小切口无张力腹股沟疝修补术十年临床观察和评价

Small incision tension-free inguinal herniorrhaphy: A ten years' clinical observation and evaluation

目的探讨小切口下行腹股沟无张力疝修补术的可行性及临床治疗效果。方法回顾性分析2004年6月至2014年6月,中日友好医院收治的1 105例腹股沟疝患者的临床资料,分析小切口无张力疝修补术的可行性,并总结及分析此手术的麻醉方法、术式、手术时间、术后并发症及复发情况。结果 1 105例患者均成功完成小切口无张力腹股沟疝修补术。其中,局部浸润麻醉下实施手术975例,椎管内麻醉下实施手术130例,Millikan术式315例,Lichtenstein术式300例,Stoppa术式490例。手术时间40~90 min,平均58 min,术后随访1~11年,所有患者均良好耐受补片,无手术区域明显异物感。术后急性疼痛均可通过口服止痛药缓解,未见长期慢性疼痛患者。术后复发患者3例;肥胖患者术后出现伤口皮下积液5例,经换药处理后好转,无因感染取出补片者;术后出现阴囊水肿21例,均采用托起阴囊、穿紧身内裤等方法自愈;无睾丸萎缩、围术期死亡患者。结论小切口无张力腹股沟疝修补方法临床可行,且损伤小,适合各类腹股沟疝及各种临床常用补片,即使肥胖患者（BMI≥30 kg/m2）亦可以在小切口下完成手术,局部浸润麻醉下进行此手术患者耐受良好,术后并发症少,更适合老年患者,尤其是合并严重心脑血管疾病的患者,值得临床推广。

Objective To evaluate the feasibility and clinical outcomes of small incision tensionfree inguinal herniorrhaphy. Methods A total of 1 105 ingunial hernia patients received small incision tension-free herniorrhaphy in China-Japan Friedship Hospital during June 2004 to June 2014. A retrospective study were performed to analyze the surgical feasibility,anesthesia method,surgical procedure,duration of the surgery,postoperative complications and recurrence. Results Small incision tension-free inguinal herniorrhaphy were successfully performed on the 1 105 patients. Of these,975 surgeries were accomplished under local anesthesia, 130 under intraspinal anesthesia, including 315 Millikan,300 Lichtenstein and 490 Stoppa. Mean operation time was 58 minutes（ range 40 to 90 minutes）. After 1 to11 years of follow-up,it revealed that all patients adapted to the mesh well,without significant foreign sensation. Acute pain after surgery could be relieved by pain killer,and no chronic pain was found.3 recurrence occurred; 5 seroma in fat patients and 21 hematoma of scrotum developed and cured with conservative treatment; no testicular atrophy and perioperative death. Conclusion Small incision tensionfree inguinal herniorrhaphy is a feasible and effective procedure for all kinds of inguinal hernias and meshes.It is minimal invasive,even in obese patents（ BMI〉 30 kg / m^2）. Local anesthesia can be tolerated in patients with few complications,especially in the elderly with several cardiovascular and cerebrovascular diseases.