开放式前入路腹膜前腹股沟疝修补627例

Open anterior preperitoneal inguinal hernia repair in 627 cases

目的总结开放式前入路腹膜前腹股沟疝修补的临床经验。方法回顾性分析2005年3月至2008年6月,复旦大学附属华山医院进行手术的627例(708侧)患者,应用局部麻醉下的开放式前入路腹膜前腹股沟疝修补术。结果单侧平均手术时间(37±11)min。患者术中疼痛评分平均3.63分,术后2 h疼痛评分3.13分,术后1周疼痛评分2.12分。术后需用镇痛药物13例(2.1%),术后主要并发症包括:术后1年复发6例(1.0%),3年7例(1.1%),5年7例(1.1%);腹股沟区感觉异常53例(8.4%),腹股沟区不适感56例(8.9%),慢性疼痛3例(0.5%);浆液肿35例(5.6%);血肿13例(2.1%),尿潴留8例(1.3%),切口感染5例(0.8%),肠梗阻1例(0.2%)。结论开放式前入路腹膜前腹股沟疝修补术安全、有效,值得临床推广。

Objective To summarize the experience of open anterior preperitoneal inguinal hernia repair. Methods From March 2005 to June 2008, 708 inguinal hernias （in 627 patients） were operated in Huashan Hospital of Fudan University. Results The average operation time was （37 4- 11 ） minutes. The mean pain score （VAS） during the operation, 2 hours and 1 week after the operation, were 3.63, 3.13 and 2.12, respectively. 13 patients （2. 1% ） were given pain killer after the operation. Hernia recurrence rate at 1 years, 3 years and 5 years after the operation were 1.0% （6 eases）, 1. 1% （7 cases）, and 1. 1% （7 cases）, respectively. 53 cases （ 8.4% ） of abnormal sensation and 56 cases （ 8.9% ） of discomfort in groin area were observed. But severe chronic pain only found in 3 eases （0.5%）. Postoperative seroma, hematoma, retention of urine, wound infection and bowel obstruction, respectively, occurred in 35 cases （5.6%）, 13 cases （2.1%）, 8 cases （ 1.3% ）, 5 cases （0. 8% ） and 1 case （0.2%）. Conclusion Open anterior preperitoneal inguinal hernia mesh repair is a safe and effective procedure, which is worthy of promotion.