Femalegroinhernia:totallyextraperitoneal(TEP)endoscopicrepairseemsthemostappropriatetreatmentmodality.
Author
SchoutenN1,BurgmansJP,vanDalenT,etal
Source
Hernia.Aug;16(4):-92
发生在女性腹股沟区的疝约30%为股疝。诊断常较困难，甚至发生误诊。Lichtenstein技术虽是治疗原发性腹股沟疝的首选。但并不适用于股疝。TEP手术作为后入路修补的一种方法，适应于所有成人斜疝、直疝和股疝等。本研究共收集年至年间例（侧）成年女性腹股沟区疝的临床资料，40例（85%）患者采用TEP进行修补，另外24例则选择行开放前入路补片修补。原发性疝和复发疝中股疝的比例分别是23%和35%。共30例（18.3%）患者术前诊断错误，术前诊断为腹股沟疝的患者中，有17.3%的患者术中确诊为股疝。此外，术前诊断为股疝的患者中，有24%的患者术中确诊为腹股沟疝。术后25月随访期间，TEP术后有6.4%患者（8/)，开放修补术后21.7%（5/23)的患者存在由中至重度（VAS4-10分）的慢性疼痛，5例患者复发，其中TEP修补术后2例（复发率1.4%），开放修补术后复发3例（复发率12.5%）。
因此，作者认为股疝在女性中较为常见，术前有时确诊困难。腹膜前修补术在股疝的治疗中具有一定的价值。TEP修补术可术中明确诊断，其对股疝的修补效果确切。
BACKGROUND:
About30%ofallfemalegroinherniasarefemoralhernias,althoughoftenonlydiagnosedduringsurgery.ALichtensteinrepairthough,aspreferredtreatmentmodalityaccordingtoguidelines,wouldnotdiagnoseandtreatfemoralhernias.Totallyextraperitoneal(TEP)herniarepair,however,offerstheadvantageofbeinganappropriatemodalityforthediagnosisandsubsequenttreatmentofbothinguinalandfemoralhernias.TEPthereforeseemsanappealingsurgicaltechniqueforwomenwithgroinhernias.
METHODS:
Thisstudyincludedallfemalepatients≥18yearsoperatedforagroinherniabetweenand.
RESULTS:
Atotalofgroinherniaswererepairedinwomen.TEPwasperformedin85%ofwomen;theother24womenunderwentanopenanterior(mesh)repair.Peroperatively,femoralherniaswereobservedin23%ofpatientswithprimaryherniasand35%ofpatientswithrecurrenthernias.Therewere30cases(18.3%)ofanincorrectpreoperativediagnosis.Peroperatively,femoralherniaswereobservedin17.3%ofwomenwhowerediagnosedwithaninguinalherniabeforesurgery.Inaddition,inguinalherniaswerefoundin24.0%ofwomenwhowerediagnosedwithafemoralherniapreoperatively.Afterafollow-upof25months,moderatetosevere(VAS4-10)postoperativepainwasreportedby8ofpatients(6.4%)afterTEPand5of23patients(21.7%)afteropenherniarepair(P=0.03).Fivepatientshadarecurrenthernia,twofollowingTEP(1.4%)andthreefollowingopenanteriorrepair(12.5%,P=0.02).Twoofthesethreepatientspresentedwithafemoralrecurrenceafterapreviousrepairofaninguinalhernia.
CONCLUSION:
Femoralherniasare北京好的白癜风医院地址北京较好的白癜风医院
