老年(高龄)女性腹股沟疝诊断及治疗方案选择

Diagnosis and treatment options of inguinal hernia in elderly women

老年腹股沟疝(包括股疝)中的女性比例高于成人各年龄段腹股沟疝总体中的女性比例。老年女性腹股沟疝的急诊手术比例、疝手术的病死率均高于男性。老年女性腹股沟疝仅以腹股沟区疼痛或盆腔疼痛为表现的并不少见,对于隐匿疝的诊断须结合超声检查等影像学检查方法,甚至可以腹腔镜探查。因此,对于老年女性腹股沟疝,建议尽早选择择期手术,降低高龄急诊手术并发症发生率以及可能死亡的风险。老年女性腹股沟疝手术推荐腹膜前疝修补术,包括完全腹膜外疝修补术(TEP)、经腹腔腹膜前疝修补术(TAPP)等,在病情特殊或手术技术有限的情况下,网塞或网塞平片疝修补术也是一种很好的选择。

The proportion of females in the aged groin hernia is higher than that in the total adult groin hernia. The proportion of emergency surgery for groin hernia and mortality rate of hernia surgery in older women are higher than those of older men. The performance of groin hernia with only inguinal region or pelvic pain is not uncommon in elderly female. For the diagnosis of those hidden hernias, that sonographie imaging examination and other methods, can be used, even laparoseopie exploration. Therefore, for the elderly female groin hernia, it is recommended to choose elective surgery as soon as possible, so as to reduce the risk of more morbidity and mortality of emergency surgery. Preperitoneal hernia repair is recommend to those patients, including totally extraperitoneal prosthetic （TEP） and transabdominal preperitoneal prosthetic （TAPP）. For some frail elderly, or surgeon whose skill is limited, plug hernia repair or mesh-plug hernia repair is also a good choice.