无张力疝修补术在老年人腹壁疝中的应用

Application of surgical treatment for ventral hernia in the elderly

目的 分析老年人腹壁疝的特点和疝环充填式无张力疝修补术治疗的效果。 方法 回顾性分析我院 1999年 1月至 2 0 0 1年 12月收治的 2 0 7例接受疝环充填式无张力疝修补术的老年腹壁疝病例。 结果 2 0 7例 6 0～ 90岁老年腹壁疝患者 ,均采用疝环充填式无张力疝修补术。其中斜疝 14 4例 ,直疝 38例 ,斜疝伴直疝 11例 ,滑疝 6例 ,切口疝 6例 ,股疝 1例 ,直疝伴股疝 1例。疝环大小 0 8～ 6 5cm ,平均 (3 3± 1 0 )cm ,疝环直径≥ 5cm者有 2 0例。手术并发症 :尿潴留 8例 ,皮下出血 4例 ,阴囊水肿 1例 ,切口感染 1例。随访 4～ 4 0个月 ,187例获随访 ,术后无复发。 结论 疝环充填式无张力疝修补术具有手术创伤小、术后恢复快、疼痛轻、复发率低等优点 ,是目前较为理想的疝修补方法 ,尤其适合于治疗老年人腹壁疝 ;同时重视老年患者并存症的处理 ,对减少术后并发症十分重要。

Objective To assess the characteristics of abdominal hernia and summarize the therapeutic efficacy of mesh plug tension-free hernioplasty in elderly ventral hernia. Methods All 207 elderly patients with abdominal hernia who were admitted to our hospital during January 1999 to December 2001 and received the mesh plug tension-free hernioplasty were analyzed retrospectively. Results There were 405 patients receiving the mesh plug tension-free hernioplasty from 1999 to 2001, in whom 207 had elderly ventral hermia. Among the 207 elderly patients, 144 had inguinal oblique hernia, 38 direct hernia, 11 direct and indirect hernia, 6 sliding hernia, 6 incisional hernia, 1 femoral hernia, and 1 femoral and inguinal direct hernia. Postoperative complications were urinary retention(8 cases), hypoincisional hematoma(4), scrotal hydroceles(1), and incisional infection (1). One hundred eithty-seven patients were followed-up for 4-40 months and no recurrence was found. Conclusions The mesh plug tension-free hernioplasty is of advantages for elderly abdominal hernia, such as simpleness in performance and a good therapeutic effect. It is especially suitable for the elderly patients due to less trauma and low recurrence rate. It is also important to pay attention to the postoperative complications to the elderly.