生物材料在不同年龄腹股沟疝患者中应用价值的探讨

Application value of biological mesh in inguinal hernia patients of different ages

目的分析生物材料在不同年龄的腹股沟疝患者中的应用价值和适用条件。方法回顾性分析在2014年4月-2020年3月期间在复旦大学附属中山医院及复旦大学附属华东医院对254例单侧腹股沟疝患者使用生物材料进行修补治疗的临床资料。结果所有患者按年龄进行分组,其中试验组(≥60岁)123例,对照组(<60岁)131例。2组的中位年龄分别是69岁和34岁,平均BMI分别为(23.8±6.8)kg/m^2、(23.1±4.0)kg/m^2,平均住院天数分别为(2.5±0.8)d、(3.0±1.5)d。按中国腹股沟疝分型,Ⅰ型疝18例(7.1%),Ⅱ型疝209例(82.3%),Ⅲ型疝27例(10.6%),病程中位时间2.4年。所有患者在围术期无死亡,术后共有32例出现并发症,有2例出现复发,2例出现尿潴留,10例SSI,2例出现血肿,17例出现血清肿,无慢性疼痛的病例。术后VAS评分,对照组在术后1 d和术后1个月均高于试验组,其余2组间比较差异无统计学意义,其它手术并发症2组之间差异也无统计学意义。结论在老年腹股沟疝患者中使用生物材料安全有效,其术后短期内疼痛较中青年患者更轻,但中远期的差异无统计学意义。为在合适的老年患者中逐步推广生物补片的使用提供依据。

Objective To analyze the application value and applicable conditions of biological mesh in inguinal hernia patients of different ages. Methods The clinical data of 254 cases of unilateral inguinal hernia patients treated with biological meshs in our hospital from April 2014 to March 2020 were analyzed retrospectively. Results All patients were divided into two groups according to age, including 123 cases in the experimental group(≥60 years old) and 131 cases in the control group(<60 years old). The median ages of the two groups were 69 and 34 years old, the average BMI was(23.8±6.8) kg/m^2,(23.1±4.0)kg/m^2 and the average hospital stay was(2.5±0.8) d,(3.0 ±1.5) d. According to the classification of inguinal hernia in China,18 cases(7.1%) were type Ⅰ hernia, 209 cases(82.3%) were type Ⅱ hernia, and 27 cases(10.6%) were type Ⅲ hernia. The median duration of disease was 2.4 years. No patients died during the perioperative period. Postoperative complications occurred in 32 cases, including 2 cases of recurrence, 2 cases of urinary retention, 10 cases of SSI, 2 cases of hematoma, 17 cases of seroma,and no case of chronic pain. The VAS score of the control group was higher than that of the experimental group at 1 day and 1 month after operation, and there was no significant difference between the two groups in other time;also there was no significant difference in other complications between the two groups. Conclusion The use of biological meshs in elderly patients with inguinal hernia is safe and effective. The short-term postoperative pain in elderly patients is less than that in young and middle-aged patients, but the difference in the long-term and mid-term is not statistically significant.