成人腹股沟疝修补术原理再认识

Reconsideration of the principle of adult inguinal hernia repairment

成人腹股沟疝修补手术经过一个多世纪的演变,已逐渐进入基本符合人体生理状态修补的阶段。腹股沟疝修补术原理分为3个阶段的认识:第一阶段通过关闭疝出的孔隙达到修补目的(Close);第二阶段通过人工假体修补或重建腹股沟管后壁达到治疗目的,Lichtenstein将其称为无张力修补(tension-free repair);第三阶段通过人工假体封堵整个肌耻骨孔来达到治疗目的(Cover)。Cover理念是利用人工假体替代退化或有缺陷的肌耻骨孔封闭结构达到治疗目的,理论上应是成人腹股沟疝修补最符合生理状态的手术。以完全腹膜外疝修补术(TEP)、经腹腔腹膜前疝修补术(TAPP)、经腹腔部分腹膜外疝修补术(TAPE)为代表的Cover概念手术将会成为未来治疗成人腹股沟疝的主流手术。

Through the development of more than a century, the treatment of adult inguinal hernia came to the stage of repairment generally match the physiologic conditions of human. In author＇ s opinion, the principle of inguinal hernia repairment can be classified into three stages. The first stage is closing the interstice of hernia （Close）. The second stage is repairing or rebuilding the posterior inguinal floor by using prosthesis, which is also known as tension-free repair by Lichtenstein. The third stage is plugging the myopectineal orifice by prosthesis （Cover）. The concept of ＂Cover＂ is to use the prosthesis to replace the degenerate or defective closed structure of myopectineal orifice, which theoretically is the ideal surgery for the treatment of adult inguinal hernia that could match the physiologic conditions. ＂Cover＂ surgery will become the mainstream in the future, represent as totally extraperitoneal （TEP）, transabdominal preperitoneal （TAPP）, transabdominal partial extraperitoneal （TAPE）.