腹膜前間隙無張力修補(bǔ)術(shù)治療疝氣的臨床效果觀察(1)
[摘要] 目的 探討腹膜前間隙無張力修補(bǔ)術(shù)治療疝氣的臨床療效。 方法 選取本院2012年1月～2014年1月收治的腹股溝疝患者70例，隨機(jī)分為試驗(yàn)組和對照組，試驗(yàn)組行腹膜前間隙無張力疝修補(bǔ)術(shù)；對照組行疝環(huán)填充式無張力疝修補(bǔ)術(shù)，比較兩組療效。 結(jié)果 兩組患者手術(shù)時間、術(shù)中出血量、術(shù)后疼痛程度、下床活動時間、住院時間以及復(fù)發(fā)率比較均無明顯差異(P>0.05)，試驗(yàn)組術(shù)后并發(fā)癥發(fā)生率為2.6%，明顯小于對照組(P<0.05)。 結(jié)論 腹膜前間隙無張力修補(bǔ)術(shù)治療疝氣具有創(chuàng)傷小、恢復(fù)快、并發(fā)癥少、復(fù)發(fā)率低等優(yōu)勢，值得臨床推廣應(yīng)用。
[關(guān)鍵詞] 腹股溝疝；腹膜前間隙；無張力修補(bǔ)術(shù)
[中圖分類號] R656.2 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1674-4721(2015)05(b)-0041-03
Clinical effect observation of preperitoneal space tension-free repair in the treatment of hernia
LI Quan-xi
Department of General Surgery，West Section，the Second People′s Hospital of Lianyungang City in Jiangsu Province，Lianyungang 223023，China
[Abstract] Objective To explore the clinical effect of preperitoneal space tension-free repair on treating hernia. Methods 70 patients with inguinal hernia admitted into our hospital from January 2012 to January 2014 were selected and randomly divided into experimental group and control group.Preperitoneal space tension-free repair was applied to experimental group，while plug mesh tension-free hernia repair was used to control group.The effect between two groups was compared. Results There was no statistical difference in operation time，intraoperative amount of bleeding，pain degree after surgery，time of being off bed，hospital stay and recurrence rate between two groups(P>0.05).The incidence of postoperative complications in experimental group was 2.6%，much lower than that in control group(P<0.05). Conclusion In the treatment of hernia，preperitoneal space tension-free repair gets superiorities of small trauma，rapid recovery，few complications，and low recurrence rate，which is worthy of clinical application and promotion.
[Key words] Inguinal hernia；Preperitoneal space；Tension-free repair
腹股溝疝俗稱“疝氣”，指腹腔內(nèi)臟器通過腹股溝區(qū)的缺損向體表突出所形成的疝，該病若不及時治療，會引起嚴(yán)重并發(fā)癥。目前手術(shù)是治療該病唯一可靠的方法，可減少復(fù)發(fā)[1]。無張力疝修補(bǔ)術(shù)是近年來治療腹股溝疝應(yīng)用最廣泛的術(shù)式。無張力疝修補(bǔ)術(shù)術(shù)式較多，臨床常用的包括疝環(huán)填充式術(shù)和開放式腹膜前間隙無張力修補(bǔ)術(shù)(開放TDP術(shù))，兩種術(shù)式哪種更好，臨床尚存分歧[2]。本院近年采用開放TDP術(shù)治療疝氣取得滿意療效，現(xiàn)與疝環(huán)填充式術(shù)式進(jìn)行比較分析。
1 資料與方法
1.1 一般資料
選取本院2012年1月～2014年1月收治的腹股溝疝患者70例，所有患者經(jīng)臨床癥狀和輔助檢查等明確診斷[3]，均為單側(cè)腹股溝疝患者，排除雙側(cè)腹股溝疝及伴有嚴(yán)重心肺功能障礙等患者。將所有患者隨機(jī)分為試驗(yàn)組和對照組，各35例患者，試驗(yàn)組男性27例，女性8例，年齡28～84歲，平均(54.2±4.3)歲；腹股溝疝類型：斜疝28例，直疝5例，股疝2例；原發(fā)疝33例，復(fù)發(fā)疝2例。對照組男性28例，女性7例，年齡27～82歲，平均(52.7±4.6)歲，腹股溝疝類型：斜疝27例，直疝5例，股疝3例；原發(fā)疝31例，復(fù)發(fā)疝4例。兩組患者的一般資料比較，差異無統(tǒng)計學(xué)意義(P>0.05)，具有可比性。
1.2 手術(shù)方式
1.2.1 試驗(yàn)組 行開放TDP術(shù)：選用連續(xù)硬膜外麻醉，取腹股溝管一長約5～6 cm的斜切口，依次切開皮膚、皮下組織及腹外斜肌腱膜，并向兩側(cè)鈍性分離，游離精索，處理疝囊。若為直疝游離疝囊將其縫合后直接回納入腹腔；若為斜疝根據(jù)疝囊大小取橫斷或完全游離后回納入腹腔，自環(huán)內(nèi)水平腹膜游離精索和輸精管，使其與腹膜分開，拉起腹膜下血管，游離出約8 cm×15 cm的腹膜前間隙，游離至恥骨下方后完全分離腹膜和周圍組織，可見恥骨疏韌帶，將補(bǔ)片(北京天助暢運(yùn)公司生產(chǎn)的聚丙烯補(bǔ)片)置入腹膜前間隙，覆蓋整個缺損處，將補(bǔ)片下端與恥骨疏韌帶縫合固定1針，徹底止血后逐層關(guān)閉手術(shù)切口，完成手術(shù)。 (立全晰)
[關(guān)鍵詞] 腹股溝疝；腹膜前間隙；無張力修補(bǔ)術(shù)
[中圖分類號] R656.2 [文獻(xiàn)標(biāo)識碼] A [文章編號] 1674-4721(2015)05(b)-0041-03
Clinical effect observation of preperitoneal space tension-free repair in the treatment of hernia
LI Quan-xi
Department of General Surgery，West Section，the Second People′s Hospital of Lianyungang City in Jiangsu Province，Lianyungang 223023，China
[Abstract] Objective To explore the clinical effect of preperitoneal space tension-free repair on treating hernia. Methods 70 patients with inguinal hernia admitted into our hospital from January 2012 to January 2014 were selected and randomly divided into experimental group and control group.Preperitoneal space tension-free repair was applied to experimental group，while plug mesh tension-free hernia repair was used to control group.The effect between two groups was compared. Results There was no statistical difference in operation time，intraoperative amount of bleeding，pain degree after surgery，time of being off bed，hospital stay and recurrence rate between two groups(P>0.05).The incidence of postoperative complications in experimental group was 2.6%，much lower than that in control group(P<0.05). Conclusion In the treatment of hernia，preperitoneal space tension-free repair gets superiorities of small trauma，rapid recovery，few complications，and low recurrence rate，which is worthy of clinical application and promotion.
[Key words] Inguinal hernia；Preperitoneal space；Tension-free repair
腹股溝疝俗稱“疝氣”，指腹腔內(nèi)臟器通過腹股溝區(qū)的缺損向體表突出所形成的疝，該病若不及時治療，會引起嚴(yán)重并發(fā)癥。目前手術(shù)是治療該病唯一可靠的方法，可減少復(fù)發(fā)[1]。無張力疝修補(bǔ)術(shù)是近年來治療腹股溝疝應(yīng)用最廣泛的術(shù)式。無張力疝修補(bǔ)術(shù)術(shù)式較多，臨床常用的包括疝環(huán)填充式術(shù)和開放式腹膜前間隙無張力修補(bǔ)術(shù)(開放TDP術(shù))，兩種術(shù)式哪種更好，臨床尚存分歧[2]。本院近年采用開放TDP術(shù)治療疝氣取得滿意療效，現(xiàn)與疝環(huán)填充式術(shù)式進(jìn)行比較分析。
1 資料與方法
1.1 一般資料
選取本院2012年1月～2014年1月收治的腹股溝疝患者70例，所有患者經(jīng)臨床癥狀和輔助檢查等明確診斷[3]，均為單側(cè)腹股溝疝患者，排除雙側(cè)腹股溝疝及伴有嚴(yán)重心肺功能障礙等患者。將所有患者隨機(jī)分為試驗(yàn)組和對照組，各35例患者，試驗(yàn)組男性27例，女性8例，年齡28～84歲，平均(54.2±4.3)歲；腹股溝疝類型：斜疝28例，直疝5例，股疝2例；原發(fā)疝33例，復(fù)發(fā)疝2例。對照組男性28例，女性7例，年齡27～82歲，平均(52.7±4.6)歲，腹股溝疝類型：斜疝27例，直疝5例，股疝3例；原發(fā)疝31例，復(fù)發(fā)疝4例。兩組患者的一般資料比較，差異無統(tǒng)計學(xué)意義(P>0.05)，具有可比性。
1.2 手術(shù)方式
1.2.1 試驗(yàn)組 行開放TDP術(shù)：選用連續(xù)硬膜外麻醉，取腹股溝管一長約5～6 cm的斜切口，依次切開皮膚、皮下組織及腹外斜肌腱膜，并向兩側(cè)鈍性分離，游離精索，處理疝囊。若為直疝游離疝囊將其縫合后直接回納入腹腔；若為斜疝根據(jù)疝囊大小取橫斷或完全游離后回納入腹腔，自環(huán)內(nèi)水平腹膜游離精索和輸精管，使其與腹膜分開，拉起腹膜下血管，游離出約8 cm×15 cm的腹膜前間隙，游離至恥骨下方后完全分離腹膜和周圍組織，可見恥骨疏韌帶，將補(bǔ)片(北京天助暢運(yùn)公司生產(chǎn)的聚丙烯補(bǔ)片)置入腹膜前間隙，覆蓋整個缺損處，將補(bǔ)片下端與恥骨疏韌帶縫合固定1針，徹底止血后逐層關(guān)閉手術(shù)切口，完成手術(shù)。 (立全晰)