Таблица 2 Подробная информация о повреждения сосудов и внутренних брюшных органов из исследований TAPP и TEP Исследование
| TAPP
| TEP
|
| Повреждение брюшных органов (n)
| Повреждение сосудов (n)
| Повреждение брюшных органов (n)
| Повреждение сосудов (n)
|
|
| Травма кишечника
| Травма мочевого пузыря
| Нижние эпигастральные сосуды
| Повздошные сосуды
| Травма кишечника
| Травма мочевого пузыря
| Нижние эпигастральные сосуды
| Повздошные сосуды
| Felix et al. [15]
| 3/733
| -
| -
| -
| -
| -
| -
| -
| Cohen et al. [17]
| -
| 1/108
| -
| -
| -
| -
| -
| -
| Bobrzynski et al. [19]
| -
| -
| 3/809
| -
| -
| -
| -
| 1
| Bittner et al. [25]
| 9/8050
| 8/8050
| 14 (в области троакара)
5 (паховые)
6 (другие)
|
|
|
|
|
| Schultz et al. [2З]
| 1/2500
| 3/2500
| 5/2500
1 (мезентериальные)
1 (corona mortis)
|
|
|
|
|
| Kapiris et al. [24]
| -
| 7/3530
| -
| -
| -
| -
| -
| -
| Ramshaw et al. [22]
| 2/300
| 1/300
| -
| -
| 2/300
| 1/300
| -
| -
| Khourey [16]
| -
| -
| -
| -
| -
| -
| 2/60
| -
| Vanclooster et al. [27]
| -
| -
| -
| -
| 1/1259 (толстый кишечник)
| -
| 4/1259
| -
| Tamme et al. [28]
| -
| -
| -
|
| -
| 8/5203
| 29/5203 (11 IEV)
| -
| Dulucq et al. [29]
| -
| -
| -
| -
| 1/3100
| -
| 11/3100
| -
| Таблица 3 Частота осложнений и рецидивов после герниопластики TAPP в различных сериях наблюдений с 1990 по 1998 год
| Число пациентов
| Частота осложнений N (%)
| Частота рецидивов N (%)
| Bittner et al. [30]
| 3400
| 241 (7,1)
| 31 (0,9)
| Phillips et al. [31]
| 1944
| 120 (6,2)
| 19 (1)
| Tetik et al. [32]
| 553
| NR
| 4 (0,7)
| Fitzgibbon et al. [33]
| 562
| NR
| 28 (5)
| Felix et al. [15]
| 733
| 9 (1,2)
| 2 (0,2)
| Ramshaw et al. [34]
| 300
| 13 (4,3)
| 6 (2)
| Fielding [35]
| 386
| 4(1)
| 2 (0,5)
| Kald et al. [36]
| 339
| 42 (11)
| 7 (2)
| Stoker et al. [37]
| 75
| 6 (8)
| 0
| Payne et al. [38]
| 48
| 6(12)
| 0
| Maddern et al. [39]
| 42
| 7 (17)
| 0
| Lawrence et al. [40]
| 58
| 7 (12)
| 1 (1,7)
| Wright et al. [41]
| 67
| 15 (22)
| NR
| Всего
| 8507
| 470 (6,36)
| 100 (1,33)
| Стоимость процедуры не различалась. Отсутствие рецидивов наблюдалось на момент среднего периода наблюдения 17 месяцев.
Выводы
Существуют две стандартизированные методики лапароскопической пластики паховой грыжи (LIHR): (1) трансабдоминальная предбрюшинная (ТАРР) и (2) полностью предбрюшинная (ТЕР) пластика. Имеется малое количество опубликованных данных с уровнем доказательности 1 по сравнению ТАРР и ТЕР. Обе методики TAPP и TEP имею свои преимущества и недостатки. Отсутствуют статистически значимые различия в отношении послеоперационных осложнений, в частности, рецидивов и хронической боли в паховой области.
Таблица 4. Частота осложнений и рецидивов после герниопластики TЕP в различных сериях наблюдений с 1990 по 1998 год
| Исследования
| Число пациентов
| Частота осложнений N (%)
| Частота рецидивов N (%)
| Smith et al. [42]
| 100
| 14 (14)
| 2(2)
| Vanclooster et al. [27]
| 158
| 23 (6,3)
| 0
| Phillips et al. [31]
| 253
| 36 (14,2)
| 2 (0,3)
| Felix et al. [15]
| 382
| 40 (10,5)
| 1 (0,2)
| Heithold et al. [43]
| 346
| 7 (2)
| 1 (0,4)
| McKernan и Laws [44]
| 633
| 73 (11,5)
| 4 (0,6)
| Phillips et al. [45]
| 578
| 55 (9,5)
| 0
| Tetik et al. [32]
| 457
| -
| 2 (0,4)
| Fitzgibbon et al. [33]
| 87
| -
| 0
| Ramshaw et al. [34]
| 600
| 5 (0,8)
| 2 (0,3)
| Fielding [35]
| 218
| 0
| 2 (0,9)
| Kald et al. [36]
| 87
| 7 (8)
| 0
| Liem et al. [46]
| 487
| 15 (3)
| 16 (3,4)
| Всего
| 4386
| 275 (7,6)
| 32 (0,60)
|
Таблица 5 Частота осложнений и рецидивов после герниопластики TАРP в различных сериях наблюдений с 1999 по 2008 год
| Исследования
| Число пациентов
| Частота осложнений N (%)
| Частота рецидивов N (%)
| Lepere et al. [20]
| 1290
| 129 (10)
| 13 (<1)
| Weiser и Klinge [21]
| 1216
| 83 (6,8)
| 15 (1,2)
| Ramshaw et al. [22]
| 300
| 9 (3)
| 6(2)
| Bobrzynski et al. [19]
| 809
| 95 (11,7)
| 23 (2,84)
| Schultz et al. [23]
| 2500
| 89 (3,56)
| 26 (1,04)
| Kapiris et al. [24]
| 3530
| 300 (8,5)
| 22 (0,62)
| Bittner et al. [25]
| 8050
| 209 (2,6)
| 32 (0,4)
| Всего
| 17695
| 914 (5,2)
| 137 (0,77)
|
Таблица 6 Частота осложнений и рецидивов после герниопластики TАРP в различных сериях наблюдений с 1999 по 2008 год
| Исследования
| N
| Частота осложнений N (%)
| Частота рецидивов N (%)
| Lepere et al. [20]
| 682
| 68 (10)
| 7 (< 1)
| Weiser и Klinge [21]
| 1547
| 135 (8,7)
| 8 (0,5)
| Ramshaw et al. [22]
| 924
| 6 (0,64)
| 2 (0,21)
| Bobrzynski et al. [19]
| 416
| 69 (16,6)
| 8 (1,92)
| Tamme et al. [28]
| 5203
| 164 (3,15)
| 31 (0,6)
| Chiofalo et al. [26]
| 431
| 25 (5,7)
| 2 (0,5)
| Vanclooster et al. [27]
| 1259
| 106 (8,4)
| 1 (0,1)
| Dulucq et al. [29]
| 3100
| 167 (5,4)
| 14 (0,46)
| Всего
| 13562
| 740 (5,4)
| 73 (0,54)
| Считается, что методике ТАРР легче обучить и обучиться, несмотря на отсутствие каких-либо литературных доказательств уровня 1, которые это подтверждают. Необходимо получить больше данных по сравнению TAPP и TEP путем проведения рандомизированных контролируемых исследований. Хирург, выполняющий лапароскопическую герниопластику должен быть знаком с открытой методикой в связи с необходимостью конверсии у некоторых больных. Метод TEP позволяет легче перейти к ТАРР, чем к открытой операции. Список литературы (в скобках указан уровень доказательности)
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