无张力疝修补术在腹股沟复发疝中的应用价值

Management of recurrent inguinal hernia;the value of tension-free repair

目的评价无张力疝修补术在腹股沟复发疝中的应用价值。方法对1993年1月至2002年12月163例腹股沟复发疝修补术的临床资料进行回顾性分析。163例复发疝患者中,男138例,女25例,年龄34～76岁,平均(54±11)岁。既往手术方式:传统疝修补术142例(87．1％),其中Bassini术65例、McWay术35例和Shouldice术42例;无张力疝修补术12例(7．4％),其中包括3例腹腔镜无张力疝修补术,另有9例(5．5％)既往手术方式不明。第一次术后疝复发时间3个月至10年,平均(36±14)个月。结果再次手术的方式:Shouldice术71例(43．6％),无张力疝修补术92例(56．4％),其中包括腹腔镜无张力疝修补术3例。随访率100％,随访时间30个月至12年,平均(56±21)个月,Shouldice术后复发率为16．1％(11／71),无张力疝修补术后复发率为2．2％(2／92),两者差异有统计学意义(x2=8．327,P<0．01)。结论无张力疝修补术应作为腹股沟复发疝的首选手术方式。

Objective To evaluate tension-free repair in the management of recurrent inguinal hernia. Methods From 1/1993 to 12/2002, 163 patients with recurrent inguinal hernia underwent reoperation, clinical data were reviewed. Results The male： female ratio was 138： 25, age from 34 to 76 years. The primary surgery had been traditional herniorrhaphy without prothesis in 142 cases （87.1% , including 65 cases of Bassini ,35 cases of McWay and 42 cases of Shouldice） , a tension-free procedure in 12 cases（7.4% , including 3 cases of laparoscopic mesh repair） and unknown techniques in 9 cases（5. 5% ）. The average interval from the initial surgery to recurrence was 36±14 months （range from 3 months to 10 years）. Recurrent hernias were treated with a Shouldice repair in 71 cases（43.6% ） , a tension-free repair in 92 cases（56. 4%, including a laparoscopic mesh repair in 3 cases）. All these 163 cases（ 100% ） were followed up for 56±21 months （range from 30 months to 12 years） after the second surgery. It was found that after reoperation the recurrence rate of Shouldice procedure and tension-free repair was 16. 1% （ 11/71 ） and 2. 2% （2/92） respectively （χ^2 = 8. 327,P 〈 0. 01 ）. Conclusions Tension-free repair is the therapy of choice for patients suffering from recurrent inguinal hernia.