股管内环口网塞填塞联合腹膜前间隙平片在股疝无张力修补术中的应用

Insertion of plug into femoral canal from internal ring combined with preperitoneal space mesh in the treatment of femoral hernia

目的分析经股环股管网塞填塞联合应用平片在腹膜前间隙无张力疝修补术中的应用价值。方法回顾性分析2010年2月至2013年12月,上海交通大学医学院附属新华医院崇明分院收治的的女性股疝患者17例。从患侧腹股沟韧带中点上方2 cm,向同侧耻骨结节作一切口。在子宫圆韧带的内下方,切开腹横筋膜,进入腹膜前间隙,将疝从股管中拉出。将网塞从股环处置入股管并妥善固定。将平片越过耻骨梳韧带下方2 cm,于腹膜前间隙摊平。结果所有患者手术均顺利结束,手术时间49～78 min,平均62 min。术中出血少,没有股静脉损伤。术后无局部红肿,切口愈合佳。术手术区域不适感2例,不影响生活和工作。下肢活动正常。术后随访3～48个月,无复发。结论将网塞经股环置入股管联合腹膜前间隙平片治疗股疝,是一种安全可靠的股疝修补方法。

Objective To present a novel technique for the treatment of femoral hernia by combining plug and preperitoneal space mesh. Methods From February 2010 to December 2013,17 female patients with femoral hernia underwent tension-free hernia repair. An incision was made above the inguinal ligament （2 cm）, between midpoint of inguinal ligament to pubic tubucle. After the transver salis facisa being incised immediately below the round ligament, the hernia sac was dissected completely and sent back into the preperitoneal space. Plug was inserted into the femoral canal from the internal ring and fixed with sutures. A flat mesh was placed in preperitoneal space and covered the myopectineal orifice. Results The duration of operation ranged from 49 to 78 minutes. All procedures were almost bloodless. No femoral vein injury, and no wound hematoma occurred in our series. Two patients complained of foreign body sensation in operation area, which did not influence their daily life. No recurrence of hernia was documented during the period of follow- up （ range 3 to 48 months）. Conclusion Our approach for femoral hernia repair is safe and reliable.