600例腹股沟疝修补术的临床对比研究

Comparison on Repair of Indirect Inguinal Herniorrhaphy:an analysis of 600 cases

目的研究比较传统腹股沟疝修补、开放性无张力疝修补及腹腔镜疝修补术的临床选择。方法从1999年1月至2004年1月,共收治600例腹股沟疝修补术患者作回顾性分析,其中传统性疝修补术186例,开放性无张力疝修补术204例,腹腔镜疝修补术210例。传统疝修补分别采用McVay及Bassini法。开放无张力疝修补采用Marlex网塞和补片;腹腔镜疝修补采用腹腔镜下内环口荷包缝扎和腹膜内置网法。结果传统疝修补平均手术时间(2.0±0.5)h,无张力组(1.6h±0.6)h,腹腔镜组(1.3h±0.5)h。术后随访2～2.5年,传统疝修补16例复发,无张力疝组无复发,腹腔镜组2例复发。恢复正常活动时间,腹腔镜组6.8d,无张疝组8.5d,传统手术组为16.3d。结论开放性无张力疝修补是一种简单,手术时间短,痛苦小且可靠的手术,适于腹股沟原发或继发疝,腹腔镜疝修补术后恢复工作比其他两组短,但复发率比无张力疝组稍高,除适用于腹股沟原发疝外,更加适于双侧疝和复发疝。

Objective To compare results following conventional, open tension-free and laparoscopic inguinal herniorrhaphy. Methods From January 1999 to January 2004,600 patients were offered inguinal hernia repair. Of them, 186 patients underwent conventional herniorrhaghy（McVay or Bassini repair according to the surgeon＇s preferance）, 204 patients underwent open tension-free herniorrhaghy and 210 patients were subjected to laparoscopic repair. The open tension-free repair was performed by using the mesh-plug technique or the mesh technique. Laparoscopic repair was performed by using the transperitoneal onlay technipue. Results Mean operative time was （2.0±0.5）h for the conventional group, （1.6±0.6）h for the tension-free group and （1.3±0.5）h for the Laparoscopic group. After a follow-up of 2~2.5 year, there were 16 recurrences in the convenional group, 2 recurronce in the laparoscopic group and none in the tension-free group. After operation, the laparoscopic group retuns to normal activity in 6.8d the tension-free group in 8.5d and the conventimal group in 16.3d. Conclusions the open tension-free herniorrhaghy in simple, rapid, less painful and effective, and it could be adopted in primary or recurrent hernia. Laparoscopic hernioplasty renders the paitents earilier retun to work but has a slightly higher recurrence rate than the open tension-free repair, and it is most suitable for bilateral and recurrent hernias.