腹腔镜下经腹腔腹膜前疝修补术与无张力疝修补术治疗老年腹股沟疝患者的临床效果比较

目的:探讨腹腔镜下经腹腔腹膜前疝修补术(TAPP)与无张力疝修补术(TF)在老年腹股沟疝治疗中的临床效果。方法:研究选取2023年5月到2024年2月收治的60例腹股沟疝患者实施研究,并按照患者采用的手术方案分组各30例。其中对照组以TF术式治疗,观察组以TAPP术式治疗。比较两组手术一般指标、并发症、术后疼痛情况、血清炎性因子、血清氧化应激水平、肠道功能。结果:观察组出血量、手术时间、下床活动时间等指标低于对照组,组间对比(p<0.05)。观察组尿潴留、感染、水肿等发生率为10.00%(3/30),相较对照组更低,组间对比(p<0.05)。术前两组数字模拟评分法(NRS)对比(p>0.05);术后1d、3d、5d观察组的NRS评分低于对照组(p<0.05)。术前两组患者C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)对比(p>0.05);术后观察组CRP、TNF-α低于对照组(p<0.05)。术前两组超氧化物歧化酶(SOD)、丙二醇(MDA)对比(p>0.05);术后观察组SOD高于对照组,MDA低于对照组(p<0.05)。术前两组肠道益生菌指标对比(p>0.05);术后观察组肠道双歧杆菌、乳酸杆菌水平高于对照组(p<0.05)。结论:开展TAPP术式治疗腹股沟疝的效果良好,不仅恢复时间短,而且疼痛程度低,能减少并发症的发生,还可以减轻炎性反应与氧化应激反应,使肠道功能受到的影响降低。

Objective:To investigate the clinical efficacy of laparoscopic transabdominal preperitoneal hernia repair(TAPP)and tension-free hernia repair(TF)in the treatment of elderly inguinal hernia.Method:A study was conducted on 60 patients with inguinal hernia admitted from May 2023 to July 2024,and they were divided into two groups according to the surgical plan adopted by the patients,with 30 cases in each group.The control group was treated with TF procedure,while the observation group was treated with TAPP procedure.The general indicators,complications,postoperative pain,serum inflammatory factors,serum oxidative stress levels,and intestinal function were compared between the two groups.Results:The observation group had lower indicators such as blood loss,operation time,and time to get out of bed and move around than the control group,with a significant difference between the two groups(p<0.05).The incidence of urinary retention,infection,edema,etc.in the observation group was 10.00%(3/30),which was lower than that in the control group,and the comparison between the groups(p<0.05).The comparison of the preoperative NRS scores between the two groups(p>0.05);The NRS scores of the observation group were lower than those of the control group on postoperative day 1,3,and 5(p<0.05).Before surgery,there was no significant difference in C-reactive protein(CRP)and tumor necrosis factor-α(TNF-α)levels between the two groups(p>0.05);After surgery,the CRP and TNF-αlevels in the observation group were lower than those in the control group(p<0.05).There was no significant difference in the levels of superoxide dismutase(SOD)and malondialdehyde(MDA)between the two groups before surgery(p>0.05);After surgery,the SOD level in the observation group was higher than that in the control group,while the MDA level was lower than that in the control group(p<0.05).Preoperative comparison of intestinal probiotics indicators between the two groups(p>0.05);The levels of bifidobacteria and lactobacilli in the intestinal tract of the observation group were higher than those of the control group after surgery(p<0.05).Conclusion:The TAPP procedure has good effects in treating inguinal hernia,not only with a short recovery time and low pain level,but also with reduced complications,alleviated inflammatory and oxidative stress reactions,and reduced impact on intestinal function.