Dion Y M
Department of Surgery, St.-François d'Assise Hospital and Laval University, Québec City, Canada.
Surg Laparosc Endosc. 1993 Dec;3(6):451-5.
Between March 1991 and December 1992, we treated 63 patients with symptomatic inguinal hernias using a laparoscopic transabdominal preperitoneal approach adapted from Nyhus' technique. Treatment was individualized according to the classification of groin hernias described by Nyhus. We treated 32 type II hernia defects (indirect hernia) by preperitoneal closure of the internal ring with two to four stitches of 0-Prolene. Eighteen type IIIA (direct), three type IIIB (large indirect with weak posterior wall), and 10 type IV (recurrent) hernias were treated by fixing a prolene mesh with 0-Prolene sutures and staples from the pubic tubercle medially to the lateral aspect of the internal ring (including the cord into the mesh) laterally. The mesh was secured to the transversalis fascia and muscle and inferiorly to Cooper's ligament. No peroperative complications occurred. One patient had testicular pain of 1 week's duration after treatment of a type IV hernia. No mortality was recorded. Patients took, on an average, parenteral analgesia once (range, 0-5) and two enteral analgesics (range, 0-6). With a median follow-up of 8 months (range, 1-21), no recurrences were noted. Results are encouraging, and longer follow-up will determine the long-term efficacy of this procedure.
1991年3月至1992年12月期间，我们采用一种借鉴Nyhus技术改良的腹腔镜经腹腹膜前修补术，治疗了63例有症状的腹股沟疝患者。治疗方案根据Nyhus描述的腹股沟疝分类进行个体化制定。我们用0号普理灵缝线两到四针经腹膜内缝合内环，治疗了32例II型疝缺损（间接疝）。18例IIIA型（直疝）、3例IIIB型（后壁薄弱的大间接疝）和10例IV型（复发疝）疝，通过用0号普理灵缝线和吻合器将聚丙烯网片从耻骨结节内侧固定到内环外侧（包括将精索纳入网片）进行治疗。网片固定于腹横筋膜和肌肉以及下方的Cooper韧带。术中无并发症发生。1例IV型疝患者治疗后出现持续1周的睾丸疼痛。无死亡病例记录。患者平均接受一次胃肠外镇痛（范围0 - 5次）和两次胃肠内镇痛（范围0 - 6次）。中位随访时间为8个月（范围1 - 21个月），未发现复发。结果令人鼓舞，更长时间的随访将确定该手术的长期疗效。
