Velasco J M, Vallina V L, Esposito D J, Theodore S
Department of Surgery, Rush North Shore Medical Center, Skokie, Illinois 60076, USA.
Am Surg. 1998 Jul;64(7):633-7.
Laparoscopy has brought controversy to herniorrhaphy, particularly in the elderly. We reviewed our experience with this technique in patients older than 65 years at a single teaching institution. Data include demographics, American Society of Anesthesiologists (ASA) class, operative time, hernia type, type of repair, hospital stay, and complications. A telephone questionnaire was used to assess return to normal activity, recurrence, and reason for choosing the laparoscopic approach. From March 1992 through March 1996, 110 of 328 patients were eligible. Mean age was 73 +/- 5.6 years; 34 patients had bilateral and 20 had recurrent hernias; 73 patients (66.4%) were ASA-2, and 22 (20%) were ASA-3. The extra-abdominal and transabdominal preperitoneal approaches were used in 64 and 46 patients, respectively; mean operative time was 87.9 +/- 34 minutes. The overall complication rate was 15 per cent, with 71 per cent of these being urinary retention. Patients were discharged the same day (59%) and at 1 day (33%). Follow-up was available in 84.5 per cent. Recurrence rate was 9.7 per cent, which was not significantly influenced by complication rate, hernia repair type, or ASA class. Median return to normal activity was 7 days. ASA classification correlated with hospital stay (P = .02), but not with complications, recurrence, or return to normal activities (P = not significant). Laparoscopic herniorrhaphy appears safe in the elderly.
腹腔镜检查给疝修补术带来了争议，尤其是在老年患者中。我们回顾了在一家单一教学机构中对65岁以上患者使用该技术的经验。数据包括人口统计学资料、美国麻醉医师协会（ASA）分级、手术时间、疝的类型、修补类型、住院时间和并发症。通过电话问卷调查来评估恢复正常活动情况、复发情况以及选择腹腔镜手术入路的原因。从1992年3月至1996年3月，328例患者中有110例符合条件。平均年龄为73±5.6岁；34例为双侧疝，20例为复发性疝；73例患者（66.4%）为ASA-2级，22例（20%）为ASA-3级。分别有64例和46例患者采用了腹外和经腹腹膜前入路；平均手术时间为87.9±34分钟。总体并发症发生率为15%，其中71%为尿潴留。59%的患者在同一天出院，33%的患者在术后1天出院。随访率为84.5%。复发率为9.7%，不受并发症发生率、疝修补类型或ASA分级的显著影响。恢复正常活动的中位时间为7天。ASA分级与住院时间相关（P = 0.02），但与并发症、复发或恢复正常活动无关（P = 无显著性差异）。腹腔镜疝修补术在老年患者中似乎是安全的。
