嵌顿疝合并新型冠状病毒感染高龄患者的外科诊治体会

Diagnosis and treatment experience of elderly patients with incarcerated hernia complicated with novel coronavirus infection

目的探讨新型冠状病毒流行期间针对高龄腹股沟嵌顿疝患者的外科处置方案。方法回顾性分析2022年11月至2023年1月,苏州大学附属第二医院胃肠疝外科接收治疗的16例合并新型冠状病毒感染的腹股沟嵌顿疝老年患者临床资料,依据术前快速评估与术中探查结果,分别对患者进行了腹腔镜经腹腹膜前腹股沟疝修补(TAPP)(10例)、腹腔镜辅助小肠部分切除(3例)、全身麻醉下手法复位(3例)。出院后通过电话随访,观察不同方法处置后的患者病情转归。结果10例行TAPP患者康复出院,随访1个月全部存活。3例行腹腔镜辅助小肠部分切除患者,1例出院后因突发心肌梗死死亡,2例患者出院后随访1个月存活。3例全身麻醉下再次手法复位成功患者,1例康复出院,1例因再次高血压性脑出血死亡,1例出院后失随访。结论针对感染新型冠状病毒的高龄患者快速做出相对全面的术前评估,据此制定灵活的外科治疗策略,多学科协作贯穿救治始终,这些都是保障高龄患者康复的必要条件。

Objective To explore the surgical treatment for elderly patients with incarcerated inguinal hernia during the pandemic of novel corona virus.Methods From November 2022 to January 2023,the clinical data of 16 elderly patients with incarcerated inguinal hernia who suffered from novel coronavirus infection were retrospectively analyzed in the Gastrointestinal Hernia Surgery Department of the Second Affiliated Hospital of Soochow University.According to the preoperative rapid assessment and the results of intraoperative exploration,10 patients were treated with laparoscopic transabdominal preperitoneal(TAPP)inguinal hernia repair,3 patients were treated with laparoscopic assisted partial small bowel resection,3 patients were treated with manual reduction under general anesthesia.The outcomes of patients with different treatments were observed by telephone follow-up after discharge.Results 10 patients who underwent TAPP recovered and were discharged from hospital,and all survived after 1 month follow-up.Of the 3 patients underwent laparoscopic assisted partial small bowel resection,1 patient died of sudden myocardial infarction after discharge,and 2 patients survived after 1 month follow-up.Of the 3 patients who treated with manual reduction under general anesthesia,1 patient recovered and was discharged from hospital,1 patient died of recurrent hypertensive intracerebral hemorrhage,and 1 patient lost follow-up after discharge.Conclusion Rapid and relatively comprehensive preoperative assessment for elderly patients with COVID-19,flexible surgical treatment strategies based on this,and multidisciplinary cooperation throughout the treatment are all necessary conditions to ensure the recovery of elderly patients.