腹膜前修补技术(Kugel补片)治疗腹股沟疝:11年单中心3510例临床经验

Preperitoneal herniorrhaphy for inguinal hernias with Kugel match: 11-year single-center experience in 3510 consecutive patients

目的 ：总结腹膜前修补技术（Kugel补片）治疗腹股沟疝11年单中心的临床经验,分析术后并发症发生的原因,比较后入路和经内环入路Kugel手术的疗效。方法：对我科自2004年11月至2015年8月间行腹膜前修补技术（Kugel补片）的3 510例（3 950侧）腹股沟疝病人的临床资料进行回顾性研究,其中后入路Kugel手术1 480侧,经内环入路Kugel手术2 470侧,术后通过门诊或电话随访,总结术后并发症发生和两种术式疗效。结果：单侧平均手术时间（38.6±10.2）min。术后平均随访时间（50.2±5.6）个月（3个月~11年）。术后发生血清肿105侧,血肿42侧,皮下淤斑50侧,异物感44侧,复发10侧,无慢性疼痛、切口感染和补片感染。经内环入路Kugel手术后无复发,优于后入路手术。后入路和经内环入路Kugel手术在并发症发生率上无统计学差异。分析术后并发症发生原因。结论：腹膜前修补后入路和经内环入路Kugel手术均能达到全腹股沟修补,后者学习曲线较前者短,更易掌握,复发率低,术后异物感发生率低。经内环入路Kugel手术容易掌握。

Objective To evaluate 11-year experience of preperitoneal herniorrhaphy for inguinal hernias using Kugel match in single center with the cause of postoperative complications and compare the results between posterior approach and via internal ring approach. Methods A retrospective study was performed on the clinical data of 3 510 consecutive patients （3 950 hernias） who underwent preperitoneal herniorrhaphy for inguinal hernias with Kugel match including posterior approach 1 480 hernias and via internal ring approach 2 470 hernias from Nov 2004 to Aug 2015. Outpatient follow-up or telephone interview was made to analyze postoperative complications and the clinical results of both procedures. Results The mean operative time was （38.6±10.2） min for each hernia. All patients were followed up for （50.2±5.6） months （3 months to 11 years）. Postoperative complications included 105 cases with seroma, 42 cases with hematoma, 50 cases with subcutaneous ecchymosis, 44 cases with foreign body sensation, 10 cases with hernias recurrence. There was no chronic pain, incisional or mesh infection. The recurrence with approach via internal ring was not found so that the result by herniorrhaphy via internal ring approach was better than via posterior approach. The difference of complication was not present statistically between two approaches. The cause of postoperative complication was analyzed. Conclusions Preperitoneal herniorrhaphy both posterior approach and via internal ring approach for inguinal hernias with a Kugel match is safe and useful for inguinal hernias, the latter is associated with groin repair completely, lower recurrence and lower foreign body sensation. Kugel herniorrhaphy via internal ring approach is easy to learn with shorter learning curve.