Lichtenstein无张力疝修补手术治疗成人腹股沟嵌顿疝

Lichtenstein tension-free hernioplasty repair in adult patients with inguinal incarcerated hernia

目的总结无张力疝修补术治疗成人腹股沟嵌顿疝的优越性和安全性。方法回顾性分析华中科技大学同济医学院附属武汉中心医院2010年1月至2014年1月行腹股沟嵌顿疝松解后Lichtenstein无张力疝修补术治疗的86例腹股沟嵌顿疝患者的临床资料。结果86例患者均为初发嵌顿疝，男59例，女27例，平均年龄（63±18）岁；股疝11例，合并肝硬化腹水患者8例，糖尿病患者21例；全麻手术56例，术中行小肠切除吻合术38例，局麻手术30例；手术均获成功，手术时间平均（54±16）min；术后住院时间（8．0±1．3）d；术后阴囊皮肤瘀斑7例，无迟发性肠穿孔，肠吻合口瘘，肝性脑病及上消化道出血发生；早期24例患者中术后伤口感染3例，脂肪液化10例，远端疝囊积液10例及阴囊血清肿6例，后期术中放置创腔引流管负压引流患者，术后未见伤口感染，远端疝囊积液和阴囊血清肿；全部患者术后获随访，随访时间12～48个月，平均（274-12）个月。均无复发，无慢性疼痛，缺血性睾丸炎及2年内死亡患者。结论Lichtenstein无张力疝修补术是成人腹股沟嵌顿疝的一种理想的治疗方式。

Objective To investigate the preoperative management and the clinical effeciency of Lichtenstein tension-free hernioplasty in adult patients with inguinal incarcerated hernia. Methods Clinical data of 86 patients with inguinal incarcerated hernia were analyzed retrospectively. Hernia was repaired with Lichtenstein tension free after reposition. Results There were 59 male patients and 27 female patients with median age of （63± 18） years. There were 8 patients with liver cirrhosis. The operation was performed successfully in all patients. Segmental bowel resection with end-to-end anastomosis was performed in 38 emergency cases. Operative time was 20 - 120 min, with an average time of 54 min. The postoperative hospitalization was 5 - 17 d, with an average of 8 d. There were 7 cases of skin ecchymosis at the scrotum, there were no intestinal perforation, hepatic encephalopathy and upper gastrointestinal hemorrhage after operation. In early series of 24 cases without drainage tube left in place, there were 10 cases of fat liquefaction, 10 cases of hydrops of hernial sac ,6 cases of seroma and 3 cases of wound infection after operation. After 12 to 48 months of follow-up, there was no mortality after 2 years, no hernia recurrence. Conclusions Tension free repair in the treatment of incarcerated inguinal hernia is safe and feasible.