高龄腹股沟疝无张力修补日间手术的术式选择

目的 比较不同腹股沟疝无张力修补方式在高龄（≥70岁）患者中的疗效。方法 回顾性分析2009年5月至2013年4月，首都医科大学宣武医院接受腹股沟疝无张力修补日间手术的253例老年患者的临床资料料。依据术式不同分为疝环填充式修补组（157例）及腹膜前间隙修补组（96例）。比较二组患者术后总体并发症率、腹股沟区慢性疼痛及疝复发率。结果 腹膜前间隙修补组手术时间较疝环填充式修补组略长，但均未超过50min。二组患者术中麻醉药用量差异均有统计学意义（t=2．081，P=0．032），术后镇痛比例比较差异有统计学意义（X^2=15．722，P=0．000）。疝环填充式修补组与腹膜前间隙修补组患者术后并发症率比较差异无统计学意义（X^2=0．024，P=0．878），术后复发率差异无统计学意义（P=0．636），术后切口区域慢性疼痛发生率差异无统计学意义（P=1．000）。结论老年患者经日间手术行腹股沟疝疝环填充式疝修补或腹膜前间隙修补均是安全可行的。

Choice of surgical procedures in day surgery for inguinal hernia in eldly patients

Objective To compare the results of different surgical procedures after day surgical repair of inguinal hernia in eldly patients （ age ≥70 years）. Methods The medical data of eldly patients （253 cases）receiving day surgical repair of inguinal hernia who were admitted to Xuanwu Hospital, between May 2009 and April 2013, were retrorespectively analyzed. The patients were subdivided into two groups according to the surgical pmeedurereeeived, including Robbins＆Rutkow group （157 cases） and Modified Kugel group （96 cases）. We compared the overall complication rate, incidence of chronic pain in groin area, and recurrence rate of two groups. Results The operation time of Modified Kugel group was longer than Robbins＆Rutkow group, but neither was over than 50 minutes. Both anesthetic dosage （t = 2. 081, P = 0.032） and postoperative pain control（X^2 = 15. 722, P = 0. 000） in two groups were significantly different. But there were no differences in complication rate （X^2 = 0. 024, P = 0. 878 ）, recurrence rate （ P = 0. 636）, and incidence of chronic pain （ P = 1. 000）. Conclusion Both Robbins＆Rutkow and Modified Kugel procedures in day surgery are safe and effective for eldly patients.