探讨腹腔镜微创手术对老年腹股沟嵌顿疝全麻术后认知功能的影响。

回顾性分析2015年3月至2018年6月，内江市第二人民医院接受治疗的44例腹股沟嵌顿疝老年患者临床资料，根据手术方式不同分为观察组（24例）和对照组（20例）。对照组采用开放式无张力疝修补术治疗，观察组采用腹腔镜经腹腹膜前疝修补术（TAPP）治疗。比较2组患者手术相关指标、手术前后焦虑、抑郁状态及认知功能及2组术后并发症发生情况。

与对照组比较，观察组术后排气时间、进食时间及自主下床活动时间均明显提前，差异有统计学意义（P<0.05）。与术前比较，术后2周2组患者焦虑自评量表、抑郁自评量表评分均明显降低，且观察组明显低于对照组，差异有统计学意义（P<0.05）。与术前比较，术后第2天2组患者即刻记忆力、回忆力、定向力、注意力及语言能力评分均明显降低，且观察组明显高于对照组，差异有统计学意义（P<0.05）。观察组总并发症发生率明显低于对照组，差异有统计学意义（P<0.05）。

TAPP配合围手术期精心护理可更有效地缓解腹股沟嵌顿疝老年患者不良心理情绪，对患者术后认知功能的影响更小，并发症少，有利于患者术后恢复，建议临床推广使用。

To explore clinical influence of laparoscopic minimally invasive surgery on cognitive dysfunction after general anesthesia in elderly patients with incarcerated inguinal hernia.

The clinical data of 44 elderly patients with incarcerated inguinal hernia treated in Neijiang Second People's Hospital from March 2015 to June 2018 were retrospectively analyzed, they were divided into the experiment group (n=24) and the control group (n=20) according to the different surgical methods. The control group was treated with open tension-free hernia repair, the experiment group was treated with laparoscopic trans-abdominal preperitoneal hernia repair (TAPP). The surgery related index, situation of anxiety/depression and cognitive function before and after the operation in two groups were compared, and the complications of the 2 groups were recorded.

Compared with the control group, the exhaust time, eating time and spontaneous bed-out activity time significantly advanced in the experiment group (P<0.05). Compared with period before operation, the scores of SAS and SDS significantly decreased in two groups during two weeks after operation, and the scores of experiment group was significantly lower than of the control group (P<0.05). Compared with period before operation, the scores of immediate memory, recall, orientation, attention and language ability significantly decreased in the two groups during 2 days after operation, and the scores of experiment group was significantly higher than of the control group (P<0.05). The incidence of total complications in the experiment group was significantly lower than that in the control group (P<0.05).

TAPP combined with perioperative care can more effectively alleviate the bad psychological emotions of elderly patients with incarcerated inguinal hernia. It has less impact on postoperative cognitive function and less complications, which is conducive to postoperative recovery, it is worthy of use in clinic.