关于成人腹股沟疝开放性无张力修补术的几个问题

Some aspects with open inguinal hernia repair in adult patients

腹股沟疝的治疗大体经历了蛮荒时代的探索性手术、始于19世纪末的组织修补术和20世纪末的无张力修补术三个阶段。无张力修补术是应用假体材料加强修补腹股沟管后壁或肌耻骨孔,有多种开放性术式和腹腔镜术式。开放性手术具有适用范围广、技术要求低、安全又经济、可快速康复等优点。加强腹股沟管后壁的手术主要有Lichtenstein手术和Rutkow手术,适用于腹膜前间隙游离困难者。开放性腹膜前无张力修补术大体有M-K或PHS/UHS手术、Kugel手术和Stoppa手术,复发率更低,但操作难度稍大于加强腹股沟管后壁的手术。在疝修补材料方面,金属材料因并发症多已被废弃,以聚丙烯为代表的高分子合成材料应用非常广泛,取材于牛心包、同种异体真皮、猪小肠黏膜等生物材料的应用呈增加趋势。在网片固定方式上,先后曾采用不吸收缝线、可吸收缝线、胶水、自粘材料以及尝试免固定的方法,总体原则是在确保修补牢靠前提下尽量少固定。

The treatment of inguinal hernia has undergone three stages,exploratory surgery in early age,tissue repair at the end of nineteenth century,tension-free repair at the end of the twentieth century.Tension free repair is the application of prosthetic material to strengthen the posterior wall of the inguinal canal or the myopectineal orifice.There are a variety of open and laparoscopic operations.Open surgery has many advantages,such as wider application,lower technical requirements,safer and much cheaper,rapid recovery and so on.The operation of strengthening the posterior wall of the inguinal canal mainly includes Lichtenstein operation and Rutkow operation,which is suitable for those who have difficulty in preperitoneum seperation.Open preperitoneal tension-free repair is generally performed with M-K or PHS/UHS operation,Kugel operation and Stoppa operation.The recurrent rate is lower,but the operation difficulty is slightly larger than that of the posterior wall surgery.In terms of materials for hernia repair,metal materials have been abandoned due to many complications.Polymer synthetic materials represented by polypropylene are widely used.The applications of biomaterials such as bovine pericardium,allogenic dermis and porcine intestinal mucosa are increasing.In the way of mesh fixation,non absorbable sutures,absorbable sutures,glue and self-adhesive materials are used.The general principle is to try to minimize fixation and ensure that the repair is reliable.