腹腔镜手术治疗老年腹股沟疝2771例分析

Analysis of 5050 cases of elderly inguinal hernia patients after laparoscopic inguinal hernia repair

目的分析老年腹股沟疝病人的临床特点,探讨腹腔镜治疗的合理性、安全性和有效性。方法回顾性分析2001年1月至2016年12月在上海交通大学医学院附属瑞金医院接受腹腔镜腹股沟疝修补术(LIHR)的5050例病人(6047侧)的临床资料。其中<65岁组2279例(2622侧),65~80岁组2332例(2883侧),>80岁组439例(542侧)。结果老年病人(65~80岁组和>80岁组,下同)的男/女比、手术史、双侧疝、直疝、复合疝、Ⅲ型疝、Ⅳ型疝(复发疝)比例高于中青年病人(<65岁组,下同)(P=0.000)。>80岁组的经腹腔腹膜前疝修补术(TAPP)比例最高,65~80岁组的TEP比例最高。重量型补片(HWM)的使用和机械性固定的比例在>80岁组最高,<65岁组最低,三组差异有统计学意义(P=0.000)。随访时间18~60个月(中位时间36个月)。三组在单侧手术时间、术后第1天疼痛视觉模拟评分(VAS)评分、术后2周和4周恢复非限制性活动病例数等方面差异无统计学意义(P>0.05)。老年病人双侧手术时间长于中青年病人(P=0.001),三组病人术后住院时间比较,>80岁组最长,<65岁组最短,差异有统计学意义(P=0.000)。共有13例复发(0.021%)病例,老年病人的复发率高于中青年病人(P=0.006)。并发症依次为血清肿、尿潴留、暂时性神经感觉异常和肠麻痹,其中,病人的尿潴留发生率>80岁组最高,<65岁组最低,三组差异有统计学意义(P=0.000)。结论对于术前评估合格的老年腹股沟疝病人,LIHR是安全、有效、合理的术式。

Objective To investigate the clinical characteristics and outcomes of laparoscopic inguinal hernia repair （LIHR） in elderly patients and explore the rationality, safety and effectiveness of laparoscopic inguinal hernia repair. Methods The clinical data of 5050 patients （6047 hernias） underwent LIHR in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2001 to December 2016 were analyzed retrospectively. Patients were categorized into 3 groups： 2279 （2622 hernias） nonelderly patients （〈65 years old）, 2332 （2883 hernias） elderly patients （65-80 years old）, and 439 （542 hernias） octogenarian patients （〉80 years old）. Results Elderly and octogenarian patients had higher male/female ratio, more bilateral hernias, direct hernias, combined hernias, large hernias and recurrent hernias（P=0.000）. Transabdominal preperitoneal prosthetic （TAPP） was the most favorable procedure in octogenarian group, whereas totally extraperitoneal prosthetic （TEP） was mostly performed in elderly patients. The use of high-weight mesh and mechanical fixation was the most in octogenarian group,and the less in nonelderly group, There were significant differences among 3 groups （P=0.000）. The follow-up period was 18-60 months （median 36 months）. There were no significant differences among 3 groups in terms of operation time for unilateral hernias, visual analogue scale （VAS） at 1 st day after operation, and return to non-restrained activity time at 2,4 week after operation （P〉0.05）. The operation time for bilateral hernias was longer in elderly and octogenarian patients than in nonelderly patients （P=0.001）, octogenarian patients have the longest hospital stay, while the nonelderly patients have the shortest （P=0.000）. Thirteen cases of recurrence occurred （0.021%） during follow-up, and the rate was higher in elderly and octogenarian patients（P=0.006）.The post-operative complications were seroma, urinary retention, paraesthesia and paralytic ileus, respectively. The rate of urinary retention was the highest in octogenarian group ,and the lowest in nonelderly group,the differences among 3 groups were significant（P=0.000）. Conclusion LIHR is rational,safe and feasible for all the age groups. A comprehensive pre-operative evaluation is essential for elderly and octogenarian inguinal hernia patients.