| 杨栋 吴晓明 刘丰 郭世伟.腹股沟疝腹腔镜下修补术与无张力修补术应用于老年患者的综合疗效研究[J].,2016,16(18):3492-3495 |
| 腹股沟疝腹腔镜下修补术与无张力修补术应用于老年患者的综合疗效研究 |
| Clinical Effect Analysis between Laparoscopic Repair and Tension FreeRepair in Elderly Inguinal Hernia Patients |
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| DOI： |
| 中文关键词: 腹股沟疝 腹腔镜下修补术 无张力修补术 老年 综合疗效 |
| 英文关键词: Inguinal hernia TEP TF Elderly Comprehensive therapy |
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| 中文摘要: |
| 目的：腹股沟疝是外科中最常见的疾病之一，手术治疗是腹股沟疝的惟一可靠方法。腹腔镜下腹股沟疝修补术，尤其是完全
腹膜外腹腔镜(Totally Extra-preperioneal Prosthetic，TEP)疝修补术，已经成为腹股沟疝治疗的“金标准”。然而，针对65岁以上老年
人群，心血管基础疾病较多，全麻风险大，TEP 术式疗效是否优于无张力疝修补术还未有报道，本研究拟探讨针对老年人腹股沟
疝修补的最佳手术方式。方法：排除两种修补术明确的禁忌症患者，对研究入组的92 例≥ 65 岁腹股沟疝老年患者，根据手术方式
（TEP 术或无张力疝修补术）进行分组，术后分别统计：(1)围手术期评价指标（手术时间、术中出血量、手术并发症、疼痛等级、离床
活动时间、住院时间及住院总费用）；(2)远期随访指标（术后2 年内的慢性疼痛和复发情况）。综合评估腹腔镜下修补术与无张力
修补术应用于老年腹股沟疝气治疗的综合疗效。结果：TEP 术相比于无张力疝术只显示出在平均减少20 mL 出血量及缓解术后
24 小时1 个AVS疼痛数量级的优势（P<0.01）；在术后下床活动时间、手术时间、术后96 小时疼痛指数、围手术期并发症、住院天
数、慢性疼痛指数及远期疗效等主要评价指标中均与无张力修补术相当（P＞0.05）；但却大大增加了手术费用（P<0.01）。结论：针
对≥ 65岁腹股沟疝老年患者，尤其是基础疾病多，对医疗费用敏感的人群，开展无张力修补术仍不失为目前最佳选择。 |
| 英文摘要: |
| Objective:Inguinal hernia is one of the most common diseases in surgery. Surgical treatment is the only reliable
method for inguinal hernia. Laparoscopic repair of inguinal hernia, especially laparoscopic totally extraperitoneal (TEP) hernia repair, has
become the gold standard for the treatment of inguinal hernia. However, the risk of general anesthesia is raised for the cardiovascular
disease patients over 65 years old, whether TEP is better than tension free (TF) hernia repair has not been reported.Methods:92 inguinal
hernia patients over 65 years old were randomly separated into two groups, TEP group and tension Free group. Respectively, two kinds of
index were used to The analysis the clinical effect: 1, perioperative period index (operation time, amount of bleeding, surgical
complications, pain level, ambulation time and hospitalization time and total hospitalization expenses); 2, the long-term follow-up index
(within 2 years after surgery in chronic pain and recurrence).Results:Both TEP group and Tension Free group showed their own
advantages. TEP group reduced 20ml bleeding volume and 1 AVS score in first 24 hours than Tension Free group(P<0.01). Tension Free
group reduced average 2000 RMB hospitalization expenses than TEP group (P<0.01). The other index, including AVS score in 96 hours,
postoperative complications, length of stay, chronic pain index and long-term efficacy showed no significant difference.Conclusion:For
elderly inguinal hernia patients, especially the patients undergoing severe underlying disease or caring the medical cost, tension-free
inguinal hernia repair method is the best choice. |
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