女性腹股沟疝临床特点及治疗方法(3)
疝修补术中的另一个伟大进步就是"充填式无张力修补术"(plug mesh hernia repair)。我们认为该术式是腹股沟疝的最合理术式，所以也更适合于女性腹股沟疝病人的治疗。对于女性病人我们一般采用硬膜外麻醉，取得腹股沟韧带上2cm做切口，长约4cm，切开腹外斜肌后不做广泛游离，找到疝囊后，由于女性斜疝疝囊一般较小，所以不予切开，将疝囊高位游离直至看到腹膜外脂肪。将疝囊还纳腹腔，置入充填物，将其外瓣与疝环固定1～2针，放入成形网状补片与腹股沟管后壁的前表表面从耻骨结节至高于内环处，补片周围不予缝合，连接缝合腹外斜肌腱膜。值得一提的是，所有6例行此术式者有1例复发，二次手术时发现平状补片挛缩，究其原因可能与补片平放周围无固定有关，而同期手术的男患，其补片上有使精索通过的开口则不易移位。充填式修补也同样适用于股疝病人，Sanchez-Bustos等报道长期随93例充填式股疝修补的病人，发现只有1例复发和1例感染并且认为该术式为原发性股疝的首选术式[12]。方法介绍如下：通过腹股沟下方式，我们可以看到蘑菇状的股疝从股管伸出。游离疝囊与周围组织的粘连，当股环过小同时疝囊又过大，以至于疝囊不容易还纳时，分离和结扎疝囊，疝囊从股管还纳后置入充填物(purfix plug)，去掉补片内层的瓣叶，将外部有凹槽层的补片通过股管的开口处置入，调整好位置后，与周围组织间断缝合数针。股疝的修补不需要网状补片的置入。
, 百拇医药
参考文献
1、Iriving L,Lichenstein. Herniorrhaphy: a personal experiences with 6321 cases Am J Surg , 1987,153(6):553
2、童鹤翔，王伟，谢宝姗，等. 女孩腹股沟疝的诊断和治疗，中华小儿外科杂志，1996，3(2)：174
3、Spangen L,Anderson R,Ohlsson L,Nonpalpable inguinal hernia in the female Am J Surg,1998,54(9):574
4、Ando H,Kammar B,Muhlbauer B,et al .Congenital inguinal hernia in female triplets. Harefuah, 1992,122(9):573
, 百拇医药
5、Nagar H,Hammar B,Muhibauer B,et al .Congenital inguinal hernia in female triplets Harefuah, 1992,122(9):573
6、Magrina JF,Tahery MM,Heppll J,et al . Femoral hernia : a complication of laparoendosc Adv Surg Tech A,1997,7(3):191
7、Pans A, Pierard GE,Albert A.Biomechanical assessment of the transversalis fascia and rectus abdominis aponeurosis in inguinal herniation : preliminary results Hernia,1997,1(1):17
, 百拇医药
8、Bendavid R.Femoral hernias, primary vs recurrent, Int Surg,1989,74(2):99
9、Rutkow IM.Epidmiologic, economic, and sociologic aspects of hernia surgery in the United States in the 1990s . Surg Clin Noth Am,1998,78(6): 941
10、Crawford DL,Hiatt JR,Phillips EH.Laparoscopy identifies unexpected groin hernias . Am Surg,1998,64(10):976
11、McGillicuddy JE.Prospective randomized comparison of the Shouldice and Lichtenstein hernia repair procedures . Arch Surg, 1998,133(9):974
12、Sanchez-Bustos F,Ramia JM,Fernandez FF.Prosthetic repair of femoral hernia :audit of long term follow - up Eur J Surg,1998,164(3):191, 百拇医药(刘冰 张宇阳 姜洪池)
, 百拇医药
参考文献
1、Iriving L,Lichenstein. Herniorrhaphy: a personal experiences with 6321 cases Am J Surg , 1987,153(6):553
2、童鹤翔，王伟，谢宝姗，等. 女孩腹股沟疝的诊断和治疗，中华小儿外科杂志，1996，3(2)：174
3、Spangen L,Anderson R,Ohlsson L,Nonpalpable inguinal hernia in the female Am J Surg,1998,54(9):574
4、Ando H,Kammar B,Muhlbauer B,et al .Congenital inguinal hernia in female triplets. Harefuah, 1992,122(9):573
, 百拇医药
5、Nagar H,Hammar B,Muhibauer B,et al .Congenital inguinal hernia in female triplets Harefuah, 1992,122(9):573
6、Magrina JF,Tahery MM,Heppll J,et al . Femoral hernia : a complication of laparoendosc Adv Surg Tech A,1997,7(3):191
7、Pans A, Pierard GE,Albert A.Biomechanical assessment of the transversalis fascia and rectus abdominis aponeurosis in inguinal herniation : preliminary results Hernia,1997,1(1):17
, 百拇医药
8、Bendavid R.Femoral hernias, primary vs recurrent, Int Surg,1989,74(2):99
9、Rutkow IM.Epidmiologic, economic, and sociologic aspects of hernia surgery in the United States in the 1990s . Surg Clin Noth Am,1998,78(6): 941
10、Crawford DL,Hiatt JR,Phillips EH.Laparoscopy identifies unexpected groin hernias . Am Surg,1998,64(10):976
11、McGillicuddy JE.Prospective randomized comparison of the Shouldice and Lichtenstein hernia repair procedures . Arch Surg, 1998,133(9):974
12、Sanchez-Bustos F,Ramia JM,Fernandez FF.Prosthetic repair of femoral hernia :audit of long term follow - up Eur J Surg,1998,164(3):191, 百拇医药(刘冰 张宇阳 姜洪池)