Kugel腹股疝修补术——后入路或前入路？

摘要] 目的 比较后入路和前入路途径Kugel技术治疗腹股沟疝患者的疗效、并发症和复发率等。方法 回顾性复习2003年至2008年国内有关后、前入路Kugel疝斜修补术的文献资料。记录各组患者的年龄、性别、疝的类型、手术时间、方法、并发症等，然后进行统计分析。结果 两组患者（各为1262例和 1119例）在年龄、性别、手术时间、住院时间和随访时间上差异无显著性（P>0.05）。两组在切口血肿、阴囊积液和术后尿潴留上差异无显著性，但切口感染、切口重度疼痛后入路组明显多于前入路组（P<0.05）。后入路组有15例复发（1.19%），而前入路组仅有1例复发（0.09%），两组相比差异有显著性（P<0.05）。此外，在后入路组中有2例因手术损伤腹膜而引起严重的肠梗阻并发症。结论 采用改良前入路的Kugel疝修补技术不仅降低手术难度，而且明显减少术后切口感染、切口重度疼痛等并发症，显著降低复发率，特别适合我国国情。

Kugel inguinal hernia repair—— posterior approach or anterior approach?

Abstract] Objective To compare the effect, postoperative complications and recurrence rate between posterior approach and anterior approach in Kugel hernia repair. Methods Two groups of cases of inguinal hernias (1262 of posterior approach and 1119 of anterior approach) were retrospectively studied between 2003 and 2008. The data of two groups were recorded respectively and statistic. Results There was no significant difference in age, sex, operation time, hospitalization and follow-up of two groups (P<0.05). Although no significant differences were observed for hematoma, seroma and urinary retention between the two groups during the same follow-up time (10.31±7.43 months vs. 11.46±7.18 months, respectively) . The data showed that incision infection and sever pain significantly reduced in anterior approach group (P<0.05). There were fifteen recurrences in group posterior approach （1.19%）, while only one case of recurrence in group anterior approach （0.09%） (P<0.05). In addition, two cases of bowel obstruction owing to peritoneum injury were observed in group posterior approach. Conclusion Modified anterior approach Kugel hernia repair offered both a decrease in recurrence rate as well as a decrease in the patient’s post-operative complications. The technique is rather easy to master, may well be suitable for repair of either primary or recurrent inguinal hernias in Chinese patients.