- 期刊
The Evolution of Groin Hernioplasty, an Update
鼠蹊部疝氣手術的演進及最新進展
摘要
疝氣修補是最常見的外科手術之一，疝氣治療的演進幾乎可反映出整個外科的發展過程。近年來由於手術的進步及對人工材質的應用，結果大有進步，過去15%以上的復發率目前已降低至5%以下。成功的疝氣手術要有低復發率，快速復原，少併發症及術後急慢性疼痛。二十多年前還流行的傳統組織對組織修補，目前已被無張力手術(Tension-free repair)及腹腔鏡疝氣手術(TAPP, TEP)所取代，無張力手術的應用率最高，約佔七成，而腹腔鏡手術在雙側疝氣及前開式修補後復發的病人較具優勢。無張力手術(Tension-free Hernioplasty)最常見的有(1)Lichtenstein平片人工網手術（25年）：(2)Plug and Patch Repair人工網塞加平片（20年）：(3)The Xugel Groin Hernia Repair庫克爾氏後置網具（15年）；(4)Prolene Hernia System三合一人工網具（11年）等。國內的腹股溝疝氣在2009年約有一半合併使用人工網。總之，疝氣的修補應對肌恥骨孔(myopectineal orifice)作整體考量，人工材質的應用可補組織的薄弱或不足，減少修補處的張力及術後疼痛，進而避免復發。但人工材質日新月異，其種類及設計及植入人體後的局部組織效應也應細加了解，才能爲病人做最好的選擇，以期達到最佳手術結果，另方面膠原蛋白代謝異常與相關基因變異的基礎研究，未來也許可解答疝氣的根本病因並可能提供手術以外的治療。
關鍵字
無資料並列摘要
Hernia repair is one of the most common surgical procedures; the evolution of hernia management reflects the development of surgery. Recently, due to the advance in repair techniques and utilization of a prosthetic mesh, the overall recurrence rate has been reduced from 15% to less than 5%. An ideal hernia repair should have short convalescence, low recurrence, low complications, and minimal postoperative pain. Most tissue to tissue repairs, which were still popular two decades ago, have now been replaced by open tension-free repairs and endoscopic repairs. Tension-free repairs are the most popular repairs, representing 70% of repairs performed in developed countries, followed by endoscopic repairs, which represent 15-20% of repairs. The former includes the Lichtenstein repair (plain flat mesh, for 25 years), the Plug and Patch repair (for 20 years), the Kugel posterior patch (for 15 years) and Prolene Hernia System (for 11 years). In the year of 2009, about half of the adult herniorraphy in Taiwan utilized some kind of mesh. The important concepts in herniorraphy today are: treating the myopectineal orifice as a whole, using prosthetic material to replace or re-enforce the attenuated abdominal fascia and muscles, to reduce the suture line tension and postoperative pain, and to prevent recurrences. However, hernioplasties using a prosthetic mesh are not without complications. The mesh will evolve rapidly and always improve in material, configuration, and three-dimentional design. Only those surgeons who know thoroughly the details of different kinds of mesh, including the interaction between the mesh and human body after they are implanted, can select the best and most appropriate repair for each of their individual patients. Further basic studies on collagen metabolism and related genetic anomalies may provide nonsurgical treatment of groin hernias.