摘要
目的观察L型腔镜拉钩辅助显露下行经腹膜前疝修补术(TAPP)治疗老年巨大腹股沟疝的临床应用疗效。方法选取2020—2021年间180例老年巨大腹股沟疝患者,随机分为观察组和对照组,各90例,观察组行L型腔镜拉钩辅助显露下的TAPP治疗,对照组行常规腔镜TAPP治疗。结果手术用时间[(56.8±8.3)min和(62.5±6.9)min,t=3.509,P=0.001]、术中出血量[(18.0±5.3)ml和(22.2±5.59)ml,t=3.698,P<0.001]、术后肛门排气时间[(17.8±1.6)h和(18.7±1.4)h,t=3.043,P=0.003]、术后2 d视觉模拟评分(VAS)疼痛评分[(1.3±0.3)分和(1.6±0.3)分,t=3.509,P=0.001]、住院时间[(2.7±0.5)d和(4.1±0.6)d,t=3.746,P<0.001]和并发症发生率(3.3%和18.9%,χ^(2)=4.406,P=0.036)观察组均低于对照组;两组术后随访6~9个月,复发率无显著性差异(P>0.05);观察组患者生活质量评分高于对照组(P<0.05);治疗后观察组患者肿瘤坏死因子、C反应蛋白、白细胞介素-6水平改善优于对照组(均P<0.05)。结论L型腔镜拉钩辅助显露下行TAPP治疗老年巨大腹股沟疝具有操作方便、增加膀胱前间隙显露、节省手术时间,减少手术创伤,促进术后恢复等优势,且安全性较高,值得临床推广。
Objective To assess the clinical efficacy of transabdominal preperitoneal(TAPP)repair aided by the L-shaped laparoscopic retractor in the treatment of giant inguinal hernia in the elderly.Methods A total of 180 elderly patients with giant inguinal hernias from 2020 to 2021 were randomly divided into an observation group and a control group with 90 in each group.The observation group underwent TAPP surgery with the L-shaped laparoscopic hook-assisted exposure,and the control group underwent conventional laparoscopic TAPP surgery.Results Operative time[(56.8±8.3)min vs.(62.5±6.9)min,t=3.509,P=0.001],intraoperative bleeding[(18.0±5.3)ml vs.(22.2±5.59)ml,t=3.698,P<0.001],time to first postoperative flatus[(17.8±1.6)h vs.(18.7±1.4)h,t=3.043,P=0.003],postoperative 2d VAS pain score[(1.3±0.3)points vs.(1.6±0.3)points,t=3.509,P=0.001],length of hospital stay[(2.7±0.5)d vs.(4.1±0.6)d,t=3.746,P<0.001]and incidence of complications(3.3%vs.18.9%,χ^(2)=4.406,P=0.036)in the observation group were significantly lower than in the control group.There was no significant difference in the recurrence rate between the two groups during month 6-9 follow-up(P>0.05).After treatment,the levels of tumor necrosis factor,C-reactive protein and interleukin-6 in the observation group were more favorable than in the control Group(all P<0.05).Conclusions L-shaped laparoscopic hook-assisted exposure in TAPP for the treatment of giant inguinal hernias in the elderly has the advantages of easy maneuver,increased exposure of the anterior bladder,shortened operative time,reduced surgical trauma,and early postoperative recovery.It is also safe and should be recommended in clinical practice.
作者
周小平
谢清
Zhou Xiaoping;Xie Qing(Department of General Surgery,Three Gorges Hospital Affiliated to Chongqing University,Chongqing 404100,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2022年第5期570-573,共4页
Chinese Journal of Geriatrics
关键词
疝
腹股沟
腹腔镜
Hernia,inguinal
Laparoscopes
