開放式腹膜前間隙和疝環充填式無張力腹股溝疝修補術95例對照研究

王新平　陳進紅　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充填式無張力疝修補術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。按照手術方式分為兩組。A組34例，采用腹膜前間隙無張力疝修補術，B組61例，采用疝環充填式無張力疝修補術，比較兩組治療后的效果以及術后并發癥。 結果 兩組平均住院日差異無統計學意義；術后最早下地活動時間A組明顯短于B組，術后24h視覺模擬評分法疼痛評分A組小于B組，差異均有統計學意義。兩組患者隨訪4～36個月，均無一例復發。兩組術后并發癥發生率差異無統計學意義。A組在術后局部疼痛不適、慢性疼痛等方面優于B組。 結論 兩種方法對腹股溝疝修補都具有良好的療效，但是腹膜前間隙無張力疝修補術后局部舒適度更佳，手術更安全。

[關鍵詞] 疝；腹股溝；疝環充填式無張力腹股溝疝修補術；腹膜前間隙無張力腹股溝疝修補術

[中圖分類號] R656.21 [文獻標識碼] B [文章編號] 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

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