開放式腹膜前間隙和疝環(huán)充填式無張力腹股溝疝修補(bǔ)術(shù)95例對(duì)照研究

王新平　陳進(jìn)紅　張華　于鳴　張偉　梁曉

[摘要] 目的 比較開放式腹膜前間隙與疝環(huán)充填式無張力疝修補(bǔ)術(shù)治療成年人腹股溝疝的療效。 方法 回顧性分析2012年1月～2014年12月收治的95例腹股溝疝患者的臨床資料。按照手術(shù)方式分為兩組。A組34例，采用腹膜前間隙無張力疝修補(bǔ)術(shù)，B組61例，采用疝環(huán)充填式無張力疝修補(bǔ)術(shù)，比較兩組治療后的效果以及術(shù)后并發(fā)癥。 結(jié)果 兩組平均住院日差異無統(tǒng)計(jì)學(xué)意義；術(shù)后最早下地活動(dòng)時(shí)間A組明顯短于B組，術(shù)后24h視覺模擬評(píng)分法疼痛評(píng)分A組小于B組，差異均有統(tǒng)計(jì)學(xué)意義。兩組患者隨訪4～36個(gè)月，均無一例復(fù)發(fā)。兩組術(shù)后并發(fā)癥發(fā)生率差異無統(tǒng)計(jì)學(xué)意義。A組在術(shù)后局部疼痛不適、慢性疼痛等方面優(yōu)于B組。 結(jié)論 兩種方法對(duì)腹股溝疝修補(bǔ)都具有良好的療效，但是腹膜前間隙無張力疝修補(bǔ)術(shù)后局部舒適度更佳，手術(shù)更安全。

[關(guān)鍵詞] 疝；腹股溝；疝環(huán)充填式無張力腹股溝疝修補(bǔ)術(shù)；腹膜前間隙無張力腹股溝疝修補(bǔ)術(shù)

[中圖分類號(hào)] R656.21 [文獻(xiàn)標(biāo)識(shí)碼] B [文章編號(hào)] 2095-0616（2015）24-178-04

[Abstract] Objective To compare the effect on open preperitoneal space and filling hernia ring of tension-free inguinal herniorrhaphy in adult patients with inguinal hernia. Methods 95 patients inguinal hernia of clinical data， who were received and treated from January 2012 to December 2014， were retrospectively analyzed and were divided into two groups according to operative methods. 34 cases in A group were treated with preperitoneal space tension-free inguinal herniorrhaphy， and 61 cases in B group were treated with preperitoneal space and filling hernia ring tension-free inguinal herniorrhaphy. To compare the treatment effect and postoperative complications between the two groups. Results The differences of the average hospitalization day and operation time between the two groups were no statistical significance. The most early activity time of leave a sickbed after operation in A group was obviously shorter than which in B group， the pain score according to visual analogue scale after 24h operation in A group was less than which in B group， the differences were statistical significance. Patients of the two groups were followed-up 4 to 36 months， without recurrence. The differences of the incidence rate of complication after operation was no statistical significance compared with the two groups. The local pain and discomfort， the chronic pain etc. after operation in A group were better than which in B group. Conclusion The two methods of inguinal herniorrhaphy all have better treatment effect， while preperitoneal space tension-free inguinal herniorrhaphy has much better local degree of comfort， has much safety on surgical operation.

[Key words] Hernia； Inguinal； Filling hernia ring tension-free inguinal herniorrhaphy； Preperitoneal space tension-free inguinal herniorrhaphy

腹股溝疝由于其發(fā)病率高、復(fù)雜多樣以及社會(huì)-經(jīng)濟(jì)影響，一直是外科醫(yī)生最大的挑戰(zhàn)之一。從2014年6月沈陽中華醫(yī)學(xué)會(huì)第八屆全國疝和腹壁外科學(xué)術(shù)研討會(huì)[1]獲悉，中國每年約有300萬新發(fā)的腹股溝疝患者，以及50萬例以上的其他各類疝。其中腹股溝疝的發(fā)病率約為3‰～5‰，而老年男性的發(fā)病率顯著增高，可達(dá)11.6‰。成年人一旦腹股溝疝形成，自行愈合的可能很小，手術(shù)仍然是目前治愈腹股溝疝的唯一方法[2-3]。……