腹膜前间隙无张力修补术治疗疝气的临床效果观察(1)
[摘要] 目的 探讨腹膜前间隙无张力修补术治疗疝气的临床疗效。 方法 选取本院2012年1月～2014年1月收治的腹股沟疝患者70例，随机分为试验组和对照组，试验组行腹膜前间隙无张力疝修补术；对照组行疝环填充式无张力疝修补术，比较两组疗效。 结果 两组患者手术时间、术中出血量、术后疼痛程度、下床活动时间、住院时间以及复发率比较均无明显差异(P>0.05)，试验组术后并发症发生率为2.6%，明显小于对照组(P<0.05)。 结论 腹膜前间隙无张力修补术治疗疝气具有创伤小、恢复快、并发症少、复发率低等优势，值得临床推广应用。
[关键词] 腹股沟疝；腹膜前间隙；无张力修补术
[中图分类号] R656.2 [文献标识码] A [文章编号] 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
腹股沟疝俗称“疝气”，指腹腔内脏器通过腹股沟区的缺损向体表突出所形成的疝，该病若不及时治疗，会引起严重并发症。目前手术是治疗该病唯一可靠的方法，可减少复发[1]。无张力疝修补术是近年来治疗腹股沟疝应用最广泛的术式。无张力疝修补术术式较多，临床常用的包括疝环填充式术和开放式腹膜前间隙无张力修补术(开放TDP术)，两种术式哪种更好，临床尚存分歧[2]。本院近年采用开放TDP术治疗疝气取得满意疗效，现与疝环填充式术式进行比较分析。
1 资料与方法
1.1 一般资料
选取本院2012年1月～2014年1月收治的腹股沟疝患者70例，所有患者经临床症状和辅助检查等明确诊断[3]，均为单侧腹股沟疝患者，排除双侧腹股沟疝及伴有严重心肺功能障碍等患者。将所有患者随机分为试验组和对照组，各35例患者，试验组男性27例，女性8例，年龄28～84岁，平均(54.2±4.3)岁；腹股沟疝类型：斜疝28例，直疝5例，股疝2例；原发疝33例，复发疝2例。对照组男性28例，女性7例，年龄27～82岁，平均(52.7±4.6)岁，腹股沟疝类型：斜疝27例，直疝5例，股疝3例；原发疝31例，复发疝4例。两组患者的一般资料比较，差异无统计学意义(P>0.05)，具有可比性。
1.2 手术方式
1.2.1 试验组 行开放TDP术：选用连续硬膜外麻醉，取腹股沟管一长约5～6 cm的斜切口，依次切开皮肤、皮下组织及腹外斜肌腱膜，并向两侧钝性分离，游离精索，处理疝囊。若为直疝游离疝囊将其缝合后直接回纳入腹腔；若为斜疝根据疝囊大小取横断或完全游离后回纳入腹腔，自环内水平腹膜游离精索和输精管，使其与腹膜分开，拉起腹膜下血管，游离出约8 cm×15 cm的腹膜前间隙，游离至耻骨下方后完全分离腹膜和周围组织，可见耻骨疏韧带，将补片(北京天助畅运公司生产的聚丙烯补片)置入腹膜前间隙，覆盖整个缺损处，将补片下端与耻骨疏韧带缝合固定1针，彻底止血后逐层关闭手术切口，完成手术。 (立全晰)
[关键词] 腹股沟疝；腹膜前间隙；无张力修补术
[中图分类号] R656.2 [文献标识码] A [文章编号] 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
腹股沟疝俗称“疝气”，指腹腔内脏器通过腹股沟区的缺损向体表突出所形成的疝，该病若不及时治疗，会引起严重并发症。目前手术是治疗该病唯一可靠的方法，可减少复发[1]。无张力疝修补术是近年来治疗腹股沟疝应用最广泛的术式。无张力疝修补术术式较多，临床常用的包括疝环填充式术和开放式腹膜前间隙无张力修补术(开放TDP术)，两种术式哪种更好，临床尚存分歧[2]。本院近年采用开放TDP术治疗疝气取得满意疗效，现与疝环填充式术式进行比较分析。
1 资料与方法
1.1 一般资料
选取本院2012年1月～2014年1月收治的腹股沟疝患者70例，所有患者经临床症状和辅助检查等明确诊断[3]，均为单侧腹股沟疝患者，排除双侧腹股沟疝及伴有严重心肺功能障碍等患者。将所有患者随机分为试验组和对照组，各35例患者，试验组男性27例，女性8例，年龄28～84岁，平均(54.2±4.3)岁；腹股沟疝类型：斜疝28例，直疝5例，股疝2例；原发疝33例，复发疝2例。对照组男性28例，女性7例，年龄27～82岁，平均(52.7±4.6)岁，腹股沟疝类型：斜疝27例，直疝5例，股疝3例；原发疝31例，复发疝4例。两组患者的一般资料比较，差异无统计学意义(P>0.05)，具有可比性。
1.2 手术方式
1.2.1 试验组 行开放TDP术：选用连续硬膜外麻醉，取腹股沟管一长约5～6 cm的斜切口，依次切开皮肤、皮下组织及腹外斜肌腱膜，并向两侧钝性分离，游离精索，处理疝囊。若为直疝游离疝囊将其缝合后直接回纳入腹腔；若为斜疝根据疝囊大小取横断或完全游离后回纳入腹腔，自环内水平腹膜游离精索和输精管，使其与腹膜分开，拉起腹膜下血管，游离出约8 cm×15 cm的腹膜前间隙，游离至耻骨下方后完全分离腹膜和周围组织，可见耻骨疏韧带，将补片(北京天助畅运公司生产的聚丙烯补片)置入腹膜前间隙，覆盖整个缺损处，将补片下端与耻骨疏韧带缝合固定1针，彻底止血后逐层关闭手术切口，完成手术。 (立全晰)