开放与腹腔镜无张力疝修补术治疗老年腹股沟疝的对比研究  

Comparison of Open and Laparoscopic Techniques for Tension-free Hernia Repair for Elderly Patients with Inguinal Hernia

作　　者：刘晨[1] 张能维[1] 路夷平[1] 朱斌[1] 张展志[1] 杜德晓[1] 赵霞[1] 宫轲[1] 

机构地区：[1]北京世纪坛医院普外科,北京100038

出　　处：《中国微创外科杂志》2011年第5期406-408,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的比较开放和腹腔镜完全腹膜外无张力疝修补治疗老年腹股沟疝的疗效。方法 2006年1月～2010年1月136例老年腹股沟疝行开腹无张力填充式腹股沟疝修补术(开放组,n=72)或腹腔镜完全腹膜外腹股沟疝修补术(totally extraperitoneal hernioplasty,TEP)(TEP组,n=64),比较2种术式疗效。结果开放组手术时间(65.3±18.1)min,明显短于TEP组(78.1±12.6)min(t=4.742,P=0.000)。开放组住院费用(4960.2±1033.3)元,明显低于TEP组(6998.0±1632.2)元(t=8.796,P=0.000)。开放组术后24 h和1周疼痛评分明显高于TEP组(Z=-7.144,P=0.000;Z=-6.408,P=0.000);术后住院时间(4.9±2.4)d明显长于TEP组(3.6±1.5)d(t=-3.733,P=0.000)。136例无严重并发症。开放组72例随访8～46个月,平均15个月,其中>24个月11例;TEP组64例随访4～35个月,平均14个月,其中>24个月9例,2组均无术后复发。结论 2种术式治疗老年腹股沟疝是安全有效的。TEP疼痛轻,恢复快,应首选,尤其适用于双侧腹股沟疝修补;开放无张力疝修补术费用低,易开展,非常适用于合并有心肺疾病无法耐受全麻或CO2气腹的老年患者。Objective Tto compare the efficacy of open surgery with laparoscopy for tension-free hernia repair in elderly patients suffering from inguinal hernia. Methods Between January 2006 and January 2010,136 elderly patients diagnosed with inguinal hernia underwent open tension-free mesh-plug and patch（open group,n=72） or total extraperitoneal hernioplasty（TEP group,n=64）.We collected and compared the clinical data between the two groups.ResultsCompared to TEP group,the open group showed significantly shorter operation time,lower hospital cost,higher pain score in 24 hours and 1 week,and longer hospital stay [（65.0±18.1） min vs.（78.1±12.6） min,t=4.742,P=0.000;（4960.2±1033.3） RMB vs.（6998.0±1632.2） RMB,t=8.796,P=0.000;Z=-7.144,P=0.000 and Z=-6.408,P=0.000;（4.9 ±2.4）d vs.（3.6±1.5） d,t=-3.733,P=0.000].No severe complications were found in the patients.The open group were followed up for 8 to 46 months with a mean of 15 months（24 months in 11 cases）;and the TEP group was followed up for 4 to 35 months with a mean of 14 months（24 months in 9 cases）.None of the patients had recurrence during the period. Conclusions Both open surgery and TEP are effective for elderly patients with inguinal hernia.TEP can be the first choice,especially for bilateral inguinal hernia,for it＇s less pain and quicker recovery.Open surgery for tension-free hernia repair is less expensive,and easier to perform,and thus is especially suitable for patients with cardiopulmonary diseases that cannot tolerate general anesthesia and CO2 pneumoperitoneum.

关 键 词：腹股沟疝 无张力修补术 腹腔镜 老年患者 

分 类 号：R656.21[医药卫生—外科学]