疝环充填式无张力疝修补术在老年腹股沟疝中的应用效果分析

Effect of application of mesh plug hernia repair in the treatment of elderly inguinal hernia

目的探讨疝环充填式无张力疝修补术在老年腹股沟疝治疗中的应用价值。方法选取2016年11月至2018年2月,三亚市人民医院接受治疗的老年腹股沟疝患者82例,按随机数字表法将患者分为试验组和对照组,每组41例。对照组行Lichtenstein无张力疝修补术,试验组行疝环充填式无张力疝修补术。比较2组手术相关指标、术后不同时间疼痛程度、术后第1天血清β-内啡肽(β-EP)水平,记录2组并发症及复发情况。结果 82例患者顺利完成手术及随访,随访率100%,平均随访时间为(12.45±1.14)个月。相较于对照组,试验组术后伤口疼痛持续时间明显缩短(P<0.05),2组手术时间、术中出血量、自主活动时间及住院时间无明显差异(P>0.05)。术后2 h 2组VAS评分均最低,术后2 h至7 d 2组患者VAS评分均先升高后降低,且术后12 h及3 d试验组VAS评分均明显低于对照组(P<0.05)。术后第1天,试验组血清β-EP水平明显低于对照组(P<0.05)。试验组术后急性疼痛发生率明显低于对照组。对照组疝复发1例,试验组无疝复发病例。结论疝环充填式无张力疝修补术对老年腹股沟疝患者产生的应激反应更小,可降低术后疼痛程度,并发症少,安全性高。

Objective To study the application value of mesh plug tension-free hernia repair in the treatment of elderly inguinal hernia.Methods 82 elderly patients with inguinal hernia who were treated in the Sanya People's Hospital from November 2016 to February 2018 were selected and divided into the experiment group and the control group according to random number table method,with 41 cases in each group.The control group underwent Lichtenstein tension-free hernia repair,and the experiment group underwent mesh plug tension-free hernia repair.The surgical related indexes,degree of pain at different time after operation and the level of serumβ-endorphin(β-EP)on the 1st day after the operation were compared between the 2 groups,and the complications and recurrence of the 2 groups were recorded.Results All patients successfully completed the operation and follow-up.Compared with the control group,the autonomic activity time of the experiment group significantly advanced,and the duration of wound pain significantly shortened(P<0.05),while there was no significant difference in the operation time,intraoperative blood loss,the autonomic activity time and hospitalization time between the two groups(P>0.05).The VAS scores of the 2 groups were the lowest at 2 hours after operation,and the VAS scores of the 2 groups increased first and then decreased from 2 hours to 7 days after operation,the VAS scores of the experiment group were significantly lower than the control group at 12 hours and 3 days after operation(P<0.05).The level of serumβ-EP on 1st day after the operation in the experiment group was significantly lower than that in the control group(P<0.05).The incidence of acute pain in the experiment group was significantly lower than that in the control group(P<0.05).There was 1 case of recurrence in the control group,and none in the experiment group during the follow-up of 12 months.Conclusion The mesh plug tension-free hernia repair has less stress response to elderly patients with inguinal hernia.It can reduce postoperative pain,has less complications and high safety.