老年腹股沟疝手术选择和自我临床报告结果

目的探讨老年腹股沟疝患者的术式选择,比较开放和腹腔镜疝修补≧60岁,小于60岁的患者临床报告结果。方法日期从2015年1月到2016年5月接受腹股沟疝手术患者被纳入本研究,共有137例接受调查,其中72例小于60岁(60组),65例大于等于60岁(≧60组)。在60组,29例患者行腹腔镜疝修补术(TEP)和43例开放式疝修补术。在≧60组,29例患者行腹腔镜疝修补术(TEP)和36例开放式疝修补术。术后6月随访,患者临床报告结果(PROM)包括总体感觉、疼痛、恶心、呕吐、头晕、疲倦和满意度。结果 137例得到术后6个月随访。严重疼痛患者8例,其中6例为60岁组,≧60岁组仅2例出现严重疼痛(P0.05)。≧60 TEP组中只有1例患者中度疼痛,60 TEP组中有3例中度疼痛(P0.05)。绝大多数患者对手术满意程度在所有组患者中满意或非常满意,只有2例病人主诉手术疤痕和术后疼痛。结论 60岁以上腹股沟疝患者的手术,采用TEP术式安全、痛苦少;但比较60岁患者,无论腹腔镜还是开放的腹股沟疝修补术,均未体现更多优势。

Surgical selection and patient reported outcomes in the elderly patients with inguinal hernia

［Abstract］ Objective To compare open and laparoscopic hernia repair in patients ≧ 60 years old and those <60 years old with respect to patient reported outcomes. Methods A total of 137 cases of inguinal hernia surgery from January 2015 to May 2016 were included in this study, in which 72 cases were less than 60 years old（<60 group）, 65 were more than and equal to 60 years old（≧60 group）. In <60 group, 29 patients underwent laparoscopic hernia repair（TEP）and 43 open hernia repair（open）. The patient?reported outcomes（PROMS）was carried out in all patients 24 hour after surgical procedure. The PROMS included an optional survey with questions to quantify pain, general feeling, nausea, dizziness, drowsiness, satisfaction and vomiting since the operation. Results Data was presented from patients 6 months after operation by a follow?up for 137 cases. There were 8 cases reported severe pain, in which 6 patients were <60 and only 2 cases reported severe pain. This was significantly lower （P<0.05）. One patient reported moderate pain in the ≧65 TEP group and 3 in <60 TEP group. Patient satisfaction with the surgery was satisfied or very satisfied in almost all patients in all groups. Only 2 patient complained their surgical scars and post?operative pain. Conclusion The patients over 60 can expect the same high levels of satisfaction and low levels of pain following either technique for inguinal hernia repair as younger patients.