经下腹部正中切口行完全腹膜前腹股沟疝修补

Open total extraperitoneal herniorrhaphy for inguinal hernia via a ventral midline incision

目的 探讨经下腹部正中切口行完全腹膜前腹股沟疝修补术的技术操作要点及其对腹股沟疝的有效性.方法 对2008年6月至2009年12月经下腹部正中切口行腹膜前腹股沟疝修补术的106例患者临床资料进行回顾性分析.分析该术式临床特点及效果.结果 全组患者中,男性86例,女性20例,平均年龄60.2岁（21～86岁）.平均手术时间（32.6±10.5）min.术后住院时间（2.3±0.7）d.术中腹膜穿孔2例,予以关闭腹膜.术后尿潴留4例,切口血清肿2例,术后早期术区疼痛6例,均经保守治疗治愈.阴囊积液3例,其中2例保守治疗痊愈,1例经严格无菌穿刺抽吸后治愈.无切口感染、阴囊血肿发生.随访3～22个月,平均10.2个月;其间无明显腹股沟区不适及异物感、慢性神经疼痛和深部补片感染发生.术后2个月及11个月各出现1例复发,复发率为1.9%,再次入院手术治愈.结论 经下腹部正中切口行完全腹膜前腹股沟疝修补技术安全可靠,疗效确切,操作简单,并发症少,单一切口可完成双侧疝修补,值得临床推广.

Objective To discuss the operation skills and evaluate the effects of open total extraperitoneal herniorrhaphy for inguinal hernia via a ventral midline incision. Methods From June 2008 to December 2009, 106 patients with inguinal hernia received open total extraperitoneal herniorrhaphy via a ventral midline incision, the clinical data were analyzed retrospectively. Results Of the patients,86 cases were male, 20 were female, the mean age was 60. 2 years（ range,21-86 years）. The mean operation time was （32.6 ± 10.5 ） minutes. The postoperative hospital stay was （ 2.3 ± 0.7 ） days. Intra-operative peritoneal perforation occurred in 2 cases. Four cases experienced urine retention and seroma happened in 2 cases,6 cases suffered early surgical-site pain, and all of the complications were cured with conservative treatment.Three cases developed scrotal hydrocele. No neuralgia or incisional infection occurred in this group. During a 3- to 22-months follow-up period （ mean, 10.2 months）, no patient complained of discomfort or foreign body sensation in the inguinal area. Two cases recurred 2 and 11 months after the surgery, respectively; the recurrence rate was 1.9%, the two patients healed after reoperation. Conclusions Open total extraperitoneal herniorrhaphy operation via a ventral midline incision is a safe, effective and convenient technique for inguinal hernia with few postoperative complications. This method is worth popularizing.