B超对疝环充填式无张力疝修补术后网塞和成型补片的观察(附16例临床报告)

Observe the shape of plug mesh and patch by B ultrasound after plug-mesh hernia repair.

目的 了解疝环充填式无张力疝修补术后网塞与成型补片的形态 ,探讨改进手术方法的必要性。方法 应用B超对 16例疝环充填式无张力疝修补术后病人网塞和成型补片进行观察并复习病历 ,评估手术方法对网塞和成型补片形态的影响及修补效果。结果 16例中有 4例成型补片下端与耻骨缘重叠 ,12例未达到耻骨缘。对未达到耻骨缘的 12例改变探头切入角度 ,发现 8例成型补片下端呈高密度区增宽影 ,提示有折叠或卷曲 ,此高密度影与耻骨间还出现一低密度组织影间隙。未达到耻骨缘的 12例中 11例在手术中没有将成型补片下端与耻骨结节固定或曾剪短成型补片。结论 施行疝环充填式无张力疝修补术时 ,成型补片的处理应视术中情况把经典的疝环充填式无张力疝修补方法与Lichtenstein的修补方法结合起来 ,将成型补片缝合固定到耻骨结节的腱膜上。

Objective Investigate the shape of plug mesh and patch after plug-mesh hernia repair and discuss the necessity of improving the operative procedures.Methods Use B ultrasound to investigate the shape of plug-mesh and patch after mesh plug hernia repair and review the patient's medical record,evaluate how operative procedures affect the shape of patch and the results.Results In 4 of the 16 cases,the distant end of patches overlapped the pubic margin,in the remaining 12 cases the distant end of patches didn't reach the pubic margin.When changing the cut-in direction of B ultrasound probe,a wide and dense shadow was discovered in 8 cases whose patches didn't reach the pubic margin.Between the pubic margin and dense shadow there was a space showing low dense shadow.These photocopies showed that the patches had folded up or crimped.In 11 of 12 cases,the patches didn't fix on pubic margin or cut shorter during operation.Conclusion It is suggested to fix the distant end of patch on the aponeurosis tissue of pubic in the procedure of mesh plug hernia repair,and combine the plug-mesh repair with Lichtenstein repair.