无张力疝修补术后腹股沟疝复发原因及再手术方法探讨

目的探讨无张力疝修补术后腹股沟疝复发原因、再次手术策略。方法对1997年1月至2005年1月间收治的95例无张力疝修补术后腹股沟复发疝患者资料进行回顾性分析。结果第一次手术伴前列腺增生症者67例,慢性咳嗽15例,慢性便秘8例,糖尿病7例;手术时直疝患者40例,斜疝39例,记录不详16例;第一次手术单位中三甲医院16例,二甲医院64例,一甲医院15例;复发者Miss疝8例,原修补部位复发87例,其中有疝环缺损过大(>4cm)49例,网塞或补片移位24例,平片过小、变形、卷曲等14例。开放手术69例(后进路及单侧巨大补片加强内脏囊方法)和腹腔镜手术26例(TAPP和TEP),术后随访6~52个月均未复发。结论无张力修补术后腹股沟疝复发与患者腹内压增高、修补缝合技术、补片材料选择等因素相关;选择开放后径路、单侧巨大补片加强内脏囊方法及腹腔镜下修补是治疗无张力疝修补术后腹股沟疝复发的主要方法。

Clinical study on the causes of recurrence of hernia after tension-free hernioplasty and methods of re-operation

Objective To investigate the causes of recurrence of groin hernia after tension-free hernioplasty and study the re-operative strategies.Methods Ninety-five male cases of recurrent groin hernia after tension-free hernioplasty were studied and analyzed retrospectively.ZResults On the first operation,67 patients were accompanied by hyperplasia of prostate,15 by chronic cough,8 patients by chronic constipation and 7 by DM.There were 40 cases of direct hernia,39 cases of indirect hernia and 16 cases of unknown in primary operation.Sixteen patients were operated firstly in Three-A hospital,64 in Two-A hospital and 9 in One-A hospital.Fifteen indirect hernia patients displayed recurrent direct hernia postoperatively.Eighty-seven cases recurred in primary operative position,including 49 cases of justomajor hernia ring (>4?cm),24 cases of displaced patch or plug and 14 cases of justominor or distorted mesh.Open operation (including posterior approach and GPRVS) was conducted for 69 cases and laparoscopy (including TAPP and TEP) for the remaining 26 cases according to the patients' conditions.No postoperative recurrence was found after 6 to 52 months followed-up.Conclusion Many factors can cause groin hernia to recur after tension-free hernioplasty,such as high intra-abdominal pressure,suture technique,choice for mesh and plug,etc.According to the patient's conditions,we can mainly choose several methods including open posterior approach,GPRVS and laparoscopy to re-operation.