青年腹股沟疝临床特点及腹腔镜手术治疗疗效分析

Analysis of the clinical characteristics and laparoscopic treatment efficacy of inguinal hernia in young patients

目的分析青年腹股沟疝病人的临床特点,探讨腹腔镜手术治疗策略及疗效。方法对2001年1月至2018年12月间在上海交通大学医学院附属瑞金医院普外科行腹腔镜腹股沟疝修补术(LIHR)6220例(7415侧)病人进行回顾性同期非随机对照研究。其中,青年组(18~44岁)804例(860侧),中年组(45~64岁)1976例(2323侧),老年组(≥65岁)3440例(4232侧)。结果与中老年组相比,青年组病人的病程时间长、女性比例高、单侧疝比例高、腹部手术史少、体重指数低(P=0.000)。青年组的斜疝比例高,直疝、复合疝、复发疝、IV型疝比例低(P=0.000)。青年组的经腹腹膜前修补术(TAPP)和轻量大网孔补片比例高(P=0.000)。青年组的手术时间长(P=0.000),术后住院时间短(P=0.000)。青年组和中老年组在术后第1天疼痛分数、术后2周恢复非限制性活动方面差异无统计学意义(P>0.05)。青年组有1例复发,中老年组有13例复发,差异无统计学意义(P>0.05)。青年组无严重并发症(需要手术干预)发生,尿潴留发生率低(P=0.000),其他普通并发症(如血清肿、暂时性神经感觉异常和肠麻痹)与中老年组相比差异无统计学意义(P>0.05)。结论青年腹股沟疝病人以斜疝为主,病程较长,合并症较多,LIHR是安全有效的手术方式。术式选择取决于术者的临床经验。青年疝病人建议选择轻量大网孔补片,复杂病人推荐行TAPP。

Objective We analyzed the clinical characteristics of inguinal hernias in young patients and investigated the laparoscopic treatment strategy and efficacy.Methods A retrospective contemporaneous non-randomized controlled study was performed on the clinical data of 6,220 patients(7,415 hernias) who underwent laparoscopic inguinal hernia repair(LIHR) in general surgery of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between Jan. 2001 and Dec. 2018. The young group(18-44 yo) included 804 cases(860 hernias), the middle-aged group(45-64 yo) included 1976 cases(2323 hernias), and the elderly group(≥ 65 yo) included 3440 cases(4232 hernias).Results The young group has a longer history, more female patients, more unilateral hernias, less abdominal surgery history, less BMI(P=0.000) when compared with the middle-aged and elderly group. There are more indirect hernias and fewer Type IV hernias in the young group, while more direct, combined, and recurrent hernias in the middle-aged and elderly groups(P=0.000). TAPP and light-weighted meshes with large pores are more frequently applied in young patients(P=0.000). The young group witnessed more operating time(P=0.000) but less time of hospital stay(P=0.000)than the middle-aged and elderly groups. Young patients suffered less urine retention than the elderly ones(P=0.000).There are no significant differences in pain score by the first post-operation day and return to nonrestricted activities by two weeks after surgery, as well as the rates of seroma, transient paresthesia, and paralytic ileus(P>0.05). One case of the young group and 13 cases of the middle-aged and elderly groups encountered recurrence, which showed no significant difference(P>0.05).Conclusion The majority hernias in young patients are indirect ones with long disease history and frequently with concomitant diseases. LIHR is a safe and effective procedure. The selection of procedures depends on the surgeon’s experiences. It is recommended to apply light-weighted meshes with large pores for hernias in young patients, and TAPP for complicated patients.