老年腹股沟疝合并肠破裂手术治疗的对比研究

目的：总结老年腹股沟疝合并肠破裂的临床特点及合适的手术方式。方法回顾性分析2002年9月至2013年12月，湖北省应城市第一人民医院收治的老年腹股沟疝合并肠破裂患者36例的手术治疗住院资料。患者随机分为三组：A 组14例，行肠破裂修补同时行疝修补术；B 组14例，一期行肠破裂修补加疝囊颈荷包缝合术，3个月后择期行疝修补术；C组8例，一期行肠破裂修补加疝囊颈荷包缝合术，术后未行疝修补术。结果 B、C二组患者手术后愈合时间均长于A组（χ2＝33．873、13．981，P＝0．000、0．007）；术后复发率均较A组低（χ2＝22．789、10．139，P＝0．006、0．004）；手术成功率较A组高（χ2＝5．789、4．569，P＝0．036、0．041）。B、C二组患者术前休克发生率较A组高（χ2＝4．543、9．793，P＝0．037、0．003）；术前腹腔感染发生率较 A 组高（χ2＝33．805、34．139，P＝0．000、0．000）；术中休克发生率较A组高（χ2＝14．475、4．837，P＝0．008、0．039）；腹股沟伤口感染率较A组高，差异均有统计学意义（χ2＝4．256、34．376，P ＝0．044、0．000）。结论对于病情相对较重的老年腹股沟疝并肠破裂患者，传统的二期处理方式即一期行肠破裂修补同时行疝囊荷包缝合，二期再行疝修补术是较合适的手术方式，而对于病情相对较轻的老年腹股沟疝并肠破裂患者，也可以选择行肠破裂修补同时行疝修补术。重视腹股沟疝并肠破裂老年患者并存疾病及并发症的防治，可改善患者的预后。

Comparative study of surgical treatment for inguinal hernia complicated with intestine rupture in the elderly

Objective To summarize the clinical features and suitable surgical treatment of indirect inguinal hernia complicated with intestine rupture in elderly patients.Methods The clinical data of 36 cases of inguinal hernia with intestine rupture in elderly patients who were admitted to The First People′s Hospital of Yingcheng from September 2002 to December 201 3,were analyzed retrospectively.The patients were randomly divided into three groups：1 4 cases in group A underwent intestinalrupture repair and hernia repair;1 4 cases in group B received primary intestinal rupture repair and hernia sac neck purse-string suture,then had selective hernia repair 3 months later;patients in group C （n=8）got intestinal rupture repair and hernia sac neck purse-string suture without further hernia repair.Results The cure-duration, recurrence rate and success rate of the operation in group B and group C were more than those in group A and all the differences were significant（χ2 =33.873,13.981 and P=0.000,0.007;χ2 =22.789,10.1 39 and P=0.006,0.004;χ2 =5.789,4.569 and P =0.036,0.041 ,respectively）.There was significant difference in the incidence of shock before and during the operation not only between group B and group A, but also between group C and group A （χ2 =4.543,9.793,1 4.475,4.837 and P=0.037,0.003, 0.008,0.039）.The incidence of inta-abdominal infection and mortality in group B and group C were higher than those in group A and all the difference were significant （χ2 =33.805,34.1 39 and P=0.000,0.000;χ2 =4.873 and P=0.027,respectively）.The inguinal wound infection rate in group B and group C were higher than those in group A,and all the difference were significant （χ2 =4.256,34.376 and P=0.044,0.000）.Conclusions The traditional two-stage operation strategy,undergoing intestinal rupture repair and hernia sac neck purse-string suture at first and then having hernia repair in second phase,is more appropriate for relatively serious elderly patients with inguinal hernia and intestinal rupture.On the con