摘要
目的探讨前入路腹膜前Kugel补片治疗无张力腹股沟疝修补术后复发疝的有效性和安全性,并分析其并发症和复发率。方法回顾性分析2006年1月至2016年1月,广州中医药大学附属东莞中医院40例腹股沟疝复发患者,记录复发疝类型、手术时间、并发症和复发率,采用视觉模拟评分(visual analogue scale,VAS)记录术前术后慢性疼痛的发生率。手术采取前入路,切除手术瘢痕和取出卷曲挛缩的合成补片。创建腹膜前间隙后,将Kugel补片置入腹膜和腹横筋膜之间加强耻骨肌孔。结果平均手术时间50 min(50~65 min)。术中有8例腹膜轻度损伤,发现后立即修补。无切口感染,3例皮下血肿、1例血清肿,5例术后尿潴留需插尿管。术前慢性疼痛率77.5%,术后12个月后下降至12.5%。随访时间24个月(12~50个月),无复发患者。结论前入路腹膜前Kugel补片治疗无张力腹股沟疝修补术后复发疝安全有效、操作简单,尤其适合平片或网塞修补术后有慢性疼痛的复发患者。
Objective The aim of this study is to examine the efficacy and safety of anterior preperitoneal Kugel patch repair in recurrent inguinal hernias after previous tension-free prosthetic repair and to assess its morbidity and recurrence rate. Methods Forty patients with recurrent inguinal hernia previously repaired by prosthetic materials were studied retrospectively between January 2006 and January 2016. The hernia types of the recurrence, operative time, complications and recurrence rate were recorded. Visual analogue scale（VAS） were used to record the incidence of chronic pain. All patients underwent transinguinal incision. By removing surrounding scar tissue, previous mesh or plug and cutting transversalis fascia, the Kugel patch was placed preperitoneally between transversalis fascia and peritoneum. Results Mean operative time was 50 min（50-65 min）. There were 8 minor peritoneum injury during operation. 3 patients had hematoma and 1 patient had seroma. After a mean of 24 months follow-up, chronic pain was improved remarkably from 77.5% preoperatively to 12.5% postoperatively, and no recurrence was detected. Conclusions Anterior preperitoneal Kugel patch repair is safe and effective in treatment of recurrent hernia after previous tension-free prosthesis repair, and it is especially suitable for patients with chronic pain following mesh or plug repair.
出处
《中华疝和腹壁外科杂志（电子版）》
2018年第1期38-42,共5页
Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition)
关键词
疝修补术
腹股沟复发疝
KUGEL补片
慢性疼痛
Herniorrhaphy
Recurrent inguinal hernia
Kugel patch
Anterior approach
Chronic pain
