探究腹腔镜经腹腹膜前疝修补术（TAPP）治疗老年急性嵌顿性腹股沟疝的临床疗效和安全性。

本研究为回顾性临床对照研究。纳入2022年4月至2025年6月，江苏省中医院连云港医院急诊医学科收治的老年急性嵌顿性腹股沟疝患者80例。由主管医师根据临床情况综合判断决定患者的手术方式并获得患者知情同意。依据手术方式将患者分为对照组（传统开放无张力疝修补术，n=38）和试验组（TAPP，n=42）。比较两组患者的手术相关指标、术后早期疼痛评分、应激指标、胃肠功能恢复情况、肠黏膜屏障功能指标以及并发症发生情况。

2组患者均顺利完成手术及3个月随访，无脱落病例。试验组手术时间、术后首次下床活动时间及术后住院时间均较对照组更短，差异有统计学意义（P<0.05）。术后1 d、1周、3个月，试验组疼痛视觉模拟评分法评分较对照组更低，差异有统计学意义（F=0.816，P=0.041）；术后1 d，2组患者的P物质、神经肽Y水平较术前均明显下降，且试验组均更低，差异有统计学意义（P<0.05）。试验组术后首次排便时间、肠鸣音恢复时间均优于对照组，差异有统计学意义（P<0.05）。术后1 d，2组患者肾上腺素、皮质醇、血清丙二醛水平均明显升高，但试验组均低于对照组，差异有统计学意义（P<0.05）。术后1 d，2组患者二胺氧化酶水平、血清D-乳酸水平均明显降低，且试验组均低于对照组，差异均有统计学意义（P<0.05）。2组均无不全性肠梗阻及疝复发病例。试验组总并发症发生率11.90%（5/42）与对照组7.89%（3/38）比较，差异无统计学意义（Fisher精确检验，P=0.715）。

TAPP治疗老年急性嵌顿性腹股沟疝在减轻术后早期疼痛与应激、促进胃肠功能恢复方面优于传统开放手术，且安全性相当。

To observe the clinical efficacy and safety of laparoscopic preperitoneal hernia repair (TAPP) in the treatment of elderly patients with acute incarcerated inguinal hernia.

This retrospective controlled clinical study included 80 elderly patients with acute incarcerated inguinal hernia who were admitted to the Department of Emergency Medicine, Lianyungang Hospital of Jiangsu Provincial Hospital of Traditional Chinese Medicine, from April 2022 to June 2025. The surgical approach was determined by the physician in charge based on a comprehensive assessment of each patient's clinical condition, and informed consent was obtained from all patients. According to the surgical approach, the patients were divided into the control group, which underwent conventional open tension-free hernia repair (n=38), and the experimental group, which underwent TAPP (n=42). Surgical-related indicators, early postoperative pain scores, stress indicators, gastrointestinal function recovery, intestinal mucosal barrier function indicators, and postoperative complications were compared between the two groups.

Both groups of patients successfully underwent surgery and completed the 3-month follow-up and no drop-out cases were found. The operation time, the time of the first postoperative ambulation, and the postoperative hospital stay in the experimental group were all shorter than those in the control group, and the differences were statistically significant (P<0.05). The visual analogue scale scores for pain in the experimental group on the 1st day, 1st week, and 3rd month after surgery were lower than those in the control group, and the differences were statistically significant (F=0.816, P=0.041). On the 1st day after surgery, the levels of substance P and neuropeptide Y in both groups decreased significantly compared to those before the operation, and the levels in the experimental group were lower, with statistically significant differences (P<0.05). The first defecation time and the recovery time of bowel sounds in the experimental group were better than those in the control group, and the differences were statistically significant (P<0.05). The levels of epinephrine, cortisol, and serum malondialdehyde in both groups significantly increased on the 1st day after surgery, but the levels in the experimental group were lower than those in the control group, with statistically significant differences (P<0.05). The levels of diamine oxidase and serum D-lactic acid in both groups significantly decreased on the 1st day after surgery, and the levels in the experimental group were lower than those in the control group, with statistically significant differences (P<0.05). There were no cases of partial intestinal obstruction or recurrence of hernia in both groups. The complication and recurrence rates between groups were 11.90% (5/42) and 7.89% (3/38), there was no statistically significant difference (Fisher's exact test, P=0.715).

Compared with conventional open surgery, TAPP is superior in alleviating early postoperative pain and stress response and promoting gastrointestinal function recovery in elderly patients with acute incarcerated inguinal hernia, while providing comparable safety.