成人鼠径ヘルニアのNyhus分類による病態別術式選択法の検討  [in Japanese] SURGICAL PROCEDURE FOR GROIN HERNIAS SELECTED BY THE NYHUS' CLASSIFICATION  [in Japanese]

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Abstract

1995年6月から1997年8月までに行った成人鼠径ヘルニア手術-従来法,Mesh Plug法,腹腔鏡下法に対しNyhus分類別に検討した. Type-I, II症例では術後入院期間,術後鎮痛剤使用回数の術式間較差は少なく,Type-III症例では入院期間,鎮痛剤使用回数で従来法の成績が悪くtension repairの短所が目立った.各術式には長短所があり病態,QOLに従った症例毎の術式選択が必要である.すなわちType-Iでは腹壁補強の必要はなく従来法を行う. Type-IIでは若年者には人工物の使用を控えた従来法を行うが, Type-IIIとの鑑別が難しい場合はMeshによる補強を行う. Type-IIIはMeshによる修復の適応で, Plug法は成績良好であるが,巨大ヘルニアには大きなMeshを用いる腹腔鏡下法が適応となる. Type-IV症例のうち,前方アプローチ後の再発例には腹腔鏡下法を行う.このNyhus分類による術式選択法を採用することにより,術後の成績は改善された.

We have made a nonrandomaized study to compare operative procedure for groin hernias including open conventional, open mesh plug, and laparoscopic mesh hernia repair by types of hernias according to the Nyhus' classification. In type-I and II hernias, there were small difference in duration of postoperative hospital stay and frequency of narcotic analgesics among three procedures. In type-III, the conventional repair required longer postoperative hospital stay and more narcotic analgesics than the mesh plug or laparoscopic technique. Each procedure has both merits and demerits. We employ surgical procedure selected by the condition of hernia and the patient's quality of life. In type-I, the conventional technique is suitable for the patients who don't require repair with prosthetic material. In type-II, the conventional procedure without prosthesis may be the preferred repair in the young patient, while the tension free repair is proper for the hernia close to type-III. The mesh plug repair that turned out good results is indicated in type-III, but for large hernias, the laparoscopic technique that uses a large mesh offers an excellent repair. In type-IV, the laparoscopic repair is appropriate for recurrent hernias after anterior approach. This approach that operative procedure is selected by the Nyhus' classification has produced good postoperative results.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 59(11), 2747-2754, 1998-11-25

    Japan Surgical Association

References:  26

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008437094
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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