老年腹股沟疝以不同疝修补术治疗的效果观察
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摘要
目的分析腹沟股疝老年患者分别以开放式无张力腹股沟疝修补术(Millikan)、腹腔镜完全腹膜外腹股沟疝修补术(TEP)治疗的有效性、安全性。方法选取2013年9月～2016年8月期间我院收治的298例腹股沟疝老年患者为观察对象,按数字表法随机分为观察A组148例(行Millikan治疗)和观察B组150例(行TEP治疗),观察不同术式手术及术后恢复情况,统计两组并发症发生,组间比较患者胃肠道动力指标差异,门诊随访2年,记录疾病复发情况。结果观察B组患者较观察A组出血量少、术后疼痛弱、下床用时短,且肛门排气、术后进食、肠鸣音恢复用时短、术后并发症少(P<0.05);观察A组手术时间短于观察B组(P<0.05);两组复发率比较无差异(P>0.05)。结论腹股沟疝老年者以Millikan、TEP治疗均能有效改善症状,避免疝复发,且TEP治疗患者术后并发症少、胃肠道动力恢复快、术中出血量少。
Objective To evaluate the efficacy and safety of open-type tension-free inguinal hernia repair(Millikan and laparoscopic totally extraperitoneal prosthetic(TEP) in elderly patients with inguinal hernia. Methods A total of 298 elderly patients with inguinal hernia admitted in our hospital from September 2013 to August 2016 were randomly divided into two groups: group A(n=148) treated with group B(n=150) treated with TEP. Different surgical procedures and postoperative recovery were observed. The complications of the two groups were counted. The differences in gastrointestinal motility indexes were compared between the groups. All patients were followed up for 2 years. And the disease recurrence was recorded. Results The patients in group B had less bleeding, less postoperative pain, shorter time to get out of bed, and the shorter time of anal exhaust, postoperative feeding, bowel sound recovery, and less postoperative complications compared with group A(P<0.05). The operation time of group A was shorter than that of group B(P<0.05). There was no difference in recurrence rate between the two groups(P>0.05). Conclusions In elderly patients with inguinal hernia, the treatment with Millikan and TEP can effectively improve symptoms and avoid recurrence of hernia. Patients with TEP have fewer postoperative complications, faster gastrointestinal motility recovery, and less intraoperative blood loss.
Objective To evaluate the efficacy and safety of open-type tension-free inguinal hernia repair(Millikan and laparoscopic totally extraperitoneal prosthetic(TEP) in elderly patients with inguinal hernia. Methods A total of 298 elderly patients with inguinal hernia admitted in our hospital from September 2013 to August 2016 were randomly divided into two groups: group A(n=148) treated with group B(n=150) treated with TEP. Different surgical procedures and postoperative recovery were observed. The complications of the two groups were counted. The differences in gastrointestinal motility indexes were compared between the groups. All patients were followed up for 2 years. And the disease recurrence was recorded. Results The patients in group B had less bleeding, less postoperative pain, shorter time to get out of bed, and the shorter time of anal exhaust, postoperative feeding, bowel sound recovery, and less postoperative complications compared with group A(P<0.05). The operation time of group A was shorter than that of group B(P<0.05). There was no difference in recurrence rate between the two groups(P>0.05). Conclusions In elderly patients with inguinal hernia, the treatment with Millikan and TEP can effectively improve symptoms and avoid recurrence of hernia. Patients with TEP have fewer postoperative complications, faster gastrointestinal motility recovery, and less intraoperative blood loss.
引文
[1]王刚,沈根海,高泉根,等.腹腔镜完全腹膜外腹股沟疝修补术与开放无张力腹股沟疝修补术治疗老年腹股沟疝的临床效果[J].中国老年学杂志,2018,38(7):1646-1648.
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[8]艾万朝,周旭坤,张成建,等.腹腔镜下腹股沟疝修补术与开放式无张力疝修补术的临床对比分析[J].中华疝和腹壁外科杂志(电子版),2016,10(4):270-272.
[9]王向征.成人腹腔镜疝修补术与无张力疝修补术的疗效对比分析[J].腹腔镜外科杂志,2018,23(3):221-224.
[10]高亚超,胡志,王卓.腹腔镜下全腹膜外腹股沟疝修补术与经腹腔腹膜前腹股沟疝修补术的疗效比较[J].中华普通外科学文献(电子版),2018,12(3):204-207,211.
[11]智永宏,郝永胜,霍瑞麟.腹腔镜经腹腹膜前疝修补术与开放式腹膜前间隙疝修补术的临床疗效[J].中华疝和腹壁外科杂志(电子版),2018,12(4):293-296.
[12]孙雪峰.腹膜外腹腔镜疝气修补术与传统疝修补术治疗腹股沟疝的疗效对比分析[J].河北医科大学学报,2015,36(6):703-705.
[13]党铁成.腹腔镜疝修补术治疗成人腹股沟疝效果分析[J].河南外科学杂志,2017,23(4):81-82.
[14]车长才.无张力疝修补术与传统疝修补术治疗老年腹股沟疝的效果比较[J].中国当代医药,2015,22(27):39-41,44.
[15]王桐生,丁磊,赵爱民,等.腹腔镜下全腹膜外腹股沟疝修补术与经正中线切口腹膜前腹股沟疝修补术的比较研究[J].中国微创外科杂志,2016,16(2):118-121.
[2]金哲敏,童伟民.改良腹腔镜全腹膜外疝修补术治疗腹股沟疝疗效[J].中国内镜杂志,2015,21(5):513-516.
[3]严林,修风民,刘新峰,等.腹腔镜经腹腹膜前疝修补术与开放无张力疝修补术治疗腹股沟疝临床比较[J].临床医学,2016,36(8):11-13.
[4]中国医师协会外科医师分会疝和腹壁外科医师委员会.成人腹股沟疝诊疗指南(2014年版)[J].浙江医学,2014,52(15):1285-1287.
[5]杜向阳,李新艳,李本勇.腹腔镜疝修补术与开放无张力疝修补术应用于腹股沟疝的疗效比较[J].中西医结合心血管病电子杂志,2017,5(27):181,184.
[6]张小兵,张丽,唐世龙,等.开放完全腹膜外腹股沟疝修补术治疗成人腹股沟疝89例临床分析[J].中华实用诊断与治疗杂志,2013,27(2):197-199.
[7]辜树勇,沈映玲,郑宗珩. TEP与开放式无张力疝修补术用于成人腹股沟疝的疗效对比分析[J].中国现代普通外科进展,2015,18(6):481-483.
[8]艾万朝,周旭坤,张成建,等.腹腔镜下腹股沟疝修补术与开放式无张力疝修补术的临床对比分析[J].中华疝和腹壁外科杂志(电子版),2016,10(4):270-272.
[9]王向征.成人腹腔镜疝修补术与无张力疝修补术的疗效对比分析[J].腹腔镜外科杂志,2018,23(3):221-224.
[10]高亚超,胡志,王卓.腹腔镜下全腹膜外腹股沟疝修补术与经腹腔腹膜前腹股沟疝修补术的疗效比较[J].中华普通外科学文献(电子版),2018,12(3):204-207,211.
[11]智永宏,郝永胜,霍瑞麟.腹腔镜经腹腹膜前疝修补术与开放式腹膜前间隙疝修补术的临床疗效[J].中华疝和腹壁外科杂志(电子版),2018,12(4):293-296.
[12]孙雪峰.腹膜外腹腔镜疝气修补术与传统疝修补术治疗腹股沟疝的疗效对比分析[J].河北医科大学学报,2015,36(6):703-705.
[13]党铁成.腹腔镜疝修补术治疗成人腹股沟疝效果分析[J].河南外科学杂志,2017,23(4):81-82.
[14]车长才.无张力疝修补术与传统疝修补术治疗老年腹股沟疝的效果比较[J].中国当代医药,2015,22(27):39-41,44.
[15]王桐生,丁磊,赵爱民,等.腹腔镜下全腹膜外腹股沟疝修补术与经正中线切口腹膜前腹股沟疝修补术的比较研究[J].中国微创外科杂志,2016,16(2):118-121.