无肠坏死嵌顿疝Millikan无张力修补技术可行性的临床观察

Clinical observation on feasibility of Millikan tension-free herniorrhaphy for incarcerated hernia without intestinal necrosis

目的探讨用Millikan无张力疝修补术式治疗无肠坏死嵌顿性腹股沟疝和股疝的方法和效果。方法2012年7月至2018年6月本科室收治的100例无肠坏死嵌顿性腹股沟疝和股疝,分为传统疝修补法(对照组n=53)和Millikan无张力疝修补法(观察组n=47)。观察并比较两组患者的住院天数、手术时间、术中出血量、卧床时间、术后伤口感染、腹股沟区疼痛,随访术后阴囊肿胀、术后复发。结果观察组卧床时间(27.83±5.75)h,住院天数(5.62±1.24)d相比对照组卧床时间(39.13±7.16)h,住院天数(7.75±1.60)d明显缩短,差异有统计学意义(P<0.05)。采用视觉模拟评分法(visual analogue scale,VAS)对两组患者腹股沟区疼痛程度进行评分,观察组术后24h、48h疼痛情况明显好于对照组(P<0.05),7d时两组疼痛无明显差异(P>0.05),所有患者术后3个月术区疼痛均减轻、消失,无患者因长期慢性疼痛影响生活质量。观察组平均手术时间、术中出血量、术后切口感染率与对照组的比较,差异无统计学意义(P>0.05)。术后随访5~72个月,观察组术后未出现复发,对照组复发率13.2%,观察组术后复发率明显低于对照组(χ^2=4.800,P<0.05)。结论Millikan无张力疝修补术治疗无肠坏死嵌顿性腹股沟疝和股疝,患者耐受性好,临床疗效确切,具有卧床时间短,术后住院天数短,术后腹股沟区疼痛率低,随访复发率低等优点,是一种安全可供选择的治疗无肠管坏死腹股沟嵌顿疝的手术方式。

Objective To explore the method and effect of Millikan tension-free hernia repair in the treatment of incarcerated inguinal hernia and femoral hernia without intestinal necrosis.Methods One hundred cases with incarcerated inguinal hernia and femoral hernia without intestinal necrosis were selected from July 2012 to June 2018,they were divided into traditional repair group(control group n=53)and Millikan tension-free repair group(observation group,n=47).The duration of hospitalization,operative time,intraoperative bleeding,bed-rest time,wound infection,groin pain,scrotum swelling and recurrence were observed and compared between the two groups.Results The bed-rest time and the duration of hospitalization in the observation group were significantly shorter than those in the control group[(27.83±5.75)h,(5.62±1.24)d v.s.(39.13±7.16)h,(7.75±1.60)d]and the difference was statistically significant(P<0.05).The degree of pain in the groin area of the two groups was scored using a visual analog scoring method(visual analogue scale,VAS).The pain in the observation group at 24 hours and 48 hours after operation was significantly lesser than that in the control group(P<0.05).There was no significant difference between two groups at day 7(P>0.05).The pain was relieved and disappeared in all patients 3 months after operation,and there was no long-term chronic pain affecting the quality of life of all patients.There was no significant difference in the mean operative time,the intraoperative blood loss,postoperative incision infection rate between two groups(P>0.05).During the follow-up for 5 to 72 months after the operation,no recurrence occurred in the observation group,while in the control group the relapse rate was 13.2%.The recurrence rate of the observation group was significantly lower than that in the control group(χ2=4.800,P<0.05).Conclusion Millikan tension-free herniorrhaphy for incarcerated inguinal hernia and femoral hernia without intestioul necrosis has the advantages of better tolerance,definite clinical efficacy,shorter bed-rest time,shorter postoperative hospitalization,less pain in the groin area,less recurrence rate.It is a safe alternative in the treatment of incarcerated inguinal hernia without intestinal necrosis.