经下腹部正中切口腹膜前修补术治疗腹股沟嵌顿疝的临床疗效

摘要

目的:探讨嵌顿疝急诊经下腹部正中切口行腹膜前修补手术的疗效.方法:回顾性分析2010年1月至2016年8月因嵌顿疝行急诊手术的126例患者的临床资料.根据手术切口将其分为两组:观察组为下腹部正中切口,共41例;对照组为传统腹股沟区切口,共85例.比较两组围手术期情况及远期疗效.结果:观察组41例中,35例完成腹膜前Ⅰ期无张力修补,术后复发1例再次修补,2例行坏死肠段切除吻合.对照组85例中,8例复发(其中7例再次修补),33例行Ⅰ期无张力修补术(其中1例复发再次修补),3例行坏死肠段切除吻合.观察组Ⅰ期行疝无张力修补术率较对照组高(85.4％ vs 38.8％,P＜0.001),补片修补总的手术并发症(包括慢性疼痛、异物感、疝复发、切口感染及局部血清肿)发生率较对照组低(5.7％ vs24.2％,P=0.031).两组手术时间、住院天数、围手术期急性疼痛、尿潴留等差异无统计学意义.结论:经下腹部正中切口行腹膜前嵌顿疝无张力修补术操作简单,可提高嵌顿疝Ⅰ期无张力修补率,且手术并发症发生率低,适合临床推广应用.%Objective:To explore the efficacy of preperitioneal tension-free hernia repair by lower abdominal median incision in incarcerated inguinal hernia.Methods:The clinical data of 126 patients with incarcerated hernia who underwent emergency operation from January 2010 to August 2016 were retrospectively analyzed.According to the surgical incision,they were divided into two groups:the observation group (41 cases) had the lower abdominal midline incision,and the control group (85 cases) had the traditional inguinal incision.The time of operation,the postoperative hospital stay,perioperative complications and the main long-term complication were compared between the two groups.Results:In the observation group (41 cases),35 cases underwent preperitoneal tension-free repair (85.4％),1 case recurred and was repaired again,and 2 cases underwent intestinal resection and anastomosis on account of intestinal necrosis.Of the 85 cases in the control group,8 cases recurred and 7 cases underwent reoperation,33 cases underwent first-stage tension-free repair and 1 cases was repaired again,and 3 cases underwent intestinal resection and anastomosis on account of intestinal necrosis.The rate of herniorrhaphy was significantly higher in the observation group than that in the control group (85.4％ vs 38.8％,P＜0.001).The incidence of total surgical complications (including chronic pain,foreign body sensation,hernia recurrence,incision infection,and local serum swelling) in the observation group was lower than that in the control group (5.7％ vs 24.2％,P=0.031).There was no significant differences between the two groups in terms of operation time,hospital stay,perioperative acute pain,and urinary retention.Conclusions:The tension-free repair of preperitoneal hernia through lower abdominal midline incision is simple and can improve the rate of first-stage tension-free repair of incarcerated hernia,and the complication rate is low.It is suitable for clinical application.