Lichtenstein无张力修补术治疗腹股沟疝的临床应用分析

发布时间：2018-07-03 10:54

本文选题：腹股沟疝 + 无张力疝修补术　；参考：《大连医科大学》2017年硕士论文

【摘要】：背景腹股沟疝属于腹外疝中的一种,发生位置在腹股沟区,主要包括斜疝、直疝、股疝。患者的症状主要为腹股沟区的包块,为可复性或不可复性,同时伴随局部区域的肿胀不适,对于患者的日常活动及生活质量都存在影响。腹股沟疝是一种外科常见病。一旦成年人出现腹股沟疝,就必须通过外科手术的方法才能得有效的治愈。随着修补理念和医疗材料器械的不断进步,腹股沟疝的外科修补方式主要经历了开放式有张力、开放式无张力和腹腔镜下无张力几个重要的阶段。目前疝外科手术现状是种类众多,且在临床上应用均比较广泛,各自都占有重要的位置。术式的不同选择都会产生不尽相同的疗效,那么如何才能更好的治疗腹股沟疝那?目前对于不同术式的优劣比较的研究很多,但针对不同的疝类型或不同患者人群,选择具体术式的临床效果分析和研究较为少见。本文旨在总结我院针对Ⅰ、Ⅱ型(中华医学会2004年分型标准)腹股沟疝患者,应用Lichtenstein术式的效果及心得体会。目的1.观察Lichtenstein无张力疝修补术治疗Ⅰ、Ⅱ型(中华医学会2004年分型标准)腹股沟疝的临床应用效果。2.探讨Lichtenstein无张力疝修补术的临床价值,为该术式的临床应用和个体化治疗提供理论依据。方法本文收集2014年1月-2016年7月,大连医科大学附属第一医院应用lichtenstein术式治疗分型为Ⅰ、Ⅱ型腹股沟疝的患者的临床病例资料。共69例,其中Ⅰ型27例,Ⅱ型42例;斜疝31例,直疝34例,其中合并斜疝和直疝4例;单侧疝63例,双侧疝6例;男性61例,女性8例;年龄范围为30-75岁,平均年龄:45.8±14.3岁。本组患者均营养良好,无恶病质,无严重凝血功能障碍,无心、脑、肺、肾等器官的重大疾病,无免疫系统及血液系统等合并症,排除Ⅲ、Ⅳ型腹股沟疝,排除股疝、严重嵌顿致使需要切除部分肠段的疝。对这组患者的术后短期复发率、术后并发症发生率、手术时间、术中出血量、术后住院时间、术后疼痛、术后异物感等方面的临床指标情况进行分析和研究。之后再将这组病例资料按照Ⅰ和Ⅱ型,斜疝和直疝分成两个亚组,并对上述指标进行分析及差异比较。采用电话随访方式。结果本组69例患者均成功接受完成了 Lichtenstein无张力疝修补术。平均手术时间为42.1±8.6 min。平均术后住院时间为4.1±1.2d。平均出血量为5.8±1.8 ml。随访中未发现复发患者。术后并发症:出现切口感染2例,尿潴留1例。术后24小时、3个月、6个月V.A.S疼痛评分的平均数分别为:2.0±1.2分、0.4±0.2分、0.1 ±0.4分。术后异物感百分率为:无异物感:92.0%,轻度:6.4%,中度:1.6%。Ⅰ型组和Ⅱ型组,斜疝组和直疝组在各临床指标上均无明显差异,无统计学意义(P值均0.05)。结论(1)Lichtenstein术式对于Ⅰ、Ⅱ型腹股沟疝的临床治疗效果良好,具有操作简单、安全有效、术后恢复快、并发症发生率低的优势,且符合个体化治疗原则。(2)自固定补片应用于Lichtenstein术可以简化手术步骤,节省手术时间,且理论上避免了形成慢性疼痛的可能原因,但缺乏具体的论据支持,需要进一步的研究论证。
[Abstract]:Background inguinal hernia is one of the abdominal hernia, which occurs in the inguinal area, mainly including oblique hernia, direct hernia, and inguinal hernia. The symptoms of the inguinal area are mainly the masses of the inguinal area, which are complex or unrefolding, accompanied by swelling discomfort in the local area, and have an impact on the daily activities and quality of life of the patients. Inguinal hernia is a kind of hernia. The surgical repair of inguinal hernia is mainly through open tension, open tension-free and tension-free laparoscopic stages. The present situation of hernia surgery is a large number of types and is widely used in clinical practice. Each of them occupies an important position. The different options of the operation will produce different effects. Then how can the inguinal hernia be better treated? At present, there are many studies on the advantages and disadvantages of different surgical methods, but for different types of hernia. The purpose of this paper is to summarize the effect and experience of Lichtenstein operation for inguinal hernia patients with type I and II (Chinese Medical Association in 2004). Objective 1. to observe Lichtenstein tension-free herniorrhaphy for the treatment of type I, type II (China, China) The clinical application of inguinal hernia by the Medical Association in 2004) the clinical application of inguinal hernia.2. to explore the clinical value of Lichtenstein tension-free herniorrhaphy, to provide theoretical basis for the clinical application and individualized treatment of this type of operation. Methods this article collected the first hospital of Dalian Medical University in July, January 2014, with the application of Lichtenstein type treatment classification. The clinical data of patients with type I and type II inguinal hernia were reported in 69 cases, including 27 cases of type I, 42 cases of type II, 31 cases of oblique hernia and 4 direct hernia, 63 cases of unilateral hernia and 4 cases of bilateral hernia, 63 cases of unilateral hernia, 6 cases of bilateral hernia, 61 men in male, 8 cases, age 30-75 years, average age of 45.8 + 14.3 years. All patients of this group were well nourished, no cachexia and no Severe coagulation dysfunction, unintentional, brain, lung, kidney and other major diseases, no immune system and blood system complications, excluding type III, type IV inguinal hernia, removing inguinal hernia, and serious incarcerated hernia that require partial resection of the intestine. The postoperative short-term recurrence rate, postoperative complication rate, operation time, intraoperative bleeding volume and operation for this group of patients The post hospitalization time, postoperative pain, and postoperative foreign body sensation were analyzed and studied. Then the case data were divided into two subgroups according to type I and type II, oblique hernia and direct hernia, and the above indexes were analyzed and compared. The results of 69 patients in this group were successfully accepted L. Ichtenstein tension-free herniorrhaphy. The average operation time was 42.1 + 8.6 min. and the average postoperative hospital time was 4.1 + 1.2d.. The average bleeding amount was 5.8 + 1.8 ml.. The postoperative complications were 2 cases of incision infection, 1 cases of urinary retention. The average number of V.A.S pain scores in 24 hours, 3 months and 6 months after operation was 2 + 1.2, respectively. 0.4 + 0.2, 0.1 + 0.4. The percentage of foreign body sensation after operation was: no foreign body sensation: 92%, mild: 6.4%, moderate: 1.6%. type I group and type II group. There was no significant difference in clinical indexes between the oblique hernia group and the direct hernia group. There was no statistical significance (P value 0.05). Conclusion (1) Lichtenstein operation has good clinical treatment effect on type I and type II inguinal hernia. It has the advantages of simple operation, safe and effective, quick recovery and low complication rate, and accords with the principle of individualized treatment. (2) the application of self fixed patch to Lichtenstein can simplify the procedure of operation, save the time of operation, and theoretically avoid the possible causes for the formation of chronic pain, but lack of specific support of the argument, need further Research argumentation.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.21

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