老年腹股沟斜疝的复发原因及手术治疗

Analysis and Treatment of Recurrent Gerontic Oblique Inguinal Hernia

目的探讨老年患者的腹股沟斜疝复发原因及其手术治疗方案。方法回顾性分析24例老年腹股沟斜疝复发患者的临床资料,对比不同初始术式、患者状况、术后并发症对斜疝复发的影响。采用无张力疝修补术对所有复发疝患者再次行手术修补。结果老年腹股沟斜疝的总复发率为9.1%(24/264),初始手术采用传统疝修补术的复发率(10.7%,21/197)显著高于采用无张力疝修补术的患者(4.5%,3/67)(P<0.05)。疝复发的主要原因还包括老年患者的慢性病,以及初始术式选择和术中操作的失误。再次手术后有3例出现并发症,经对症治疗所有患者均痊愈出院。21例手术患者随访6个月～2.5年,20例(95.2%)显示临床效果良好,1例术后2年复发,再次手术。结论健康因素、术式选择、术中操作失误,都是导致老年腹股沟斜疝复发的重要原因。无张力疝修补术安全有效、复发率低,宜作为治疗老年复发斜疝的首选术式。

Objective To determine the causes and surgical treatment of recurrent gerontie oblique inguinal hernia. Methods The data of 24 patients with recurrent gerontic oblique inguinal hernia was analyzed retrospectively. The original treatment, physical status, and post-operation complications were compared. Results The total recurrence rate of oblique inguinal hernia was 9.1% （24/264）. The rate in the patients receiving Lichtenstein＇s tension-free hemiorrhaphy （4.5%, 3/67） （P 〈 0.05）, The principal causes of recurrence included gerontic chronic disease or incorrect original treatment. There were 3 cases with complications after operation for the recurrent hernia. Among twenty-one patients followed-up from 6 months to 2.5 years, 20 cases （95.2%） showed good responses, and 1 case recurred after 2 years. Conclusion The principal factors for recurrent oblique inguinal hernia in elderly people were physical statues and the original treatment. The tension-free hemiorrhaphy was more efficient and worth applying in view of its lower recurrence rate.