标题：后入路修补法治疗特殊类型疝的体会

      作者：张伟耀
    (中山市小榄人民医院普外科，广东 中山 528415)

      卷次： 2014年25卷1期

      【摘要】 目的 探讨后入路腹膜前修补术治疗复发疝、复合疝、股疝、滑疝、隐匿疝、老年双侧疝等特殊类型
疝的优势、操作要点及手术效果。方法 回顾性分析 2009年 6月至 2013年 6月期间我院普外科 85例采用改良
Kugel法修补术治疗腹股沟区特殊疝患者的临床资料。观察手术时间、出血量、伴发疝的诊治率、术后疼痛、术后
恢复情况、并发症和复发率。结果 手术时间30~100 min，平均(45±10) min，除1例发生血肿外其余出血量均在
10 ml以下。术后1 d能下床活动，术后均未使用止痛剂，术后住院时间3~6 d。2例巨大直疝术后腹股沟区积液，
无特殊治疗，4周内肿胀消失，1例肥胖患者皮下脂肪轻度液化，无切口感染发生，随访1个月至4年，无腹股沟区
异物感、慢性疼痛等不适，未发现复发。结论 改良Kugel法后入路疝修补术具有相对微创、无张力、免缝合、疼
痛轻、恢复快、复发率低等优点，而且能同期发现、处理伴发疝，不会造成遗漏疝，在治疗复发疝等特殊类型疝方
面优势明显。

      【关键词】 特殊疝；后入路；修补；无张力；优势

      【中图分类号】 R656.2 【文献标识码】 A 【文章编号】 1003—6350（2014）01—0074—04


Posterior approach to repair special types of hernia.
ZHANG Wei-yao. Department of General Surgery, Xiaolan
People's Hospital of Zhongshan, Zhongshan 528415, Guangdong, CHINA

【Abstract】 Objective To explore the efficacy of the posterior approach preperitoneal repair for special types
of hernia such as recurrent hernia, complex hernia, femoral hernia, sliding hernia, occult hernia, elderly bilateral her-
nia. Methods A retrospective analysis was conducted on the clinical data of 85 cases with special hernia treated by
modified Kugel method for repair of inguinal region in Department of General Surgery in two hospital from June 2009
to June 2013. The operation time, bleeding volume, rate of diagnosis and treatment of accompanying hernia, postopera-
tive pain, postoperative recovery, complications and recurrence rate were to observed. Results The operation time
was 30 min~100 min, (45±10) min in average; the bleeding volume was less than 10 ml except one case of hematoma;
the patients were able to get out of bed 1 d after surgery; no analgesics was used; postoperative hospitalization time
was 3~ 6 d. Two cases of huge direct hernia were found with postoperative groin effusion, with no special treatment
employed, and swelling disappeared after 4 weeks. One case of subcutaneous fat in obese patients was found with
mild liquefaction, with no incision infection. All the cases was followed up from 1 month to 4 years, with no foreign
sensation discomfort or chronic pain in groin regiont, no recurrence were found. Conclusion The improved method
of Kugel posterior hernia repair is minimally invasive, with no tension, no suture, slight pain, fast recovery, low re-
currence rate, which can find and handle accompanying hernia at the same time, and will not cause the omission of
hernia.

      【Key words】 Special hernia; Posterior approach; Repair; Tension-free; Advantage