两种手术方法治疗老年复发性腹股沟疝的临床效果

Clinical effect of two surgical methods on elderly patients with recurrent inguinal hernia

目的探讨Lichtenstein术和腹腔镜经腹腹膜前疝修补术(TAPP)联合腹膜前疝囊部分横断术治疗老年复发性腹股沟疝的临床效果与安全性。方法选择2013年2月至2018年5月,河北医科大学第二院东院区收治的腹股沟疝患者132例。随机分为对照组和试验组,每组患者66例。对照组患者采用Lichtenstein术,试验组采用TAPP联合腹膜前疝囊部分横断术。比较2组患者的手术时间、术中出血量、术后4h疼痛视觉模拟评分(VAS)、首次下床时间和住院时间、术后48h的血清IgM、IgA、IgG水平,以及术后的并发症发生情况和复发情况。结果试验组患者的手术时间及术中出血量分别为(46.4±9.6)min及(36.5±5.1)ml,与对照组(41.3±8.7)min及(39.2±5.4)ml比较,差异有统计学意义(t=3.198、2.953,P=0.002、0.004);试验组患者术后4hVAS评分、首次下床时间及住院时间分别为(4.6±1.5)分、(14.9±3.1)h及(5.2±1.8)d,与对照组(5.3±1.4)分、(16.2±3.6)h及(6.5±1.9)d比较,差异有统计学意义(t=2.772、2.223、4.035,P均<0.05);试验组患者IgM、IgA、IgG水平分别为0.78±0.10、1.43±0.31、6.84±0.73,与对照组0.67±0.11、1.26±0.25、5.79±0.61比较,差异有统计学意义(t=6.011、3.648、8.967,P均<0.05);试验组患者总并发症发生情况为2(3.03%)与对照组9(13.64%)比较,差异有统计学意义(χ^2=4.860,P=0.027);试验组患者复发情况为1(1.52%)与对照组3(4.55%),差异无统计学意义(χ^2=1.031,P=0.310)。结论TAPP联合腹膜前疝囊部分横断术治疗老年复发性腹股沟疝的安全性较高,患者术后的免疫功能恢复较显著,并发症发生率较低,临床效果较显著。

Objective To evaluate the clinical efficacy and safety of Lichtenstein operation and laparoscopic trans-abdominal preperitoneal hernia repair (TAPP) repair combined with partial transection of preperitoneal hernia sac for the treatment of elderly patients with recurrent inguinal hernia. Methods A total of 132 patients with inguinal hernia admitted to the East campus of Second hospital of Hebei medical university between February 2013 and May 2018 were selected as subjects. They were randomly divided into the control group and the study group, with 66 cases in each group. The control group was treated with Lichtenstein operation, while the study group was treated with TAPP repair and partial peritoneal hernia sac transection. The operation time, intraoperative bleeding volume, pain degree at 4 hours after operation, first time out of bed and hospitalization time, serum IgM, IgA and IgG levels at 48 hours after operation, as well as the occurrence of complications and recurrence at 3 months follow-up were compared between the two groups. Results The operation time of the study group was significantly longer than that of the control group [(46.4±9.6) minutes vs (41.3±8.7) minutes], the amount of bleeding during operation, the pain score at 4 hours after operation and the incidence of complications in the study group after operation were significantly lower than those in the control group [(36.5±5.1) ml vs (39.2±5.4) ml,(4.6±1.5) scores vs (5.3±1.4) scores, 2 (3.03%) vs 9 (13.64%)], the first time of bed-out and hospitalization in the study group was significantly shorter than that in the control group [(14.9±3.1) hours vs (16.2±3.6) hours ,(5.2±1.8) days vs (6.5±1.9) days], the levels of IgM, IgA and IgG in the study group were significantly higher than those in the control group (0.78±0.10 vs 0.67±0.11, 1.43±0.31 vs 1.26±0.25, 6.84±0.73 vs 5.79±0.61), and the differences were statistically significant (all P<0.05);There was no significant difference in recurrence between the two groups after 3 months (P>0.05). Conclusion TAPP repair combined with partial transection of preperitoneal hernia sac is safe for the treatment of elderly recurrent inguinal hernia, which can recover the immune function significantly, lower the incidence of complications, and worthy popularizing in clinic.