尿毒症患者腹股沟疝手术方式的选择及其对肾移植手术的影响

reatment of inguinal hernia in uremic patients and its effect on kidney transplantation operation

目的探讨尿毒症患者腹股沟疝手术方式的选择及其对肾移植手术操作的影响。方法回顾性分析了2004年至2008年尿毒症患者腹股沟疝手术修补方式和腹股沟疝修补术后的同侧肾移植术。结果尿毒症患者行腹股沟疝手术修补25例,手术方式分别为Lichtenstein平片修补法13例,疝环充填式无张力修补术10例,Bassini法1例,疝囊高位结扎1例。腹股沟疝修补术后同侧肾移植术5例;其中传统手术修补术后2例,肾移植手术操作无特殊;无张力疝修补术后3例;平片修补法2例因无法游离精索而致切口暴露困难,术中被迫切断精索;疝环充填式无张力修补术后1例,腹膜前及膀胱顶部致密粘连,输尿管膀胱吻合困难。结论传统的腹股沟疝修补术后对尿毒症患者以后的肾移植手术操作无明显影响。无张力修补术式中,以使用膨化聚四氟乙烯补片的Lichtenstein法对肾移植手术操作影响最小。腹膜前间隙的聚丙烯网塞或补片可引起局部致密纤维瘢痕形成,导致膀胱暴露和输尿管再植困难,不宜在尿毒症患者中应用,尤其禁忌用于双侧疝患者。

Objective To explore the selection of operative repair methods for inguinal hernia in uremic patients and its effect on kidney transplantation operation.Methods The repair operations for inguinal hernia in uremic patients and kidney transplantation operations in patients after ipsilateral inguinal hernia repairs performed between 2004 and 2008 in our hospital were retrospectively analyzed.Results There were 25 uremic patients suffering from inguinal hernia treated by operative repairs,including 13 cases of Lichtenstein tension-free hernia repairs,10 cases of plug-and-patch repairs,1 case of Bassini repair and 1 case of ligation of hernia sac.There were 5 cases of kidney transplantation in patients after ipsilateral inguinal hernia repairs.In 2 cases after traditional repairs,transplant operations were performed without special difficulty.In 2 cases after Lichtenstein repair,difficulty in incision exposure was encountered,the spermatic cord had to be divided.In one case after plug-and-patch repair,the fundus of the bladder was encased in fibrous tissue and mesh making the standard extraperitoneal ureteroneocystostomy impossible.Conclusions The traditional inguinal hernia repairs have little influence on ipsilateral kidney transplantation.In tension-free hernia repair methods,the Lichtenstein repair using expanded polytetrafluoroethylene patch has least influence on subsequent kidney transplantation.Mesh plug or patch prosthesis of polypropylene placed preperitoneally causes severe fibrosis,makes graft ureter reimplantation difficult,it is not suitable for potential kidney transplant recipients,especially in bilateral inguinal hernia.