Yokomori K, Ohkura M, Kitano Y, Toyoshima H, Tsuchida Y
Department of Pediatric Surgery, Japanese Red Cross Medical Center, University of Tokyo Hospital.
J Pediatr Surg. 1995 Jan;30(1):97-100. doi: 10.1016/0022-3468(95)90620-7.
Based on a review of operative notes of recurrent inguinal hernia cases from the authors' primary series, a surgical technique modified from the Marcy repair is described. With this technique, emphasis is placed on preservation of the intact internal spermatic fascia and reduction in the size of the internal inguinal ring. Through the inguinal approach, the sleeve-like extension of the internal spermatic fascia is incised longitudinally along the cord and up to the internal ring. The cord structures are dissected off the sac, and as much of the fascial tissue as possible is preserved intact. Both edges of the fascial defect are approximated with an unabsorbable suture; great care is taken to not penetrate the wall of the sac. The same suture is then used for high ligation, via a stay suture placed on the transversalis fascia on the other side of the neck, to reduce the size of the internal ring. The technique can be used in premature babies who have a flimsy, easily torn sac, and in some cases of giant hernia with a widely dilated internal inguinal ring, if the direct wall integrity remains adequate.
基于对作者主要系列复发性腹股沟疝病例手术记录的回顾，描述了一种从马尔西修补术改良而来的手术技术。采用这种技术时，重点在于保留完整的精索内筋膜并缩小腹股沟内环的尺寸。通过腹股沟入路，沿精索纵向切开精索内筋膜的袖状延伸部分，直至内环。将精索结构从疝囊上分离，尽可能保留完整的筋膜组织。用不可吸收缝线将筋膜缺损的两边拉拢；要格外小心不穿透疝囊壁。然后通过在疝囊颈部另一侧的腹横筋膜上放置一根牵引缝线，用同一根缝线进行高位结扎，以缩小内环尺寸。如果直疝壁完整性仍然良好，该技术可用于疝囊脆弱、易撕裂的早产儿以及某些内环广泛扩张的巨大疝病例。
