疝环充填式无张力疝修补术后复发疝的再手术探讨

Postoperative hernia recurrence after Mesh Plug tension-free inguinal hernioplasty and reoperation

目的探讨疝环充填式疝修补术后疝复发原因及再手术方法。方法回顾性分析21例疝环充填术治疗腹股沟疝的术后复发的病例资料,探讨预防的方法,全组均为男性。前次手术时21例均为腹股沟斜疝,Ⅱ型2例,Ⅲ型15例,Ⅳ型4例。复发入院时临床检查腹股沟斜疝13例,直疝8例。复发时间术后5 d至24个月。结果再次手术发现网塞自疝环口下滑7例;疝内容物自网塞旁疝环口脱出2例;疝内容物通过2个网塞间自疝环口脱出2例;网片位置过高,疝内容物自网片下方脱出3例;网片卷曲和移位,疝内容物自网片下方脱出5例;疝内容物从自制网塞圆椎体中央脱出1例;复发原因不明1例。结论疝环充填式无张力修补术后复发的主要原因是手术操作不当,规范的手术方法能减少术后复发。

Objective To analyze hernia recurrence after Mesh Plug tension-free inguinal hernioplasty. Methods A retrospective analysis was made in 21 patients with recurrent hernia after Mesh Plug tension-free hernioplasty. All patients were male and diagnosed as indirect hernia during the first operation. Of them, 2 eases belonged to type Ⅱ, 15 to type Ⅲ and 4 to type IV. Recurrent patients were readmitted, 13 of those were diagnosed to have indirect inguinal hernia and 8 to have direct inguinal hernia. The time of recurrence ranged from 5 day to 24 months. Results The Mesh Plug slid off the internal ring in 7 cases, sac extruded from the internal ring along the Mesh Plug in 2 cases, herniary contents extruded between the two Mesh Plug in 2, sac extruded below the too high-positioned Bard mesh in 3 eases, herniary contents extruded below the coiled and/or dislocated Bard mesh in 5 eases, herniary content extruded from the middle part of a self-made cone-shaped mesh in one, and the cause was not found in one. Condusion The main causes of hernia recurrence after Mesh Plug tensin-free hernioplasty are related to a failure in applying the correct operative techniques, and reoperation is indicated.