伴肠坏死的绞窄性腹股沟疝高龄患者一期疝修补术23例

One-stage herniorrhaphy for strangulated inguinal hernia with bowel necrosis in elderly patients: Analysis of 23 cases

目的:探讨对难以耐受或接受再次手术的高龄绞窄性腹股沟疝伴肠坏死患者一期疝修补术可行性.方法:回顾性分析44例腹股沟绞窄疝临床资料,对比分析其年龄,手术时间,住院时间,术后并发症及术后腹股沟切口感染发生率,急性生理与慢性健康评分Ⅱ(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ),术后复发率.并进行统计学分析.结果:一期处理坏死肠段加腹股沟疝修补术组(A组)23例,年龄80岁±6岁.未行疝修补组(B组)21例,年龄66岁±12岁.A组手术时间、APACHEⅡ评分长于(高于)B组(133min±12 min vs 116 min±12 min,10分±2分vs 6分±2分),住院时间无显著差异(18 d±3d vs 17 d±3 d,P>0.05),A组术后并发症16例,其中腹股沟区切口感染4例,B组术后并发症12例,其中腹股沟区感染2例,两组术后并发症率、术后腹股沟切口感染概率无显著差异.术后随诊18-36 mo复发率低于B组(0/16vs 4/18).结论:对于高龄绞窄性腹股沟疝伴肠坏死患者,如果术中采取严格的防护措施,术后积极抗感染治疗,一期行坏死肠段切除加腹股沟疝修补术是可行的.

AIM：To explore the feasibility of one-stage herniorrhaphy in the treatment of strangulated inguinal hernia with bowel necrosis in elderly patients who could not tolerate a second operation.METHODS：Clinical data for 44 elderly patients with strangulated inguinal hernia and bowel necrosis were analyzed retrospectively.Age,operative time,postoperative complications and hospitalization,number of cases of inguinal surgical site infection,rate of recurrence,and Acute Physiology and Chronic Health Evaluation Ⅱ（APACHEⅡ） scores were compared between patients who underwent one-stage herniorrhaphy（group A） and those who did not（group B）.RESULTS：The operative time in group A was longer than that in group B（133 min ±12 min vs 116 min ±12 min）,and the age was older in group A（80 years ± 6 years） than in group B（66 years ±12 years）.Hospitalization duration（18 d±3 d vs 17 d ± 3 d）,number of cases of postoperative complications（16 vs12） and inguinal surgical site infection（4 vs 2）did not differ significantly between the two groups.APACHEⅡ score was higher in group A than in group B（10 ± 2 vs 6 ± 2）.The rate of recurrence was higher in group A than in group B（0/16 vs 4/18）.CONCLUSION：One-stage herniorrhaphy is feasible in elderly patients with strangulated inguinal hernia with bowel necrosis.