原切口Kugel术治疗腹横筋膜前腹股沟疝修补术后伴慢性疼痛复发疝的疗效观察

Kugel procedure through the primary incision in treatment of recurrent inguinal hernia with chronic pain after anterior repair of transversalis fascia

回顾性分析2015年6月至2019年1月温岭市第一人民医院普外科67例腹横筋膜前腹股沟疝修补术后伴慢性疼痛复发疝患者行原切口Kugel手术治疗的临床资料。67例中病变在右侧者39例,左侧者28例;轻、中、重度疼痛者分别为39、20、8例。Kugel手术中切除瘢痕组织,将原有的网塞与平片全部取出,分离腹膜前间隙,将补片覆盖耻骨肌孔。单侧手术时间平均57 min(51~85 min);6例(8.9%)术中腹膜破裂;5例(7.5%)发生术后血清肿。平均随访18个月(12~50个月),均未复发;与术前比较,术后3个月轻、中、重度疼痛均有缓解,总疼痛缓解率92.5%(62/67)。提示原切口Kugel手术治疗腹横筋膜前腹股沟疝修补术后伴慢性疼痛复发疝安全、有效,操作简单。

Clinical data of 67 patients with recurrent inguinal hernia and chronic pain after anterior repair of transversalis fascia who underwent Kugel procedure through the primary incision in Wenling First People′s Hospital between June 2015 and January 2019 were retrospectively reviewed.During the operation the surrounding scar tissue and previous mesh or plug were removed,the transversalis fascia was separated and the patch was placed to overlay myopectineal orifice.The mean operative time was 57 min(51-85 min).The peritoneum rupture occurred during the operation in 6 cases(8.9%),and seroma was developed in 5 patients(7.5%).After a mean 18 months of follow-up,no recurrence occurred in all patients.Three months after operation,the mild,moderate or severe pain in all 67 patients were all improved remarkably with a total pain relief rate of 92.5%.The results show that Kugel procedure through the primary incision is safe and effective in treatment of recurrent inguinal hernia with chronic pain after anterior repair of transversalis fascia.