疝囊剥离与横断在男性腹股沟斜疝中的随机对照研究

目的前瞻性比较前入路Kugel修补术中疝囊完全剥离与疝囊横断远端旷置2种不同处理方式对男性腹股沟斜疝患者的临床疗效。 方法收集2014年1月至2016年12月，福建医科大学附属第一医院120例原发性男性腹股沟斜疝患者临床资料。采用随机数字表法分成疝囊完全剥离组和疝囊横断旷置组。比较2组手术时间、术后住院时间、术后视觉模拟疼痛评分（visual analogue score，VAS）、血肿、血清肿、切口感染、异物感、复发率发生情况。 结果疝囊完全剥离组在术后第1天疼痛VAS评分（2.4±0.7）、血清肿（1例）、术后2周恢复活动人数（57例）及异物感（4例）方面明显优于疝囊横断旷置组（2.7±0.9、7例、50例、12例），差异均有统计学意义（P均<0.05）。而2组在手术时间、术中出血量、术后住院时间、术后血肿、尿潴留、阴囊积液、切口感染、术后4周恢复活动人数、慢性疼痛、精索和睾丸并发症及复发率比较，差异无统计学意义（P>0.05）。 结论男性腹股沟斜疝患者术中疝囊完全剥离可明显降低术后早期疼痛及血清肿发生，有利患者早期恢复。

Dissection or transection of the indirect inguinal hernia sac in males: A randomized controlled trial

ObjectiveThis study compares the effect of dissection and transection of the hernia sac in anterior Kugel repair for indirect inguinal hernia in males. MethodsThis prospective randomized controlled trial included 120 patients with primary indirect inguinal hernia. 120 patients were divided into 2 groups randomly. In group A, the hernia sac was dissected totally. In group B, the hernia sac was transected at the neck and then ligated. Each group contained 60 patients. Finally, 58 patients in group A and 56 patients in group B were involved in the analyses. The effect of the two methods in operation time, hospital stays after operation, VAS pain score after operation, hematoma, seroma, incision infection, foreign body sensation, and recurrence were compared between the 2 groups. ResultsGroup A was superior to group B in VAS pain score on the first day after operation, seroma, return to normal activities after two weeks, and foreign body sensation (P<0.05). The results were comparable in operation time, surgical blood loss, hospital stays after operation, hematoma, urinary retention, hydrocele of testes, incision infection, return to normal activities after four weeks, chronic pain, complication in testis and spermatic cord, and recurrence (P>0.05). ConclusionNeither of totally dissection of the hernia sac or transection of the hernia sac has serious adverse effects on the surgery. Totally dissection of the hernia sac can reduce the risk of postoperative complications, and is a proper method for indirect inguinal hernia repair in male patient.