術後QOLと安全性からみた各種成人鼠径ヘルニア手術の検討 WHICH HERNIORRHAPHY IS JUSTIFIED IN STAND POINT OF POSTOPERATIVE DISCOMFORT AND SAFETY?

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97成人鼠径部ヘルニアに対してMarcy法, Lichtenstein法(LT),腹腔鏡下修復術(TAPP), IP tract repair (AITR), McVay法, Bassini法を施行しQOLおよび安全性の観点から各術式の妥当性を検討した.第1, 7病日のつっばり感,屈伸運動等の早期QOL評価ではMarcy, LT, TAPPが他に比して優れていた.術後愁訴の持続期間ではMarcy, LTが各々7±16, 5±1(平均日数±SD)とTAPP, AITR, McVay, Bassiniの97±186, 69±53, 125±147, 59±72比して有意に短かった(p<0.01). TAPPの3例(43%)に鼠径部痛が生じ中期QOLは悪かった.鼠径部法の各術式は安全に施行できたが, TAPPでは癒着性イレウス(開腹術),および陰部大腿神経損傷の各1例を経験した. Nyhus分類のtype IIヘルニアに対するMarcy,その他のtypeに対するLTはQOLと安全性の観点から推奨される術式である. TAPPの有用性は見いだせなかった.

In order to find out which herniorrhaphy is justified in stand point of postoperative discomfort and safety, Marcy repair, Lichtenstein repair, Transabdominal preperitoneal repair (TAPP), Iliopubic tract repair (AITR), McVay repair and Bassini repair were performed on 97 adult groin hernias.<br> There were no difference in the QOL score of day 1 and 7 among Marcy repair. Lichtenstein repair and TAPP but these scores were superior to those of the other three repairs. The average periods of continuation of discomfort for Marcy repair and Lichtenstein repair were 7±16 and 5±1 (days±SD), which were statistically shorter than those of TAPP, AITR, McVay repair and Bassini repair which were 97±186, 69±53, 125±147 and 59±72 respectively (p<0.01). A chronic pain in the groin subsequently developed in three cases (43%) of TAPP which deteriorated QOL. There were no severe complications for the open repairs, but with TAPP there was a case of small bowel obstruction which was indicated for laparotomy and a case of genitofemoral nerve entrapment.<br> Marcy repair for Nyhus type II and Lichtenstein repair for the rest of hernias are recommended in the aforementioned stand point of view. There was no validity in performing TAPP.

収録刊行物

  • 日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society

    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 57(4), 816-823, 1996-04-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10008520312
  • NII書誌ID(NCID)
    AN00198696
  • 本文言語コード
    JPN
  • 資料種別
    ART
  • ISSN
    03869776
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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