肾移植术后腹股沟疝患者12例临床诊治分析

Clinical diagnosis and treatment of inguinal hernia after renal transplantation

目的探讨应用不同补片进行无张力修补术治疗肾移植术后腹股沟疝的临床应用体会。方法对温州医科大学附属第一医院2008年7月至2014年7月期间收治的12例肾移植术后腹股沟疝患者临床资料进行回顾性分析。结果 12例患者肾移植术后出现腹股沟疝的中位时间为72个月;腹股沟疝类型包括斜疝9例,直疝2例,斜疝合并直疝1例,均为单侧。患者均在疝确诊后6-12个月内手术治疗,10例使用聚丙烯疝补片行Lichtenstein平片修补术,2例使用超普疝修补装置（UHS）行疝环充填式无张力修补术,平均手术时间（54±26）min。1例UHS修补斜疝合并直疝术中损伤移植输尿管,行移植输尿管膀胱再植。术后切口疼痛3例,阴囊积液1例。截至2014年7月,术后随访12-32个月,肾功能均无明显变化,未观察到切口感染、疝复发、异物不适感、睾丸萎缩、射精痛及慢性疼痛等并发症。结论肾移植术后腹股沟疝患者使用传统聚丙烯疝补片行Lichtenstein平片修补术对移植肾影响较小,应用UHS行疝环充填式无张力修补术中易损伤移植输尿管。

Objective To explore the clinical application experience of tension-free herniorrhaphy with different patch for inguinal hernia after renal transplantation. Method A retrospective study was performed on 12 patients with inguinal hernia after renal transplantation between2008 and 2014 at the First Affiliated Hospital of Wenzhou Medical University. Results The median time when 12 cases occured inguinal hernia was 72 months after renal transplantation. A total of 12 patients underwent tension-free herniorrhaphy of inguinal hernia,9 of indirect inguinal hernia,2 of direct inguinal hernia,1 of indirect inguinal hernia with hernia. All hernias were unilateral,no recurrence after operation. The operation time was average 54 ± 26 min,including 10 cases using of Lichtenstein flat patch method with Johnson polypropylene hernia patch,2 using inguinal hernia ring filling tension-free herniorrhaphy with ULTRAPRO  hernia system（ UHS） repair. One patient underwent reimplantation operation of ureter bladder,because transplant ureter was injured during UHS repair of indirect inguinal hernia with hernia. All patients were maintained follow-up with a follow-up time from 12 to 32 months. Postoperative renal function were not changed significantly,3 cases of postoperative wound pain,1 of scrotal hydrocele. No complications such as incision infection hernia recurrence,foreign body discomfort, testicular atrophy, ejaculation pain and chronic pain were observed. Conclusion The treatment of inguinal hernia after renal transplantation by using traditional polypropylene hernia tension-free herniorrhaphy is preferred.