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頁籤選單縮合
題名 | The Evolution of Groin Hernioplasty, an Update=鼠蹊部疝氣手術的演進及最新進展 |
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作者姓名(中文) | 黃清水; | 書刊名 | 臺灣外科醫學會雜誌 |
卷期 | 43:6 2010.11-12[民99.11-12] |
頁次 | 頁278-284 |
分類號 | 416.2423 |
關鍵詞 | 鼠蹊部; 疝氣手術; Groin hernia; Tension-free repair; Prosthetic mesh; |
語文 | 英文(English) |
英文摘要 | 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 Most tissue to tissue repairs, which were still popular two decades ago, have now been replaced by open tension-free repairs and endoscopic repairs.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. |
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