腹腔镜联合腹壁小切口疝回纳修补术对老年腹股沟疝伴疝环粘连的治疗效果
Effect of Laparoscopic Ventral and Incisional Hernia Repair in the Treat-ment of Senile Inguinal Hernia with Hernia Ring Adhesion
仲任 1吴岑 1高志慧 1蔡兵2
作者信息
- 1. 226400 江苏 南通,南通大学附属如东医院普外科
- 2. 214000 江苏 无锡,南京医科大学附属无锡人民医院 无锡市人民医院普外科
- 折叠
摘要
目的 探讨腹腔镜联合腹壁小切口疝回纳修补术对老年腹股沟疝伴疝环粘连的治疗效果.方法 选取2020 年1 月—2022 年8 月收治的100 例老年腹股沟疝伴疝环粘连为研究对象,按手术方式不同分为对照组和观察组,每组50 例.对照组行开放手术,观察组行腹腔镜联合腹壁小切口疝回纳修补术.比较2 组术中情况、并发症、术后恢复指标、手术切口满意度、切口瘢痕率、复发率以及手术前后应激指标[血清皮质醇(Cor)、醛固酮(ALD)、去甲肾上腺素(NE)]、肠黏膜屏障功能[血浆谷氨酰胺(Gln)、二胺氧化酶(DAO)和尿肠脂肪酸结合蛋白(IFABP)].结果 观察组术中出血量低于对照组,切口长度短于对照组(P＜0.01).术后1d,观察组血清ALD、NE、Cor、血浆DAO及尿IFABP水平低于对照组,血浆Gln水平高于对照组(P＜0.05).观察组肛门排气时间、住院时间、下床活动时间短于对照组,术后1d视觉模拟评分法评分低于对照组(P＜0.01).观察组并发症总发生率低于对照组(P＜0.01).术后3 个月随访,观察组手术切口满意度高于对照组(P＜0.01),2 组切口瘢痕率、复发率比较差异无统计学意义(P＞0.05).结论 腹腔镜联合腹壁小切口疝回纳修补术治疗老年腹股沟疝伴疝环粘连患者效果明显,可减轻机体应激反应、改善肠黏膜屏障功能,并有效促进患者术后恢复.
Abstract
Objective To investigate the effect of laparoscopic ventral and incisional hernia repair(LVHR)in the treatment of senile inguinal hernia with hernia ring adhesion.Methods A total of 100 elderly patients with inguinal hernia and hernia ring adhesion treated from January 2020 to August 2022 were selected as the research subjects and divided into con-trol group and observation group according to different surgical methods,with 50 cases in each group.The control group un-derwent open surgery,and the observation group underwent LVHR.The intraoperative conditions,complications,postopera-tive recovery indexes,surgical incision satisfaction,incision scar rate,recurrence rate,stress indexes before and after surgery[serum cortisol(Cor),aldosterone(ALD),noadrenaline(NE)],intestinal mucosal barrier function[plasma glutamine(Gln),diamine oxidase(DAO)and urinary intestinal fatty acid binding protein(IFABP)]were compared between the two groups.Results The intraoperative blood loss and incision length of observation group were lower or shorter than those of control group(P＜0.01).At 1 d after operation,serum ALD,NE,Cor,plasma DAO and urinary IFABP levels in observa-tion group were lower than those in control group,and plasma Gln levels were higher than those in control group(P＜0.05).The time of anal exhaust,length of hospital stay and time of off-bed activity in the observation group were shorter than those in the control group,and the visual analogue scale scores at 1 d after operation were lower in the observation group than in the control group(P＜0.01).The total complication rate of the observation group was lower than that of the control group(P＜0.01).At 3-month follow-up after the operation,the incision satisfaction of the observation group was higher than that of the control group(P＜0.01),and there was no significant difference in the scar rate and recurrence rate of the incision between the two groups(P＞0.05).Conclusion LVHR is effective in the treatment of elderly patients with inguinal hernia and her-nia ring adhesion,which can reduce body stress response,improve intestinal mucosal barrier function,and effectively promote postoperative recovery of patients.
关键词
疝,腹股沟/老年人/腹腔镜/小切口疝回纳修补术/疝环粘连/皮质醇/谷氨酰胺/并发症Key words
Hernia,inguinal/Elderly/Laparoscopes/Small incision hernia repair/Hernia ring adhesion/Cortisol/Glutamine/Complications引用本文复制引用
基金项目
江苏省自然科学基金(200818JS311)
南通市卫生健康委员会科研课题(QB2021040)
南通市卫生健康委员会科研课题(MSZ2022088)
出版年
2023
国家科技期刊平台
NSTL
万方数据