腹股沟巨大复发疝无张力修补术式选择及决策

Surgery Choice and Decision-Making of the Big-recrudesce Hernia Tension-free Repair.

目的 :探讨腹股沟巨大及复发疝无张力修补术的术式选择及决策。方法 :选择 4 9例年龄 6 0岁以上年龄组 ,用疝环充填式无张力修补 38例 4 6例次 ,其中双侧疝 8例 ,复发疝 14例 ,11例巨大疝 ,疝内环口均大于5cm ,腹横筋膜缺损萎缩 ,内口边界不清 ,无明显内口界限 ,行单丝聚丙烯网片无张力修补 (Lichtenstein)。结果 :全组均痊愈 ,平均住院 14d ,最早 4d出院 ,2例发生术后尿潴留 ,6例病人行前列腺摘除 ,同时行疝修补 ,故出院延迟 ,随访 6～ 18月无复发。结论 :无张力疝修补作为腹股沟疝修补的金标准[1] ,具有操作简便省时 ,创伤小 ,复发率低 ,修补符合腹股沟管的正常生理要求及形态特点 ,尤其适应于后壁薄弱 ,缺损大 ,张力疝修补多次复发 ,并发症多的患者。故术式选择及术中决策在此类患者中显得十分重要 ,它直接影响患者术后的康复。

Objective:To investigate the surgery choice and decision-making of big-recrudesce hernia tension-free repair. Methods:49 cases (over 60 years old)were chosen. 38 patients(46 times) were treated with mesh plug tension-free hernia repair,Among them,8 cases suffered from double-side hernia , 14 cases from big-recrudesce hernia,11cases from grain hernia.The interior mesh plug openings in every case were bigger than 5 cm, abdomen cross muscle membranes were incomplete and in atrophy,and the boundaries of interior openings were not very chear. Results:All of the cases were cured. The average hospitalization time was 14 days.The earliest hospital-leaving time was four days after the operation.The transient retention of urine occured in 2cases,and prostate removal operation and hernia repairing operation were performed in 6 cases,thus their hospital-leaving time were postponed.No recrudesce was found in the follow-up of 6～18 months. Conlusions: As the golden criterion of grain hernia repair,the tension-free hernia repair is simple,convenient,time-saving.It has low relapse rate,and accord with the shape and physiology of grain duct. This repair is suitable for those patients with weak rear wall,multiple recrudesce after hernia repair and many complications. Therefore, surgery choice and decision-making during the operation is very important for these patients, and directly influences patients' recovery after operation.