嵌顿性腹股沟疝的外科治疗策略

Surgical treatment of acute incarcerated inguinal hernias

目的比较无张力疝修补术与传统修补术在嵌顿性腹股沟疝治疗中的利弊。方法回顾性分析2002年1月至2009年12月间收治的嵌顿性腹股沟疝70例，急诊手术分为两组：无张力疝补片修补术组（47例），行疝环充填式无张力修补术（Rutkow）；传统疝修补手术组（23例），行Bassini修补术。术前有腹膜炎体征、术前考虑为嵌顿疝而术中发现为绞窄疝者不在此研究之列。结果无张力手术组平均手术时间为（87±13）min，较传统手术组长（78±14）min;住院时间传统手术组（6．4±2．9）d稍高于无张力组（5．9±2．3）d；术后阴囊血肿的发生无张力组为8．5％（4例），而在传统手术组仪4．3％（1例），但以上结果差异均无统计学意义。两组患者术后均无切口感染病例。传统手术组术后应用止痛剂11例，而无张力组仅有2例，差异有统计学意义（P=0．001）。术后随访9～100个月，传统手术组复发率13％（3例）与无张力组（0例）相比差异有统计学意义（P=0．032）。结论在嵌顿性腹股沟疝的治疗中采用无张力疝修补术可以取得较好的效果，但术中的手术技巧和预防感染的措施，对防止手术并发症的作用值得重视。

Objective To compare tension - free mesh repair with Bassini technique in treatment of incarcerated inguinal hernia. Methods A retrospective study of 70 patients was conducted ,who underwent emergency hernioplasty for acute incarcerated inguinal hernia between January 2002 and December 2009. These patients were divided into two groups ：47 patients receiving open tension -free anterior repair （Rutkow） utilizing a monofilament polypropylene mesh and plug（ tension -free group）, whereas the other 23 patients receiving Bassini technique（ traditional repair group）. Patients with preoperative peritonitis and bowel necrosis caused by strangulated inguinal hernia were excluded from the study. Results Mean duration of surgery, average postoperative hospital length and incidence of scrotal hematoma were 87 ± 13 rain, 5.9 ± 2.3 days and 8.5% （ 4 cases） in tension - free repair group, versus 78 ± 14 min ,6.4±2.9 days and 4.3% （4 cases）in traditional repair group, respectively. There was no statistically significant difference with regard to these results between the two groups. Incision infection was not detected postoperatively in both group patients. Eleven patients were administered with painkiller after operation in traditional repair group, which was significantly more than those in tension -free repair group（2 patients,P = 0.001 ）. After a follow - up period for 9 - 100 months, the recurrence rate in traditional repair group （ 13 %, 3 patients ） was significantly higher than in tension - free repair group （ 0% , P = 0. 032% ）. Conclusion Tension - free repair in the treatment of incarcerated inguinal hernias is safe and effective with low rate of postoperative complications. Surgical techniques and anti - infection measures during surgery were important to pre- vent operative complications.