改良前入路腹膜前平片修补腹股沟疝的临床应用

Reformational application of the polypropylene mesh in preperitoneal tension-free hernia repair via open anterior approach

目的探讨前入路腹膜前置入平面补片修补腹股沟疝的临床应用和改良技术要点。方法回顾性分析总结从2007年1月至2010年8月,采用平面补片,做腹股沟疝(斜疝、直疝、复发疝)的特定修补术式428例临床资料,对患者术前合并症、手术时间、手术方式、术后并发症、住院天数等进行综合分析。结果手术时间40～90min(平均50min),术后12～24h下床活动(平均20h),术后3～5d恢复日常行走活动,术后切口轻微疼痛,无需止痛剂使用,3d后白细胞、体温均恢复正常,术后5～7d出院。随访8～51个月,局部硬物感0.7%(3/428),疼痛发生率0.47%(2/428),无复发。结论改良前入路腹膜前平片无张力疝修补术的临床应用是全腹股沟区修补,适合修复各型腹股沟疝,尤其适用于腹横筋膜缺损大的患者,操作简便、安全、经济,易于推广。

Objective To investigate the modify methods and technical key points of polypropylenc mesh in preperitoneal tension - free hernia repair via open anterior approach. Methods Retrospetively analyses of the clinical data of 428 cases who suffered inguinal hernia repair by open preperitonal anterior approach from January 2007 to August 2010. Preoperative complications, operation time, operative methods, postoperative pain, hospital time and the results of follow - up were analyzed. Results The mean operation time were 50 minute （ rang 40 to 90）. The mean time of getting out of bed were 20 hours （ rang 12 to 24）. The mean resuming regular activities time was rang 3 to 5 days. The method had slight incision pain without the need of analgesics, white blood count and temperature were normal. The average postoperative hospital stay was 5 to 7 days. Patients fell foreign body were in O. 7% , pain in 0.47% and there was no recurrence during the follow up period from 8 to 51 months. Conclusions The modified methods of inguimal hernia rcpair using preperitoneal patch is a total inguinal repair and feasible for all types of inguinal hernia reparatiou, especially for the inguinal hernias with evident defect of transversalis fascia. It is characteristics of simple, security and inexpensive, and to popularize the method is an easy job.