无张力疝修补术治疗老年腹股沟疝患者的临床效果及术后发生深静脉血栓的危险因素分析

Clinical Effect of Tension-free Hernioplasty in Elderly Patients with Inguinal Hernia and the Risk Factors of Postoperative Deep Vein Thrombosis

目的探讨老年腹股沟疝(IH)患者采用无张力疝修补术治疗的临床效果,并分析术后发生深静脉血栓(DVT)的危险因素。方法选取信阳市第三人民医院2018年1月至2022年1月期间收治的92例老年IH患者,均接受无张力疝修补术治疗,统计围手术期指标、DVT发生率,进行单因素分析与多因素Logistic回归分析以明确老年IH患者无张力疝修补术后发生DVT的危险因素。结果92例老年IH患者手术时间为(45.82±5.94)min、术中出血量为(33.49±6.21)mL、术后肛门排气时间为(28.16±3.78)h,住院时间为(5.73±0.96)d,其中有17例(18.48%)患者发生DVT设为发生DVT组,剩余术后未发生DVT的72例患者为未发生DVT组。发生DVT组年龄≥70岁、BMI≥25 kg/m^(2)、合并高血压、合并静脉曲张、术后下床活动时间≥36 h、住院时间≥4 d占比大于未发生DVT组,差异有统计学意义(P<0.05)。多因素Logistic分析发现,年龄≥70岁(OR=2.793)、BMI≥25 kg/m^(2)(OR=2.906)、合并高血压(OR=3.417)、合并静脉曲张(OR=3.8291)、术后下床活动时间≥36 h(OR=3.256)、住院时间≥4 d(OR=2.948)是影响老年IH患者无张力疝修补术后发生DVT的独立危险因素,差异有统计学意义(P<0.05)。结论无张力疝修补术用于治疗老年IH的临床效果较好,但术后易发生DVT,其与年龄、BMI、合并高血压、合并静脉曲张、术后下床活动时间、住院时间密切相关。

Objective To explore the clinical effect of tension-free hernioplasty treatment for elderly patients with inguinal hernia(IH),and analyze the risk factors of postoperative deep vein thrombosis(DVT).Methods A total of 92 elderly IH patients who were admitted in Xinyang Third People's Hospital from January 2018 to January 2022 were selected,all of whom received tension-free hernia repair surgery,perioperative indicators and the incidence of DVT were analyzed.Univariate analysis and logistic multivariate regression analysis were conducted to identify the risk factors for DVT after tension-free hernia repair in elderly inguinal hernia patients.Results The operative time of 92 elderly patients with IH was(45.82±5.94)min,the amount of intraoperative blood loss was(33.49±6.21)mL,the postoperative anal exhaust time was(28.16±3.78)h,and the length of hospital stay was(5.73±0.96)d.Among them,17(18.48%)patients with DVT were set as the DVT group,and the remaining 72 patients without DVT were set as the non-DVT group.The proportion of patients with age≥70 years old,BMI≥25 kg/m^(2),combined hypertension,combined varicose veins,postoperative ambulatory time≥36 hours,and hospitalization time≥4 days in the DVT group were higher than the without DVT group,and the difference was statistically significant(P<0.05).The results of logistic multivariate analysis showed that age≥70 years old(OR=2.793),BMI≥25 kg/m^(2)(OR=2.906),concomitant hypertension(OR=3.417),concomitant varicose veins(OR=3.8291),postoperative ambulatory time≥36 hours(OR=3.256),and hospitalization time≥4 days(OR=2.948)were independent risk factors for DVT in elderly IH patients after tension-free hernioplasty,and the difference was statistically significant(P<0.05).Conclusion Tension-free hernioplasty has a good clinical effect in the treatment of elderly IH,but it is prone to postoperative DVT,which is closely related to age,BMI,concomitant hypertension,varicose veins,postoperative ambulatory time,and hospital stay.