老年腹股沟嵌顿疝87例急诊手术疗效分析

Emergency operation strategies and treatment effect of incarcerated inguinal hernia in elderly patients: A report of 87 cases

目的探讨老年腹股沟嵌顿疝的急诊手术选择和治疗效果。方法回顾性分析2015年1月至2017年4月北京朝阳医院急诊手术的87例老年腹股沟嵌顿疝病人资料,分为腹腔镜组(12例)和开放组(75例),分析病人的临床资料、手术方式选择及并发症发生率等。结果腹腔镜组12例均行腹腔镜腹股沟疝修补手术;开放组75例病人中,71例行开放腹股沟疝修补术,4例行传统疝修补术。随访时间11(10~14)个月。79例(90.8%)病人完成随访,1例病人死亡。开放组出现肠瘘1例,两组病人均未出现复发、慢性疼痛等并发症。腹腔镜组和开放组的的感染发生率分别为0和5.3%(P=0.000),血肿发生率分别为0和14.7%(P=0.000),术后1个月血清肿发生率分别为33.3%(4/12)和40.3%(27/67)(P=0.012)、术后3个月血清肿发生率分别为16.7%(2/12)和31.3%(21/67)(P=0.024),住院时间分别为5(4~6)d和7(6~10)d(P=0.032),差异均有统计学意义。结论老年腹股沟嵌顿疝病人诊断明确后均应行急诊手术,手术策略与手术方式的选择应遵循个体化治疗的理念,尽管腹腔镜手术具有探查腹腔的优势,但应综合评估后慎重选择。

Objective To discuss the emergency operation strategies and treatment effect of incarcerated inguinal hernia in elderly patients. Methods The clinical data of 87 emergency cases of elderly incarcerated inguinal hernia from January 2015 to April 2017 in Beijing Chao-Yang Hospital were analyzed retrospectively. The clinical data and complications were analyzed between laparoseopic group （12 cases） and open group （75 cases）. Results Laparoscopie inguinal hernia repair were performed in 12 cases （laparoseopie group）; In open group, open inguinal hernia repair were performed in 71 cases, and traditional repair were performed in 4 cases. The follow-up time was 1 l（10~14）months. Among 87 cases, 79 cases （90.8%） finished follow-up,1 death case was observed during perioperative period. In open group, 1 intestinal fistula case was observed. No recurrent or chronic pain case was observed in both two groups. The difference of incidence of infection （Lap. 0 vs. Open 5.3%, P=0.O00）, hematomas （Lap. 0 vs. Open 14.7%, P=0.O00）, seroma after 1 month （Lap. 33.3% vs. Open 40.3%, P--0.012） , seroma after 3 month （Lap. 16.7% vs. Open 31.3%, P= 0.024） and hospital stay [Lap. 5 （4-6）d vs. Open 7 （6-10）d, P=0.032] between two groups was statistically. Conclusion Emergency operation is important for incarcerated inguinal hernia of elderly after diagnosis. An individualized operative strategies is needed. General evaluation is important although laparoscopy has advantage in exploration.