传统、改良疝环充填式和普理灵疝装置在无张力腹股沟疝修补中的对比研究

A comparative study on conventional, modified Mesh PIug & Patch and prolene hernia system for tension-free inguinal herniorrhaphy

目的为临床合理选用无张力疝修补方式提供依据。方法采用临床上应用较广的疝环填充式修补术(Rutkow术式)、改良术式(Millikan术式)和普理灵疝装置(PHS)对315例单侧腹股沟疝进行治疗并做随机对比研究。结果 Rutkow、Millikan和PHS三组手术时间平均为36 min、39min和45 min,平均住院时间分别为3.5 d、1.5 d和1.3 d,术后并发症发生率为10.7%(12/112)、3.8%(4/104)和5.0%(5/99),Rutkow组住院时间及并发症发生率都高于其它两组。与Rutkow组相比,PHS组手术时间较长(P=0.043),但住院时间短(P=0.007),术后并发症发生少(P=0.008);而Millikan组手术时间较PHS组短(P=0.048),在住院时间和术后并发症方面两组之间差异无统计学意义(P>0.05)。术后随访4～36个月,306例获有效随访,共有3例出现复发,复发率<1%(3/306),其中Rutkow组有2例,Millikan组有1例,PHS组至今尚未出现。结论三种无张力腹股沟疝修补术式均取到了较好的临床效果,但各有优缺点,需"个体化"选择。

Objective To present clinical evidence for selecting reasonable method on tension-free inguinal herniorrhaphy. Methods 315 cases with unilateral inguinal hernia were randomized to receive respectively classical （Rutkow method）, modified （Millikan method） Mesh Plug ＆ Patch and prolene hernia system （PHS） herniorrhaphy. Results In Rutkow, Millikan and PHS three groups, the average operative time were 36 min, 39 rain and 45 min, the average stay were 3.5 d, 1.5 d and 1.3 d, the postoperative complication rate were respectively 10.7% （12/112） , 3.8% （4/104） and 5.0% （ 5/99 ）. The average stay and postoperative complication rate of Rutkow group were longer and higher than other groups. Compared with Rutkow group, PHS group has longer operation time （ P= 0. 043 ） and significant difference on average stay and complication rate （ P value respective was 0. 007 and 0.008 ）. Millikan group has shorter operation time than PHS group （ P = 0. 048）, but has no significant difference on latter two index （ P 〉 0.05 ）. Follow-up of 4 - 36 months ,306 cases （97%） obtained effectively follow-up. There were 3 cases recurrence, 2 cases in Rutkow group, 1 case in Millikan group. Total recurrence rate was lower than 1% （3/306）. Conclusions Three operation methods have well clinical curative effect. Because of individual characteristic of three methods , we should directly select.