【摘要】：背景:腹外疝是外科中最常見的疾病之一,以腹股溝疝發(fā)病率最高,腹股溝疝可分為腹股溝斜疝和直疝。斜疝是最常見的腹外疝,發(fā)病率約占腹外疝總數(shù)的90%,或占腹股溝疝的95%。腹股溝疝成人不可以自愈,手術(shù)是唯一的治愈方法。目前主要存在兩種手術(shù)方式:傳統(tǒng)的疝囊高位結(jié)扎疝修補(bǔ)術(shù)和無張力疝修補(bǔ)術(shù),通過查閱相關(guān)文獻(xiàn),發(fā)現(xiàn)這兩種疝修補(bǔ)術(shù)均能治愈成人腹股溝疝,各自具有本身的優(yōu)勢,同時(shí)也存在各自缺點(diǎn)。對(duì)于腹股溝疝臨床術(shù)式的選擇,目前仍有在爭論。目的:通過對(duì)131例在齊齊哈爾醫(yī)學(xué)院附屬第三醫(yī)院普外科住院手術(shù)的腹股溝疝患者病歷資料的分析,比較傳統(tǒng)修補(bǔ)術(shù)和無張力修補(bǔ)術(shù)治療腹股溝疝的臨床療效,為該院推廣應(yīng)用無張力疝修補(bǔ)術(shù)治療腹股溝疝提供參與和依據(jù)。方法:收集2011年至2014年在齊齊哈爾醫(yī)學(xué)院附屬第三醫(yī)院普外科住院手術(shù)的腹股溝疝患者病歷資料131例,根據(jù)手術(shù)方式分為:傳統(tǒng)手術(shù)組41例和無張力疝手術(shù)組90例。比較分析兩組患者手術(shù)時(shí)間、術(shù)中出血量、術(shù)后最高體溫及其出現(xiàn)時(shí)間、術(shù)后平均住院時(shí)間、術(shù)后下床活動(dòng)時(shí)間、排氣時(shí)間、住院費(fèi)用,以及術(shù)后并發(fā)癥:尿潴留、陰囊腫脹、切口異物感、術(shù)后疼痛、切口感染、血腫及血清腫等。結(jié)果:無張力修補(bǔ)術(shù)式組術(shù)中出血量少于傳統(tǒng)術(shù)式組,術(shù)后下床時(shí)間早,排氣時(shí)間早,手術(shù)費(fèi)用高于傳統(tǒng)術(shù)式,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);無張力修補(bǔ)術(shù)組并發(fā)癥尿:潴留、術(shù)后、疼痛、陰囊腫脹、切口異物感、切口感染、最高體溫及其出現(xiàn)時(shí)間、血腫及血清腫等發(fā)生以及手術(shù)時(shí)間、住院天數(shù)與傳統(tǒng)術(shù)式組相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.無張力疝修補(bǔ)術(shù)在術(shù)中的出血量少,對(duì)組織損傷小,有利于組織的恢復(fù)。2.施行無張力疝修補(bǔ)術(shù)的患者術(shù)后排氣時(shí)間早,胃腸蠕動(dòng)恢復(fù)快、進(jìn)食時(shí)間早、營養(yǎng)損失少,有利于傷口的愈合。3.施行無張力疝修補(bǔ)術(shù)施行的患者術(shù)后下床時(shí)間早,減少臥床時(shí)間,有利于老年手術(shù)患者某些并發(fā)癥的預(yù)防。4.無疑力疝修補(bǔ)術(shù)組患者各種術(shù)后并發(fā)癥的發(fā)生率不高于傳統(tǒng)術(shù)式組。5.施行無張力疝修補(bǔ)術(shù)的患者住院費(fèi)用顯著高于施行傳統(tǒng)術(shù)式的患者。醫(yī)院必須通過一系列措施,降低患者住院費(fèi)用,縮小與傳統(tǒng)疝修補(bǔ)術(shù)住院費(fèi)用的差距來促進(jìn)無張力疝修補(bǔ)在臨床上的推廣應(yīng)用。
[Abstract]:Background: external abdominal hernia is one of the most common diseases in surgery. The incidence of inguinal hernia is the highest. Inguinal hernia can be divided into indirect inguinal hernia and direct hernia. Indirect hernia is the most common external hernia, accounting for about 90% of the total number of external hernia, or 95% of inguinal hernia. Inguinal hernia adults cannot heal themselves. Surgery is the only cure. At present, there are two main surgical methods: traditional high ligation hernia repair and tension-free herniorrhaphy. By consulting relevant literature, it is found that both hernioplasty can cure adult inguinal hernia, and each of them has its own advantages. At the same time, there are their own shortcomings. The choice of clinical operation for inguinal hernia is still controversial. Objective: to analyze the medical records of 131 cases of inguinal hernia treated in general surgery department of the third affiliated Hospital of Qiqihar Medical College, and to compare the clinical effect of traditional repair and tension-free repair in the treatment of inguinal hernia. To provide the basis for the application of tension-free hernioplasty in the treatment of inguinal hernia. Methods: from 2011 to 2014, 131 cases of inguinal hernia were collected from general surgery department of the third affiliated Hospital of Qiqihar Medical College. According to the operation mode, 131 cases were divided into traditional operation group (41 cases) and tension-free hernia group (90 cases). The time of operation, the amount of blood lost during operation, the maximum body temperature after operation, the time of appearance, the average time of hospitalization, the time of getting out of bed, the time of exhaust, the cost of hospitalization, and the postoperative complications: urinary retention, scrotal swelling, and postoperative complications were compared and analyzed between the two groups. Incision foreign body sensation, postoperative pain, wound infection, hematoma and serum swelling. Results: the amount of intraoperative bleeding in the tension free repair group was less than that in the traditional operation group, the time of getting out of bed was earlier, the time of exhaust was earlier, the cost of operation was higher than that of the traditional operation, the difference was statistically significant (P0.05), the complications of tension free repair group: urine retention, postoperative, postoperative, Pain, scrotum swelling, incision foreign body sensation, wound infection, maximum body temperature and its occurrence time, hematoma and serum swelling, and operation time, hospital stay were not significantly different from the traditional operation group (P0.05). Conclusion 1. Tension-free hernioplasty has less bleeding and less tissue damage, which is beneficial to tissue recovery. The patients who underwent tension-free hernioplasty had earlier exhaust time, faster recovery of gastrointestinal peristalsis, earlier feeding time and less nutrition loss, which was beneficial to wound healing. The patients undergoing tension-free hernioplasty get out of bed early after operation and reduce bed-rest time, which is helpful to prevent some complications in elderly patients. There is no doubt that the incidence of postoperative complications in the force-hernia repair group is not higher than that in the traditional herniorrhaphy group. The hospitalization cost of tension-free herniorrhaphy was significantly higher than that of traditional herniorrhaphy. In order to promote the clinical application of tension-free hernioplasty, hospitals must reduce the cost of hospitalization and reduce the difference between the cost of traditional hernia repair and that of traditional hernioplasty.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R656.2

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