三种疝修补术治疗老年腹股沟疝患者的临床疗效比较

目的探究疝环充填手术、Lichtenstein修补术与腹腔镜经腹腹膜前修补术对老年腹股沟疝患者临床疗效情况。 方法选取2018年1月至2020年2月在东南大学附属中大医院溧水分院进行治疗的150例老年腹股沟疝患者，随机分为A组（50例）、B组（50例）及C组（50例）。A组采用疝环充填修补术、B组采用Lichtenstein修补术、C组采用腹腔镜经腹膜前修补术，观察并记录3组患者的手术时间、术后下床活动时间、术后疼痛持续时间以及术后住院时间；分别于术后1 d、7 d，采用视觉模拟评分对患者进行疼痛评估；检测术前及术后3组患者炎性因子水平：C反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）以及白细胞介素-6（IL-6）水平；记录患者术后6个月内并发症发生情况。 结果3组患者手术时间比较，差异无统计学意义（P>0.05）；C组术后下床活动时间、术后疼痛持续时间及术后住院时间显著低于A组和B组（P<0.01），B组在术后疼痛持续时间上低于C组（P<0.05）；术后1 d、7 d，C组VAS评分低于A组及B组，A组VAS评分低于B组（P<0.05）；3组术后CRP、TNF-α以及IL-6水平均较术前显著升高，C组炎性因子水平均显著低于A组和B组（P<0.05），B组术后IL-6水平低于A（P<0.05）；3组在术后6个月均未出现疝复发情况，A组并发症总发生率低于B组和C组（P<0.05），B组术后发生神经感觉异常症状高于A组（P<0.05），B组和C组并发症总发生率差异无统计学意义（P>0.05）。 结论腹腔镜经腹腹膜前修补术治疗老年腹股沟疝患者疗效较开放式无张力疝修补术更好，对老年患者损伤更小，使其术后恢复更快，安全性更高。

Comparative study on the clinical efficacy of three kinds of herniorrhaphy in the treatment of senile inguinal patients

ObjectiveTo explore the clinical efficacy of hernia ring filling surgery, Lichtenstein repair, and laparoscopic trans-abdominal preperitoneal repair for elderly patients with inguinal hernia. MethodsA total of 150 elderly patients with inguinal hernia who were treated in our hospital from January 2018 to February 2020 were selected and randomly assigned to group A (50 cases), group B (50 cases) and group C (50 cases). Group A underwent hernia ring filling repair, group B underwent Lichtenstein repair, and group C underwent laparoscopic peritoneal repair. The operation time, postoperative ambulation time, postoperative pain duration and postoperative hospital stay of 3 groups were observed and recorded. On 1 d and 7 d after surgery, pain was evaluated by a visual analog score. The levels of inflammatory factors including C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) and IL-6 were detected before and after operation in 3 groups. The incidence of complications within 6 months after surgery was recorded. ResultsThere was no significant difference in the operative time between the 3 groups (P>0.05). The postoperative ambulation time, postoperative pain duration and postoperative hospital stay in group C were significantly lower than those in group A and group B (P<0.05), and the postoperative pain duration in group B was lower than that in group C (P<0.05). 1 d and 7 d after surgery, VAS score of group C was lower than that of group A and group B, and the VAS score of group A was lower than that of group B (P<0.05). After operation, the levels of CRP, TNF-α and IL-6 in the 3 groups were significantly higher than those before operation, the levels of inflammatory factors in group C were significantly lower than those in group A and group B (P<0.05), and the levels of IL-6 in group B were significantly lower than those in group A (P<0.05). At 6 months after surgery, there was no recurrence of hernia in the three groups, and the total incidence of complications in group A was lower than that in group B and group C (P<0.05). The incidence of postoperative neuroparesthesia in group B was higher than that in group A (P<0.05), and there was no statistical significance in the total incidence of complications between group B and group C (P>0.05). ConclusionCompared with open tension-free hernia repair, laparoscopic transabdominal preperitoneal repair has better efficacy in treating elderly patients with inguinal hernia, with less damage to elderly patients, faster postoperative recovery and higher safety.