腹股沟无张力疝修补术215例治疗体会.docVIP

腹股沟无张力疝修补术215例治疗体会[摘要] 目的：探讨腹股沟疝的原因，总结无张力疝修补术的临床效果、手术方式及注意事项，以降低术后复发率。方法：对215例行无张力疝修补术的腹股沟疝患者的临床资料进行分析。结果：所有患者手术顺利，无切口感染及死亡；术后出现阴囊积液4例，经对症治疗（穿刺抽液、热敷等）痊愈；尿潴留10例（均伴有前列腺疾病），导尿及治疗前列腺疾病后恢复；术后随访6个月~2年无复发。结论：无张力疝修补术在操作仔细、解剖清晰的情况下，临床效果满意，推广价值高。 [关键词] 腹股沟疝；无张力疝修补术；补片；外科手术 [中图分类号] R656.2+1 [文献标识码]A[文章编号]1674-4721（2011）02（b）-030-02 Treatment experience of tension-free inguinal hernioplasty in 215 cases SHANG Yi，SUN Chengyu (The Second Department of General Surgey, the First People’s Hospital of Shenyang City, Liaoning Province, Shenyang 110041,China) [Abstract] Objective: To explore the reason of inguinal hernia, from summarying the clinical effect, surgical methods, notes,we can learn how to reduce the recurrence. Methods: Analyzed the clinical datas of tension-free hernioplasty for inguinal hernia in 215 cases. Results: All cases operated successfully, nobody wound infect or dead; Scrotal hydrocele in 4 cases after operation were healed by symptomatic treatment (puncture pumping fluid, hot compress); and urinary retention in 10 cases (all had prostate disease) after operation were rescured by catheterization and therapy of prostate disease; Followed-up in 6 to 24 months, no recurrence was found. Conclusion: Tension-free hernioplasty has perfect clinical effect and is worthy to popularize under the condition of operating carefully and dissecting clearly. [Key words] Inguinal hernia; Tension-free hernioplasty; Patch; Surgical procedure 无张力疝修补术腹股沟疝是一种常见病、多发病，在无张力疝修补手术出现前，复发率居高不下。自1989年Lichtenstein正式提出无张力疝修补并大规模开展以来，其复发率降至1%以下。本院1999年2月~2007年2月进行了215例腹股沟无张力疝修补术。现将临床资料报道如下： 1资料与方法 1.1一般资料 本组患者共215例，其中，男性205例，女性10例，年龄22~76岁，平均61.5岁。斜疝156例，直疝56例，骑跨疝3例。其中复发疝81例。按照中华医学会外科学分会疝和腹壁外科学组于2003年8月制定的成人腹股沟疝、股疝手术治疗方案（修订稿）中的分型法，本组215例患者，Ⅰ型29例，Ⅱ型59例，Ⅲ型78例，Ⅳ型49例。 1.2手术方法 本组患者麻醉均采用局部麻醉，麻醉效果满意后，患者取仰卧位，于腹股沟韧带中点上方1.5~2.0 cm处开始向下至耻骨结节，做与腹股沟韧带平行的斜切口，长6~8 cm，切开皮肤、皮下组织、腹外斜肌腱膜，暴露内外环，充分显露腹股沟韧带内面和联合腱，纵行分开睾提肌及腹横肌膜纤维，游离精索，分出疝囊，高位游离疝囊至腹膜前脂肪，将花瓣状充填物（Perfix Plug）顶端对准疝囊底部达疝