腹股沟疝术后复发因素及再手术106例分析

目的 探讨腹股沟疝修补术后疝复发的原因、再手术方法策略.方法 对1997年12月至2006年12月106例腹股沟复发疝修补术患者资料进行回顾性分析.106例复发疝患者中,既往手术方式:传统张力疝修补术49例(46.2%),包括Bassini术44例,McVay术2例,Shouldice术3例.各类无张力疝修补术57例(53.8%).初次手术至复发时间为2个月～21年,平均42个月.结果 复发者遗漏疝14例,原修补部位复发92例,其中有疝环缺损过大(＞5 cm)35例;网塞或补片移位31例;平片过小、变形、卷曲等26例.再手术方式:开放手术92例(前、后入路及Stoppa术)和腹腔镜手术14例(TAPP和TEP),术后随访6个月～7年,平均24个月,有1例复发.结论 腹股沟疝复发与患者腹内压增高、修补缝合技术等因素相关.对复发患者,选择开放后径路、Stoppa术及腹腔镜下修补是治疗腹股沟复发疝的主要方法.

Causes of recurrence after hernioplasty and methods of reoperation

Objective To investigate the causes of recurrence after hernia repair and hernioplasty and study reoperative strategies. Methods The clinical data were retrospectively analysed of 106 patients with recurrent inguinal hernia who had been treated from December 1997 to December 2006. Traditional hernia repair without prothesis was done in 49 patients (46.2%, including Bassini in 44 patients, McVay in 2 and Shouldice in 3 ).A tension-free procedure was performed in 57 patients (53.8%). The average interval from initial surgery to recurence was 42 months (range from 2 months to 21 years). Results Hernia was missed in 14 patients and 92 patients had recurrence of hernia after primary operatiion , including justomajor hernia ring in 35 patients (＞5cm), displaced patch or plug in 31and justominor or distorted mesh in 26. Open operation(including anterior, posterior approach and Stoppa) was conducted in 92 patients and laparoscopy(including TAPP and TEP)in the remaining 14. All patients were followed up after opreation for 6 months to 7 years .One patient had recurrence of hernia. Conclusion The main factors of recurrent hernia after hernioplasty are related to high intra-abdominal pressure and incorrect operative techniques. Open posterior approach, Stoppa and laparoscopy are the treatment of choice for patients with recurrent inguinal hernia.