正确测量成年男性腹股沟后壁裁剪合适的补片修复腹股沟疝

Correct measurement of the posterior wall size of adult male inguinal hernia used for herniorrhaphy

背景:目前国内行疝补片手术,一般根据经验裁剪补片大小,缺乏可靠的依据。目的:通过Rutkow术中测量中国籍成年男性人群腹股沟后壁大小,根据测量结果进行补片裁剪,对治疗效果进行评价。方法:精细测量180例行无张力疝修补术的中国籍成年男性患者的腹股沟后壁大小,计算出适合中国成年男性腹股沟组织解剖结构的补片尺寸数据,并将180例患者随机分为2组,每组90例,试验组测量腹股沟后壁大小后进行补片裁剪的Rutkow术,对照组根据经验进行补片裁剪的Rutkow术,比较两组患者各项临床指标以及并发症发生率和复发率。结果与结论:1耻骨结节与腹内斜肌在腹股沟韧带起点之间距离为(6.03±0.58)cm;弓状下缘的最高点至腹股沟韧带的垂直距离为(3.02±0.32)cm,相应补片尺寸长度应当大于(13.04±0.74)cm,宽度应当大于(5.88±0.52)cm;2试验组下床活动时间、进食时间、住院时间均小于对照组(P<0.05);两组手术时间、恢复正常活动时间比较,差异无显著性意义(P>0.05);3试验组术后并发症发生率及复发率明显低于对照组(P<0.01);4结果表明,测量腹股沟后壁大小后进行补片裁剪的Rutkow术用于腹股沟疝修补,效果明显,并发症和复发率低。

BACKGROUND： The mesh size used for herniorrhaphy mainly depends on clinicians＇ experience, which is less reliable. OBJECTIVE： To obtain the mesh size by measuring the posterior wall of inguinal hernia in Chinese adult men undergoing Rutkow surgery, and to assess the postoperative effect.METHODS： The posterior wall size of inguinal hernia in 180 Chinese adult male patients undergoing tension-free hernioplasty was measured, and then the optical mesh size was calculated. All patients were equivalently randomized into two groups, followed by subjected to Rutkow surgery according the calculated mesh size（experimental group） or subjective size（control group）. Clinical indexes, the incidence of complications and recurrence rate were compared between groups. RESULTS AND CONCLUSION： The distance of pubic tubercle to internal oblique inguinal ligament starting point was（6.03±0.58） cm; the vertical distance of the highest point on the edge of the arcuate to inguinal ligament was（3.02±0.32） cm; therefore, the length of mesh should be larger than（13.04±0.74） cm, and width larger than（5.88±0.52） cm. The time of off-bed, dieting and hospitalization in the experimental group were significantly less than those in the control group（P〈0.05）; the time of operation and recovery of normal activities showed no significant difference between groups（P〈0.05）. The rates of postoperative complication and recurrence in the experimental group were significantly lower than those in the control group（P〈0.01）. These results suggest that after measuring the posterior wall size of inguinal hernia, the Rutkow used for inguinal hernia repair, obtains desired treatment outcomes with low incidence of complications and recurrence.