中国组织工程研究

中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (6): 957-961.doi: 10.3969/j.issn.2095-4344.2017.06.024

• 膜生物材料 membrane biomaterials • 上一篇    下一篇

正确测量成年男性腹股沟后壁裁剪合适的补片修复腹股沟疝

涂志强，王卫星
  

  1. 武汉大学人民医院普外科，湖北省武汉市  430060
  • 收稿日期:2017-01-11 出版日期:2017-02-28 发布日期:2017-03-16
  • 通讯作者: 王卫星，博士，主任医师，武汉大学人民医院普外科，湖北省武汉市 430060
  • 作者简介:涂志强，男，1977年生，湖北省枣阳市人，汉族，2000年郧阳医学院毕业，主治医师，主要从事普外科研究。
  • 基金资助:

    国家自然科学基金(81370562)

Correct measurement of the posterior wall size of adult male inguinal hernia used for herniorrhaphy

Tu Zhi-qiang, Wang Wei-xing
  

  1. Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
  • Received:2017-01-11 Online:2017-02-28 Published:2017-03-16
  • Contact: Wang Wei-xing, M.D., Chief physician, Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
  • About author:Tu Zhi-qiang, Attending physician, Department of General Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81370562

PDF

212

被引次数

4

摘要：

文章快速阅读：

 

文题释义：
无张力疝修补术：美国医师Lichtenstein首先于1986年提出无张力疝修补术的概念。这种修补以人工生物材料作为补片用以加强腹股沟管的后壁，此法克服了传统手术(即不用补片的缝合修补法)对正常组织解剖结构的干扰，层次分明，而且修补后周围组织无张力，故命名为“无张力疝修补术”。目前常用的有平片式无张力疝修补术和疝环充填式无张力疝修补术。
医用聚丙烯编织材料：分为多丝聚丙烯(SURGICAL)、双丝聚丙烯(PROLEN)、单丝聚丙烯(MARLEX)等。材料中丝的结构对网片特性有影响(编织网丝越多，补片柔软性越好，然而感染的机会越大)。Rutkow术所用的圆锥形网塞为多丝聚丙烯，补片为单丝聚丙烯，具有良好的组织相容性及较大的抗张力强度，为目前最为适宜的疝修补材料，但它皱缩的性质，给临床应用带来较多问题，为降低该性质带来的不良影响，需适当加大补片的尺寸和术中固定补片。

背景：目前国内行疝补片手术，一般根据经验裁剪补片大小，缺乏可靠的依据。
目的：通过Rutkow术中测量中国籍成年男性人群腹股沟后壁大小，根据测量结果进行补片裁剪，对治疗效果进行评价。
方法：精细测量180例行无张力疝修补术的中国籍成年男性患者的腹股沟后壁大小，计算出适合中国成年男性腹股沟组织解剖结构的补片尺寸数据，并将180例患者随机分为2组，每组90例，试验组测量腹股沟后壁大小后进行补片裁剪的Rutkow术，对照组根据经验进行补片裁剪的Rutkow术，比较两组患者各项临床指标以及并发症发生率和复发率。
结果与结论：①耻骨结节与腹内斜肌在腹股沟韧带起点之间距离为(6.03±0.58) cm；弓状下缘的最高点至腹股沟韧带的垂直距离为(3.02±0.32) cm，相应补片尺寸长度应当大于(13.04±0.74) cm，宽度应当大于(5.88±0.52) cm；②试验组下床活动时间、进食时间、住院时间均小于对照组(P < 0.05)；两组手术时间、恢复正常活动时间比较，差异无显著性意义(P > 0.05)；③试验组术后并发症发生率及复发率明显低于对照组(P < 0.01)；④结果表明，测量腹股沟后壁大小后进行补片裁剪的Rutkow术用于腹股沟疝修补，效果明显，并发症和复发率低。

关键词: 生物材料, 材料相容性, 腹股沟疝后壁, 疝环充填式无张力疝修补术, 疝补片尺寸, 术后效果, 国家自然科学基金

Abstract:

BACKGROUND: The mesh size used for herniorrhaphy mainly depends on clinicians’ experience, which is less reliable.
OBJECTIVE: To obtain the mesh size by measuring the posterior wall of inguinal hernia in Chinese adult men undergoing Rutkow surgery, and to assess the postoperative effect.
METHODS: The posterior wall size of inguinal hernia in 180 Chinese adult male patients undergoing tension-free hernioplasty was measured, and then the optical mesh size was calculated. All patients were equivalently randomized into two groups, followed by subjected to Rutkow surgery according the calculated mesh size (experimental group) or subjective size (control group). Clinical indexes, the incidence of complications and recurrence rate were compared between groups.
RESULTS AND CONCLUSION: The distance of pubic tubercle to internal oblique inguinal ligament starting point was (6.03±0.58) cm; the vertical distance of the highest point on the edge of the arcuate to inguinal ligament was (3.02±0.32) cm; therefore, the length of mesh should be larger than (13.04±0.74) cm, and width larger than (5.88±0.52) cm. The time of off-bed, dieting and hospitalization in the experimental group were significantly less than those in the control group (P < 0.05); the time of operation and recovery of normal activities showed no significant difference between groups (P > 0.05). The rates of postoperative complication and recurrence in the experimental group were significantly lower than those in the control group (P < 0.01). These results suggest that after measuring the posterior wall size of inguinal hernia, the Rutkow used for inguinal hernia repair, obtains desired treatment outcomes with low incidence of complications and recurrence.

Key words: Hernia, Inguinal, Biocompatible Materials, Tissue Engineering

中图分类号: