腹腔镜联合腹壁小切口疝回纳修补术对老年腹股沟疝伴疝环粘连的治疗效果  

Effect of Laparoscopic Ventral and Incisional Hernia Repair in the Treatment of Senile Inguinal Hernia with Hernia Ring Adhesion

作　　者：仲任 吴岑 高志慧 蔡兵 ZHONG Ren;WU Cen;GAO Zhihui;CAI Bing(Department of General Surgery,Rudong Hospital Affiliated to Nantong University,Nantong,Jiangsu 226400,China;Department of General Surgery,Wuxi People's Hospital Affiliated to Nanjing Medical University Wuxi People's Hospital,Wuxi,Jiangsu 214000,China)

机构地区：[1]南通大学附属如东医院普外科,江苏南通226400 [2]南京医科大学附属无锡人民医院无锡市人民医院普外科,江苏无锡214000

出　　处：《临床误诊误治》2023年第9期58-62,共5页Clinical Misdiagnosis & Mistherapy

基　　金：江苏省自然科学基金项目(200818JS311);南通市卫生健康委员会科研课题(QB2021040、MSZ2022088)。

摘　　要：目的 探讨腹腔镜联合腹壁小切口疝回纳修补术对老年腹股沟疝伴疝环粘连的治疗效果。方法 选取2020年1月—2022年8月收治的100例老年腹股沟疝伴疝环粘连为研究对象,按手术方式不同分为对照组和观察组,每组50例。对照组行开放手术,观察组行腹腔镜联合腹壁小切口疝回纳修补术。比较2组术中情况、并发症、术后恢复指标、手术切口满意度、切口瘢痕率、复发率以及手术前后应激指标[血清皮质醇(Cor)、醛固酮(ALD)、去甲肾上腺素(NE)]、肠黏膜屏障功能[血浆谷氨酰胺(Gln)、二胺氧化酶(DAO)和尿肠脂肪酸结合蛋白(IFABP)]。结果 观察组术中出血量低于对照组,切口长度短于对照组(P<0.01)。术后1 d,观察组血清ALD、NE、Cor、血浆DAO及尿IFABP水平低于对照组,血浆Gln水平高于对照组(P<0.05)。观察组肛门排气时间、住院时间、下床活动时间短于对照组,术后1 d视觉模拟评分法评分低于对照组(P<0.01)。观察组并发症总发生率低于对照组(P<0.01)。术后3个月随访,观察组手术切口满意度高于对照组(P<0.01),2组切口瘢痕率、复发率比较差异无统计学意义(P>0.05)。结论 腹腔镜联合腹壁小切口疝回纳修补术治疗老年腹股沟疝伴疝环粘连患者效果明显,可减轻机体应激反应、改善肠黏膜屏障功能,并有效促进患者术后恢复。Objective To investigate the effect of laparoscopic ventral and incisional hernia repair(LVHR)in the treatment of senile inguinal hernia with hernia ring adhesion.Methods A total of 100 elderly patients with inguinal hernia and hernia ring adhesion treated from January 2020 to August 2022 were selected as the research subjects and divided into control group and observation group according to different surgical methods,with 50 cases in each group.The control group underwent open surgery,and the observation group underwent LVHR.The intraoperative conditions,complications,postoperative recovery indexes,surgical incision satisfaction,incision scar rate,recurrence rate,stress indexes before and after surgery[serum cortisol(Cor),aldosterone(ALD),noadrenaline(NE)],intestinal mucosal barrier function[plasma glutamine(Gln),diamine oxidase(DAO)and urinary intestinal fatty acid binding protein(IFABP)]were compared between the two groups.Results The intraoperative blood loss and incision length of observation group were lower or shorter than those of control group(P<0.01).At 1 d after operation,serum ALD,NE,Cor,plasma DAO and urinary IFABP levels in observation group were lower than those in control group,and plasma Gln levels were higher than those in control group(P<0.05).The time of anal exhaust,length of hospital stay and time of off-bed activity in the observation group were shorter than those in the control group,and the visual analogue scale scores at 1 d after operation were lower in the observation group than in the control group(P<0.01).The total complication rate of the observation group was lower than that of the control group(P<0.01).At 3-month follow-up after the operation,the incision satisfaction of the observation group was higher than that of the control group(P<0.01),and there was no significant difference in the scar rate and recurrence rate of the incision between the two groups(P>0.05).Conclusion LVHR is effective in the treatment of elderly patients with inguinal hernia and hernia ring adhesion,which c

关 键 词：疝 腹股沟 老年人 腹腔镜 小切口疝回纳修补术 疝环粘连 皮质醇 谷氨酰胺 并发症 

分 类 号：R565.21[医药卫生—呼吸系统]