腹股沟疝无张力修补术后复发的原因分析及对策

The causes and countermeasures of recurrence after tension-free inguinal hernioplasty

目的探讨分析腹股沟疝无张力修补术后复发的原因及对策。方法回顾分析2008年1月～2010年12月收治的腹股沟疝无张力疝修补术后复发病例17例,对复发原因、再手术方式进行总结。结果聚丙烯网片出现卷曲、皱缩、移位8例,疝囊自网片旁脱出;疝囊自耻骨结节旁突出4例;网塞移位于腹膜前间隙或腹壁浅层3例,未良好充填疝环致疝复发;网塞与疝环口间隙过大疝囊自网塞边缘脱出2例。再次手术15例采用平片式无张力疝修补,2例采用网塞填充式无张力疝修补。再次手术后无切口感染,术后随访12～42个月无复发。结论熟悉腹股沟区的解剖生理、了解修补材料的物理特性、遵循手术操作规范有助于降低腹股沟疝无张力修补术后的复发率。

Objective To study the causes and countermeasures of recurrence after tension-free inguinal hernioplasty.Methods A retrospective analysis was made in 17 cases with recurrent inguinal hernia after tension-free hernioplasty in our hospital from January 2008 to December 2010.Causes of rencurrence and reoperation types were analyzed.Results Hernia sac emerged along the mesh due to curl,shrink and shift of polypropylene mesh in 8 cases;Hernia sac extruded near the pubic tubercle in 4 cases;Mesh plug shifted into the preperitoneal space or superficial abdominal wall in 3 cases,Which leaded to hernia recurrence;Hernia sac emerged from the mesh plug edge in 2 cases because the gap between mesh plug and Hernia ring was too large.All patients were operated once again with tension-free hernioplasty（15 patch and 2 mesh plug）.No wound infection appeared after reoperation.No one had recurrence during the follow-up 12 to 42 months.Conclusion To be familiar with anatomy and physiology of inguinal region,understanding with physical properties of repair materials,and following rules of operation contribute to reducing postoperative recurrence rate of tension-free hernioplasty,