腹腔镜腹股沟疝修补术合理应用再思考

Rethinking about the reasonable choice of laparoscopic inguinal hernia repair

腹股沟疝无张力修补术可分为三大类术式:肌前修补、网栓充填术和腹膜前修补术,前两者修补腹股沟管后壁和疝环缺损,后者修补腹股沟部位的所有薄弱区域即肌耻骨孔。腹膜前修补术可以通过开放式手术完成,也可通过腹腔镜手术来完成。事实上,腹腔镜腹股沟疝修补术是众多腹膜前修补术中的一种方式,其特点是利用"腹腔镜器械"、通过"真正的后入路"、在"直视下操作"所进行的腹膜前手术。在临床上适用的人群主要有三大类:(1)具有腹膜前修补指征的人群,如腹横筋膜薄弱的老年病人、直疝或复合疝、存在腹内压增高因素的病人。(2)需要尽快恢复体力活动的病人。(3)复发疝和双侧疝。腹腔镜和开放式腹股沟疝修补术均是安全有效的修补方式,具有互补性,合理选择术式可获得最佳的临床和卫生经济学效益。

The tension-free inguinal hernia repair can falls into three different surgical techniques including premuscular repair,plug and patch repair and preperitoneal repair. The method of first two repairs the posterior wall of the inguinal canal and the hernia defect,and the latter repairs all of the weak area of the groin area,that is myopectineal orifice. Preperitoneal repair can be achieved through open surgeries or laparoscopic approach. Actually,laparoscopic inguinal hernia repair(LIHR) is one of the preperitoneal repair,which is through 'real posterior approach',under 'direct vision' and by the 'laparoscopic instruments'. The three clinical suitable crowd:(1) The patients with preperitoneal repair indications,such as the patients with old aged and the transversalis fascia feebleness,direct hernia or complex hernia and the abdominal cavity internal pressure increased and so on;(2) The patients need recover physical activity as soon;(3) Recurrent and bilateral inguinal hernia patients. Laparoscoic and open surgery are both safe and efficient tension-free techniques for inguinal hernias repair. The reasonable choice of repair method can offer the best clinical and cost-effective results.