中国实用外科杂志

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青年腹股沟疝外科治疗策略

李健文,乐    飞   

  1. 上海交通大学医学院附属瑞金医院普外科 上海市微创外科临床医学中心,上海200025
  • 出版日期:2019-08-01 发布日期:2019-08-01

  • Online:2019-08-01 Published:2019-08-01

摘要:

青年腹股沟疝的外科治疗较为复杂,Shoudice手术、Lichtenstein手术和腹腔镜腹股沟疝修补术(LIHR)等均为合理的术式。精子活力下降等并发症与技术操作有关而与术式无关。修补材料应选择轻量型补片或生物补片。青年男性大多为先天性斜疝,可合并隐睾、鞘膜积液、精索静脉曲张等其他先天性疾病,应制定个体化治疗方案。青年女性可合并子宫圆韧带囊肿,需与嵌顿股疝鉴别。子宫圆韧带囊肿切除和疝修补可在腹腔镜下同时完成,囊肿切除后是否须行预防性疝修补术有待于进一步探讨。青年女性建议保护子宫圆韧带,LIHR中可采用内环口成形术或腹膜切开再缝合术(T形切开)来保留子宫圆韧带。

关键词: 青年, 腹股沟疝, 疝修补术, 腹腔镜

Abstract:

Treatment of adolescent inguinal hernia repair        LI Jian-wen, YUE Fei. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine,Shanghai Minimally Invasive Surgery Center,Shanghai 200025,China
Corresponding author: LI Jian-wen, E-mail:ljw5@yeah.net
Abstract    It is complicated to treat adolescent inguinal hernias. Shouldice, Lichtenstein and laparoscopic inguinal hernia repair (LIHR) are all reasonable procedures. Complications, such as impaired spermatogenesis and etc., are related with surgical techniques instead of procedure types. Light-weighted meshes or biological meshes are recommended. Indirect inguinal hernias are common in young males, which could accompanied with undescended testicles, hydrocele of tunica vaginalis,varicocele and other benign lesions. Tailored therapy is preferred. Young females could accompanied with hydroceles of the round ligament of uterus, which should be differential diagnosed with incarcerated femoral hernias. The removal of hydroceles and hernia repair could be performed under laparoscopy simultaneously. Prophylactic hernia repair after hydrocele resection is still controversial. The reservation of round ligament of uterus is recommended, which could be managed with techniques of keyhole or T-dissection.

Key words: youth, inguinal hernia, hernioplasty, laparoscopy