老年腹股沟疝患者局麻下Lichtenstein术和TAPP的临床疗效和应激反应比较

A Comparison study of Tension-free Repair Under Local Anesthesia and Transabdominal Preperitoneal for Elderly Inguinal Hernia on Clinical Effect and Stress Response

目的分析比较老年腹股沟疝患者局麻下Lichtenstein术和TAPP的临床疗效和应激反应。方法选取2012年6月~2014年6月收治的老年腹股沟疝患者82例作为研究对象,按手术方式的不同,分为对照组（n=41例）和观察组（n=41例）,对照组局麻下行TAPP手术治疗,观察组局麻下行Lichtenstein手术治疗,观察对比两组患者的手术效果及术后恢复情况,包括手术时间、术中出血量、首次下床活动时间、住院费用、住院时间等,并统计记录两组患者并发症发生情况。结果观察组手术时间、首次下床活动时间、住院费用及住院时间均优于对照组,差异有统计学意义（P〈0.05）;两组患者术后1 d的血清IL-6、皮质醇及胰岛素指标比较差异有统计学意义（P〈0.05）;术后3 d组间血清IL-6水平比较差异有统计学意义（P〈0.05）;两组患者术后3 d、7 d各项指标均降至正常。结论老年腹股沟疝采取Lichtenstein术和TAPP术治疗均有各自优势,且安全性好,临床可根据患者的实际情况合理选择手术方式。

Objective To analyze and compare the clinical effect and stress response of tension-free repair under local anesthesia and transabdominal preperitoneal for elderly inguinal hernia. Methods 82 elderly patients with inguinal hernia and who accepted treatment in our hospital from June 2012 to June 2014,were taken as the research objects. These patients were randomly divided into the control group（n=41）and the observation group（n=41）according to the different operation mode. In the control group,they were given the local anesthesia TAPP operation for treatment while in the observation group,they were treated with the Lichtenstein treatment under local anesthesia operation. Then,the operation and postoperative recovery of the two groups were observed and compared,including the operation time,bleeding volume,the time of the first bed,hospitalization expenses,hospitalization time,and the complications occurred of two groups of patients. Results The operation time,the time of first bed,hospitalization expenses and hospitalization time in the observation group were better than those of the control group,the difference had statistically significant（P〈0.05）. In addition,the serum levels of IL-6,cortisol and insulin in the two groups after operation 1day were statistically significant（P〈0.05）. The serum level of IL-6 in 3 d was significantly different（P〈0.05）. The two groups of patients after the 3 d,7 d can be reduced to normal. Conclusion There are advantages of Lichtenstein and TAPP in the treatment of elderly patients with inguinal hernia,and the safety is good. The clinical can choose the operation mode according to the actual situation of patients.