膨式补片前入路腹膜前腹股沟疝修补术381侧(360例)体会

Experience of 360 cases of preperitoneal inguinal hernias repair with Kugel patch though anterior approach

目的探讨前入路腹膜前自膨式补片治疗腹股沟疝的手术方法和治疗经验。方法 2003年10月至2010年8月使用自膨式补片,进行开放式前入路腹膜前修补381侧(360例)腹股沟疝,并记录手术时间、术后并发症、复发率等。结果男328例,女32例,年龄21～93岁,平均68.5岁。在381侧(360例)腹股沟疝中,原发性疝363例,复发性斜疝18例。左侧疝106例,右侧疝233例,双侧42例。斜疝291例,直疝72例,股疝18例。手术时间30～60min(平均45min),术后1～6h下床活动,术后出院时间4～8d(平均6d)。术后皮下血肿13例、血清肿3例,急性尿潴留11例,腹膜损伤2例,切口慢性疼痛3例。随访12～96个月(平均50个月),1例复发。结论前入路腹膜前自膨式补片疝修补术具有微创、无张力,术后并发症少,复发率低等特点,而且安全有效、操作简单、学习曲线短、手术适应证广,更适合我国腹股沟疝患者。

Objective The aim of the present study is to report the experience of patients with inguinal hernias undergoing anterior approach preperitonial repair using Kugel patch. Methods A series of 381 inguinal hernia repairs in 360 patients performed between October 2003 and August 2010 were entered into the study. The operation time, complications, and the recurrence rate were evaluated. Results The patients consisted of 328 men and 32 women with a mean age of 68.5 years （range from 21 to 93 years）. We included 291 indirect, 72 direct and 18 femoral hernias. Mean operative time was 45 minutes; local anesthesia was applied in 353 （92.7%） cases. Postoperative complications affected 32 patients （8.4%）. There was only one recurrence in long follow-up. Conclusions Anterior approach preperitoneal hernia repair with Kugel patch offers advantages of safety and efficacy, it is easy to learn and less complications and recurrence.