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復發性腹股溝疝氣的無張力人工網修補經驗報告

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由於人工網的普遍應用,腹股溝疝氣手術近20年來有極大的改變並有效的降低術後疼痛及復發率。但由官方及保險的數據分析,仍然有15%的疝氣手術對象是復發性疝氣的病人,這數字比例卻一直沒有什麼改變,復發性疝氣的手術相對較為困難,再復發率也高達30%。最新無張力疝氣手術自2001年引進國內後,我們的經驗顯示對原發性疝氣有很好的效果,因此我們也使用這種新方法來治療復發性疝氣。

2001-2016共有 447位、542邊的復發性疝氣接受個人無張力修補;男女比為20:1;年齡平均61.5歲(16~106歲);病人的復發情況(手術所見)均依Gilbert分類,術後第1天、6天及90天疼痛指數以VAS疼痛指數紀錄,並長期追蹤病人的再復發情況,使用的無張力方法為:人工網塞(175)、PHS (179)、Modified Kugel (188),72% 使用脊椎外麻醉,其他為局部麻醉(15)、全身麻醉(13)。 結果:右邊 (56%)、左邊 (29%)、雙側 (15%);直接型 (43%)、間接型 (44%)、合併型 (13%),前次修補至此次修補平均間隔55.2個月(1周至29年),手術時間平均44分(17~80分),平均術後住院1.4天(3小時至4天);併發症6%,包括尿儲積 (3)、睪丸萎縮 (1)、傷口感染或血腫 (2)及慢性傷口疼痛但皆輕微。長期追蹤再復發率為2%(86 % 追蹤率)。

結論:無張力人工網修補是目前復發性疝氣的最好治療選擇。

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