个体化无张力疝修补术在老年腹外疝中的应用

Application of individuated tension-free hernioplasty in abdominal external hernia in elderly

目的评价个体化无张力疝修补手术治疗老年人腹外疝的疗效。方法回顾性分析医院1999年￣2002年间113例老年人行无张力疝修补术的临床资料。结果113例老年病人共施行了131次无张力疝修补术,其中83例行疝环充填式无张力疝修补术,48例行Lichtenstein手术,单侧疝、双侧疝及切口疝平均手术时间分别为36、73和92min。术后并发症包括小的皮下血肿,1例巨大切口疝术后出现腹胀,无切口感染,无围手术期死亡。腹股沟疝及切口疝病人分别于3～9d和8～19d出院。73%(82/113)病人获得随访,随访时间5～50个月,无术后复发,1例有腹股沟区疼痛。结论采用无张力疝修补手术治疗老人腹外疝是安全的,其并发症少,复发率低;对老年性腹外疝病人施行个体化无张力疝修补术有利于减少疝复发;对双侧腹股沟疝的病人可同期进行手术,避免再次手术;对腹壁巨大缺损者,可选用防粘连补片,避免腹腔高压。

[Objective]To analyze the characteristics of abdominal external hernia and evaluate the therapeutic effect individuated tension-free hernioplasty on abdominal external hernia in the elderly patients. The clinic data of 131 tension-free hernioplasty in 113 cases with abdominal external hernias admitted from 1999 to 2002 were retrospectively analysed. 131 open tension-free hernia repairs in 113 cases were performed, 83 of them underwent mesh plug tension-free hernioplasty, and 48 underwent Lichtenstein operations according to the diameters of internal ring and degree of weakness of the transversalis fascia. The average time of operation in unilateral, bilateral, and incisional hernias was respectively 36 min, 73 min, 92 min. Postoperative complications included small hypoincisional haematoma in 2 cases and abdominal distension in one case, no wound infection and mortality. All patients in inguinal and incisional hernias were respectively discharged 3~9 days and 8~19 days after operation. 73%(82/113) of patients were follow up for 5 to 50 months. During the follow-up there was one case with chronic pain in the groin, no recurrence was found. [Conclusions] Open tension-free hernia hernioplasty for the treatment of abdominal external hernia in the elderly and simultaneous bilateral repair for the patient with bilateral inguinal hernias are safe and reliable methods. Individuated operation for hernia is benefical to obtain better therapeutic effect and reduce recurrence rate.