杨春雷　李璟

[摘要] 目的 比较Lichtenstein术式、Rutkow术式与开放式TEP术式三种无张力疝修补术的手术临床疗效。 方法 回顾性分析我院2014年1月～2017年1月期间收治的125例疝修补患者，根据应用Lichtenstein术式、Rutkow术式与开放式TEP术式的不同分成A、B、C三组，观察三组的术中及术后近、远期指标等。 结果 三组患者术中出血量、下床活动时间、住院时间、术后切口感染、阴囊积液、尿潴留、切口血清肿、腹股沟疝复发等并发症比较无显著差异（P>0.05）。腹股沟区慢性疼痛及异物感A、B组高于C组（P<0.05）。双侧疝手术时间A、B组高于C组（P<0.05），A、B组之间比较均无显著差异（P>0.05）。 结论 Lichtenstein术式、Rutkow术式与开放式TEP术式三种无张力疝修补术均是治疗腹股沟疝安全有效的手术方法，应针对不同的病人及个体医师的手术经验选择更合理的个体化腹股沟疝手术方式。

[关键词] 腹股沟疝；Lichtenstein术式；Rutkow术式；开放式TEP术式；无张力疝修补术

[中图分类号] R657 [文献标识码] A [文章编号] 1673-9701（2018）04-0012-04

[Abstract] Objective To compare the clinical effects of three types of tension-free hernia repair： Lichtenstein procedure， Rutkow procedure and open TEP procedure. Methods 125 cases of patients receiving hernia repair who were admitted to our hospital from January 2014 to January 2017 were retrospectively analyzed. According to the different applications of Lichtenstein procedure， Rutkow procedure and open TEP procedure， the patients were divided into A、B、C three groups. The intraoperative and postoperative short-term and long-term indicators were observed in the three groups. Results There were no significant differences among the three groups in the amount of intraoperative bleeding， off-bed activity time， length of hospital stay， postoperative incision infection， scrotal effusion， urinary retention， incisional seroma， inguinal hernia recurrence and other complications（P>0.05）. The chronic pain and foreign body sensation at the groin area were higher in group A and B than in group C（P<0.05）. Bilateral hernia operation time in group A and B was higher than group C（P<0.05）. There was no significant difference between group A and B（P>0.05）. Conclusion The three types of tension-free hernia repair（Lichtenstein， Rutkow and open TEP）are safe and effective surgical treatment methods in the treatment of inguinal hernia. Regarding the different patients and surgical experience of individual physicians， a more appropriate individualized surgical procedure for inguinal hernia should be selected.

[Key words] Inguinal hernia； Lichtenstein procedure； Rutkow procedure； Open TEP procedure； Tension-free hernia repair

腹股沟疝属于外科常见病，无张力疝修补术效果非常好，已经被医生在临床中普遍运用。无张力疝修补包括开放式和经腹腔镜疝修补两种，经腹腔镜疝修补术具有微创、疼痛轻、康复快的特点，但是经腹腔镜疝修补手术技术要求高，学习曲线长，需要全身麻醉及腹腔镜等设备，应用起来有一定限制[1，2]。而开放式无张力疝修补术仍是当前大多數医院的主流术式。Lichtenstein、 Rutkow、开放式 TEP（下腹部正中切口腹膜前无张力疝修补术）三种均为开放式无张力疝修补术的常用方法，相对于腹腔镜疝修补术，这几种方式更容易推广[3-5]。本研究采取回顾性对比研究方法，将以上三种术式用于治疗成人腹股沟疝，为如何选择最好手术方法提供依据，现报道如下。