摘要
目的:比较前进路(常规疝手术)修补方法和后进路(腹膜前)修补方法治疗腹股沟疝病人的疗效、住院时间、总体费用、恢复工作时间、手术并发症等。方法:采用前瞻性随机对照方法,213例病人222侧疝(其中有9例同时患有双侧疝,男196例,女17例)随机分为前进路组(105例)和后进路组(108例)。前进路组采用常规修补,其中约1∕4病人(共27侧疝,Nyhus分型Ⅰ、Ⅲ型)用经典方法修补(Bassini术式21例和McVay术式6例)。3∕4病人(83侧疝,Nyhus分型Ⅱ、ⅢB、Ⅳ型)用假体的无张力修补(Lichtenstein术式21侧疝和Rutkow术式62侧疝);后进路组超过1∕3病人(38侧疝Nyhus分型Ⅰ、Ⅱ和ⅢA型)用不吸收缝线直接缝合修补,近2∕3病人(74侧疝,ⅢB、Ⅳ型)加用单层网片修补。结果:两组病人手术并发症的发生无明显差异。而平均住院时间、恢复日常生活时间前进路组要明显短于后进路组(P<0.01),在平均费用方面,后进路组明显少于前进路组(P<0.01),后术腹股沟区疼痛不适的发生率明显降低。结论:采用后进路方法进行腹股沟疝修补,可明显减少手术花费(不用人工假体或仅用单层平片),降低术后疼痛不适的发生率,改善疗效。因此,经后进路行腹股沟疝修补是一安全有效的方法,适合我国的国情,具有推广的价值。
Objective To compare the effect, hospital stay, mean expense, time for returning to work, and operative complications between operations adopting either the anterior approach(conventional procedures)or the posterior approach (preperitoneal approach) in the repair of inguinal hernias. Methods In a prospective randomized controlled study, 213 cases with 222 hernias (196 men and 17 women, 8 cases had bilateral hernias) were allocated randomly to either the anterior approach group (105 cases, 110 lateral hernias) or the posterior approach group(108 cases, 112 lateral hernias). In the anterior approach group, patients were operated upon with conventional methods, nearly1/4 of the hernias (27 hernias,Nyhus typeⅠand ⅢA) were treated with classic methods (21 hernias of Bassini repair and 6 hernias of McVay repair), while over 3/4 of the hernias (83 hernias, Nyhus type Ⅱ,ⅢB and Ⅳ) were submitted to tension-free techniques using synthetic meshes (21 hernias of Lichtenstein repair and 62 hernias of Rutkow repair). In the posterior approach group, over 33% (38 hernias, Nyhus type Ⅰ,Ⅱ and ⅢA) were sutured directly with non-absorbable suture, mearly 67% (74 hernias, Nyhus type ⅢB and Ⅳ) were repaired with single-layer mesh. Results No significant differences were recorded between the two groups in the operative complications, but outcome of mean hospital stay and time for return to normal work was significantly reduced in anterior approach group (P<0.01). The mean cost of treatment in posterior approach group was significantly reduced than that in anterior approach group(P<0.01) and the occurrence of postoperative groin pain was also significantly lowered. Conclusions The posterior approach in repairing inguinal hernias offers a double advantage of reducing the operative expense(by using no artificial prosthesis or employing only single sheet mesh), and lowering the incidence of postoperative groin pain. It is an effective method in performing herniorraphy and deserves to be popularized.
出处
《外科理论与实践》
2005年第2期136-138,共3页
Journal of Surgery Concepts & Practice
关键词
疝
腹股沟
疝修补术
对比研究
Inguinal hernia
Posterior approach (preperitoneal) repair
