Peiper C, Junge K, Füting A, Conze J, Bassalaý P, Schumpelick V
Chirurgische Universitätsklinik und Poliklinik, RWTH Aachen.
Chirurg. 1998 Oct;69(10):1077-81; discussion 1081. doi: 10.1007/pl00002562.
A special instrument was developed in order to quantify intraoperatively the traction forces which are employed during Shouldice repair of a primary inguinal hernia while adapting the lateral edge of the rectus sheath and the iliopubic tract. Further investigations were performed under the Valsalva manoeuvre and simultaneous measurement of the intra-abdominal pressure. In 25 patients an average increase in traction forces of 3.62 +/- 0.60 N was registered when the hernial gap was decreased to 0.3 cm. By applying the Valsalva manoeuvre with an average increase of 32 mm Hg in intra-abdominal pressure, traction was increased by a further 1.67 +/- 0.20 N on average. Hernia repair, tensing of the abdominal muscles and increasing the intra-abdominal pressure, however, have a small effect on the traction forces affecting the edges of the hernial gap. It may therefore be concluded that these factors, frequently believed causal for early hernia recurrence, are actually less influential as the force vector stressing the repair zone points in a different direction.
为了在原发性腹股沟疝的Shouldice修补术中，在调整腹直肌鞘外侧缘和髂耻束时对术中使用的牵引力进行量化，开发了一种特殊仪器。在瓦尔萨尔瓦动作（Valsalva manoeuvre）和同时测量腹内压的情况下进行了进一步研究。在25例患者中，当疝间隙减小到0.3厘米时，记录到牵引力平均增加3.62±0.60牛。通过应用瓦尔萨尔瓦动作使腹内压平均增加32毫米汞柱，牵引力平均进一步增加1.67±0.20牛。然而，疝修补、腹部肌肉紧张和腹内压增加对影响疝间隙边缘的牵引力影响较小。因此可以得出结论，这些通常被认为是早期疝复发原因的因素，实际上影响力较小，因为作用于修补区域的力矢量指向不同方向。
