下腹正中切口入路腹膜前腹股沟疝修补术临床应用研究

Preperitoneal tension-free inguinal hernia repair via hypogastric midline incision

目的：探讨下腹正中切口入路腹膜前间隙腹股沟疝无张力修补术的临床应用价值。方法回顾性分析2010年4月至2012年10月哈尔滨医科大学附属第四医院普外科收治的120例腹股沟疝病人的临床资料，均采用补片行下腹正中切口入路腹膜前间隙腹股沟疝无张力修补术。其中，单侧疝98例，双侧疝22例；斜疝85例，直疝30例，复发疝5例。观察手术时间、术后舒适性、并发症和复发率。结果120例病人手术时间为20～60 min，单侧疝平均30 min，双侧疝平均50 min。术后6 h下床活动。平均住院时间为4 d。切口积液2例，无阴囊血肿或积液，无尿潴留。术后随访6～24个月无复发。结论下腹正中切口入路腹膜前间隙腹股沟疝修补术学习曲线短、操作简便、安全性高、术后复发率低、恢复快、异物不适感轻微、术后慢性疼痛发生率低，尤其适合于双侧疝及复发疝。

Objective To explore the value of preperitoneal tension-free inguinal hernia repair via hypogastric midline incision. Methods The clinical data of 120 cases of inguinal hernia underwent the tension-free hernia repair with 3D-Max patch from April 2010 to October 2012 in Department of General Surgery,the Fourth Affiliated Hospital of Harbin Medical University were analyzed retrospectively. Among them,there were 98 cases of unilateral hernia,22 cases of bilateral hernia, 85 cases of inguinal hernia,30 cases of direct hernia,5 cases of recurrent hernia. Operation time, degree of comfort,complications and recurrence rate were recorded. Results The operation time was 20 min to 60 min. The mean operative time was 30 min for the cases with unilateral hernia and 50 min for the cases with both sides. The mean time of ambulation was 6 h. The mean hospitalization days were 4 days. Incision effusion occurred in 2 cases. Neither scrotal hematoma nor scrotal effusion nor urinary retention occurred. No recurrence occurred during follow-up for 6 months to 2 years. Conclusion Preperitoneal tension-free inguinal hernia repair via hypogastric midline incision has many advantages with short learning curve,simple operation,high safety,low recurrence rate,quick recovery after operation,mild foreign body discomfort and low incidence of chronic pain after a hernia repair,which is suitable for bilateral hernia and recurrent hernia especially.