嵌顿性腹股沟疝修补术中使用补片材料的经验

Tension-free mesh repair for incarcerated groin hernia

目的探讨补片材料治疗嵌顿性腹股沟疝的安全性及有效性,比较生物补片与聚丙烯材料的临床效果。方法回顾性分析2013年1月至2017年12月,北京朝阳医院收治的118例嵌顿性腹股沟疝患者的临床资料。对比分析不同手术方式、不同补片修补术后患者的手术部位感染等不良事件发生情况,比较患者术后异物感、慢性疼痛、血清肿/血肿、复发情况。结果1W例患者行单纯缝合修补术14例(A组),补片修补手术(TAPP手术或Lichtenstein修补)104例,包括生物补片23例(B组),聚丙烯平片81例(C组)。中位随访20.5个月(6~65个月),A组复发率(21.4%)高于B组(4.3%)、C组(0);B组血清肿/血肿(26.1%)发生率高于A组(7.1%)、C组(7.4%)。3组手术部位感染、围手术期死亡、术后异物感、慢性疼痛发生情况差异均无统计学意义(均P〉0.05)。结论使用补片材料治疗急诊嵌顿性腹股沟疝安全、有效,可减少疝复发率,而不增加感染风险。

Objective To investigate the safety and efficacy of tension-free mesh repair in the treatment of incarcerated groin hernia, and to compare the outcome of biological mesh and polypropylene mesh repairment.Methods A retrospective study was conducted on 118 patients admitted from Jan 2013 to Dec 2017 receiving emergency incarcerated groin hernia repair in Beijing Chao-Yang Hospital.The incidence of surgical site infection (SSI), perioperative mortality, sepsis and ileus were compared.In the follow-up, the postoperative foreign body sensation, chronic pain, seroma/hematoma and recurrence were recorded.The outcome of different surgical procedures (with mesh/without mesh, biological mesh/polypropylene mesh, TAPP/Lichtenstein repair) were compared and analyzed.Results 14 cases received suture repair (group A), 104 cases underwent TAPP (n=44) repair or Lichtenstein repair (n=60) with meshes, including 23 cases using biological mesh (group B) and 81 cases using polypropylene mesh (group C).After 20.5 months of follow-up (ranging from 6-65 months), 3 cases in group A (21.4%) developed recurrence , the rate was significantly higher than that of group B (4.3%) and group C (0).The incidence of seroma/hematoma in group B was higher than that in group A (7.1 %) and group C (7.4%).There were no significant differences between the 3 groups regarding the postoperative adverse events rate, SSI, mortality, sepsis and ileus (all P>0.05 ).Conclusions Tension-free mesh repair in the treatment of emergency incarcerated groin hernia is safe and effective, which can reduce the recurrence rate of hernia, without increasing the risk of infection.