中国实用外科杂志

中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (07): 558-561.

• 国际疝外科精粹 • 上一篇    下一篇

疝病学：历史 现状和未来

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  1. University of Arkansas for Medical Sciences, 304 Potomac Street, Rockville, MD 20850, USA
  • 出版日期:2010-07-01 发布日期:2010-06-17

  • Online:2010-07-01 Published:2010-06-17

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摘要：

疝修补术是一种常见手术，大多数医生认为这是一种小手术。但是有些医生却不这么认为。疝修补术的创造者是Bassini(1884)，他发明了腹股沟疝的根治性治疗方法：切开腹股沟的三层，即腹内斜肌、腹横肌、腹横筋膜，进入了腹膜前间隙，以高位结扎疝囊和以上三层缝合至腹股沟韧带。这种手术方式只有2.7%的复发率，因此引起世界范围内的争相仿效。但同时问题也接踵而至，提睾肌仍然残留，没有切开的层面不缝合，没有重叠加强修补，采用提睾肌或腹直肌加强修补，使用筋膜瓣，减张切开。这种讹误使人们对Bassini的工作产生了怀疑。自1906年采用Russsell（Lancet,1906, 2：1197-1203.）的疝囊结扎手术直到1953年。此后Shoudice 诊所使Bassini 原则重新流行，并被奉为疝修补的金标准而历时数十年。Cheatle引入了后路腹膜前疝修补术（Br Med J，1920，2:68-69）。Acquaviva和Bourret设计了第一个植入假体（尼龙），后来被聚丙烯取代。这些贡献为Rives、Stoppa、Wantz 及Gilbert等后来者的修补方法，Ger的腹腔镜修补法以及一些不常见的疝修补术铺平了道路。Chevrel(1979)创建了GREPA，这就是后来的欧洲疝学会，后来又和美国疝学会一起创建了《Hernia》杂志。Nilsson(1993)制定了全国性疝登记制度，致力于更低的复发率和更好的前瞻性研究。在21世纪，Lichtenstein疝修补术逐渐占据主流地位。疝学者接受了系统性结缔组织疾病是腹部疝和盆底脱垂的原因。这种病因可以解释为什么植入物推迟了复发但并没有根除复发。更好的解决方法还有待研究和应用。

Abstract:

Herniology: past, present and future    Read RC. University of Arkansas for Medical Sciences, 304 Potomac Street, Rockville, MD 20850, USA
Abstract    Introduction  Despite herniorrhaphy being performed frequently, most surgeons consider it to be a minor procedure. However, a few surgeons’ views differed. The Master was Bassini (1884), who introduced a radical cure for inguinal hernia. Incising his triple layer, internal oblique, transversus, and transversalis, he entered the preperitoneal space, allowing high ligation of the sac and mass suturing to the inguinal ligament. A 2.7% recurrence rate evoked worldwide emulation. Corruption ensued. The cremaster remained and few unincised layers were stitched, without imbrications, along with reinforcement using the cremaster or rectus muscles, fascial flaps, relaxing incisions, and silver coils. Little improvement cast doubt on Bassini’s work. Russell's (Lancet 2:1197-1203, 1906) ligation of the hernial sac was adopted until 1953, when the Shouldice clinic revived Bassini's tenets, becoming the gold standard for decades. Cheatle (Br Med J 2:68-69, 1920) introduced posterior pre-peritoneal repair. Acquaviva and Bourret (Presse Med 73:892, 1948) designed the first plastic prosthesis (nylon), replaced by polypropylene. Usher (Surg Gynecol Obstet 117:239-240, 1963) parietalized the cord. These contributions paved the way for the Rives, Stoppa, Wantz, and Gilbert repairs, Ger’s laparoscopic approach, and less common herniorrhaphies.  Chevrel (1979) formed the GREPA, which evolved into the European Hernia Society (EHS), joining with the American Hernia Society (AHS) to form the journal ‘Hernia.’ Nilsson (1993) instituted national hernia registries, enabling less recurrences and better prospective research. In the 21st century, the Lichtenstein procedure has dominated inguinal herniorrhaphy. Herniologists accepted systemic connective tissue disorder as the etiology of abdominal hernia and pelvic prolapses. This malady explains why prostheses slow but do not eliminate recurrence. Antidotes need to be developed and employed.
Conclusion   This malady explains why prostheses slow but do not eliminate recurrence. Antidotes need to be developed and employed.