腹腔镜手P术与开放手术对老年患者围手术期指标、术后康复及并发症的影响

目的比较腹腔镜完全腹膜外疝修补术（TEP）、腹腔镜经腹腹膜外疝修补术（TAPP）与开放手术对老年患者围手术期指标、术后康复及并发症的影响。 方法选取2015年4月至2019年12月北京市丰台区铁营医院收治的老年腹股沟疝患者157例，采用投掷法随机分为TEP组、TAPP组及开放组，分别接受TEP术、TAPP术及开放手术，统计各组围手术期指标及术后并发症发生、复发情况。采用视觉模拟评分法（VAS）评估术后疼痛程度，应用健康调查简表（SF-36）评估各组手术前后生活质量；术前、术后12 h采集静脉血检测各组患者血清基质金属蛋白酶-9（MMP-9）、基质金属蛋白酶组织抑制物-1（TIMP-1）水平。 结果TEP组手术时间显著高于TAPP组和开放组（P<0.05）；开放组术后排气时间、术后下床活动时间、住院时间、术后24 h VAS评分、MMP-9、TIMP-1水平显著高于TEP组和TAPP组（P<0.05），住院费用、SF-36评分低于TEP组和TAPP组（P<0.05）；开放组术后并发症发生率高于TEP组和TAPP组（P<0.05）。 结论与开放手术相比，TAPP和TEP术后恢复更快，疼痛程度低，生活质量更优，并发症少。

Effects of laparoscopic and open inguinal hernia repair on perioperative indexes,postoperative rehabilitation and complications in elderly patients

ObjectiveTo compare the effects of laparoscopic total extra-peritoneal repair (TEP), laparoscopic trans-abdominal pre-peritoneal repair (TAPP) and open inguinal hernia repair on perioperative indexes, postoperative rehabilitation and complications in elderly patients. MethodsA total of 157 elderly patients with inguinal hernia admitted to Tieying Hospital, Fengtai District from April 2015 to December 2019 were selected, and randomly divided into TEP group, TAPP group and open group by throwing method, undergoing TEP, TAPP and open inguinal hernia repair respectively. The perioperative indexes, postoperative complications and recurrence of the two groups were analyzed. The visual analogue scale (VAS) and 36-item short form health survey (SF-36) were used to assess pain and quality of life before and after operation. Venous blood samples were collected before operation and at 12 hours after operation to detect the levels of serum matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1). ResultsThe operation time of TEP group was significantly longer than that of TAPP group and the open group (P<0.05). The postoperative exhaust time, postoperative ambulation time, hospital stay, postoperative 24 hours VAS score, MMP-9 and TIMP-1 levels in the open group were significantly higher than those in TEP group and TAPP group (P<0.05), while the hospitalization cost and SF-36 score were lower than those in TEP group and TAPP group (P<0.05). The incidence of postoperative complications in the open group was higher than those in TEP group and TAPP group (P<0.05). ConclusionCompared with open inguinal hernia repair, TAPP and TEP have advantages of faster recovery, lower pain, better quality of life and fewer complications, which are of clinical value.