老年腹股沟疝开放修补术后并发症及防治(附4678例报告)

Prevention and treatment of complications after open repair of inguinal hernia in elderly patients: A report of 4678 cases

目的总结分析老年腹股沟疝行开放修补手术后并发症的主要原因及防治措施。方法回顾性分析2010年1月至2016年12月复旦大学附属华东医院开展老年腹股沟疝开放修补手术4678例临床资料。结果术后平均随访(36.8±2.4)个月,术后1、3个月,1、3、5年随访率分别为100%(4678/4678)、98.2%(4594/4678)、88.6%(4145/4678)、78.4%(3668/4678)、53.4%(2498/4678)。5年随访期内共复发18例,其中择期手术后6例(择期手术后复发率0.13%),急诊手术后12例(急诊手术后复发率5.7%)。术后发生心血管疾病1169例,脑血管意外51例,肺炎351例,静脉血栓栓塞症(VTE)79例,慢性感染4例(均术前伴有糖尿病,同时伴有长期服用激素1例),慢性疼痛110例,血清肿68例,血肿19例,睾丸并发症108例,尿潴留179例。其中脑血管意外(6.1%vs. 0.9%)、腿部深静脉血栓形成(15.1%vs. 0.9%)、慢性疼痛(12.7%vs. 1.9%)、血清肿(12.7%vs. 0.9%)、睾丸下垂(8.5%vs. 1.5%)等的急诊手术后发生率和择期手术后的发生率比较,差异有统计学意义(P<0.05)。6例死亡。结论充分了解老年腹股沟疝术后并发症的发生原因,重视并发症的防治,有助于老年病人术后快速康复。

Objective To summarize and analyze the main causes of postoperative complications and put forward valuable preventive and therapeutic measures. Methods The clinical data of 4678 cases of open hernia repair operation performed from January 2010 to December 2016 in the elderly at Huadong Hospital Affiliated to Fudan University were analyzed retrospectively. Results The mean follow up was 36.8±2.4 months. The follow-up rates of 1 month, 3 months, 1 year, 3 years and 5 years after operation were 100%（4678/4678）,98.2%（4594/4678）,88.6%（4145/4678）,78.4%（3668/4678）and 53.4%（2498/4678）respectively. There were 18 cases of recurrence during the follow-up period of 5 years, including 6 cases after selective operation （0.13%） and 12 cases after emergency operation （5.7%）. There were 1169 cases of cardiovascular disease, 51 cases of cerebrovascular accident, 351 cases of pneumonia, 79 cases of venous thromboembolism （VTE）, 4 cases of chronic incisional infection, 110 cases of chronic pain, 68 cases of seroma, 19 cases of hematoma, 108 cases of testicular complication, and 179 cases of urine retention after hernia repair. The rates of occurrence of cerebrovascular accident （6.1% vs. 0.9%）, deep venous thrombosis （15.1% vs. 0.9%）, chronic pain （12.7% vs. 1.9%）, seroma （12.7% vs. 0.9%） and orchidoptosis （8.5% vs. 1.5%） after emergency operation and selective operation. The difference was significant （P〈0.05）. There were 6 dead cases. Conclusion Fully understanding the causes of postoperative complications and attaching the importance to the prevention and treatment of complications will help to enhance the recovery after surgery in elderly patients with inguinal hernia.