult patients with recurrent inguinal hernia from December 2010 to January 2015.The patients were randomly divided into TAPP group and Lichtenstein group.The operation time,intraoperative bleeding volume,postoperative hospitalization time,cost of hospitalization,postoperative complications,early postoperative pain and the recurrence of hernia were compared between the two groups.Results All patients were successfully completed surgery.The operation time of TAPP group (47.2 ±9.4)min was significantly shorter than (73.1 ±10.4)min of Lichtenstein group (t=-2.503,P=0.034).The median amount of bleeding during operation of TAPP group was 40(15 -110)ml,which was significantly less than 73(11 -130)ml in Lichtenstein group (t=-6.018,P=0.000). Postoperative hospital stay of TAPP group[(6.5 ±1.4)d]was shorter than (8.2 ±1.6)d of the Lichtenstein group (t=-2.613,P=0.028).Early postoperative pain score of TAPP group[(1.8 ±1.2)points]was better than (2.9 ± 1.4)points in Lichtenstein group (t=-7.006,P=0.000),the difference was statistically significant.However,the hospitalization cost of TAPP group[(8 842.8 ±415.2)yuan]was higher than (6 676.9 ±327.6)yuan of the Lichtenstein group,the difference was statistically significant(t=6.782,P<0.05).In TAPP group,2 cases had complications after operation,which were less than 5 cases of Lichtenstein group.Postoperative follow up ranged from 6 to 48 months,1 case of recurrence in Lichtenstein group,the recurrence rate was 3.8%.There was no recurrence in the TAPP group.Conclusion TAPP has the advantages of short operation time,less bleeding,rapid postoperative recovery,less postoperative pain and so on.It can be used as a recommended procedure for the treatment of recurrent inguinal hernia in adults.
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Objective To investigate the causes and prevention of postoperative pain of laparoscopic transabdominal preperitoneal (TAPP) and Lichtensteinrepair in the treatment of adult recurrent inguinal hernia.Methods Sixty adult recurrent inguinal hernia patients were enrolled in this study.They were divided into TAPP group and Lichtenstein group by random digits table,with 30 cases in each group.At 6 h Mter operation,the pain degree was evaluated by visual analogue scale (VAS) and compared between two groups.The level of VAS in TAPP group was (3.76 ± 1.47) scores,in Lichtenstein group was (6.36 ± 1.54) scores,and there was significant difference (t =-5.978,P =0.000).In TAPP group,pain was mainly moderate (17 cases,56.67％) and mild (11 cases,36.67％).In Lichtenstein group,pain was mainly moderate (14 cases,46.66％) and severe (13 cases,43.33％).Postoperative follow-up ranged from 6 to 48 months.No chronic pain appeared in TAPP group.There were 4 cases with chronic pain in Lichtenstein group,and the incidence rate of chronic pain was 13.3％.Conclusions The operation of TAPP in the treatment of recurrent inguinal hernia in adult patients has the advantage of shorter operation time,less postoperative pain,faster postoperative recovery,and can effectively reduce the incidence of postoperative pain.
RESUMO
Objective To study the feasibility of rat models of renal edema based on disease combined with traditional Chinese medicine syndrome yin-deficiency and yang-deficiency types .Methods Gastric gavage of thyroxine and tail vein injection of Adriamycin were performed to induce a rat model of kidney Yin deficiency edema , and intramuscular injection of hydrocortisone and tail vein injection of Adriamycin were used to establish a rat model of kidney Yang deficiency edema .The 24 h urine protein content , triiodothyronine ( T3 ) , thyroxine ( T4 ) , cyclic adenosine monophosphate ( cAMP ) , cyclic guanosine monophosphate ( cGMP ) , estradiol ( E2 ) and testosterone ( T ) and other indicators were assayed to determine whether the rat models were successfully established .Result The rats of Yin deficiency edema group had clinical presentation such as hyperactivity , hair loss, dry stool, weight loss and temperature rise.Compared with the blank group , T3, T4, cAMP, E2, and 24 h urinary protein levels were significantly increased , cGMP and T content decreased , and cAMP/cGMP ratio was significantly increased , showing significant differences ( P<0.05 for all).The Yang deficiency edema animals displayed reduced activity , diarrhea, decreased body weight and body temperature, and other signs of disease.Compared with the blank group, T3, T4, cAMP, and E2 contents were significantly decreased , cGMP, T, and 24 h urinary protein levels were significantly increased , and cAMP/cGMP ratio decreased , showing significant differences ( P <0.05 for all ) .Conclusions The rat model of renal edema disease combined with TCM syndrome yin-deficiency was successfully induced by thyroxine in combination with Adriamycin , and the rat model of renal edema based on disease combined with TCM syndrome yang-deficiency is successfully established by administration of hydrocortisone plus Adriamycin .These two rat models demonstrate similar clinical manifestations of human renal edema based on disease combined with TCM syndrome yin-deficiency and yang-deficiency, respectively, therefore, may serve as useful tools for further research on this disease .