Tehran University Medical Journal
مجله دانشکده پزشکی، دانشگاه علوم پزشکی تهران
Tehran Univ Med J
Medical Sciences
http://tumj.tums.ac.ir
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1683-1764
1735-7322
10.18869/acadpub.tumj
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jalali
1390
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2011
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مدت زمان عمل و عوارض کوتاهمدت جراحی ترمیم فتق اینگوینال به روش لاپاروسکوپی پرهپریتونئال از راه شکم در وضعیت ترندلنبرگ یا ترندلنبرگ معکوس در مرحله دوختن پریتوان
The operation duration and short-term complications of laparoscopic transabdominal prepritoneal hernia repair: Trendelenburg versus reverse-Trendelenburg positions
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<p dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><em><span style="font-size: 10pt">زمینه و هدف</span></em></strong><em><span style="font-size: 10pt">:</span></em><span style="font-size: 10pt"> </span><span style="font-size: 10pt">مطالعه حاضر جهت
مقایسه نتایج جراحی، عوارض و مدت زمان ترمیم لاپاروسکوپیک فتق اینگوینال در وضعیت
ترندلنبرگ با ترندلنبرگ معکوس در مرحله دوختن پریتوان صورت گرفت. </span><strong><span style="font-size: 10pt"><br></span></strong></p><p dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt">روش بررسی</span></strong><span>:</span><span style="font-size: 10pt"> </span><span style="font-size: 10pt">در این مطالعه کارآزمایی بالینی
بیماران بعد از تشخیص فتق اینگوینال توسط جراح بر اساس روش نمونهگیری </span><span style="font-size: 7pt">B</span><span style="font-size: 8pt">lock randomization</span><span style="font-size: 10pt"> <span lang="AR-SA">وارد
مطالعه شدند. روش جراحی به صورت پرهپریتونئال از راه شکم</span></span><span lang="AR-SA" style="font-size: 10pt"> </span><span style="font-size: 10pt">بود. در
مرحله انتهایی </span><span style="font-size: 8pt">(</span><span style="font-size: 7pt">R</span><span style="font-size: 8pt">epritonealization</span><span style="font-size: 8pt">)</span><span style="font-size: 10pt"> در گروه مورد در
وضعیت ترندلنبرگ معکوس 15 درجه قرار گرفتند. گروه شاهد در طول عمل در وضعیت
ترندلنبرگ 15 درجه قرار داشتند بیماران روز بعد از جراحی در بیمارستان و یک هفته
پس از جراحی بیمار توسط جراح ویزیت شده و از نظر بروز عوارض مورد ارزیابی قرار گرفتند.</span></p><p dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><span style="font-size: 10pt">یافتهها:</span></strong><span style="font-size: 10pt"> </span><span style="font-size: 10pt">در این مطالعه 20 نفر
با روش ترندلنبرگ و 19 نفر به روش ترندلنبرگ معکوس حین دوختن پریتوان جراحی شدند.
در بررسی عوارض پارگی پریتوان در 9 بیمار (23%) خونریزی از پوست تنها در یک بیمار
(6/2%) مشاهده شد. کشش پریتوان حین ترمیم در 33 بیمار (6/84%) وجود داشت و مدت
دوختن پریتوان در بیماران تحت لاپاروسکوپی در وضعیت ترندلنبرگ، بیشتر از بیماران
تحت ترندلنبرگ معکوس بود. شدت درد روز اول پس از عمل در بیمارانی که دوختن پریتوان
در وضعیت ترندلنبرگ انجام شد بهطور معنیداری بیشتر بود. همچنین زمان بازگشت به
کار، مدت زمان بستری و فعالیت روزانه نیز در دو گروه تفاوت معنیداری نداشت.</span><strong><em><span style="font-size: 10pt"> <br></span></em></strong></p><p dir="rtl" style="text-align: justify direction: rtl unicode-bidi: embed" class="MsoNormal"><strong><em><span style="font-size: 10pt"></span></em></strong><strong><span style="font-size: 10pt">نتیجهگیری:</span><em><span style="font-size: 10pt"> </span></em></strong><span style="font-size: 10pt">طبق
نتایج مطالعه حاضر دوختن پریتوان به روش ترندلنبرگ معکوس زمان کمتری از نظر جراحی
و دوختن پریتوان میبرد و البته تفاوتی از نظر عوارض کوتاهمدت میان دو گروه
مشاهده نشد.</span></p>
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<!--stripped--> <strong>Background</strong><strong>:</strong> The aim of this study was to compare operating time and short-term
complications of laparoscopic transabdominal preperitoneal hernia repair during
reperitonealization in Trendelenburg versus reverse-Trendelenburg positions.<br><strong>Methods</strong> <strong>:</strong> Thirty-nine patients with inguinal hernia were enrolled in this clinical
trial. Study was done in Milad and Rasoul Akram hospitals in Tehran, Iran,
during 2008-2010. The patients neither were pregnant nor did they have any signs of
peritonitis, strangulation, perforation or infection. Moreover, they had a Body
Mass Index (BMI) below 35 kg/m<sup>2</sup> and were physically fit for general anesthesia. The
participants were divided into two groups by block randomization. The first (20) and the second (19) groups of patients underwent
laparoscopic herniorrhaphy in Trendelenburg and reverse-Trendelenburg positions.
Respectively all the operations were performed by one surgeon. The patients were
visited one day and one week after the surgery.<br><strong>Results</strong> <strong>:</strong> Most frequent complications were rupture in peritoneal repair in 9 patients (23%), skin site bleeding in one
patient (2.6%), and peritoneal tension in 33 patients (84.6%) patients. Duration of surgery and peritoneal repair took a significantly
longer time in Trendelenburg versus the reverse-Trendelenburg position. There were
no differences in duration for returning to work or resumption of daily activities
between the two groups. Pain in the first day following surgery was
statistically more severe in the Trendelenburg group.<br><strong>Conclusion:</strong> This
study demonstrated that reverse-Trendelenburg position took less time for herniorrhaphy
and peritoneal repair than Trendelenburg position, although the complications
were the same.</p>
فتق اینگوینال،لاپاروسکوپی،پوزیشن،عوارض
Complication,inguinal hernia,laparoscopy,position
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http://tumj.tums.ac.ir/browse.php?a_code=A-10-25-205&slc_lang=fa&sid=1
Soltani
R
رضا
سلطانی