278例老年腹股沟疝三种术式修补的疗效评估  

Effect of three repairing approaches of Shouldice,Lichtenstein and Millikan on the elderly with inguinal hernia

作　　者：陈千益 庄文侠[2] 毕玉瑛 周君 

机构地区：[1]上海市杨浦区老年医院普外科,上海市200090 [2]北华大学附属吉化总医院普外科,吉林省吉林市132021

出　　处：《实用老年医学》2010年第5期396-399,共4页Practical Geriatrics

摘　　要：目的对老年腹股沟疝采用不同手术方式治疗,探讨Shouldice术、Lichtenstein术、Millikan术后个体化的疗效。方法对2004年6月至2009年6月已手术的278例老年人腹股沟疝的临床资料及随访结果进行回顾性分析。根据不同手术方式分为Shouldice组(n=82)、Lichtenstein组(n=95)、Millikan组(n=101)。对术前急性生理及慢性健康评估系统(APACHEⅡ)评分、手术时间、术后急性疼痛程度及慢性疼痛、局部肿胀恢复时间、下床活动时间、异物感、感染、复发情况进行统计学分析。结果平均随访时间(20.3±15.6)月。(1)3组术前APACHEⅡ评分有显著差异(P<0.05),术中根据疝分型选择术式,Lichtenstein组和Millikan组分值高,疝分型程度重;(2)Lichtenstein组和Millikan组手术时间短、术后急性疼痛程度轻、下床活动早、局部肿胀恢复快、复发率低,但可能存在局部感染、异物感及慢性疼痛,差异有显著性(P<0.05)。结论Lichtenstein术和Millikan术治疗老年腹股沟疝优势明显,效果好、恢复快、禁忌证少、易于操作、复发率极低;可能存在感染、异物感及慢性疼痛。采用更新型材料及术中疝分型个体化无张力疝修补术效果更佳。Objective To explore the individual curative effect by using Shouldice,Lichtenstein and Millikan approaches for inguinal hernia in the elderly.Methods The clinical data and follow-up of 278 elderly patients with inguinal hernia from June 2004 to June 2009 were retrospectively analyzed.According to the different operation methods,patients were divided into three groups：Shouldice group（n=82）,Lichtenstein group（n=95）,Millikan group（n=101）.Preoperative APACHE Ⅱ score,operation time,acute pain and chronic pain,local swelling,ambulation time,foreign body sensation,infection,recurrence after operation were observed and analyzed.Results The average follow-up time was （20.3±15.6） months.（1）Preoperative APACHE Ⅱ score was significantly different among the three groups（P0.05）.Surgery type was selected according to type of hernia.The score of APACHE Ⅱ was high and the type of intraoperative hernia was severe in Lichtenstein group and Millikan group.（2）Compared with Shouldice group,there were significant differences in operation time and acute pain,getting out of bed,local swelling recovery,recurrence rate after operation in Lichtenstein group and Milikan group（P0.05）.But there might be local infection,foreign body sensation and chronic pain,and the differences were significant （P0.05）.Conclusions Lichtenstein and Millikan operation treatment for elderly inguinal hernia have obvious advantages,such as being effective,rapid recovery,fewer contraindications,being easy to operate and the very low recurrence ratio,but there may be infection,foreign body sensation and chronic pain.It is much better using updated materials and intraoperative individualized typing and tension-free hernia repair in elderly patients with inguinal hernia.

关 键 词：腹股沟疝 老年人 不同术式 疗效 

分 类 号：R656.21[医药卫生—外科学]