开放式腹股沟疝无张力修补术1136例临床分析

Open Tension-free Repair of Inguinal Hernia Analysis of 1 136 Cases

目的分析比较3种常用开放式腹股沟疝无张力修补术(Lichtenstein术式、Rutkow术式、腹膜前修补术式)的临床疗效。方法本文将2003年2月至2009年8月在首都医科大学附属北京同仁医院普外科诊断患腹股沟疝的共1136例住院患者,根据患者当时采用的开放式腹股沟疝无张力修补术术式的不同分为3类:即Lichtenstein术式、Rutkow术式、腹膜前修补术式。对比分析这3种腹股沟疝无张力修补术在住院时间、住院费用、术后并发症、复发率和术后疼痛等方面的差异。结果开放式腹股沟疝修补术1136例均成功实施手术。3种手术类型间Lichtenstein组平均住院费用显著低于Rutkow组和腹膜前修补组;术后并发症未见到,组间差异无统计学意义。住院时间、复发率和术后疼痛组间差异均无统计学意义。结论 3种腹股沟疝无张力修补术均是治疗腹股沟疝安全、有效的手术方法 ,均有微创、住院时间短、复发率低和术后疼痛轻、术后并发症少的优点,个体化治疗仍是最佳选择。严重的早期术后疼痛预示着持续的慢性腹股沟痛发生的可能性。

Objective To evaluate the effects of three operation methods on the open tension-free repair of inguinal hernia. Methods The data of 1 136 cases of inguinal hernias seen between Feb. 2003 and Aug. 2009 after tension-free hernioplasty were analyzed retrospectively. Total expenses,length of hospital stay,post operation complications,rate of recurrence were compared among the groups. Results In all the 1 136 cases the tension-free hernia repair was successful. The operation methods included Lichtenstein,Rutkow,preperitoneal inguinal herniorrhaphy（PIH）. The average hospital expense was significantly lower in the Lichtenstein group than in the Rutkow and PIH groups. There were no significant differences in recurrence rate,post operative complications,length of hospital stay among the three groups. Conclusion All the 3 hernioplasty procedures showed ideal effects,characterized by low recurrence rate,minor postoperative pain,quick recovery,short hospital stay and few post-operative complications. Individualized treatment programs are still the optimal choices. Severe early postoperative pain reliably predicted the likelihood of persisting chronic groin pain.