加强腹横筋膜在Ⅲ型腹股沟疝无张力修补术中的作用研究

Study of the efficacy of transversalic fascia reinforcement in tension-free herniorrhaphy of Type Ⅲ inguinal hernias

目的探讨加强腹横筋膜在Ⅲ型腹股沟疝无张力修补术中的作用和价值。方法回顾性分析2005年1月至2006年12月的135例腹股沟疝患者的临床资料。第一组65例采用Millikan技术或应用双层普理灵补片加强腹横筋膜,第二组70例采用经典的疝环充填式无张力修补术。结果两组病例在性别比例、平均年龄、合并疾病等方面相似,具有可比性。两组的平均手术时间分别为49min、41min,术后平均住院天数分别为5.4d、5.1d,均无显著差异。两组总体并发症发生率分别为12.3%(8/65)、15.7%(11/70),无明显差异,但第一组术后慢性疼痛发生率(1.5%)明显低于第二组(7.1%)。随访24个月以上,第一组无复发病例,第二组复发率为4.3%(3/70),两组差异有显著性意义。结论在腹股沟疝无张力修补术中注重腹横筋膜的加强,可以有效地提高疗效、减少并发症。

Objective To evaluate the clinical efficacy of transversalic fascia reinforcement in tension-free herniorrhaphy of Type Ⅲ （ Chinese Classification ） inguinal hernias. Methods The clinical data of 135 cases with inguinal hernias received tension-free hernioplasty in our hospital from Jan. 2005 to Dec. 2006 were retrospectively analyzed. Group 1 （ n = 65） ： the Millikan＇ s modified technique or Prolene Hernia System （PHS） was adopted in order to reinforce the transversalic fascia. Group 2 （ n = 70 ） ： conven- tional Mesh Plug ＆ Patch was used. Results There was no significant difference between two group in gender, mean age and combined diseases. The mean operating time of group 1 was 49 min, and that in group 2 was 41 min. The mean postoperative hospital stay was 5.4 days （group 1 ） and 5.1 days （ group 2） respec- tively. There were no significant difference . The common complication rate was 12.3 % （8/65） and 15.7 % （11/70） respectively in the two groups without significant difference, but the postoperative chronic pain in group 1 （ 1.5 % ） was significant lower than that in group 2 （7.1% ）. All patients were followed-up over 24 months. The recurrence rate in group 1 （0） was notablely lower than that in group 2 （4.3 % ）. Conclusions In tension - free herniorrhaphy, paying attention to reinforce transversalic fascia can effectively improve efficacy and reduce the complications.