无张力修补术后腹股沟复发疝再手术的探讨  

Clinical study on hernia recurrence after tension-free inguinal hernioplasty and methods of reoperation

作　　者：杨斌[1] 赖东明[1] 江志鹏[1] 张育超[1] 周军[1] 陈双[1] 

机构地区：[1]中山大学孙逸仙纪念医院胃肠外科,广州510120

出　　处：《中华疝和腹壁外科杂志（电子版）》2010年第4期14-16,共3页Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)

摘　　要：目的探讨腹股沟疝无张力修补术后复发的原因及再手术治疗的原则。方法对2007年1月至2009年6月间31例腹股沟疝无张力修补术后复发患者的资料进行回顾性分析。复发时间为前次术后3个月至10年,平均(32±10)个月。既往手术方式:疝环填充式修补术14例,平片修补术10例,腹腔镜无张力疝修补术5例(TAPP、TEP、IPOM术后分别有2例、2例、1例),开放式腹膜前修补术2例。结果手术时间28～86 min,平均(38±6)min。首次复发行开放式全腹膜外无张力修补12例,平片修补6例,腹腔镜下修补4例(TEP2例、TAPP2例),巨大补片加强内脏囊(GPRVS)3例。多次复发者中2例行腹腔镜下修补(包括1例TEP和1例IPOM),2例行开放式完全腹膜外无张力修补,2例GPRVS。随访时间8～52个月,平均(29±8)个月,再复发1例。结论无张力腹股沟疝修补术后复发的原因主要是术中操作不当或患者复发的高危因素处理不当。应根据复发疝的类型和性质,选择个体化的治疗方案和手术路径。Objective To investigate the causes of recurrence after tension-free hernioplasty and study the reoperative strategies. Methods From Jan. 2007 to Jun. 2009, 31 recurrent inguinal hernia patients underwent reoperation, clinical data were analyzed retrospectively. The average interval from the initial surgery to recurence was（32 ±10） months （range from 3 months to 10） years. There are 14 recurrent cases after mesh-plug hemioplasty, 10 cases after Lichtenstein repair, 5 cases after laparoscopie repair （including 2 cases of TAPP, 2 cases of TEP, 1 case of IPOM） ,2 cases of open total extraperitoneal herniorrhaphy. Results The mean operation time was（38 ±6） minuts （range from 28 to 86 ） minuts. Recurrent hernias for the first time were treated with open total extraperitoneal herniorrhaphy in 12 cases, Liehtenstein repair in 6 eases, laparoscopie repair in 4 cases（2 eases of TEP and 2 cases of IPOM） and GPRVS in 3 cases. Repetitious recurrent patients received laparoseopic repair in 2 cases （ 1 case of TEP and 1 ease of IPOM） , open total extraperitoneal herniorrhaphy in 2 cases and GPRVS in 2 cases. One recurrent case was found during 8 to 52 months follow-up period （ on an average of 29 ±8 ） months. Conclusions The main factors of recurrent hernia after tension-free hernioplasty were related with incorrect operative techniques, improper management of the high risk factors of recurrence. The treatment strategy and operative approach should be chosen according to the types and characters of recurrent hernia.

关 键 词：疝 腹股沟 疝修补术 复发 

分 类 号：R656.2[医药卫生—外科学]