腹腔镜下腹股沟无张力疝修补术与Lichtenstein疝修补术治疗老年腹股沟疝的临床研究

Clinical application of laparoscopic tension-free hernioplasty and Lichtenstein hernioplasty in the treatment of elderly patients with inguinal hernia

目的比较腹腔镜下腹股沟无张力疝修补术(LTIHR)与Lichtenstein无张力疝修补术治疗老年腹股沟疝的临床疗效及安全性。方法回顾性分析2014年3月至2017年6月新疆维吾尔自治区人民医院收治的老年腹股沟疝患者251例,年龄≥60岁,其中122例患者行LTIHR术(LTIHR组),129例患者行Lichtenstein无张力疝修补术(Lichtenstein组),观察比较2组患者一般资料、术后恢复情况、术后并发症及复发等情况。结果 2组患者一般资料比较,差异无统计学意义(P>0.05)。2组患者手术时间、术前住院时间、术中出血量、下床活动时间、术后住院时间比较,差异均无统计学意义(均P>0.05);但术后24 h视觉模拟评分(VAS),LTIHR组小于Lichtenstein组,差异有统计学意义(P<0.05)。术后LTIHR组和Lichtenstein组中尿潴留、阴囊或大阴唇肿胀、切口感染、腹股沟区感觉异常情况比较,差异均无统计学意义(均P>0.05);切口血清肿、慢性疼痛(VAS>3分)分别依次为2、3和11、11例,差异有统计学意义(P<0.05)。术后随访时间为13~34个月,中位随访时间为18个月,LTIHR组和Lichtenstein组复发情况比较,差异无统计学意义(P>0.05)。结论腹腔镜下腹股沟无张力疝修补术治疗老年腹股沟疝安全有效,与Lichtenstein无张力疝修补术对比,具有术后创伤小、恢复快、术后切口血清肿发生率及术后疼痛少等优点。术前应充分结合个体情况,合理选择应用不同术式治疗腹股沟疝,以便达到更好效果。

Objective To compare the clinical efficacy and safety of laparoscopic tension-free hernioplasty(LTIHR)and Lichtenstein tension-free hernioplasty in the treatment of elderly patients with inguinal hernia.Methods A retrospective analysis was made of 251 elderly patients with inguinal hernia(aged over 60 years)admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from March 2014 to June 2017.122 patients underwent LTIHR(laparoscopic group)and 129 patients underwent Lichtenstein tension-free hernioplasty(Lichtenstein group).The baseline data,postoperative recovery,postoperative complications and recurrence of the two groups were observed and compared.Results There was no significant difference in baseline data between laparoscopic group and Lichtenstein group(P>0.05).There was no significant difference between the two groups in operation time,preoperative hospital stay, intraoperative bleeding volume, time of getting out of bed and days of hospitalization after operation (P>0.05). However, the visual analogue score (VAS) at 24 hours after operation in LTIHR group was lower than that in Lichtenstein group, and the difference was statistically significant (P<0.05). There was no significant difference between the two groups (P>0.05) in urinary retention, scrotal or labia major swelling, incision infection and groin sensory abnormality. Incision seroma and chronic pain (VAS>3) were 2, 3 cases and 11, 11 cases, respectively, and there was significant difference between the two groups (P<0.05). The follow-up time was 13 to 34 months, with median follow-up time of 18 months. There was no significant difference between the two groups in recurrence (P>0.05). Conclusion Laparoscopic tension-free inguinal hernia repair is safe and effective in the treatment of elderly inguinal hernia. Compared with Lichtenstein tension-free hernia repair, it has the advantages of less trauma, faster recovery, less incision seroma and less pain. Different surgical methods should be reasonably selected to treat inguinal hernia combined with the individual situation before operation in order to achieve better results.