自固定补片行开放无张力疝修补汇总.ppt

腹股沟疝无张力修补的现状 方法多 材料多 个体化治疗 重视并发症 Lichtenstein(李金斯坦) Tension free(无张力)，1989 李金斯坦手术 简单，易学，适合大多数疝 仍是欧洲应用最多的方法 分离范围大，缝合多 材料和缝合技术仍在演变 理想的李金斯坦手术补片 适合的形状和大小 有一定的弹性并且不皱缩 对组织的刺激最小 最小的残量和足够的支撑张力 缝合的演变 腹股沟疝术后慢性疼痛 持续6个月以上《Amid 防治腹股沟疝术后慢性疼痛国际指南》 发生率0.5~6%；10~12% 原因 神经源性（缝扎，卡压，粘连） 非神经源性（瘢痕，骨膜刺激） 其他因素（年龄、性别、职业） 心理因素  有自动固定功能的微型锚扣(micro-grips)是由聚乳酸（PLA）成分制成的。通过水解自然吸收，减少体内的异物质量。 micro-grips均匀地分布在整张补片的表面，不需要依靠补片外围的几个缝合固定点来固定补片。并且自动固定的功能可以减少对患者组织穿透的创伤和牵拉神经造成的慢性疼痛的风险。 micro-grips式补片对小白鼠的输精管没有任何不良影响 Influence of a new self-gripping hernia mesh on male fertility in a rat modelThomas Kolbe ? Christian Hollinsky ? Ingrid Walter ? Anja Joachim ? Thomas RülickeSurg Endosc 结论 ProGrip自固定补片行腹股沟疝开放式无张力修补是安全可行的 修补方法源自李金斯坦手术 手术步骤简单 不进入腹膜前间隙 单一平面补片 不需缝合 复发率低 我们的结果（近期0/15复发） 文献 0/70复发. P. Chastan. 2/181复发（1.1%） Nicolás Pedano 术后疼痛轻 我们的对照研究（进行中） a Abstract INTRODUCTION: Secure fixation of the mesh in groin hernia repair is essential to avoid mesh dislocation. The fixation, however, is also thought to be a source of chronic postoperative pain. We tested the new self-fixating mesh Parietene progrip vs. traditional suture fixating Lichtenstein repair in a double-blinded randomized study evaluating postoperative pain and the use of analgesics. METHODS: Fifty patients were randomized into two groups: Patients of group A (24 patients) were operated with the new self-fixating Parietene progrip mesh without fixation sutures and patients of group B (26 patients) were operated with the traditional Lichtenstein repair. Postoperative course including pain and the use of analgesics were monitored. Patients were reinvestigated after 6 months regarding pain score and the amount of analgesics used during this interval. Primary end point was pain on the first operative day. RESULTS: The visual analog scale pain score showed at the first postoperative day a significantly lower level in group A than in group B (mean 17.9 vs. 32.3 mm, p = 0.03). Additionally, the cumulative dose of postoperatively required a