日间手术模式下合理开展老年腹股沟疝TAPP安全性及可行性分析  

Analysis of the safety and feasibility carrying out TAPP for elderly inguinal hernia reasonablely under day surgery

作　　者：胡小忍 安伟德[1] 徐雪东[1] 张伟国[1] 王嘉[1] 陈瑶[1] 王景超 向甫 Hu Xiaoren;An Weide;Xu Xuedong;Zhang Weiguo;Wang Jia;Chen Yao;Wang Jingchao;Xiang Fu(Hernia and Abdominal Wall Surgery,The First Affiliated Hospital of Dalian Medical University,Dalian 116600,China)

机构地区：[1]大连医科大学附属第一医院疝与腹壁外科,辽宁省116600

出　　处：《中华疝和腹壁外科杂志（电子版）》2020年第4期403-407,共5页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的评价日间手术模式下老年腹股沟疝行腹腔镜经腹腹膜前疝修补术(TAPP)安全性及可行性。方法回顾性分析2017年1月至2019年1月,大连医科大学附属第一医院疝与腹壁外科诊治中心收治的167例腹股沟疝患者的临床资料。根据入院方式及年龄不同分成3组:日间手术老年组、日间手术青中年组及普通住院手术老年组。分别比较日间手术老年组与普通住院手术老年组、日间手术老年组与日间手术青中年组术中术后各项指标。采用SPSS20.0软件进行数据分析。结果日间手术老年组与普通住院手术老年组一般情况比较,差异无统计学意义(P>0.05);日间手术老年组与日间手术青中年组一般情况比较,差异无统计学意义(P>0.05)。日间手术老年组与普通住院手术老年组手术时间、术中出血量、横断疝囊情况比较,差异无统计学意义(P>0.05);日间手术老年组与日间手术青中年组手术时间、术中出血量、横断疝囊情况比较,差异无统计学意义(P>0.05)。对比普通住院手术老年组,日间手术老年组住院时间、术后住院时间及住院费用明显减少(P<0.05),尿潴留、异物感、术后慢性疼痛等无显著差异(P>0.05);对比日间手术青中年组,日间手术老年组住院时间、术后住院时间明显增加(P<0.05),术后24 h疼痛评分、慢性疼痛发生率明显降低(P<0.05),尿潴留、异物感、住院费用等无显著差异(P>0.05)。结论日间手术模式下合理开展老年腹股沟疝TAPP安全可行,能够缩短住院时间,减少住院费用,为社区医疗及全科医学的发展提供了新的可能,值得临床应用和推广。Objective To evaluate the safety and feasibility in carrying out laparoscopic transabdominal preperitoneal hernia repair(TAPP)for elderly inguinal hernia under day surgery.Methods The clinical data of 167 patients with inguinal hernia admitted to the First Affiliated Hospital of Dalian Medical University from January 2017 to January 2019 were analyzed retrospectively.They were divided into three groups according to the admission method and age:the elderly group under day surgery,the young and middle-aged group under day surgery,the elderly group under conventional hospital surgery.The measurement data conform to the normal distribution using t test,otherwise use Non-parametric test.Count data was tested by chi-square test.P<0.05 was statistically different.Results The three groups of patients had no significant differences in general information,operation time,intraoperative blood loss,and hernia sac management,and were comparable(P>0.05).Compared with the elderly group under conventional hospital surgery,the hospitalization days,postoperative hospitalization days and hospitalization expenses in the elderly group under day surgery were significantly decreased(P<0.05).There was no significant difference in urine retention,foreign body sensation and postoperative chronic pain(P>0.05).Compared with the young and middle-aged group under day surgery,the hospitalization days and postoperative hospitalization days of the elderly group under day surgery were significantly increased(P<0.05).The 24-hour pain score after surgery and the incidence of chronic pain decreased significantly(P<0.05).There was no significant difference in urinary retention,foreign body sensation and hospitalization expenses(P>0.05).Conclusion It is safe and feasible to carry out TAPP reasonably in elderly patients with inguinal hernia under day surgery,which can shorten the length of stay and reduce the cost of hospitalization,and provide a new possibility for the development of community medicine and general medicine.And it is worthy of clinical

关 键 词：疝 腹股沟 日间手术 疝修补术 老年人 

分 类 号：R656.21[医药卫生—外科学]