双层立体补片与聚丙烯充填式网塞补片修补无张力腹股沟疝的效果比较

Prolene hernia system versus polypropylene mesh plug in tension-free hernia repair

背景:应用补片行无张力腹股沟疝修补现已被广大临床外科医生所普遍认同,但补片类型很多,临床外科医生往往很难选择。目的:对比双层立体补片、聚丙烯充填式网塞补片修补腹股沟疝的疗效。方法:回顾性分析150例腹股沟疝患者的临床资料,其中男133例,女17例,年龄21-80岁,81例采用双层立体补片行无张力疝修补,69例采用聚丙烯充填式网塞补片行无张力腹股沟疝修补,均为首次接受手术治疗。总结两种治疗方式适应证,记录两组手术时间、下床活动时间、平均住院时间、术后局部疼痛及不适感和异物感情况,随访2年观察复发情况。结果与结论:疝环口大、腹横筋膜薄弱、腹股沟管后壁缺损适宜选择双层立体补片,而不宜选择聚丙烯充填式网塞补片。两组手术时间、下床活动时间及平均住院时间比较差异无显著性意义,但双层立体补片组术后局部疼痛、术后不适感和异物感及随访2年后复发率明显低于聚丙烯充填式网塞补片组(P<0.05)。结果表明与聚丙烯充填式网塞补片相比,双层立体补片适应证广,组织相容性好,局部不适和异物感症状轻,疼痛发生率及复发率低,是更为理想的补片选择。

BACKGROUND： Patch for tension-free inguinal hernia repair has been generally accepted by the majority of surgeons, but it is difficult for surgeons to select the proper patch type. OBJECTIVE： To compare the clinical efficacy of prolene hernia system versus polypropylene mesh plug in tension-free hernia repair. METHODS：A retrospective analysis was conducted in 150 patients with inguinal hernia, including 133 males and 17 females, aged 21-80 years old. Among them, 81 patients were operated with prolene hernia system, and 69 patients were subjected to polypropylene mesh plug. It was the first surgery for all patients. We concluded indications, and recorded operation time, out of bed time, the average hospitalization time, postoperative pain, foreign body sensation and discomfort situation, as well as relapse during the 2-year follow-up. RESULTS AND CONCLUSION： The prolene hernia system patch was suitable for large-bore hernial annulus, the weak trensversalis fascia, inguinal canal with posterior wall defect. There were no significant differences between the two groups in operation time, out of bed time and the average hospitalization time, but the postoperative pain, foreign body sensation, discomfort situation and recurrence within 2-year follow-up were significantly lower in patients undergoing prolene hernia system than polypropylene mesh plug （P 〈 0.05）. The results show that the prolene hernia system is a more ideal choice than the polypropylene mesh plug because of its wide indication, good tissue compatibility, slight local discomfort and foreign body sensation, low incidence of pain, and low relapse rate.