Nyhus后入路修补治疗腹股沟疝的临床应用

Nyhus Posterior Preperitoneal Approach for the Treatment of Inguinal Hernia

目的 探讨Nyhus后入路治疗腹股沟疝的临床效果. 方法 2001年8月～2007年2月,行182例Nyhus后入路疝修补术,包括Ⅱ型34例,Ⅲ型116例,Ⅳ型32例.由腹直肌后直接进入腹膜前间隙,利用髂耻束和耻骨梳韧带作间断缝合或用单层网片修补. 结果 手术时间(38.3±13.8)min (23～96 min),术后住院时间(2.6±0.8)d (1～9 d).术后2～24 h下床活动.2例阴囊积液,3例急性尿潴留,均治愈.手术后切口无红肿、渗液,术后伤口仅有轻微疼痛,均未使用镇痛药.全部病例随访2～40个月,平均19个月,无明显的腹股沟区不适及异物感,复发1例. 结论 采用Nyhus后入路进行腹股沟疝修补安全、可靠,操作简单,并发症少,费用低,是治疗成人斜疝、直疝、股疝,特别是复发疝、巨大或复杂疝、嵌顿性疝合并肠梗阻的有效手段.

Objective To evaluate the clinical efficacy of Nyhus posterior preperitoneal approach for the treatment of inguinal hernia. Methods From August 2001 to February 2007,a total of 182 patients with inguinal hernia,including 34 cases of typeⅡ,116 type Ⅲ,and 32 type Ⅳ,were treated with inguinal herniorrhaphy through the Nyhus posterior preperitoneal approach.An entrance into the preperitoneal space was created through an approach behind the rectus abdominis.The hernia was repaired by interrupted suturing of the iliopectineal tract and Cooper's ligament or using monolayer mesh.Results The mean operation time was(38.3±13.8) min(range,23 to 96 min) and the mean hospital stay was(2.6±0.8) d(range,1 to 9 d).The patients got out of bed 2-24 h after the operation.After the surgery,2 cases developed scrotal hydrocele and 3 had acute urinary retention.All of them were cured.No incision infection occurred in this series.The incision pain was mild without needing to use analgesics.During a 2-to 40-month follow-up(mean,19 months),no patient complained of discomfort in the inguinal area or foreign body sensation;only one patient had recurrence.Conclusions It is safe,effective,and convenient to repair inguinal hernia through the Nyhus posterior preperitoneal approach.Since the operation is a cheap treatment method associated with few postoperative complications,it is recommended for adult patients with direct,indirect,and femoral inguinal hernia,especially for those with recurrent,large,complicated,and incarcerated hernia accompanied by intestinal obstruction.