高龄患者对侧隐匿性腹股沟疝的外科治疗

Surgical treatment of elderly patients with occult contralateral inguinal hernia

目的探讨高龄患者对侧隐匿性疝（concealed hernia，COH）的临床特点和外科治疗。方法回顾性分析2009年5月至2013年4月，中南大学湘雅医院收治高龄腹股沟疝患者96例，行经腹腹前疝修补术（TAPP）治疗的临床资料。分析其中20例高龄患者COH的临床特点和治疗结果。结果96例患者均顺利完成手术。术后出现并发症13例，主要包括血清肿和皮下气肿。全组平均手术时间（105±27）min，单侧疝手术时间（100±15）min，双侧疝手术时间（140±30）min，单侧疝合并COH手术时间（130±25）min。双侧疝、单侧疝合并COH与单侧疝组手术时间比较，差异有统计学意义（t=-2．36、2．12，P=0．03、0．04）。合并COH术后并发症发生率15．0％（3／20），单侧疝术后并发症发生率11．6％（8／60），差异无统计学意义（X2=3．34，P=0．12）。随访2～48个月，中位随访时间30个月，无复发。结论行TAPP时同时修补高龄患者对侧隐匿性疝是安全可行的，是腹腔镜腹股沟疝修补术相对于开放式腹股沟疝修补术的重要优势之一。

Objective To investigate the clinical features and surgical treatment in those elderly patients with contralateral hernia （concealed hernia, COH）. Methods From May 2009 to April 2013, a total of 96 elderly patients with inguinal hernia were hospitalized in Xiangya Hospital Central South University. The clinical features and treatment results were analyzed in the 20 cases. Results All the patients successfully completed laparoscopic operation, and no cases were converted to open operation. Postoperative complications were observed in 13 cases including seroma and subcutaneous emphysema. The mean of operation time was （ 105 ± 27 ） minutes, （ 100 ±15 ） minutes for unilateral hernia operation time （140±30）minutes for bilateral hernia operation time, and （130 ± 25）minutes for the operation time of unilateral hernia complicated with COH. The operation time in bilateral hernias, unilateral hernia with COH and unilateral hernia is long with statistically significant difference （t = -2. 36,2. 12, P = 0.03,0.04）. The rate of complication with COH after operation was 15% （3/20） and 11.6% （8/60） was for unilateral hernia postoperative complication. No significant difference was found（X2 = 3.34, P = 0. 12 ）. The patients were followed up for 2 to 48 months with the median follow-up time of 30 months without any recurrence. Conclusions TAPP and repair in the elderly patients are safe and feasible for contralateral hernia, which is the strength for laparoscopic inguinal hernia repair compared with open inguinal hernia repair.