老年腹股沟疝手术方式选择及安全性分析

Surgical approach selection and safety analysis for elderly patients with inguinal hernia

背景与目的:腹股沟疝是外科常见疾病,其中老年患者是接受腹股沟疝修补术的主要群体。然而,对于老年腹股沟疝患者选择何种手术方式目前尚无定论。局麻Lichtenstein术难度低、效果好、术后愈合较快,在临床中运用广泛。腹腔镜下腹股沟疝无张力修补术因其视野开阔、可发现对侧隐匿疝、可同时处理双侧疝等优势而被越来越多外科医生接受和推荐。本文主要对接受局麻开放疝修补术或全麻腔镜疝修补术的老年患者临床数据进行分析,以期为临床提供一定参考。方法:通过电话随访和病历系统搜集资料,回顾性分析东南大学附属中大医院2019年1月—2021年12月期间130例行腹股沟疝修补手术老年患者(>60岁)的临床资料,其中开放Lichtenstein术67例(开放组),腔镜疝修补术63例(腹腔镜组)。比较两组患者的基线资料及手术相关指标。结果:基线资料分析结果显示,开放组患者平均年龄大于腹腔镜组(78.94岁vs.71.83岁),术前麻醉风险比例、各种合并症比例以及双侧疝发病率均高于腹腔镜组(均P<0.05);其余基线指标在两组间差异无统计学意义(均P>0.05)。手术相关指标分析结果显示,腹腔镜组术后住院时间较开放组缩短(1.51 d vs.2.16 d)、术后1 d疼痛评分低于开放组(2.70 vs.3.58)(均P<0.05);两组间术后各并发症(切口感染、血肿、血清肿、神经感觉异常、尿潴留)发生率、1年复发率、长期疼痛(>3个月)等指标差异均无统计学意义(均P>0.05)。结论:在老年患者中,疝侧、麻醉风险分级、术前合并症均是临床医师选择手术方式时需要评估的内容。经过充分的术前评估后,选择行腔镜手术是安全的。

Background and Aims:Inguinal hernia is a common surgical condition,with elderly individuals being the primary population undergoing inguinal hernia repair.However,there is currently no consensus on the choice of surgical approach for elderly inguinal hernia patients.Local anesthesia Lichtenstein repair is characterized by low difficulty,good outcomes,and faster postoperative recovery and is widely used in clinical practice.Laparoscopic tension-free inguinal hernia repair is increasingly accepted and recommended by surgeons due to its advantages such as a wide field of vision,and the ability to detect contralateral occult hernia and to simultaneously repair a bilateral hernia.This study was performed to analyze the clinical data of elderly patients undergoing local anesthesia open hernia repair or general anesthesia laparoscopic hernia repair,so as to provide guidance for clinical practice.Methods:The clinical data of 130 elderly patients(>60 years old)who underwent inguinal hernia repair in Zhongda Hospital Affiliated with Southeast University from January 2019 to December 2021 were collected through telephone follow-up and medical record system and retrospectively analyzed.Among them,67 cases underwent open Lichtenstein surgery(open surgery group),and 63 cases underwent laparoscopic hernia repair surgery(laparoscopic group).Baseline data and surgery-related variables were compared between the two groups.Results:The analysis of baseline data showed that the average age of patients in the open surgery group was higher than that in the laparoscopic group(78.94 years vs.71.83 years),and the proportion of cases with high anesthesia risk,the proportion of cases with different comorbidities,and the rate of bilateral hernia were all higher in the open group than those in the laparoscopic group(all P<0.05);the remaining baseline variables showed no statistically significant differences between the two groups(all P>0.05).Analysis of surgery-related variables showed that the length of postoperative hospital stay was shorter(1.51 d vs.2.16 d),and the pain score on postoperative day 1 was lower in the laparoscopic group(2.70 vs.3.58)than those in the open surgery group(both P<0.05);there were no statistically significant differences between the two groups in terms of postoperative complications(incision infection,hematoma,seroma,nerve sensory abnormalities,urinary retention),one-year recurrence rate,and longterm pain(>3 months)(all P>0.05).Conclusion:In elderly patients,the hernia side,anesthesia risk classification,and preoperative comorbidities are factors that clinical physicians need to assess when choosing a surgical approach.After comprehensive preoperative assessment,laparoscopic surgery is a safe option.