腹股沟嵌顿疝无张力修补疗效观察

Application of tension-free repair in treatment of inguinal strangulated hernia

目的观察采用补片无张力修补腹股沟嵌顿疝的疗效。方法选择2009年1月至2017年1月因腹股沟嵌顿疝而行急诊手术病人,在剔除术中探查发现肠坏死、穿孔出现严重污染及延误病情导致局部极严重感染的病例后,符合疗效观察的共105例。随机分为应用补片(研究组)52例,未应用补片的53例为对照组。在下床活动时间、住院时间、围手术出血量、围手术用时等基本治疗情况及术后并发症等进行研究。结果临床参数比较,研究组的下床活动时间为(16.3±2.7)h、住院时间为(7.5±2.5)d,均显著短于对照组的(30.5±5.4)h和(10.6±4.1)d,差异均具有统计学意义(P<0.01),围术期出血量、手术用时两组差异无统计学意义(P>0.05)。两组均未发生死亡病例。并发症比较,两组术后发生切口浅表感染及深部感染差异无统计学意义(P>0.05);研究组的血清肿、慢性疼痛并发症显著低于对照组(P<0.01)。术后6个月随访时,研究组无复发病例,对照组7例复发。结论在腹股沟嵌顿疝急诊手术中,采用补片进行腹股沟区的修补,在术后复发率及术后并发症方面明显优于传统术式,在有经验的医师指导下,该方法是安全、可行的。

Objective To investigate the curative effectiveness of tension-free hernioplasty in inguinal strangulated hernia. Methods A total of 105 patients with inguinal incarcerated hernia underwent emergency operation from January 2009 to January 2017. Thecases of intestinal necrosis,bowel perforation and severe infection were excluded from this study. All cases were analyzed prospectively. The cases were randomly divided into two groups（ experimental group and control group）. Cases in the experimental group（ n= 52） were treated by the mesh plug,and those in control group（ n = 53） received no mesh plug. Postoperative ambulation time,the length of hospital stay,intraoperrative blood loss,operative time,and postoperative complications were analyzed. Results Postoperative ambulation time was earlier,and the length of hospital stay was shorter in the experimental group than in the in control group（ P〈0. 01）. There was no significant differences in the intraoperrative blood loss and operative time between two groups（ P〈0. 05）.There were no dead cases. There was no significant difference in subcutaneous infection and deep tissue infection between two group（ P〈0. 05）. The seroma and chronic pain rate in the experimental group was lower than that in the control group significantly（ P〈0. 01）. Conclusions The tension-free hernia repair can be effectively applied to the patients with inguinal incarcerated herniawho had no intestinal necrosis and perforation,but more attentions should be paid to the operation period and experience.