复发性腹股沟疝的临床特点和腹腔镜手术方式选择  

Clinical characteristics and choice of laparoscopic surgical procedures for recurrent inguinal hernia

作　　者：王文瑞[1] 李健文[1] 王骥[1] 乐飞[1] 冯波[1] 王明亮[1] 陆爱国[1] 郑民华[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院普通外科上海市微创外科临床医学中心,200025

出　　处：《中华消化外科杂志》2015年第10期827-831,共5页Chinese Journal of Digestive Surgery

基　　金：吴阶平医学基金会临床科研专项资助基金（320.6750.14321）

摘　　要：目的：总结复发性腹股沟疝的临床特点，探讨其腹腔镜手术方式选择。方法：回顾性分析2001年1月至2014年12月上海交通大学医学院附属瑞金医院收治的330例（352侧）行腹腔镜腹股沟疝修补术复发性腹股沟疝患者的临床资料。手术由同组医师完成，手术方式由术者选择行经腹腹膜前修补术（TAPP）、全腹膜外修补术（TEP）或腹腔内补片平铺术（IPOM）。观察指标包括前次手术的复发部位，此次手术的修补方法、手术方式选择和临床疗效。采用电话或门诊方式进行随访，随访内容为疝复发情况和术后并发症发生情况。随访时间截至2015年6月。正态分布的计量资料以±s表示，偏态分布的计量资料以M（范围）表示；计数资料比较采用χ2检验。结果：（1）复发部位：352侧复发疝中，直疝区域186侧，斜疝区域111侧，股疝区域6侧，复合疝区域49侧。125侧缝合修补术后复发疝中，直疝区域44侧，斜疝区域48侧，股疝区域2侧，复合疝区域31侧；110侧网塞平片修补术后复发疝中，直疝区域85侧，斜疝区域16侧，复合疝区域9侧；61侧平片修补术后复发疝中，直疝区域37侧，斜疝区域16侧，股疝区域3侧，复合疝区域5侧；36侧腹膜前修补术后复发疝中，直疝区域19侧，斜疝区域12侧，股疝区域1侧，复合疝区域4侧；14侧疝囊高位结扎术后复发疝中，直疝区域1侧，斜疝区域13侧；6侧硬化剂注射后复发疝均为斜疝。复发疝中直疝的比例为52.84%（186/352），高于初发疝的23.70%（998/4 211），两者比较，差异有统计学意义（χ^2=171.397，P〈0.05）；植入补片的复发疝中直疝的比例为68.12%（141/207），高于未植入补片复发疝的31.03%（45/145），两者比较，差异有统计学意义（χ^2=47.052，P〈0.05）。（2）修补方法：未植入补片的复发疝和平片修补术后复发疝，均采用修补肌耻骨孔的方�Objective：To summarize the clinical characteristics of recurrent inguinal hernia and investigate the choice of laparoscopic surgical procedures. Methods：The clinical data of 330 patients with recurrent inguinal hernia （352 inguinal hernias） 〖HQK〗who underwent laparoscopic inguinal hernia repair （LIHR） at the Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine between January 2001 and December 2014 were retrospectively analyzed. The surgical procedures including transabdominal preperitoneal （TAPP） approach, total extraperitoneal （TEP） approach and intraperitoneal onlay mesh （IPOM） approach were selected and performed by doctors in the same team. Observed indicators included recurrent sites of previous surgery, repair methods, surgical procedures and clinical efficacies of this surgery. Patients were followed up by telephone interview and outpatient examination up to June 2015. The followup included the recurrence and postoperative complications.Measurement data with normal distribution were presented as ±s, skew distribution data were described as M （range）, and count data were analyzed using chisquare test.Results：（1）Recurrent sites： of 352 recurrent inguinal hernias, 186 were detected in direct hernia region, 111 in indirect hernia region, 6 in femoral hernia region and 49 in compound hernia region. Among 125 recurrent inguinal hernias after suture repair, 44 were detected in direct hernia region, 48 in indirect hernia region, 2 in femoral hernia region and 31 in compound hernia region. Among 110 recurrent inguinal hernias after meshplug repair, 85 were detected in direct hernia region, 16 in indirect hernia region and 9 in compound hernia region. Among 61 recurrent inguinal hernias after patch repair, 37 were detected in direct hernia region, 16 in indirect hernia region, 3 in femoral hernia region and 5 in compound hernia region. Among 36 recurrent inguinal hernias after preperitoneal repair, 19 were detected in direct hernia region, 12 in indi

关 键 词：腹股沟疝 复发性 治疗 腹腔镜检查 

分 类 号：R656.21[医药卫生—外科学]