中国普外基础与临床杂志

中国普外基础与临床杂志

单中心 1 078 例腹股沟疝的手术构成及术后随访分析

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目的 总结安徽医科大学第一附属医院近 7 年间的腹股沟疝术式变化及各术式的疗效。 方法 回顾性分析安徽医科大学第一附属医院于 2011 年 1 月至 2017 年 12 月期间收治的 1 078 例腹股沟疝患者的临床资料,根据术式分为组织修补组、腹腔镜疝修补术组(腹腔镜组)和开放无张力疝修补组(开放组),开放组进一步分为网塞组、平片组和腹膜前疝修补术组 [即超普疝修补系统(UHS)组],比较各术式的术后复发、慢性疼痛、异物感、手术部位触硬感、男性性功能以及生育情况。 结果 本组患者行组织修补术 52 例,行开放无张力疝修补术 889 例 [采用网塞平片技术 687 例,采用平片技术 100 例,采用 UHS 技术 102 例],行腹腔镜疝修补术 137 例。腹腔镜组和开放组的总并发症发生率、慢性疼痛、异物感和男性性功能下降发生率比较差异均无统计学意义(P>0.05),但腹腔镜组的复发率和手术部位触硬感率较低(P<0.05),数字疼痛量表(NRS)评分也略低(P=0.047)。在开放无张力疝修补术的 3 个亚组中,网塞组、平片组及 UHS 组的复发率、慢性疼痛发生率、异物感发生率及男性性功能下降发生率比较差异均无统计学意义(P>0.05),但 UHS 组的总并发症发生率和手术部位触硬感发生率均低于网塞组及平片组(P<0.05)。 结论 腹腔镜无张力修补术治疗腹股沟疝的复发率较低,值得临床推广。在开放无张力术式中,腹膜前隙疝修补术可能是较好的选择。

Objective To summarize the changes of inguinal hernia in The First Affiliated Hospital of Anhui Medical University in the past 7 years and the curative effect of each procedure. Methods Retrospectively searched the clinical data of 1 078 patients with inguinal hernia operated in The First Affiliated Hospital of Anhui Medical University from January 2011 to December 2017. According to the surgical procedure, patients were divided into tissue repair group, laparoscopic hernia repair group (laparoscopic group), and open tension-free hernia repair group (open group). Subsequently, the patients of the open group were divided into the mesh plug technique group, the plain patch technique group, and the Ultrapro Hernia System (UHS) group. The postoperative of each procedure, such as recurrence, chronic pain, foreign body sensation, hard touch of the surgical site, male sexual function, and fertility status were compared. Results In 1 078 patients, 52 patients underwent tissue repair, 889 patients underwent open tension-free hernia repair (687 patients were counted with mesh-seal tablets, 100 patients with plain patch count, 102 patients with preperitoneal hernia repair), and 137 patients underwent laparoscopic hernia repair. There was no significant difference in the incidence of total complication, chronic pain, foreign body sensation, and male sexual function decline in the laparoscopic group and the open group (P>0.05). However, the recurrence rate and hard touch of the surgical site rate of the laparoscopic group were lower (P<0.05), and the Numeric Rating Scale (NRS) score was also slightly lower (P=0.047). There was no significant difference in the incidence of the recurrence, chronic pain, foreign body sensation, and male sexual function decline between the three subgroups of the open group, but the total complication rate and hard touch of the surgical site rate in the UHS group were lower than those in the mesh plug group and the plain patch group (P<0.05). Conclusions Laparoscopic repair of the inguinal herniorrhaphy has lower incidence of occurrence, it is worthy of clinical promotion. In the open tension-free surgery, the retroperitoneal herniorrhaphy may be a better choice.

关键词: 腹股沟疝; 疝修补术; 无张力疝修补术; 腹腔镜手术

Key words: inguinal hernia; herniorrhaph; tension-free repair; laparoscopy

引用本文: 李龙龙, 王宜文, 陆明, 胡孔旺. 单中心 1 078 例腹股沟疝的手术构成及术后随访分析. 中国普外基础与临床杂志, 2018, 25(12): 1419-1424. doi: 10.7507/1007-9424.201807076 复制

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