腹腔镜无张力疝修补术在老年腹股沟疝患者中的应用研究

Application of laparoscopic tension-free repair for inguinal hernia in elderly patients

摘要:

目的 探究腹腔镜无张力疝修补术在老年腹股沟疝患者中的应用及对应激反应的影响。方法 回顾性选取2022年9月—2024年9月张家港市第一人民医院104例老年腹股沟疝患者，根据手术方式分为观察组和对照组，各52例。两组患者均予以无张力疝修补术，对照组患者予以传统开放式手术，观察组予以腹腔镜手术。比较两组围手术期相关指标、疼痛程度、应激反应、并发症及生活质量。结果 与对照组相比，观察组手术时间长、术后排气及下床时间短、住院时间短，并发症少（P <0.05）。观察组与对照组术前、术后24、48和72 h的静息状态下视觉模拟评分法（VAS）评分比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②观察组与对照组VAS评分比较，差异有统计学意义（P <0.05），观察组术后VAS评分较低，疼痛程度相对轻；③两组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。观察组手术前后皮质醇、淀粉样蛋白A（SAA）、去甲肾上腺素（NE）、白细胞介素-6（IL-6）的差值均小于对照组（P <0.05）。观察组与对照组术前、术后3和6个月的生活质量量表（SF-36）评分比较，结果 ①不同时间点SF-36评分比较，差异有统计学意义（P <0.05）；②观察组与对照组SF-36评分比较，差异有统计学意义（P <0.05），观察组术后SF-36评分较高，相对生活质量较好；③两组SF-36评分变化趋势比较，差异有统计学意义（P <0.05）。结论 腹腔镜无张力疝修补术应用于老年腹股沟疝患者，可有效促进术后快速恢复，减轻术后疼痛及应激反应，提升生活质量，且减少并发症。

Abstract:

Objective To explore the application of laparoscopic tension-free repair for inguinal hernia in elderly patients and its influence on stress response.Methods A total of 104 elderly patients with inguinal hernia treated at Zhangjiagang First People's Hospital from September 2022 to September 2024 were retrospectively selected to be included in the study, and were divided into the observation and control groups according to different surgical methods, with 52 cases in each. Both groups received tension-free hernia repair, while the control and observation groups underwent conventional open surgery and laparoscopic surgery, respectively. Perioperative indicators, pain intensity, stress response, complications and quality of life were compared between the two groups.Results Compared with the control group, the observation group had a longer operative duration but shorter postoperative exhaust time, earlier ambulation, shorter hospital stay, and fewer complications (P < 0.05). Comparison of Visual Analogue Scale (VAS) scores at rest between the observation group and the control group before surgery and at 24, 48, and 72 hours postoperatively showed that they were different across the time points (P < 0.05) and between the groups (P < 0.05), with the observation group having lower VAS scores and relatively milder pain postoperatively. The change trend in VAS scores differed between the two groups (P < 0.05). The differences in cortisol, serum amyloid A (SAA), norepinephrine (NE), and interleukin (IL)-6 levels before and after surgery were lower in the observation group than in the control group (P < 0.05). Comparison of SF-36 scores between the observation group and the control group before surgery and 3 and 6 months postoperatively revealed that they were different across the time points (P < 0.05) and between the groups (P < 0.05), with the observation group having higher SF-36 scores postoperatively and relatively better quality of life. The change trend in SF-36 scores was also different between the two groups (P < 0.05).Conclusion Laparoscopic tension-free repair for inguinal hernia in elderly patients is effective in promoting rapid postoperative recovery, alleviating postoperative pain and stress responses, improving quality of life, and reducing complications.