【作者】 张青松；

【导师】 郑启昌；

【作者基本信息】 华中科技大学 ， 外科学， 2006， 硕士

【摘要】 目的对比分析局麻下腹膜前间隙修补术和疝环充填式疝修补术两种无张力腹股沟疝修补术的手术效果,探讨个体化的疝修补方法。方法局麻下分别应用腹膜前间隙疝修补装置(普理灵疝修补装置Prolene Hernia System或Kugel补片Bard Composix Kugel Patch)和疝塞(Bard Mesh Plug & Patch或B.Braun Premilene Mesh Self-Forming Plug)作为疝修补材料行疝修补术,将100例腹股沟患者随机分成P&K组和Plug组2组,每组各50例,对2组的临床资料进行对比。结果随访6~12个月,P&K组手术时间18-65min(平均28min),术后2-6天出院,1例阴囊积液,术后3个月行鞘膜积液翻转术治愈,1例术后1个月切口感染,经换药后治愈。Plug组手术时间25-65min(平均33min),术后3-6天出院,2例术后1-5个月切口感染,经换药后治愈,1例鞘膜积液,行鞘膜翻转术后治愈。两组均无复发。Plug组术后8h和24h疼痛程度显著高于P&K组(P<0.05),两组手术时间、术后平均住院日、并发症发生率及复发率比较无显著差异(P >0.05)。结论局麻下腹膜前间隙无张力修补术及疝环充填式无张力修补术均能较好地修补腹股沟疝,均有术后恢复快、复发率低的优点,可根据患者的具体情况选择个体化的修补方案以提高手术效果。其中腹膜前间隙修补术适应性广,更符合腹股沟管解剖和生理,是“全腹股沟区”的增强修复,具有术后疼痛轻,疗效满意、复发率低等特点,尤其适合复发疝和腹股沟管后壁薄弱、缺损大,有全身合并症的老年患者。更多还原

【Abstract】 Objective To compare polypropylene-Prolene Hernia System (PHS) or Bard Composix Kugel Patch and Mesh Plug for tensing-free Inguinal herniorrhaphy under local anesthesia and find a ideal method for Inguinal herniorrhaphy. Methods 100 patients with inguinal henia were randomized to receive respectively PHS or Kugel patch and Mesh Plug (Bard ? Mesh Perfix? Plug or Premilene? Mesh Self-Forming Plug) tension-free herniorrhaphy under local anesthesia. Results In PHS group , operative time of every case was 18~65 minutes (average 28min),the hospital stay was 2~6 days;1 case was occurred scrotal hydrocele and treated with hydrocele subvolution 3 months after operation; 1 cases were suffered from superficial wound infection and were cured through change dressings 2 months after operation. In Plug group, operative time of every case was 25~65 minutes (average 33min), the hospital stay was 3~6 days; 1 case was occurred scrotal hydrocele and treated with hydrocele subvolution after operation; 2 cases were suffered from superficial wound infection and were cured through change dressings 1~5 months after operation. During a follow-up, no recurrence occurred. The painful degree of 8 hours and 24 hours after operation had significant difference between two groups. And the operation time, retention of urine, scrotal edema rate and recurrence rate were no obvious difference between two groups. Conclusions Both PHS and Mesh Plug are ideal materials for herniorrhaphy.Tension-free herniorrhaphy by PHS with local anesthesia has possessing wide indications. PHS herniorrhaphy is consonant with the anatomy and physiology of inguinal duct and is a total inguinal repair. It is a safely, minimally invasive, chronic non-disabling groin pains, prompts restoration after operation,is satisfactory with the curative effect and low relapse rate; specially suited for aged patients with weak posterior wall of inguinal duct, large defect and general complications.更多还原