腹横肌后平片腹股沟疝修补法的初步研究

Preliminary outcomes of inguinal hernia repair with posterior transverse abdominis mesh placement

目的初步评估腹横肌后平片腹股沟疝修补术的安全性和有效性。方法筛选绍兴市人民医院2018年1至6月,30例原发性单侧腹股沟疝患者进行预试验。手术中完成疝囊高位游离并回纳至腹膜前间隙,缩小内环口,分离腹横筋膜和腹横肌之间间隙,将原Lichtenstein腹股沟疝修补术中放置于腹外斜肌腱膜后的补片向后移位,放置于腹横肌后,固定。观察手术时间、术中出血、术后疼痛、住院时间及复发率。结果 30例全部顺利完成手术,平均手术(46.6±7.1)min,术中出血量(12.5±5.0)m L,术后疼痛视觉模拟评分(2.8±0.9)分,术后无其他并发症发生,平均住院时间(3.4±1.0)d。术后随访平均(2.5±1.2)个月,未见复发。结论初步的预试验证明全腹横肌后平片腹股沟疝修补术是安全有效的,但由于观察人群特殊、样本数小,随访时间短,还有待于进一步研究。

Objectives To evaluate the safety and efficacy of the inguinal hernia repair with posterior transverse abdominis mesh placement.Methods From January to June 2018,30 patients with primary unilateral inguinal hernia from Shaoxing People’s Hospital were selected for the test.In the beginning,the procedure of the operation was same as the Lichtenstein’s inguinal hernia repair such as the hernia sac was freed and returned to the preperitoneal space,the inner ring was narrowed.The next part was different,the space between the transverse fascia and the transverse abdominis muscle was separated by the operator’s finger,the mesh was shaped to fit the space,and the upper and inner parts of the mesh were placed under the transverse abdominis muscle and fixed.The data of the operation time,amount of bleeding,postoperative pain,length of hospital stay,and recurrence rate were observed.Results All of the 30 patients were successfully completed the operation,the average operation was(46.6±7.1)minutes,the amount of bleeding intraoperation was(12.5±5.0)mL,and the VAS score of postoperative pain was(2.8±0.9)scors.No other complications were observed after operation.The average hospitalization day was(3.4±1.0)days.The mean follow-up was(2.5±1.2)months,and no recurrence occurred.Conclusion Preliminary tests have shown that the inguinal hernia repair with posterior transverse abdominis mesh placement is safe and effective,and the test remains to be further studied.