做好规范的Lichtenstein疝修补术

Standard procedures of the lichtenstein tension-free hernioplasty for inguinal hernia

传统腹股沟疝手术修补腹股沟管后壁时,在局部产生了较大张力,导致手术后出现较高的复发率和术后慢性疼痛。无张力疝修补术(tension-free hernioplasty)概念首先于1984年提出的。这种修补以人工生物材料作为补片用以加强腹股沟管的后壁,克服了传统手术(即不用补片的缝合修补法)对正常组织解剖结构的干扰,层次分明,而且修补后周围组织无张力,故命名为"无张力疝修补术"。为了实现"完全无张力"理念,首要原则就是要选用足够大的网片(7.5 cm×15 cm),以保证网片松弛圆顶状固定和充分覆盖耻骨结节。其次,网片缝合固定材料的选择和固定方式也会影响张力的产生。采用Lichtenstein无张力疝手术治疗腹股沟疝是安全的,其并发症少,复发率低。在手术过程中,严格遵循和充分应用无张力原则,规范化操作,才能完成一个真正意义上标准的Lichtenstein无张力疝手术。

Traditional methods of repairingthe posterior wall of inguinal canalcausegreat tension within tissues, leading to chronic pain and high recurrence rate. The concept of tension-free hernioplastywas firstpresented at the lichtenstein institute in 1984, this procedure reinforces the inguinal floor by using a polypropylene mesh, which will not generate tension in local tissue. The following two principles of lichtenstein tension-free hernioplasty can help to accomplishthe concept of ＂totally non tension＂, ①Use a large sheet of mesh （7. 5 cm×15 cm） that can extend approximately 2 cm medial to the pubic tu- bercle and keep in a slightly relaxed dome shape; ②The choice of proper suture materials and mesh fixation procedure. Lichtenstein tension-free hernioplastycan greatly decreaseherniarecurrence and relieve postoperative pain. A standard Hicht- ensteintension-free hernioplasty Should be performed by thefollowing key principles of ＂totally non tension＂ strictly.