疝囊剥离与横断疝囊在老年TAPP术中应用效果比较

Comparison of effects of hernial sac detachment and transection in TAPP in senile patients

目的比较疝囊剥离与横断疝囊在老年腹腔镜经腹腹膜前疝修补术(TAPP)中的治疗效果。方法选取拟行TAPP治疗的老年腹股沟疝患者147例,根据对疝囊处理方法的不同分为研究组(n=85)与对照组(n=62)。对照组术中进行疝囊剥离处理,研究组术中进行横断疝囊处理,术后随访3个月。比较两组手术相关指标、并发症、复发及生活质量。结果研究组手术时间及疝囊处理时间较对照组缩短(P <0.05),术中出血量、住院费用、数字评分法(NRS)评分及术后5 d腹股沟积液量均较对照组降低(P <0.05),两组并发症发生率比较无明显差异(P> 0.05);随访期间,两组均无复发病例;随访结束后,研究组生活质量简明健康测量量表(SF-36)、巴塞尔指数(BI)和改良Rankin量表(mRS)评分均显著高于对照组(P <0.05)。结论对于疝囊长度>8 cm的老年腹股沟疝患者,TAPP中应用横断疝囊的处理方法可缩短手术时间,减轻手术对患者的损伤,有利于患者术后康复。

Objective To compare the effects of hernial sac detachment and transection in transabdominal preperitioneal laparoseopie hemiorrhaphy （TAPP） in senile patients. Methods A total of 147 senile patients with inguinal hernia to receive TAPP were selected and divided into a study group （n=85） and a control group （n=62） according to different treatments of hernial sac. The control group was treated with hernial sac detachment and the study group with hernial sac transection. The two groups were followed up for three months after the treatment. The relevant indexes, complications, reemfenee and quality- of life （QOL） between the two groups were compared, Results The duration of operation and hernial sac treatment time in the study group were shorter than those in the control group （P 〈 0.05） and the intraoperative amount of bleeding, hospitalization expenses numeric rating scale （NRS） scores and the amount of inguinal fluid five days after the operation were lower than those in the control group （P 〈 0.05）, but there was no significant difference in the incidence of complications between the two groups （P 〉 0.05）; there was no recurrence in the two groups during follow-up visit; after follow-up visit, the QOL simple health scale （SF-36）, Barthel Index （BI） and modified Rankin scale （mRS） scores in the study group were significantly higher than those in the control group （P 〈 0.05）. Conduaion For senile patients with inguinal hernia with a hernial sac longer than 8 cm, the treatment with hernial sac transection can shorten the duration of operation, reduce the injury of surgery to patients and is helpful for postoperative rehabilitation of patients.