网塞修补术与Lichtenstein无张力修补术治疗腹股沟复发疝的临床观察

Clinical value of mesh plug and Lichtenstein tension-free hernioplasty for recurrent inguinal hernia

目的分析网塞修补术与Lichtenstein无张力修补术治疗无张力疝修补术后腹股沟复发疝的临床疗效。方法回顾性分析2009年1月至2014年6月,南京大学医学院附属鼓楼医院收治127例成人无张力疝修补术后腹股沟复发疝患者的临床资料,根据术中复发疝的类型及原有补片周围粘连情况选择不同术式并分组,分别为网塞修补术组（96例）和Lichtenstein无张力修补术组（31例）,比较二组手术时间、术中出血量、术后疼痛评分、术后住院时间、术后并发症发生率、复发率等。结果二组患者均顺利完成手术并出院,随访时间6~42个月。二组患者手术时间、术中出血量、术后疼痛评分、术后住院时间及并发症比较,差异有统计学意义（t=-6.547、-5.472、-8.503、3.509、χ2=6.714,P=0.000、0.000、0.000、0.001、0.010）;二组患者复发率比较,差异无统计学意义（χ2=0.686,P=0.408）。结论网塞修补术较Lichtenstein无张力修补术治疗腹股沟复发疝,尤其是再发疝及直疝,有良好的临床疗效,且手术方式简便。

Objective To evaluate the clinical value of mesh plug tension-free hemioplasty and Lichtenstein for recurrent inguinal hernia. Methods A total of 127 patients with recurrent inguinal hernia were involved in this study and received tension-free inguinal hernia repair from January 2009 to June 2014 in Gulou Hospital of Nanjing University, with 96 patients in mesh plug tension-free hernioplasty group and 31 patients in Lichtenstein group. The operative time, intraoperative blood loss, postoperative pain scores, postoperative hospital stay, postoperative complications and recurrence rate were compared between the two groups. Results After 6 to 42 months following-up, all the 127 operations were successfully completed and released from the hospital. The mesh plug tension-free hemioplasty group had shorter operative time, less blood loss, lower postoperative pain scores, shorter postoperative hospital stay, and lower postoperative complications than those of Lichtenstein group, and the differences were significant（ t = -6. 547, -5. 472, -8. 503,3.509,χ2 =6. 714 ,P =0. 000,0. 000,0. 000,0. 001,0. 010）. While there was no difference in the rate of recurrence between the two groups （χ2 = 0. 686, P = 0.408 ）. Conclusion Mesh plug tension- free hernioplasty has more advantages in the treatment for recurrent inguinal hernia than Lichtenstein repair. The mesh plug tension-free hernioplasty is an ideal operation for recurrent inguinal hernia, especially in cases of relapsing hernia or direct hernia, for the advantages of simple procedure, minimal invasion and can be popularization.