摘要
目的 探讨L型腔镜拉钩辅助经腹膜前疝修补术(TAPP)治疗老年巨大腹股沟疝效果及其对精索血管、炎性因子水平影响。方法 选取2020-04-01-2022-06-01罗源县医院收治的80例老年巨大腹股沟疝患者为研究对象,按照随机数字表法将其分为对照组和观察组,各40例。对照组采用常规腔镜TAPP治疗,观察组采用L型腔镜拉钩辅助显露下TAPP治疗。观察2组手术情况、精索血管情况、炎性因子水平以及并发症发生情况。结果 观察组手术时间为(56.81±8.37) min,短于对照组的(62.57±8.67) min,t=3.023,P=0.003;术中出血量为(18.07±3.37) mL,少于对照组的(22.17±3.71) mL,t=5.174,P<0.001。术后24 h,观察组精索动脉管径为(1.58±0.13) mm,窄于对照组的(1.66±0.15) mm,F=3.207,P=0.046;精索动脉血流速度为(1.07±0.32) cm/s,快于对照组的(0.91±0.23) cm/s,F=3.255,P=0.044;精索静脉管径为(1.99±0.16) mm,窄于对照组的(2.09±0.18) mm,F=3.404,P=0.038;精索静脉血流速度为(1.16±0.13) cm/s,快于对照组的(1.07±0.15) cm/s,F=4.059,P=0.021。术后24 h,观察组肿瘤坏死因子-α(TNF-α)为(25.42±4.07) ng/L、IL-6为(8.69±0.82) ng/L、CRP为(24.76±2.67) mg/L,对照组TNF-α为(26.03±4.14) ng/L、IL-6为(8.75±0.84) ng/L、CRP为(24.82±2.59) mg/L,2组比较差异无统计学意义,F值分别为0.218、0.052和0.005,P值分别为0.805、0.950和0.995。观察组并发症发生率为5.00%,低于对照组的22.50%,χ^(2)=5.165,P=0.023。结论 L型腔镜拉钩辅助显露下行TAPP应用于老年巨大腹股沟疝患者对精索血管影响较小,能够减少术中出血量,缩短手术时间,降低术后并发症发生率,且不会引起炎症因子水平紊乱。
Objective To investigate the effect of transperitoneal hernia repair(TAPP)under L-shaped endoscopic hook as-sisted exposure in the treatment of giant inguinal hernia in the elderly.Methods According to the method of random number table,80elderly patients with huge inguinal hernia admitted in Luoyuan County Hospital from April 1,2020to June 1,2022 were divided into two groups.The control group(40cases)was treated with conventional endoscopic TAPP,and the observation group(40cases)was treated with L-shaped endoscopic hook assisted TAPP.The surgical conditions,spermatic vessels,levels of inflammatory factors and complications of the two groups were observed.Results The operation time in the observation group was(56.81±8.37)min,shorter than that in the control group(62.57±8.67)min,t=3.023,P=0.003;The intraoperative bleeding volume was(18.07±3.37)ml,which was less than that of the control group(22.17±3.71)ml,t=5.174,P<0.001.The diameter of spermatic artery in the observation group was(1.58±0.13)mm,which was narrower than that in the control group(1.66±0.15)mm 24hours after operation,F=3.207,P=0.046;The blood flow velocity of spermatic artery was(1.07±0.32)cm/s,which was faster than that of the control group(0.91±0.23)cm/s,F=3.255,P=0.044;The diameter of spermatic vein was(1.99±0.16)mm,which was narrower than that of control group(2.09±0.18)mm,F=3.404,P=0.038;The blood flow velocity of spermatic vein was(1.16±0.13)cm/s,faster than that of the control group(1.07±0.15)cm/s,F=4.059,P=0.021.24hours after operation,tumor necrosis factor-α(TNF-α)was(25.42±4.07)ng/L,interleukin-6(IL-6)was(8.69±0.82)ng/L,C-reactive protein(CRP)was(24.76±2.67)mg/L in observation group did not have tatistically significant difference with those in the control group(26.03±4.14)ng/L,(8.75±0.84)ng/L and(24.82±2.59)mg/L,the F-values were 0.218,0.052,and 0.005,respectively and the P-values were 0.805,0.950,and 0.995,respectively,The incidence of complications in the observation group was 5.00%,lower than 22.50%in the control group,χ^(2)=5.165,P=0.023.Conclusion The application of TAPP under L-shaped endoscopic hook assisted exposure in elderly patients with huge inguinal hernia has less impact on spermatic vessels,can reduce intraoperative bleeding,shorten the operation time,reduce the incidence of postoperative complications,and will not increase the level of inflam-matory factors.
作者
李昌顺
林丽冰
程念宁
LI Changshun;LIN Libing;CHENG Nianning(Surgery Division 1,Luoyuan County Hospital,Luoyuan 350600,China)
出处
《社区医学杂志》
CAS
2023年第17期880-884,共5页
Journal Of Community Medicine
关键词
L型腔镜拉钩
经腹膜前疝修补术
老年
巨大腹股沟疝
L-shaped endoscopic retractor
transperitoneal hernia repair
the elderly
giant inguinal hernia
