目的 比较腹腔镜完全腹膜外疝修补术(laparoscopic totally extra-peritoneal,TEP)和局部浸润麻醉下平片修补术治疗长期使用抗凝药物腹股沟疝患者的临床效果.方法 回顾分析2017年4月至2018年4月,中山大学附属第八医院行TEP和平片修补术治疗长期使用抗凝药物的腹股沟疝52例患者的临床资料,按照术式不同分为2组.TEP组25例,平片修补术组27例,随访3～12个月.比较2组手术时间、术后重大心脑血管并发症、术后引流量、血肿或浆液肿、腹股沟神经异常或慢性疼痛、术后复发、术后感染等方面的差异.结果 2组均无重大心脑血管并发症患者,均无复发及感染患者.TEP组和平片修补术组手术时间分别为(55.2±10.3) min和(32.4±4.3)min,血肿或浆液肿发生率分别为7例(28％)和1例(3.7％),引流量分别为(40.8±8.6) ml和(36.6±5.2) ml,差异有统计学意义(P＜0.05);腹股沟神经异常或慢性疼痛发生率分别为2例(8％)和2例(7.4％),差异无统计学意义(P＞0.05).结论 对老年腹股沟疝患者,长期应用抗凝药物不是手术禁忌证,做好围手术期处理,选择合适的麻醉和手术方式是治疗成功的关键.%Objective To compare the clinical effect of TEP and patch repairing for inguinal hernia with long term anticoagulant drug using.Methods From April 2017 to April 2018,a retrospective analysis was conducted on 52 patients (aged from 53 to 82) of inguinal hernia with long term anticoagulant drug using who were performed with TEP (25 patients) or patch repairing (27 patients) in the Eighth Affiliated Hospital,Sun yat-sen University.No recurrence and patch infection were found after a period of follow-up for more than 3 months.The differences in operation time,postoperative drainage,hematoma,inguinal nerve sensory abnormalities or pain of the two groups were compared.Results There were no severe cardiac and cerebral vascular complications in two groups.The operation time of the TEP group and patch repair group was (55.2±10.3) minutes and (32.4±4.3) minutes,respectively (P＜0.05).The incidence of hematoma was 28％ and 3.7％,respectively (P＜0.05),the difference was statistically significant.The drainage of the two groups were (40.8±8.6) ml and (36.6±5.2) ml (P＞0.05).The incidence of inguinal nerve sensory abnormalities or pain in TEP group and patch repair group was 8％ and 7.4％ (P＞0.05).Conclusion Long term anticoagulant drug using is not surgical contraindication for patients with inguinal hernia.It's safe for patients to choose appropriate anesthesia and operating methods.
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