无张力疝修补术治疗腹股沟区疝

Clinical application of tension-free hernioplasty in inguinal hernia

目的 总结 2 18例腹股沟区疝无张力疝修补术的经验。方法 回顾性分析我院 1997年 12月～ 2 0 0 3年 3月完成的 2 18例腹股沟区疝无张力疝修补术。统计手术时间、伤口疼痛、术后自主能力的恢复、并发症和复发率。结果 采用网塞网片行疝环充填式无张力疝修补术 2 0 6例 ,采用普理灵疝装置 (PHS)行无张力疝修补术 12例 ;其中含双侧疝 15例 ,嵌顿疝 10例 ,联合泌尿科疾患手术 2例。平均手术时间为 42 .5min ,术后 4～ 6h下床活动 ,疼痛轻微 ,持续 1～ 3d。并发症发生率为 5 .0 %,并发尿潴留 3例 ,伤口积液 3例 ,伤口感染 3例 (其中取出网塞网片 1例 ) ,睾丸炎 1例 ,巨大阴囊血肿感染 1例需手术切除引流。随访 2个月～ 5年 ,失访 2 0例 ,198例患者中复发 2例 ,复发率为 1%(1例补片卷曲 ,1例遗漏并发直疝 )。结论 无论是疝环充填式或者PHS无张力疝修补术都是较先进的术式 ,具有手术时间短、创伤小、疼痛轻、并发症发生率低、恢复活动早和复发率低的优点 ;尚可用于嵌顿疝的急诊修补、双侧疝的一期修补 ,及与其他手术联合。

Objective To summarize the experiencs of tension-free hernia repair. Methods Tension-free hernia repair was performed in 218 patients with inguinal hernia by Bard Mesh & Perfix Plug or PHS. The operative duration, postoperative pain, return to daily activities, complications and recurrence rate were analyzed retrospectively. Results The Mesh & Plug tension-free hernioplasty was accomplished in 206 patients, and the PHS in 12. The average operative duration was 42.5 min. The patients could walk up within 4～6 h after the procedure. Postoperative pain was mild, lasting 1～3 d only. The rate of complications was 5.0% including 3 retention of urine, 3 effusion under the wound, 1 large scrotal hematoma requiring surgical removal and drainage, 3 wound infection(plug-mesh was removed in one ). Only two had recurrence among 198 followed-up patients. Conclusion The tension-free hernioplasty (Bard Mesh & Perfix Plug or PHS) is an advanced therapeutic modality with shorter operative duration, minor trauma, less pain, quicker recovery , lower rate of complications and recurrences. It can be used in emergency repair of incarcerated hernia and one-stage repair of bilateral hernias.