青年男性病人的腹股沟疝修补:用补片还是单纯缝合?

Groin hernia repair in young males:mesh or sutured repair?

目的目前还没有治疗青年男性腹股沟疝病人的最佳修补方法的大宗病例报道。该文分析了丹麦全国青年男性病人接受Lichtenstein术或传统非补片修补术后复发再手术的风险。方法在丹麦国家疝数据库内前瞻性地记录了1998-01-01至2005-12-31所有接受手术治疗的腹股沟疝病例,以复发再次接受手术作为判定复发的标准。该研究的入组标准为数据库中年龄在18～30岁之间的原发性腹股沟斜疝并在研究阶段内接受了第一次修补手术的病例。结果在纳入该研究的3181例病人中,1120例(中位年龄23岁,范围18～30岁)接受了单纯的缝合修补术,2061例(中位年龄24岁,范围18～30岁)接受了Lichtenstein术。单纯缝合组的中位随访时间为62(0～96)个月,Lichtenstein组的中位随访时间为41(0～96)个月。两组的5年累积复发再手术率分别为1.6%(Lichtenstein组)和3.9%(单纯缝合组),单纯缝合组的术后总复发再手术率(39例,3.5%)为Lichtenstein组(24例,1.2%)的将近3倍(P=0.003)。结论与传统单纯缝合修补术相比,在18～30岁的青年腹股沟斜疝病人中应用Lichtenstein术可以大大降低术后复发的风险。但是,在治疗青年男性病人中应用补片时必须衡量术后可能发生的慢性疼痛的风险。

Objective Large-scale data for the optimal inguinal hernia repair in younger men with an indirect hernia is not available. We analysed nationwide data for risk of reoperation in younger men after a primary repair using a Lichtenstein operation or a conventional non-mesh hernia repair. Methods Prospective recording of all inguinal hernia repairs from 1 January 1998 to 31 December 2005 in the national Danish Hernia Database, using reoperation rate as a proxy for recurrence. We included only men between the age of 18 and 30 years with a primary repair of a primary indirect inguinal hernia. Results A primary sutured repair was performed in 1,120 men （median age 23 years, range 18-30） and a Lichtenstein mesh repair in 2,061 young men （24 years, range 18-30） （total 3,181 patients）. The observation time after conventional hernia repair was median 62 months （range 0-96） and 41 months （range 0-96） after a Lichtenstein repair. The cumulative incidence of reoperation at 5 years was 1.6% （Lichtenstein） versus 3.9% （sutured repair）, while overall reoperation rates were almost three-fold as high after a sutured repair （39 reoperations, overall reoperation rate = 3.5% ） compared to a Lichtenstein repair （24 reoperations, overall reoperation rate=l.2% ;P=0.0003）. Conclusion Lichtenstein repair for an indirect inguinal hernia reduces the risk of recurrence in young men between the age of 18 and 30 years compared with a sutured repair. The use of a Lichtenstein mesh repair in young males must be balanced against the risk of chronic pain.