目的

基于加速康复外科理念，探讨接受抗血栓治疗（ATT）老年患者行腹腔镜腹股沟疝修补术（LIHR）的安全性。

方法

本研究为回顾性队列研究，回顾分析2021年1月至2024年9月兰州大学第一医院收治413例老年腹股沟疝修补术患者的临床资料，根据患者围手术期是否使用抗血栓药物分为2组，其中接受ATT的124例为ATT组，未接受ATT的289例为非ATT组。主要结局为术后出血并发症、并发症干预措施分级（Clavien-Dindo分级）以及术后血栓栓塞并发症。次要结局为非出血性并发症、手术时间和术后住院时间。进一步在ATT组内进行基于药物类型的亚组分析，同时对ATT中开放手术和腔镜手术的术后结果进行对比分析。

结果

2组患者均无显著术中出血（＞10 ml），2组术后出血并发症差异无统计学意义：瘀斑（1.6%比0.0%，P=0.09），敷料血性渗出（6.5%比5.9%，P=0.824），均未观察到血肿。ATT组与非ATT组并发症所需的干预措施（Clavien-Dindo分级I级患者5.6%比4.5%），差异无统计学意义（P=0.619）。2组30 d内均未发生术后血栓栓塞并发症，2组在非出血性并发症、术中出血量和手术持续时间方面差异也无统计学意义（P＞0.05）。ATT组术后住院时间多于非ATT组，差异有统计学意义（P＜0.001）。亚组分析显示阿司匹林组、其他抗血小板药物组术后住院时间［M（Q₁，Q₃）］均为1.5（1.0，2.0）d，抗凝组为2.0（1.5，2.0）d，多种抗血栓药物组为1.8（1.0，2.1）d，不同药物组术后住院时间差异有统计学意义（P=0.021）；敷料血性渗出单用阿司匹林组有2例（3.4%），其他抗血小板药物组为0例（0%），抗凝组有1例（4.0%），多种抗血栓药物组有5例（22.7%），不同药物组差异有统计学意义（P=0.019），其余结局指标亚组间差异无统计学意义（P＞0.05）。不同手术方式比较，开放手术术后住院时间为2.0（1.5，2.0）d，腔镜手术为1.5（1.0，2.0）d，差异有统计学意义（P＜0.001），其余结局指标2组间差异无统计学意义（P＞0.05）。

结论

在老年人腹股沟疝修补术中接受ATT的患者占相当高的比例。基于加速康复外科理念单药抗血小板治疗患者行LIHR较安全，二联、多联抗血小板药物或联合抗凝治疗患者需谨慎处理，以免发生术后出血并发症。

Objective

Based on the concept of enhanced recovery after surgery （ERAS）， to investigate the safety of laparoscopic inguinal hernia repair （LIHR） in elderly patients receiving antithrombotic therapy （ATT）.

Methods

This was a retrospective cohort study. Clinical data of 413 elderly patients who underwent inguinal hernia repair in the First Hospital of Lanzhou University from January 2021 to September 2024 were retrospectively analyzed. Patients were divided into two groups according to perioperative ATT use：124 patients who received ATT in the ATT group and 289 patients who did not receive ATT in the non-ATT group. The primary outcomes were postoperative bleeding complications， classification of complication intervention measures （Clavien-Dindo classification）， and postoperative thromboembolic complications. Secondary outcomes included non-bleeding complications，operation time， and postoperative hospital stay. Subgroup analyses were further conducted within the ATT group based on drug types， and postoperative outcomes between open and laparoscopic surgeries in the ATT group were compared.

Results

No significant intraoperative bleeding （＞10 ml） occurred in either group. There were no statistically significant differences in postoperative bleeding complications between the two groups：ecchymosis （1.6% vs. 0.0%， P=0.09） and bloody exudation on dressings （6.5% vs. 5.9%，P=0.824）， with no hematoma observed. The intervention measures required for complications（Clavien-Dindo grade I：5.6% vs. 4.5%） between the ATT group and the non-ATT group showed no significant difference （P=0.619）. No postoperative thromboembolic complications occurred within 30 days in either group， and there were no significant differences in non-bleeding complications， intraoperative blood loss， or operation duration between the two groups （P＞0.05）. The postoperative hospital stay was significantly longer in the ATT group than in the non-ATT group （P＜0.001）. Subgroup analysis showed that the postoperative hospital stay ［M （Q₁， Q₃）］was 1.5 （1.0， 2.0） days in both the aspirin group and other antiplatelet drug groups， 2.0 （1.5， 2.0） days in the anticoagulant group， and 1.8 （1.0， 2.1） days in the multiple antithrombotic drug group， with significant differences among different drug groups （P=0.021）.For bloody exudation on dressings， there were 2 cases （3.4%） in the aspirin monotherapy group， 0 cases（0%） in other antiplatelet drug groups， 1 case （4.0%） in the anticoagulant group， and 5 cases （22.7%） in the multiple antithrombotic drug group， with significant differences among different drug groups （P=0.019）.No significant differences were found in other outcome indicators among subgroups （all P＞0.05）.Comparison of surgical approaches showed that the postoperative hospital stay was 2.0 （1.5， 2.0） days for open surgery and 1.5 （1.0， 2.0） days for laparoscopic surgery， with a statistically significant difference（P＜0.001）， while other outcomes showed no significant differences between the two groups （P＞0.05）.

Conclusion

A considerable proportion of elderly patients undergoing inguinal hernia repair receive ATT.Based on ERAS， LIHR is safe for elderly patients on monotherapy antiplatelet agents， while those on dual/multiple antiplatelet or combined anticoagulant therapies require cautious management to avoid postoperative bleeding complications.