中国实用外科杂志

中国实用外科杂志

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青少年腹股沟疝术后复发手术治疗9例临床分析

姚    干，范国勇   

  1. 佛山市第一人民医院疝和腹壁外科，广东佛山528000
  • 出版日期:2019-08-01 发布日期:2019-08-01

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

摘要：

目的    分析青少年腹股沟疝术后复发的手术方式及效果。方法    回顾性分析佛山市第一人民医院2006年1月至2018年12月收治的9例青少年（13～18岁）腹股沟疝行手术治疗后复发病人的资料。主要收集病人前次手术方式、再次手术方式、疝环口大小、术后主要并发症及复发率。结果    170 例行腹股沟疝手术治疗的青少年病人中，有9例青少年复发性腹股沟斜疝（前次手术方式均为内环口高位结扎术）病例，其中2例行开放手术，7例行腹腔镜手术。9例病人中，3例为多次复发，6例为首次复发。术中见疝环口大小0.3～3.0 cm。手术方式，4例行腹腔镜内环口缝扎术，疝环口大小0.3～2.0 cm；5例行腹腔镜腹股沟疝补片修补术（3例为多次复发病人），疝环口大小1.5～3.0 cm。随访6个月至10年，无伤口或补片感染，其中3例病人术后近期出现腹股沟区隐痛不适，行补片修补2例，行内环口高位结扎1例；1例出现血清肿，为补片修补；复发1例，为补片修补。结论    青少年复发性腹股沟疝再次手术方式应根据前次手术方式、复发次数及是否存在大的内环缺损或腹横筋膜缺损进行选择。初次复发、内环口缺损≤2 cm者，建议行腹腔镜内环口高位结扎。多次复发或内环口缺损大者，建议使用补片修补。

关键词: 青少年, 腹股沟疝, 复发, 生物补片

Abstract:

Management of postoperative recurrence of inguinal hernia in adolescents: An analysis of 9 cases        YAO Gan，FAN Guo-yong. Hernia and Abdominal Surgery, the First People’s Hospital of Foshan, Foshan 528000, China
Corresponding author: YAO Gan,E-mail:ygan61@126.com
Abstract    Objective    To analyze the reoperation method and effect of recurrent inguinal hernia in adolescents after operation. Methods    The data of 9 adolescent (13 to 18 years old) inguinal hernia patients with recurrence after surgical treatment admitted in the first people's hospital of Foshan from January 2006 to December 2018 were analyzed retrospectively. The methods of previous operation, reoperation, size of internal ring, major postoperative complications and recurrence rate were collected. Results    Among the 170 adolescent patients who underwent inguinal hernia surgery, there were 9 cases of recurrent indirect inguinal hernia (the previous operation method was high ligation of the internal ring) , including 2 cases of open surgery and 7 cases of laparoscopic surgery. Of the 9 patients, 3 had multiple recurrences and 6 had first recurrence. The sizes of internal ring were 0.3 to 3.0 cm in the operation. Surgical methods: 4 cases were performed with laparoscopic high ligation of internal ring, with the sizes of internal ring ranging from 0.3 cm to 2.0 cm. Laparoscopic inguinal hernia mesh repair was performed in 5 patients (3 patients with multiple recurrences) with the sizes of internal ring ranging from 1.5 cm to 3.0 cm. During the follow-up period of 6 months to 10 years, no wound or mesh infection, 3 patients showed discomfort in the inguinal area, 2 patients had mesh repair and 1 patient had high ligation. Seroma appeared in 1 patient which was repaired by mesh. One case of recurrence which was mesh repair. Conclusion    The choice of surgical method for recurrent inguinal hernia in adolescents should be based on the previous surgical method, recurrence frequency and the presence of large internal ring defect or transverse abdominal fascia defect. Laparoscopic high ligation is recommended for patients with primary recurrence of small internal ring defect. For patients with multiple recurrence or large internal ring defect, mesh repair is recommended.

Key words: adolescent, inguinal hernia, recurrence, biological mesh