疝环充填和平片式无张力腹股沟疝修补术后复发分析(附27例报告)

Recurrence after Mesh Plug Tension-free Repair of Inguinal Hernia (Analysis of 27 cases)

目的:分析无张力腹股沟疝修补术后复发的原因,提出预防措施。方法:回顾性分析1998年12月～2002年12月27例用疝环充填式或平片式无张力疝修补术治疗原发性腹股沟疝术后复发而再手术病例的资料。结果:17例疝环充填式手术中,疝囊未做高位游离5例,近端疝囊太小1例,疝块自原网塞旁脱出2例,疝块自二网塞间脱出1例,原斜疝再发直疝5例,再发股疝1例,原直疝再发斜疝2例。10例平片式手术中,疝囊未高位游离结扎4例,原斜疝再发直疝5例,原直疝再发斜疝1例。结论:仔细、规范及一些预防性的操作能避免无张力疝修补术后部分复发疝,以及再发疝和遗漏疝的发生,从而根本降低术后复发率。

Objective: To seek the measures of reducing recurrence rate in patients with primary inguinal hernia after mesh plug or only mesh tension-free hernioplasty. Methods: During re-operation, twenty-seven patients re-operated for recurrent hernia after mesh plug or only mesh tension-free hernioplasty during the period of 1998.12～2002.12, were analyzed retrospectively. Results: In 17 cases having had mesh plug hernioplasty, 5 failed to have high ligation of the sac; 1 had a very small sac, sac extruding with contents beside the mesh plug in 2 cases, sac extruding between two mesh plugs in 1 case; 5 cases with direct hernia and 1 case with femoral hernia appearing in patients originally treated for indirect hernia; 2 cases of indirect hernia in appearing in patients originally treated for direct hernia. In 10 cases where mesh was used only for hernioplasty, 4 failed to have high ligation of the sac; 5 cases of had direct hernia in patients originally treated for indirect hernia and 1 had indirect hernia in a patient originally treated for direct hernia. Conclusion: Careful and canonical techniques are required to reduce the recurrence rate in hernial repair.