George S M, Mangiante E C, Voeller G R, Britt L G
Department of Surgery, University of Tennessee, Memphis 38163.
Am Surg. 1991 Mar;57(3):139-41.
Elective preperitoneal or posterior repair for recurrent groin hernias and primary femoral hernias has been shown to be a technically advantageous approach. In addition to the ease of inguinal floor and femoral canal assessment, scar tissue from prior anterior herniorrhaphy can be avoided. The emergency management of the acutely incarcerated or strangulated hernia of the groin using this approach has not been addressed. During a 30-month period, all patients with a diagnosis of acute incarceration of a groin hernia (n = 28) were surgically managed using either the anterior approach (AA) (n = 14) or the preperitoneal approach (PA) (n = 14). Two patients with strangulated intestine in the AA group required an additional midline incision for bowel evaluation and resection. Intestinal evaluation was easily accomplished through the same incision in four patients in the PA group. The preperitoneal approach also allowed proximal control of incarcerated or strangulated viscera, thus avoiding excessive manipulation of gangrenous or necrotic intestine, potential spillage of infected contents into the peritoneal cavity, and entry of bacteria, toxins, potassium, and the metabolic waste products of anaerobic metabolism into the systemic circulation during hernia reduction. There have been no recurrences in either group, and minor complications, such as wound infection and cellulitis, in the two groups are not statistically different.
对于复发性腹股沟疝和原发性股疝，选择性腹膜前或后路修补术已被证明是一种技术上有利的方法。除了便于评估腹股沟底部和股管外，还可避免先前前路疝修补术留下的瘢痕组织。采用这种方法对腹股沟急性嵌顿或绞窄性疝进行急诊处理的情况尚未见报道。在30个月的时间里，所有诊断为腹股沟疝急性嵌顿的患者（n = 28）均采用前路手术（AA）（n = 14）或腹膜前手术（PA）（n = 14）进行手术治疗。AA组中有2例肠绞窄患者需要额外做正中切口进行肠管评估和切除。PA组中有4例患者通过同一切口轻松完成了肠管评估。腹膜前手术方法还能对嵌顿或绞窄的内脏进行近端控制，从而避免对坏疽或坏死肠管的过度操作、感染内容物向腹腔的潜在溢出，以及在疝还纳过程中细菌、毒素、钾和无氧代谢的代谢废物进入体循环。两组均无复发，两组的轻微并发症，如伤口感染和蜂窝织炎，在统计学上无差异。
