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三针法疝修补术:初学者的一种新技术。

Three stitch hernioplasty: A novel technique for beginners.

作者信息

Patchayappan Manikandan, Narayanasamy Sangara Narayanan, Duraisamy Nagarajan

机构信息

Department of General Surgery, Thanjavur Medical College and Hospital, Thanjavur, Tamil Nadu, India.

Department of General Surgery, Stanley Medical College and Hospital, Chennai, Tamil Nadu, India.

出版信息

Avicenna J Med. 2015 Oct-Dec;5(4):106-9. doi: 10.4103/2231-0770.166891.

DOI:10.4103/2231-0770.166891
PMID:26629464
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4637946/
Abstract

OBJECTIVE

To analyze mesh fixation with minimum sutures and postoperative complications.

STUDY DESIGN

Prospective study.

PLACE AND DURATION OF STUDY

Department of General Surgery, Thanjavur Medical College and Hospital, Tamil Nadu, from July 2010 to June 2012.

MATERIALS AND METHODS

All inguinal hernia patients, who fulfilled the sample selection criteria, were admitted and planned for surgery. The prolene mesh is fashioned as in Lichtenstein's repair, placed and fixed only by three prolene stitches. The first stitch is made in the periosteum of pubic tubercle. The second stitch is taken in the inguinal ligament (1.5 cm lateral to the pubic tubercle) and the third stitch is from the medial most part of the conjoint tendon, that is, the mesh is fixed in the medial aspect alone.

RESULTS

Majority of the patients fall between the age group of 40 and 60 (72%) years and all are male patients. Of the total cases, 50% were right sided, 25% were left sided, and 25% were bilateral. Of the postoperative complications, 12% had seroma, 4% had hematoma, 2% developed surgical site infection, 2% developed chronic groin pain, 1% presented with recurrence, and none developed foreign body sinus.

CONCLUSION

The incidence of long-term complications of three stitch hernioplasty are comparable to that of the other standard, tension-free open hernia repair as well as other laparoscopic procedures. Moreover, the three stitch hernioplasty method is a simple method, easy for the beginners to adopt, has less foreign body reaction, less time consuming, causes less tissue trauma, and lesser chance for vascular injury.

摘要

目的

分析用最少缝线进行补片固定及术后并发症情况。

研究设计

前瞻性研究。

研究地点及时间

坦贾武尔医学院及医院普通外科,泰米尔纳德邦,2010年7月至2012年6月。

材料与方法

所有符合样本选择标准的腹股沟疝患者入院并计划接受手术。普理灵补片按利chtenstein修补术的方式制作,仅用三根普理灵缝线放置并固定。第一针缝在耻骨结节骨膜上。第二针缝在腹股沟韧带(耻骨结节外侧1.5厘米处),第三针从联合腱最内侧部分穿出,即补片仅在内侧固定。

结果

大多数患者年龄在40至60岁之间(72%),且均为男性患者。在所有病例中,50%为右侧,25%为左侧,25%为双侧。术后并发症方面,12%出现血清肿,4%出现血肿,2%发生手术部位感染,2%出现慢性腹股沟疼痛,1%复发,无人出现异物窦。

结论

三针疝修补术的长期并发症发生率与其他标准的无张力开放式疝修补术以及其他腹腔镜手术相当。此外,三针疝修补术方法简单,初学者易于采用,异物反应少,耗时少,组织创伤小,血管损伤几率小。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/582c/4637946/0d9a80ed4a57/AJM-5-106-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/582c/4637946/0d9a80ed4a57/AJM-5-106-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/582c/4637946/0d9a80ed4a57/AJM-5-106-g001.jpg

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引用本文的文献

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Comments on: Three stitch hernioplasty.关于《三缝疝修补术》的评论
Avicenna J Med. 2016 Apr-Jun;6(2):60. doi: 10.4103/2231-0770.179549.

本文引用的文献

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Chronic groin pain following lichtenstein mesh hernioplasty for inguinal hernia. Is it a myth?腹股沟疝经李金斯坦修补术后的慢性腹股沟疼痛。这是个神话吗?
Indian J Surg. 2009 Apr;71(2):84-8. doi: 10.1007/s12262-009-0022-7. Epub 2009 May 2.
2
Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up.腹腔镜(TEP)和开放(Lichtenstein)腹股沟疝修补术后的低复发率:一项为期5年随访的随机多中心试验。
Ann Surg. 2009 Jan;249(1):33-8. doi: 10.1097/SLA.0b013e31819255d0.
3
Laparoscopic versus open ventral hernia mesh repair: a prospective study.
腹腔镜与开放腹疝补片修补术:一项前瞻性研究。
Surg Endosc. 2006 Jul;20(7):1030-5. doi: 10.1007/s00464-005-0554-2. Epub 2006 May 15.
4
Laparoscopic ventral hernia repair without sutures--double crown technique: our experience after 140 cases with a mean follow-up of 40 months.腹腔镜无缝合腹疝修补术——双冠技术:140例平均随访40个月后的经验
Int Surg. 2005 Jul-Aug;90(3 Suppl):S56-62.
5
Randomized clinical trial comparing lightweight composite mesh with polyester or polypropylene mesh for incisional hernia repair.比较轻质复合补片与聚酯或聚丙烯补片用于切口疝修补的随机临床试验。
Br J Surg. 2005 Dec;92(12):1488-93. doi: 10.1002/bjs.5208.
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Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia.切口疝缝合修补与补片修补随机对照试验的长期随访
Ann Surg. 2004 Oct;240(4):578-83; discussion 583-5. doi: 10.1097/01.sla.0000141193.08524.e7.
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Laparoscopic incisional and ventral hernia repair: complications-how to avoid and handle.腹腔镜切口疝和腹疝修补术:并发症——如何避免及处理
Hernia. 2004 Dec;8(4):323-31. doi: 10.1007/s10029-004-0250-5.
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Incisional hernia repair.切口疝修补术。
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Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults.比较成人脐疝缝合修补术与补片修补术的随机临床试验。
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