腹腔镜腹股沟疝修补术治疗老年腹股沟疝的临床疗效  

Clinical efficacy of laparoscopic inguinal hernia repair in elderly patients

作　　者：张云[1] 郝晓晖[2] 李健文[2] 龚航军[1] 冯波[1] 乐飞[1] 薛佩[1] 

机构地区：[1]上海中医药大学附属曙光医院胃肠外科,201203 [2]上海交通大学医学院附属瑞金医院普通外科上海市微创外科临床医学中心,200025

出　　处：《中华消化外科杂志》2016年第10期967-971,共5页Chinese Journal of Digestive Surgery

基　　金：吴阶平医学基金会临床科研专项（320.6750.14321）

摘　　要：目的：探讨腹腔镜腹股沟疝修补术（LIHR）治疗老年腹股沟疝的临床疗效。方法：采用回顾性队列研究方法。收集2001年1月至2013年12月上海交通大学医学院附属瑞金医院收治的3 203例腹股沟疝患者3 847侧疝的临床资料。979例（1 107侧）年龄〈60岁的腹股沟疝患者设为〈60岁组，2 224例（2 740侧）年龄≥60岁的腹股沟疝患者设为≥60岁组。手术由同一组医师完成，手术方式由术者根据患者的具体情况选择：经腹腹膜前修补术（TAPP）、全腹膜外修补术（TEP）、腹腔内修补术（IPOM）。补片类型分为轻量型和重量型。观察指标：（1）总体手术情况。（2）两组患者的手术情况比较。（3）两组患者的术后指标比较。（4）随访情况。采用门诊、电话等方式进行随访。随访内容为恢复非限制性活动时间、疝复发和并发症情况。随访最终点为术后5年。正态分布的计量资料以±s表示，组间比较采用t检验。计数资料比较采用χ2检验或Fisher确切概率法。等级资料比较采用非参数秩和检验。结果：（1）总体手术情况：3 203例腹股沟疝患者（3 847侧疝）均行LIHR，其中TAPP 1 475例（1 677侧）；TEP 1 718例（2 154侧）；IPOM 10例（16侧），其中6例一侧行TAPP，对侧行IPOM。2 206侧疝采用轻量型补片，1 641侧疝采用重量型补片。3 203例腹股沟疝患者手术时间为（31±12）min，其中2 559例单侧疝手术时间为（27±9）min，644例双侧疝手术时间为（44±12）min。3 203例腹股沟疝患者术后住院时间为（1.5±1.2）d。 （2）两组 患者的手术情况比较：〈60岁组腹股沟疝患者中，采用手术方式TAPP、TEP、IPOM分别为567、538、2侧， ≥60岁组分别为1 110、1 616、14侧；〈60岁组采用轻量型和重量型补片分别为751侧和356侧，≥60岁组分别为1 455侧和1 285侧，两组患者上述指标比较，差异均有统计学意义（χ2=37.976�Objective：To explore the clinical efficacy of laparoscopic inguinal hernia repair （LIHR） in elderly patients. Methods：The retrospective cohort study was adopted. The clinical data of 3 203 patients with inguinal hernias （3 847 sides） who were admitted to the Ruijin Hospital of Shanghai Jiaotong University School of Medicine between January 2001 and December 2013 were collected. Of 3 203 patients, 979 （1 107 sides） with age〈60 years and 2 224 （2 740 sides） with age≥60 years were respectively allocated into the under 60 years group and 60 years or older group. The surgical procedures including transabdominal preperitoneal （TAPP） approach, total extraperitoneal （TEP） approach and intraperitoneal onlay mesh （IPOM） approach were selected and performed by doctors in the same team. There were lightweight and heavyweight patches. Observation indicators included （1） overall operation situations, （2） surgical comparison between the 2 groups, （3） comparison of postoperative indicators between the 2 groups, （4） followup. Followup using telephone interview and outpatient examination was performed to detect the recovery time of nonrestricted activity, recurrence of hernia and complications. Measurement data with normal distribution were represented as ±s and comparison between groups was done by the t test. Comparisons of count data were analyzed using the chisquare test or Fisher exact probability. Ranked data were compared by the nonparametric rank sum test. Results：（1） Overall operation situations： 3 203 patients with inguinal hernias （3 847 sides） underwent LIHR, including 1 475 （1 677 sides） using TAPP approach, 1 718 （2 154 sides） using TEP approach and 10 （16 sides） using IPOM approach （6 using TAPP and IOPM approaches in each side）. The lightweight patch was used in 2 206 sides and heavyweight patch was used in 1 641 sides. Operation time was （31±12）minutes in all 3 203 patients, （27±9）minutes in 2 559 patients with unilateral

关 键 词：腹股沟疝 疝修补术 腹腔镜检查 

分 类 号：R656.21[医药卫生—外科学]