【2017年整理】正中切口腹股沟疝腹膜外修补.docVIP

手机号　　Ｅ-ｍａｉｌ：srongxun@ 正中切口行腹股沟疝腹膜外修补术102例 孙荣勋 陈 江 张大伟 李小燕* 姚君良 （复旦大学附属金山医院普外科，上海 201508） [摘要]目的　总结腹股沟疝行正中切口腹膜外修补术的解剖要点和初步操作体会。方法 2011年2月～2015年8月102例腹股沟疝经正中切口行完全腹膜外修补，手术步骤依次为分开腹直肌，分离腹膜外筋膜和腹横筋膜间粘连，建立腹膜外间隙，剥离疝囊，以疝环为中心将补片完全覆盖肌耻骨孔，补片与腹直肌缝合固定。结果 手术时间28~55 min，平均37 min。术后住院时间1~4 d，平均1.5 d。术后尿储留3例（2.9%），皮下、阴囊血清肿和血肿3例(2.9%)，无慢性疼痛。95例随访6个月~5年，平均3年，无慢性疼痛，术后复发2例（1.9%），均发生在术后6个月，采用网塞法行再次修补，其余患者无异常。结论 经正中切口的腹膜外修补具有操作便捷、术后腹股沟区无不适感等优势，且可作为腔镜手术的垫脚石。 [关键词] 腹膜外修补；腹股沟疝；正中切口 Operative Techniques Experience102 Cases of Inguinal Hernia Extraperitoneal Repair through Midline Incision SUN Rongxun，CHEN Jiang，ZHANG Dawei，et al. Department of General Surgery, Jinshan Hospital Affiliated to Fudan University, Shanghai 201508, China [Abstract] Objective: To summarize the experience of the anatomic landmarks and operative techniques in the extraperitoneal repair through midline incision for inguinal hernia. Methods： From Feb 2011 to Aug 2015, 102 patients with inguinal hernia received extraperitoneal herniorrhaphy through midline incision. The operative procedure was as follows. After separating the rectus abdominis muscles were separated, the adhesion between the extroperitoneal fascia and the transvasalis fascia was dissected, and the preperitoneal space was established, then the hernia sac was isolated. The prosthesis patch was placed on the myopectineal orifice, the hernia ring located locating at the center of the patch. Finally, the patch rim was fixed to the rectus. Results: The operative time was 28~55min, and the mean time was 37.2 min. The postoperative hospital stay was 1~4d, and the mean stay was 1.5d. Urinary retention occurred in 3 cases(2.9%). Seroma occurred in 3 cases(2.9%). 95 cases were followed up for 6 months ~5 years, with an average of 3 years. There was no patient with chronic pain, but 2 cases of postoperative recurrence (1.9%). Both recurrences occurred in 6 months after the operation, and received reoperations with plug method. The other patients we