腹股沟疝修补术中疝囊的处理。

Management of the hernial sac in inguinal hernia repair.

机构信息

Department of Surgery, Umeå University Hospital, Sweden.

出版信息

Br J Surg. 2010 Mar;97(3):415-9. doi: 10.1002/bjs.6890.

DOI:10.1002/bjs.6890

PMID:20104504

Abstract

BACKGROUND

There is no consensus on the best management of the indirect hernial sac in groin hernia surgery. The aim of this study was to investigate to what extent different management options are associated with reoperation for recurrence.

METHODS

This study used data from the Swedish Hernia Register. Surgeons registered whether the indirect hernial sac was managed by division (leaving the distal part in place), excision or invagination.

RESULTS

An indirect hernia was found in 48 433 operations; the sac was excised in 49.5 per cent, invaginated in 37.6 per cent and divided in 12.9 per cent of operations. The 5-year cumulative reoperation incidence was 1.7 per cent for hernial sac excision, 1.7 per cent for division and 2.7 per cent for invagination. For indirect hernia repair, the relative risk of reoperation for recurrence was 0.63 (95 per cent confidence interval 0.51 to 0.79) for excision of the sac and 0.72 (0.53 to 0.99) for division compared with invagination. Lichtenstein repair combined with hernial sac excision had a 5-year cumulative reoperation incidence of only 1.0 per cent.

CONCLUSION

Excision of the indirect hernial sac in inguinal hernia repair is associated with a lower risk of hernia recurrence than division or invagination.

摘要

背景

在腹股沟疝手术中，对于间接疝囊的最佳处理方式尚未达成共识。本研究旨在探究不同处理方式与复发后再次手术之间的关联程度。

方法

本研究采用了瑞典疝登记处的数据。外科医生记录了间接疝囊的处理方式，包括分离（保留远端部分）、切除或内翻。

结果

在 48433 例手术中发现了间接疝，其中 49.5%的疝囊被切除，37.6%的疝囊被内翻，12.9%的疝囊被分离。5 年累积再手术发生率分别为：切除疝囊为 1.7%，分离为 1.7%，内翻为 2.7%。对于间接疝修补，与内翻相比，切除疝囊的相对风险为 0.63（95%置信区间 0.51 至 0.79），分离的相对风险为 0.72（0.53 至 0.99）。Lichtenstein 修补术联合疝囊切除的 5 年累积再手术发生率仅为 1.0%。