三维双层补片治疗腹股沟疝

Three dimension with bilayer patch mesh in repairing inguinal hernia

目的 探讨采用新型无张力三维双层补片修补术治疗腹股沟疝 ,及其减少腹股沟疝的术后并发症和复发率的效果。方法 分析行三维双层补片疝修补术 47例患者的临床资料。 47例均为男性。中位年龄 65岁。斜疝 3 6例 ,直疝 11例。该组患者的五六评分总得分均大于或等于 6分。术中广泛解剖腹股沟区 ,将疝囊完全剥离至疝囊颈后 ,通过内环口将腹横筋膜与腹膜分离。在将疝囊经内环送入腹腔的同时 ,将三维补片的下层片经内环置入腹横筋膜与腹膜之间的间隙 ,上层补片缝合在腹股沟韧带和弓状下缘上 ,形成一个对腹股沟区前后修补的三维结构。结果 术后患者无不良反应 ,术后第 1天即可下床活动 ,第 3天出院。全部患者随访 1～ 2年 ,均无不适感 ,手术部位未出现硬结 ,无复发。结论 该术式适用于“五六评分法”总分 >6分且腹股沟管后壁需要修补的患者。该手术方式符合人体解剖特点 ,手术后并发症和复发率少 ,值得临床推广。但手术方法较复杂 ,对手术者的手术技巧要求较高。

Objective To study the effect of appling a new tension-free three dimension with bilayer mesh herniorraphy(TFTDBMH) in treating inguinal hernia in order to decrease the compilcation and the recurrence rates after herniorraphy. Methods The clinical data of 47 male patients with ingular hernia treated by TFTDBMH were analyzed. All the 47 patients were males with an average age of sixty-five years old. There were 36 patients with indirect hernias and 11 direct hernias in this series. During operation, their inguinal regions were extensively dissected and the transverse fascias were separated from peritoneum after the hernia sacs were completely dissected to reach the hernia sac necks. The base layer of the belayed patch mesh was put into the space between the transverse fascia and the peritoneum, then the hernia sac was put into abdominal cavities. The upper layer of the bilyer patch mesh was saw up to the inguinal ligaments and the arcade inferior boarder,then a three - dimension structures were formed at the inguinal regions. Results After operation, all the patients had no any bad reaction. They could be out-of-bed activity on the first day after operation. They could be discharged on the third day after operation.All the patients were followed up for one to two years, these patients felt well,no scar formation on the operative area,and no recurrence postoperatively. Conclusions This operation could be applied for the patients with inguinal hernia and the inguinal posterior walls need to be repaired. This operation fits to the human body anatomy. The postoperative complication and postoperative recurrence rate are low.This operative procedure is more complicated. It request that the operators must have higher operative technique.