老年腹股沟疝以不同疝修补术治疗的效果观察

Observation on the effect of different hernia repair in elderly patients with inguinal hernia

目的分析腹沟股疝老年患者分别以开放式无张力腹股沟疝修补术(Millikan)、腹腔镜完全腹膜外腹股沟疝修补术(TEP)治疗的有效性、安全性。方法选取2013年9月～2016年8月期间我院收治的298例腹股沟疝老年患者为观察对象,按数字表法随机分为观察A组148例(行Millikan治疗)和观察B组150例(行TEP治疗),观察不同术式手术及术后恢复情况,统计两组并发症发生,组间比较患者胃肠道动力指标差异,门诊随访2年,记录疾病复发情况。结果观察B组患者较观察A组出血量少、术后疼痛弱、下床用时短,且肛门排气、术后进食、肠鸣音恢复用时短、术后并发症少(P<0.05);观察A组手术时间短于观察B组(P<0.05);两组复发率比较无差异(P>0.05)。结论腹股沟疝老年者以Millikan、TEP治疗均能有效改善症状,避免疝复发,且TEP治疗患者术后并发症少、胃肠道动力恢复快、术中出血量少。

Objective To evaluate the efficacy and safety of open-type tension-free inguinal hernia repair (Millikan) and laparoscopic totally extraperitoneal prosthetic(TEP) in elderly patients with inguinal hernia. Methods A total of 298 elderly patients with inguinal hernia admitted in our hospital from September 2013 to August 2016 were randomly divided into two groups: group A (n=148) treated with group B (n=150) treated with TEP. Different surgical procedures and postoperative recovery were observed. The complications of the two groups were counted. The differences in gastrointestinal motility indexes were compared between the groups. All patients were followed up for 2 years. And the disease recurrence was recorded. Results The patients in group B had less bleeding, less postoperative pain, shorter time to get out of bed, and the shorter time of anal exhaust, postoperative feeding, bowel sound recovery, and less postoperative complications compared with group A (P<0.05). The operation time of group A was shorter than that of group B (P< 0.05). There was no difference in recurrence rate between the two groups (P>0.05). Conclusions In elderly patients with inguinal hernia, the treatment with Millikan and TEP can effectively improve symptoms and avoid recurrence of hernia. Patients with TEP have fewer postoperative complications, faster gastrointestinal motility recovery, and less intraoperative blood loss.