摘要
目的:探讨Gilbert法腹股沟疝修补术后复发原因及再手术治疗的术式选择。方法:回顾分析2012年7月至2018年2月收治的39例(共40侧)行Gilbert法腹股沟疝修补术后复发患者的临床资料。患者均再次手术治疗,其中27例采用前入路局部腹膜前疝修补术(前入路组),12例(13侧)采用腹腔镜经腹腹膜前修补术(TAPP组)。结果:31例复发病例前次手术在2010～2013年; 8例(9侧)在2014～2017年。21侧复发疝与原发疝属于不同类型,19侧属于同一类型。12例行TAPP,术中见原腹膜前补片发生折叠或卷曲11例,其中精索处折叠或卷曲8例,其他部位折叠或卷曲5例。补片过小(挛缩)或移位2例。再次手术后均无复发及慢性疼痛发生。前入路组手术时间短于TAPP组(P<0.001); TAPP组术后疼痛优于前入路组(P=0.034);术后血清肿、尿潴留发生率两组差异无统计学意义(P>0.05)。结论:Gilbert法腹股沟疝修补术后复发主要由手术因素造成。复发后再手术采前入路局部腹膜前疝修补与TAPP均是较好的选择,临床上应根据具体情况灵活应用。
Objective:To investigate the causes of recurrent inguinal hernia after Gilbert tension-free hernioplasty and the choice of reoperative method.Methods:The clinical data of 39 patients(40 sides)with recurrent inguinal hernia after Gilbert tension-free hernioplasty from Jul.2012 to Feb.2018 were retrospectively analyzed.All patients were treated by reoperation.Among them,27 cases received anterior local peritoneal hernia repair and 12 cases(13 sides)underwent laparoscopic transabdominal preperitoneal repair(TAPP).Results:There were 31 patients whose previous operation were performed in 2010-2013,and 8 patients(9 sides)in 2014-2017.The type of recurrent hernia in 21 sides was different from that of the primary hernia.And the type of recurrent hernia in 19 sides was the same as that of the primary hernia.In 12 cases of TAPP,the original preperitoneal patches were folded or curled in 11 cases,of which 8 cases were folded or curled in the spermatic cord,and 5 cases were folded or curled in the other parts.The patches were too small(contracture)or dislocated in 2 cases.There was no recurrence or chronic pain after reoperation.The time of anterior peritoneal repair was shorter than TAPP(P<0.001),and the pain after TAPP was better than that of anterior local preperitoneal repair(P=0.034).There was not any statistical difference in the postoperative seroma and postoperative urinary retention(P>0.05).Conclusions:The recurrence of inguinal hernia after Gilbert tension-free hernioplasty is mainly caused by operative factors.Local anterior peritoneal hernia repair and TAPP are good choices for recurrent inguinal hernia.The two methods should be utilized flexibly according to the specific circumstances.
作者
何领
张翼
张士虎
施裕新
孟娣娟
HE Ling;ZHANG Yi;ZHANG Shi-hu(Department of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210029,China)
出处
《腹腔镜外科杂志》
2018年第10期746-749,共4页
Journal of Laparoscopic Surgery
关键词
疝
腹股沟
腹腔镜检查
经腹腹膜前疝修补术
复发
再手术
Hernia,inguinal
Laparoscopy
Transabdominal preperitoneal herniorrhaphy
Recurrence
Reoperation
作者简介
何领(1978—)男,江苏省中医院普通外科副主任医师,主要从事胃肠道肿瘤及腹壁疝微创治疗方面的研究;通讯作者:孟娣娟,E-mail:mengdijuan@163.com。
