老年患者在三种腹股沟疝修补术后短期并发症的研究

目的探究疝环充填式无张力疝修补术（Rutkow）、腹腔镜完全腹膜外疝修补术（TEP）及腹腔镜经腹腹膜前疝修补术（TAPP）在老年腹股沟疝患者术后短期并发症中的应用。 方法选取2019年1月至2020年12月于马鞍山市人民医院收治的90例老年腹股沟疝患者为研究对象，按照所接受手术方式的不同分为Rutkow组、TEP组和TAPP组，每组各30例。比较3组患者手术时间、术中出血量、术后下床活动时间、住院时间、恢复情况、疼痛情况、并发症及复发率。 结果3组患者手术时间、术中出血量、术后住院时间、术后1 d的疼痛视觉模拟评分及术后肠鸣音恢复时间比较，差异均有统计学意义（P<0.05）。Rutkow组与TEP组及TAPP组手术时间、术中出血量、术后住院时间、术后1 d的疼痛视觉模拟评分及术后肠鸣音恢复时间比较，差异均有统计学意义（P<0.05）。3组患者术后下床时间、术后3及7 d的疼痛视觉模拟评分情况、术后肛门排气时间及首次排便时间比较，差异均无统计学意义（P>0.05）。Rutkow组、TEP组和TAPP组并发症发生率依次为20.00%、6.67%、10.00%，差异有统计学意义（P<0.05）；Rutkow组与TEP组及TAPP组术后并发症发生率比较，差异均有统计学意义（P<0.05）。Rutkow组、TEP组和TAPP组复发率依次为3.33%、0%、0%，差异无统计学意义（P>0.05）。 结论TEP术和TAPP术对改善老年腹股沟疝患者术后短期并发症方面，效果更加显著，但三种方法各有优缺点和其适应证，应根据患者的具体情况选择不同的手术修补方式。

Study of short-term complications after three inguinal hernia repairs in elderly patients

ObjectiveTo investigate the pain and short-term complications of hernia ring filling tension-free hernia repair (Rutkow), laparoscopic total extraperitoneal hernia repair (TEP), and laparoscopic transmembrane anterior hernia repair (TAPP) in elderly patients after inguinal hernia surgery. MethodsA total of 90 elderly patients with inguinal hernia admitted from January 2019 to December 2020 were selected as the research objects, and were divided into Rutkow group, TEP group and TAPP group according to the different surgical methods, with 30 patients in each group. Operation (operation time, intraoperative blood loss, postoperative time to get out of bed, length of hospital stay), pain, postoperative recovery (anal exhaust time, bowel sound recovery time, first defecation time), complications and recurrence rate of 3 groups were compared. ResultsThere were statistically significant differences between the three groups in terms of operation time, intraoperative blood loss, postoperative hospital stay, pain on the visual analog scale one day after surgery, and postoperative bowel sound recovery time (P<0.05). There were statistically significant differences between the Rutkow group, the TEP group, and the TAPP group in terms of operation time, intraoperative blood loss, postoperative hospital stay, visual analog scale of pain one day after operation, and postoperative bowel sound recovery time (P>0.05). There were no statistically significant differences in the time it took to get out of bed after surgery, the visual analog scale of pain at 3 and 7 days after surgery, the time of postoperative anal exhaust, or the timing of the first bowel movement (P>0.05). The incidence of complications was 20.00% in the Rutkow group, 6.67% in the TEP group, and 10.00% in the TAPP group, and the difference was statistically significant (P<0.05). There were significant differences in the incidence of postoperative complications between the Rutkow group and the TEP and TAPP groups (P<0.05). The recurrence rates of the Rutkow group, the TEP group and the TAPP group were 3.33%, 0%, and 0%, respectively, with no significant difference (P>0.05). ConclusionTEP and TAPP have more significant effects on the improvement of postoperative pain and short-term complications in elderly patients with inguinal hernia, but the three methods have their own advantages and disadvantages as well as their indications, so different surgical repair methods should be selected according to the specific situation of patients.