223例老年腹股沟疝无张力修补术的临床经验

Clinical Experience of Tension-free Inguinal Hernioplasty in 223 Elderly Patients

目的总结无张力修补术治疗老年人腹股沟疝的临床经验。方法回顾性分析223例(260例次)65岁以上老年腹股沟疝无张力修补术的临床资料,其中Ⅰ型疝75例次(28.8%),Ⅱ型58例次(22.3%),Ⅲ型97例次(37.3%),Ⅳ型30例次(11.5%)。98例病人(43.9%)合并不同程度的内科疾病。230例次(88.5%)采用局部麻醉,全麻6例次,连续硬膜外麻或腰麻24例次。主要术式有疝环充填+平片修补术168例次(67.5%)、双层网片修补术57例次(22.9%),普理灵疝装置疝修补术15例次(6.0%)。结果单侧手术平均时间40min,平均住院时间4d。术后切口疼痛30例次,术中或术后需留置导尿20例次,出现血(清)肿7例次,复发1例次,无手术死亡及切口感染病例。结论老年腹股沟疝无张力修补术是安全?可靠和有效的,建议应用局麻。提倡无张力疝修补术的"个体化"治疗原则。

Objective To summarize the clinical experience of tension-free inguinal hernioplasty in elderly patients. Methods Clinical data was studied respectively in 223 patients （260 patient-times）aged 65 years and over, including 75 times （28.8%）of Type Ⅰ , 58 times（22.3% ）of Type Ⅱ ,97 times（37.3% ） of Ⅲ ,and 30 times（ 11. 5% ） of Ⅳ. 98 cases were complicated with different physician diseases. The operations were done under local anesthesia in 230 .times（ 88.5% ） , general anesthesia in 6 times,and continuous epidural or lumbar anesthesia in 24 times. The main surgical treatments included in mesh and plug hernioplasty （ 168 times, 67.5% ）, bilayer patches hernioplasty （57 times, 22.9% ） and Prolene hernia system （PHS） hernioplasty （ 15 times, 6.0% ）. Results The average operation time for one inguinal hernia was 40 minutes and the mean hospitalization period was 4 days. Postoparatlon incision pain was happened in 30 times. Indwelling urethral catheter was used during intraoparation or postoperation period in 20 times. Serum mass occurred in 7 times and recurrence in I. No death or incision infection was observed. Conclusion Tension-free inguinal hernioplasty in elderly patients is safe, reliable and efficient, and local anesthesia is recommended. Individual treatment principle in tension-free inguinal hernioplasty is advocated.