复发腹股沟疝手术方式的选择及临床疗效  

Selection of surgical methods for recurrent inguinal hernia and corresponding clinical efficacy

作　　者：吴立胜 余建伟 李煜[1] Wu Lisheng;Yu Jianwei;Li Yu(Department of Hernia and Metabolic and Bariatric Surgery,the First Affiliated Hospital of University of Science and Technology of China,Anhui Provincial Hospital,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院暨安徽省立医院疝与减重代谢外科,合肥230001

出　　处：《中华消化外科杂志》2019年第11期1043-1047,共5页Chinese Journal of Digestive Surgery

基　　金：国家临床重点专科建设资助项目(201211)。

摘　　要：目的探讨复发腹股沟疝手术方式的选择及临床疗效。方法采用回顾性横断面研究方法。收集2015年1月至2017年12月中国科学技术大学附属第一医院暨安徽省立医院收治的98例复发腹股沟疝患者的临床资料;男90例,女8例;年龄为(62±16)岁,年龄范围为18~84岁。根据患者既往手术入路方式及对腹膜前间隙的干扰程度,复发疝缺损大小,复发疝分型及手术医师对腹腔镜疝修补手术技术掌握程度,选择复发腹股沟疝的手术方式。观察指标:(1)复发腹股沟疝情况。(2)再次手术情况。(3)随访情况。采用门诊、电话、网站APP方式进行随访,了解患者术后3~7 d、1个月、3个月、6个月、12个月复发疝情况和并发症情况。随访时间截至2018年12月。正态分布的计量资料以Mean±SD表示,偏态分布的计量资料以M(范围)表示;计数资料以绝对数表示。结果(1)复发腹股沟疝情况:98例患者腹股沟疝复发时间为1.5年(0.5年,4.0年),复发时间范围为术后1 d至40.0年;5例术后多次复发(≥3次);Campanelli复发疝分型R1型47例、R2型21例、R3型30例。98例患者中,75例既往手术采用前入路方式,其中Bassini修补术26例、Lichenstein修补术16例、Shouldice修补术11例、McVay修补术9例、Rutkow修补术5例、单纯高位结扎4例、Millikan修补术4例,术后复发时间为3.0年(0.7年,10.0年);23例既往手术采用后入路方式,其中联合前入路加强腹膜前间隙Kugel修补术2例、Gilbert修补术1例、Stoppa修补术1例,术后复发时间为(3.2±1.6)年,腹腔镜完全腹膜外修补术(TEP)11例、经腹腔腹膜前疝修补术(TAPP)8例,术后复发时间为(1.5±0.9)年。(2)再次手术情况:75例既往手术采用前入路方式患者,再次手术方式为TAPP 62例、Kugel修补术9例、TEP 4例;其手术时间分别为(66±25)min、(61±19)min、(70±26)min;麻醉方式为局部麻醉1例(行Kugel修补术),全身麻醉74例。23例既往手术采用后入路疝修补Objective To investigate the choice of surgical methods for recurrent inguinal hernia and their corresponding clinical efficacy.Methods The retrospective cross sectional study was conducted.The clinical data of 98 patients with recurrent inguinal hernia who were admitted to the First Affiliated Hospital of University of Science and Technology of China(Anhui Provincial Hospital)between January 2015 and December 2017 were collected.There were 90 males and 8 females,aged(62±16)years,with a range from 18 to 84 years.According to the previous surgical approaches of patients and the interference degree to the preperitoneal space,size of the defects,type of recurrent inguinal hernia,and the surgeon′s mastery of laparoscopic hernia repair technology,corresponding surgical methods for recurrent inguinal hernia were selected.Observation indicators:(1)conditions of recurrent inguinal hernia;(2)conditions of reoperation;(3)follow up.Follow up using outpatient examiantion,telephone interview,and website APP was performed to detect the conditions of recurrent hernia and complications at 3-7 days,1 month,3 months,6 months,and 12 months after operation up to December 2018.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were expressed as absolute numbers.Results(1)Conditions of recurrence inguinal hernia:the time to recurrence of inguinal hernia in 98 patients was 1.5 years(0.5 years,4.0 years),ranging from 1 day to 40.0 years after operation.Five patients had recurrence more than 3 times.There were 47 cases classified as type R1,21 cases as type R2,and 30 cases as type R3 according to Campanelli classification of recurrent hernias.Seventy five of 98 patients were treated by anterior approach,including 26 undergoing Bassini repair,16 undergoing Lichenstein repair,11 undergoing Shouldice repair,9 undergoing McVay repair,5 undergoing Rutkow repair,4 undergoing simple high ligation,and 4 undergoing Millikan repair.The time

关 键 词：疝 成人腹股沟疝 复发 治疗选择 腹腔镜检查 

分 类 号：R65[医药卫生—外科学]