目的:探讨改良直切口腹膜前股疝修补术在老年女性嵌顿性股疝治疗中的应用效果及预后。方法:选取 2020年 1 月—2024 年 1 月南通市通州区中医院收治的 100 例老年女性嵌顿性股疝患者作为研究对象，随机分为观察组(改良直切口腹膜前修补术组，n=50)和对照组(传统开放修补术组，n=50)。比较两组的手术时间、术中出血量、术后疼痛评分[视觉模拟量表(VAS)评分]、排气时间、负压引流管留置时间、住院时间、术后并发症发生率(术后感染、疝复发、尿潴留、慢性疼痛等)、术后炎症反应(术后 24 h C反应蛋白水平和白细胞计数)、生物标志物水平[术后 24 h白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平]、术后 1 个月心理健康状况[医院焦虑抑郁量表(HADS)评分]以及术后 1 个月和 3个月Barthel指数。结果:观察组术后 24 h VAS评分显著低于对照组，差异有统计学意义(P<0。05);术后恢复方面，观察组排气时间、负压引流管留置时间、住院时间均显著短于对照组，差异有统计学意义(P<0。05);观察组并发症发生率显著低于对照组，差异有统计学意义(P<0。05);观察组术后 24 h C反应蛋白水平和白细胞计数显著低于对照组，差异有统计学意义(P<0。05);观察组术后 24 h IL-6 水平和TNF-α水平显著低于对照组，差异有统计学意义(P<0。05);观察组术后 1个月HADS评分显著高于对照组，差异有统计学意义(P<0。05);观察组术后 1、3 个月Barthel指数显著高于对照组，差异有统计学意义(P<0。05)。结论:改良直切口腹膜前股疝修补术在老年女性嵌顿性股疝治疗中具有良好的应用效果，能够有效降低术后疼痛，缩短恢复时间，减少并发症发生率，改善心理健康和康复质量。
Application and Prognosis of Modified Direct Incision Preperitoneal Repair in the Treatment of Incarcerated Femoral Hernia in Elderly Women
Objective:To investigate the application and prognosis of modified direct incision preperitoneal repair in the treatment of incarcerated femoral hernia in elderly women.Method:One hundred elderly female patients with incarcerated femoral hernia admitted to Nantong Tongzhou Hospital of Traditional Chinese Medicine from January 2020 to January 2024 were selected as the study objects and randomly divided into the observation group(modified direct incision preperitoneal repair group,n=50)and the control group(traditional open repair group,n=50).The surgical duration,intraoperative blood loss,postoperative pain score[visual analogue scale(VAS)],time to first flatus,duration of negative pressure drainage,length of hospital stay,incidence of postoperative complications(postoperative infection,hernia recurrence,urinary retention,chronic pain,etc.),postoperative inflammatory response(C-reactive protein level and white blood cell count at 24 hours postoperatively),levels of biomarkers[interleukin-6(IL-60)and tumor necrosis factor-α(TNF-α)at 24 hours postoperatively],psychological health status[hospital anxiety and depression scale(HADS)]at 1 month postoperatively,and Barthel index at 1 and 3 months postoperatively were compared between the two groups.Result:The 24-hour postoperative Visual Analog Scale(VAS)pain scores in the observation group were significantly lower than those in the control group,with a statistically significant difference(P<0.05).In terms of postoperative recovery,the observation group had significantly shorter times for first flatus,indwelling time of negative pressure drainage tube,and hospital stay compared to the control group,with statistically significant differences(P<0.05).The incidence of complications in the observation group was significantly lower than in the control group(P<0.05).The levels of C-reactive protein and white blood cell count 24 hours postoperatively in the observation group were significantly lower those than in the control group,with statistically significant differences(P<0.05).The levels of IL-6 and TNF-α 24 hours postoperatively in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).One month postoperatively,the HADS scores in the observation group were significantly higher than those in the control group,with a statistically significant difference(P<0.05).Additionally,the Barthel index at one month and three months postoperatively in the observation group were significantly higher than those in the control group,with statistically significant differences(P<0.05).Conclusion:The modified direct incision preperitoneal repair has a good application effect in the treatment of incarcerated femoral hernia in elderly women,which can effectively reduce postoperative pain,shorten recovery time,reduce the incidence of complications,and improve psychological health and rehabilitation quality.
Modified direct incision preperitoneal repairElderly womenIncarcerated femoral herniaTreatment outcomesPrognosis analysis
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