成人隐睾症腹股沟情况评估与一期行无张力修补术

Evaluation of Inguen and Synchronous Tension-free Hernioplasty of Adult Patients with Cryptorchidism

目的探讨成人隐睾症术中腹股沟管情况评估的方法及一期无张力修补术的必要性。方法选取我院收治的成人腹股沟管隐睾186例,年龄18~32岁,分成两组,观察组94例,对照组92例,术中评估腹股沟情况,观察组对内环口扩张及腹横筋膜病例一期进行无张力疝修补术,对照组对单纯内环扩张病例进行单纯疝囊高位结扎术、对腹横筋膜薄弱或内环口扩张伴腹横筋膜薄弱病例进行巴西尼疝修补术,根据随访结果进行回顾性研究。结果术中评估结果分为：内环扩张无腹横筋膜薄弱、内环扩张伴腹横筋膜薄弱、无内环扩张无腹横筋膜薄弱、无内环扩张伴腹横筋膜薄弱,根据以上分类,观察组的例数分别为：21例、37例、22例、14例,对照组的例数分别为：17例、33例、25例、17例,观察组无一例术后出现腹股沟斜疝,对照组出现术后腹股沟斜疝,根据观察结果分组顺序例数分别为：2例、5例、0例、1例。结论成人腹股沟管隐睾症在完成隐睾手术后应该进行腹股沟情况评估,对出现内环口扩张或腹横筋膜薄弱情况在完成隐睾手术后进行一期无张力疝修补术是有必要的。

Objective To discuss the evaluation methods of inguinal and necessity synchronous tension-free hernioplasty of adult patients with cryptorchidism.Methods 186 adult patients with cryptorchidism in inguinal canal from 1999 to 2008,aged between 18 to 32,had been divided into two groups：the observation group had 94 cases;the control group had 92 cases.The condition of the inguinal canal was evaluated in the operation.Patients in the observation group had been taken synchronous tension-free hernioplasty in the condition of which the inner rings were expanded and transverse fascia were weak;patients in the control group had been ligatured hernial sac on the upper opposition in the condition which the inner rings were expanded,and the other cases of control case which the transverse fascia were weak and the transverse fascia were weak with the inner rings were expanded in the same patients had been taken the Bassini procedure,the retrospective study was carried out based on the result of follow-up visitde.Results The result of the evaluation had been divided into 4 conditions：expanded inner ring without weak transverse fascia,expanded inner ring with weak transverse fascia,no expanded inner ring and without weak transverse fascia,no expanded inner ring with weak transverse fascia.Based on this classification,the observation group had 21,37,22 and 14 cases,and the control group had 17,33,25 and 17 cases,respectively.The observation group had no indirect inguinal hernia,and the control group had 8 indirect inguinal hernia cases,according to the classification,which had 2,5,0 and 1 case.Conclusion The evaluation of inguinal canal must be taken for adult patients with inguinal crytorchidism,and synchronous tension-free hernioplasty after the crytorchidism＇s operation was necessary to the conditions that the inner ring was expanded and the transverse fascia was weak.