中国现代普通外科进展

目的：探讨微创技术在老年急性嵌顿性腹股沟疝治疗中的应用价值和损伤控制。方法：选取2018年6月至2023年6月安徽医科大学第一附属医院急诊外科收治的62例老年急性嵌顿性腹股沟疝患者为研究对象，获得患者家属对两种治疗方式的知情同意后随机分为开放手术组和腹腔镜手术组。观察两组患者临床疗效、围手术期指标、术后并发症和预后随访的区别。7例>80岁的高龄患者合并基础疾病较多且术中耐受力差，在处理疝内容物病变后仅实施了疝囊高位结扎的损伤控制手术。结果：两组临床疗效（显效、无效和总有效率）、围手术期指标（住院时间、消化道功能恢复时间和VAS疼痛评分）、术后并发症及预后（局部硬块、慢性疼痛和二期疝手术比例）等方面比较差异均具有统计学意义（P<0.05）,7例按损伤控制策略处置的患者术后均康复出院。结论：急诊腹腔镜手术探查老年嵌顿性腹股沟疝安全可行，同时应正确评估患者术中生命体征，必要时应简化手术为后续治疗提供机会。

Objective: To explore the application value and damage control of minimally invasive techniques in the treatment of acute incarcerated inguinal hernias in the elderly. Methods: In this study, 62 elderly patients with acute incarcerated inguinal hernias admitted to the department of emergency surgery at the First Affiliated Hospital of Anhui Medical University from June 2018 to June 2023 were selected as the research subjects. After obtaining informed consent from the patient's family for both treatment modalities, they were randomly divided into open surgery group and laparoscopic surgery group. Differences in clinical efficacy, perioperative indicators, postoperative complications, and prognostic follow-up of the two groups of patients were observed.Seven cases of elderly patients aged above 80 had many underlying diseases and poor tolerance during surgery. After treatment of lesions in the hernia contents, only damage control surgery for hernia sac high ligation was performed. Results: In comparison to patients treated with laparoscopic surgery, there were statistically significant differences(P<0.05) in the open surgery group in clinical efficacy(efficacy, ineffectiveness, and overall effectiveness), perioperative indicators(length of stay, recovery time of digestive tract function, and VAS pain score), post-operative complications, and prognostic follow-up(local mass, chronic pain, and ratio of second-stage hernia surgery). Seven patients treated according to injury control strategies all recovered and discharged from hospital after surgery. Conclusion: Emergency laparoscopic surgery for detecting incarcerated inguinal hernias in the elderly is safe and feasible. At the same time, it is essential to correctly assess the patient's vital signs during surgery. If necessary, surgery should be simplified to provide opportunities for follow-up treatment.