腹腔镜疝修补术和疝环填充式无张力疝修补术的临床对比研究
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摘要
背景和目的
腹股沟疝是普外科常见的一种疾病，其手术治疗方法主要有传统的疝修补术(traditional inguinal hernia repair)、低张力疝修补术(low tension inguinal hernia repair)、无张力疝修补术(tension-free inguinal hernia repair)、腹腔镜疝修补术(laparoscopic inguinal hernia repair，LIHP)。后两种术式(主要是疝环填充式无张力疝修补术open mesh--plug in tension free hernia repair和腹腔镜经腹膜前补片植入术transabdominal preperitoneal，TAPP)是近一二十年来出现的新术式，因为创伤小、恢复快、并发症少、复发率低，效果明显优于传统的疝修补术，已经成为现代腹股沟疝修补的主要术式。但是目前对这两种术式进行对比研究的临床资料较少，且多局限在临床和随访两方面的比较，说服力不足，从而对两种术式的优越性和适应证存在着争议。本研究除了对临床和随访两方面进行比较研究外，更是结合客观性强的实验室指标的比较——选择了能够反映出机体易感染性和应激反应程度的三个实验室指标白细胞(White blood cell，WBC)、C—反应蛋白(C-reactive protein，CRP)、白细胞介素—6(Interleukin-6，IL-6)，从多方面来探讨这两种术式(TAPP和疝环填充式无张力疝修补术)各自的优势及不足点，分析各自的适应证，给患者及医师对这两种术式的选择提供较科学、客观、全面的参考依据。
方法
选择2005年6月至2006年12月就诊于郑州大学第一附属医院的50例腹股沟疝的病人(包括腹股沟直疝和腹股沟斜疝)作为研究对象，其中，25例病人(A组)选择腹腔镜疝修补术(腹腔镜组)，25例病人病人(B组)选择疝环填充式无张力疝修补术(开放组)。比较并分析两组病人术前术后多个指标及术后一年的随访资料。观察指标为：实验室指标：血白细胞、C—反应蛋白、白介素—6：2．临床指标：分为计量指标和计数指标，计量指标包括：手术时间、住院时间、术后疼痛时间、正常活动时间、住院费用及术后并发症等；计数指标为两组病例中出现以下情况的例数：皮下或阴囊气肿、血清肿、暂时神经感觉异常、切口感染、切口血肿、血管内脏损伤、尿潴留、屈曲体位：3．随访：术后一年内由病人复诊或电话随访的方式进行。也分为计量指标和计数指标，计量指标包括：正常工作时间、腹股沟区异物感消失时间、腹股沟区硬结消失时间、腹股沟区麻木感消失时间；计数指标为两组病例中出现以下情况的例数：腹股沟区异物感、腹股沟区硬结、腹股沟区麻木感、残存疝囊积液、睾丸萎缩、性功能障碍、下肢静脉血栓形成及疝复发。采用SPSS13.0统计软件包，对计量资料用均数±标准差表示，方差齐者进行两组的t检验，不齐者进行秩和检验，对于计数资料进行x~2检验，对于1≤T(理论频数)≤5采用校正x~2值，以P＜0.05表示两组差异有统计学意义。
结果
两组病人术后WBC、CRP、IL-6都较术前明显升高(P＜0.05)，两组间比较，开放组术后四小时和术后第一天IL-6升高较腹腔镜组明显(P＜0.05)，余实验室指标的差异无统计学意义。腹腔镜组住院时间、下床活动时间、正常活动时间、术后疼痛持续时间都短(P＜0.05)，而开放组手术时间短，住院费用低(P＜0.05)。腹腔镜组有6例出现皮下或阴囊气肿，开放组未出现此并发症(P＜0.05)，余临床检查资料间的差异无统计学意义。A组随访丢失2例病人，有效率为92％，B组随访丢失4例病人，有效率为84％。两组随访资料比较可见，腹腔镜组术后开始正常工作的时间要短于开放组(P=0.045)，余指标间的差异无统计学意义，随访一年两组都未出现腹股沟疝复发。
结论
疝环填充式无张力疝修补术和腹腔镜疝修补术都有创伤小、术后并发症少及复发率低的优点，前者手术时间短、住院费用少，适合首次疝修补的病人。且手术器械要求低，简单易学，可门诊开展。而腹腔镜疝修补术术后应激反应小、疼痛时间短程度轻、住院时间短，更适合复发疝、双侧疝和老年疝病人，并且有美容效果，适合女性病人。但是住院费用高、需要全麻及学习曲线长是其主要缺点。
Background and Objective
Inguinal hernia is a common disease.The surgery therapy of inguinal hernia had experienced several stages: traditional repair, low tension hernia repair, tension-free hernia repair(the major format is mesh—plug in tension free hernia repair)and laparoscopic inguinal hernia repair(the major format is transabdominal preperitoneal TAPP). The two later operations are new formats in reccent years, which have advantages over traditional repair in effect and have been the popularized operations in inguinal hernia repair because of little ravage, quick recovery, few complication and low recurrence rate. However now there are few comparative reports between those two formates, and the most reports are limited in clinic and follow-up survey, offering weak persuasive conclusion. there is contentious about which is more advantaged. We compared the two operation and postoperative results, especially more objective laboratory index—WBC、CRP、IL-6, which can reflect the infection and stress reaction in body after operation in order to discuss the superiority, deficiency and indication of those two formates, provide scientific and objective reference to general sergeons and patients.
Method
50 patients in the First Affiliated Hospita of Zhengzhou University were selected as investigated objects. 25 patients ( group A ) were repaired with TAPP, 25 cases ( group B ) were repaired with mesh—plug in tension free hernia repair. Compare and analyse the two operation and postoperative results and follow-up survey one year after operation. The vital point : (1) laboratory index: WBC, CRP, IL-6; (2) clinic index: operation time, duration time in hospital, pain lasting time, normal activity time, complication, et al; (3) follow-up survey index: normal work time, disappeared time of inguinal discomfort, spermary atrophy and hernia recurrence, et al. t-test was used to analyze the quantity data and x~2 test was used to analyze the quality data by the SPSS 13.0 statistic soft ware pack.
Results
After operation WBC, CRP, IL-6 of all patients increased(P<0.05). Between those two groups, IL-6'increasing in group A is distinct compared with group B(P< 0.05)at 4 hours and 1 day after operation. The difference of the other laboratory indexs have no statistics meanings. Duration time in hospital, the first activity time under bed, normal activity time, normal work time, pain lasting time in group B are shorter than those in group A(P<0.05). Operation time, price in hospital in group B are shorter(P<0.05). There are 6 cases with skin or scrotum emphysema in group A, whereas 0 cases with those complications in group B(P<0.05). The difference of the other clinic indexs have no statistics meanings. Besides normal work time, the other difference of follow-up survey indexs have no statistics meanings. During one year after operation, no case appear hernia recurrence in two groups after one year.
Conclusion
Mesh—plug in tension free hernia repair and laparoscopic inguinal hernia repair are both preponderant in little ravage, few complication and low recurrence rate. The formor with shorter operation time and little price in hospital, suits the first operation patients. The later has little stress reaction, shorter pain lasting time and duration time in hospital after operation, so it suits recurrence hernias, double sides hernias and old patients with inguinal hernia. but it has the shortercoming of inhalation anesthetics and long learning time.
腹股沟疝是普外科常见的一种疾病，其手术治疗方法主要有传统的疝修补术(traditional inguinal hernia repair)、低张力疝修补术(low tension inguinal hernia repair)、无张力疝修补术(tension-free inguinal hernia repair)、腹腔镜疝修补术(laparoscopic inguinal hernia repair，LIHP)。后两种术式(主要是疝环填充式无张力疝修补术open mesh--plug in tension free hernia repair和腹腔镜经腹膜前补片植入术transabdominal preperitoneal，TAPP)是近一二十年来出现的新术式，因为创伤小、恢复快、并发症少、复发率低，效果明显优于传统的疝修补术，已经成为现代腹股沟疝修补的主要术式。但是目前对这两种术式进行对比研究的临床资料较少，且多局限在临床和随访两方面的比较，说服力不足，从而对两种术式的优越性和适应证存在着争议。本研究除了对临床和随访两方面进行比较研究外，更是结合客观性强的实验室指标的比较——选择了能够反映出机体易感染性和应激反应程度的三个实验室指标白细胞(White blood cell，WBC)、C—反应蛋白(C-reactive protein，CRP)、白细胞介素—6(Interleukin-6，IL-6)，从多方面来探讨这两种术式(TAPP和疝环填充式无张力疝修补术)各自的优势及不足点，分析各自的适应证，给患者及医师对这两种术式的选择提供较科学、客观、全面的参考依据。
方法
选择2005年6月至2006年12月就诊于郑州大学第一附属医院的50例腹股沟疝的病人(包括腹股沟直疝和腹股沟斜疝)作为研究对象，其中，25例病人(A组)选择腹腔镜疝修补术(腹腔镜组)，25例病人病人(B组)选择疝环填充式无张力疝修补术(开放组)。比较并分析两组病人术前术后多个指标及术后一年的随访资料。观察指标为：实验室指标：血白细胞、C—反应蛋白、白介素—6：2．临床指标：分为计量指标和计数指标，计量指标包括：手术时间、住院时间、术后疼痛时间、正常活动时间、住院费用及术后并发症等；计数指标为两组病例中出现以下情况的例数：皮下或阴囊气肿、血清肿、暂时神经感觉异常、切口感染、切口血肿、血管内脏损伤、尿潴留、屈曲体位：3．随访：术后一年内由病人复诊或电话随访的方式进行。也分为计量指标和计数指标，计量指标包括：正常工作时间、腹股沟区异物感消失时间、腹股沟区硬结消失时间、腹股沟区麻木感消失时间；计数指标为两组病例中出现以下情况的例数：腹股沟区异物感、腹股沟区硬结、腹股沟区麻木感、残存疝囊积液、睾丸萎缩、性功能障碍、下肢静脉血栓形成及疝复发。采用SPSS13.0统计软件包，对计量资料用均数±标准差表示，方差齐者进行两组的t检验，不齐者进行秩和检验，对于计数资料进行x~2检验，对于1≤T(理论频数)≤5采用校正x~2值，以P＜0.05表示两组差异有统计学意义。
结果
两组病人术后WBC、CRP、IL-6都较术前明显升高(P＜0.05)，两组间比较，开放组术后四小时和术后第一天IL-6升高较腹腔镜组明显(P＜0.05)，余实验室指标的差异无统计学意义。腹腔镜组住院时间、下床活动时间、正常活动时间、术后疼痛持续时间都短(P＜0.05)，而开放组手术时间短，住院费用低(P＜0.05)。腹腔镜组有6例出现皮下或阴囊气肿，开放组未出现此并发症(P＜0.05)，余临床检查资料间的差异无统计学意义。A组随访丢失2例病人，有效率为92％，B组随访丢失4例病人，有效率为84％。两组随访资料比较可见，腹腔镜组术后开始正常工作的时间要短于开放组(P=0.045)，余指标间的差异无统计学意义，随访一年两组都未出现腹股沟疝复发。
结论
疝环填充式无张力疝修补术和腹腔镜疝修补术都有创伤小、术后并发症少及复发率低的优点，前者手术时间短、住院费用少，适合首次疝修补的病人。且手术器械要求低，简单易学，可门诊开展。而腹腔镜疝修补术术后应激反应小、疼痛时间短程度轻、住院时间短，更适合复发疝、双侧疝和老年疝病人，并且有美容效果，适合女性病人。但是住院费用高、需要全麻及学习曲线长是其主要缺点。
Background and Objective
Inguinal hernia is a common disease.The surgery therapy of inguinal hernia had experienced several stages: traditional repair, low tension hernia repair, tension-free hernia repair(the major format is mesh—plug in tension free hernia repair)and laparoscopic inguinal hernia repair(the major format is transabdominal preperitoneal TAPP). The two later operations are new formats in reccent years, which have advantages over traditional repair in effect and have been the popularized operations in inguinal hernia repair because of little ravage, quick recovery, few complication and low recurrence rate. However now there are few comparative reports between those two formates, and the most reports are limited in clinic and follow-up survey, offering weak persuasive conclusion. there is contentious about which is more advantaged. We compared the two operation and postoperative results, especially more objective laboratory index—WBC、CRP、IL-6, which can reflect the infection and stress reaction in body after operation in order to discuss the superiority, deficiency and indication of those two formates, provide scientific and objective reference to general sergeons and patients.
Method
50 patients in the First Affiliated Hospita of Zhengzhou University were selected as investigated objects. 25 patients ( group A ) were repaired with TAPP, 25 cases ( group B ) were repaired with mesh—plug in tension free hernia repair. Compare and analyse the two operation and postoperative results and follow-up survey one year after operation. The vital point : (1) laboratory index: WBC, CRP, IL-6; (2) clinic index: operation time, duration time in hospital, pain lasting time, normal activity time, complication, et al; (3) follow-up survey index: normal work time, disappeared time of inguinal discomfort, spermary atrophy and hernia recurrence, et al. t-test was used to analyze the quantity data and x~2 test was used to analyze the quality data by the SPSS 13.0 statistic soft ware pack.
Results
After operation WBC, CRP, IL-6 of all patients increased(P<0.05). Between those two groups, IL-6'increasing in group A is distinct compared with group B(P< 0.05)at 4 hours and 1 day after operation. The difference of the other laboratory indexs have no statistics meanings. Duration time in hospital, the first activity time under bed, normal activity time, normal work time, pain lasting time in group B are shorter than those in group A(P<0.05). Operation time, price in hospital in group B are shorter(P<0.05). There are 6 cases with skin or scrotum emphysema in group A, whereas 0 cases with those complications in group B(P<0.05). The difference of the other clinic indexs have no statistics meanings. Besides normal work time, the other difference of follow-up survey indexs have no statistics meanings. During one year after operation, no case appear hernia recurrence in two groups after one year.
Conclusion
Mesh—plug in tension free hernia repair and laparoscopic inguinal hernia repair are both preponderant in little ravage, few complication and low recurrence rate. The formor with shorter operation time and little price in hospital, suits the first operation patients. The later has little stress reaction, shorter pain lasting time and duration time in hospital after operation, so it suits recurrence hernias, double sides hernias and old patients with inguinal hernia. but it has the shortercoming of inhalation anesthetics and long learning time.
引文
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5 Ger R.The management of certain abdominal herniae by intra-abdominal closure of the neck the sac. Ann R Coll Surg ENGL, 1982, 64(95): 342-344
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15 Stoppa RE. The treatment of complicated groin and incisional hernias. Wotrld [J] Surg, 1989, 13(5): 545-554
16 Robbins AW, RutkowIM. Mesh plug repair and groin hernia surgery. Surg Clin North Am, 1998, 78(6): 1007-1021
17 朱健．腹股沟疝无张力修补的认识进展．实用医学杂志，2005，21(2)：215-216
18 姜海平，汤汉林，杨冠群，等．腹股沟疝的个体化治疗与疝环充填式无张力疝修补术．中国综合临床，2003，19(7)：652-653
19 代永金．填充填充式无张力腹股沟疝修补术31例临床体会．基层医学论坛，2006，10(3)：259
20 Ger R. The management of certain abdominal herniae by intra-abdominal closure of the neck the sac. Ann R Coll Surg ENGL, 1982, 64(5): 342-344
21 Shultz L S, Graber J, P ietrafitta J, et al. L aser laparoscopic herniorrhaphy: A clinical trial preliminary results. Laparoendosc Surg, 1990, 1 : 41-45
22 李宇洲，梁健升，姚干，等．腹腔镜疝环口缝扎附加网片复盖治疗成人疝．中国微创外科杂志，2002，2(4)：224-225
23 姜希宏，张楠，胡三元．腹腔镜疝修补术的进展和评价．腹腔镜外科杂志，1998，3(1)：54-55
24 Mckerna JB, Laws HL. Lapatoscopic repair of inguinal herias using a totally extraperitoneal prosthetic approach. Surg Endosc, 1993, 7(1): 26-28
25 刘宁．腹腔镜疝修补术．腹部外科，1999，12(1)：47-48
26 王存川，胡友主，等．完全腹腔外腹腔镜疝修补术16例报告．中国微创外科杂志，2002，2(6)：404-405
27 王存川，乔巨峰，李谦，等．腹腔镜腹股沟疝修补术50例临床分析．中国实用外科杂志，2002，21(2)：88-90
28 滕小平，洪晓明，周连帮，等．腹腔镜成人腹股沟疝修补术28例报告．中国实用医学，2006，18(2)：94-95
29 常晓健，师天雄，何荣佳，等．腔镜下腹腔内植入式与开放无张力疝修补术的对比研究．医师进修杂志，2005，28(6)：16-18
30 麻勇．腹腔镜腹股沟疝手术治疗研究进展．中国微创外科杂志，6(2)：150-152
31 李健文．腹腔镜技术在腹股沟疝修补术中的应用．外科理论与实践，2005，15(2)：121-123
32 Sayad P, Hallak A, Ferzli G. Laparosocopic herniorrhaphy: revidw of complications and recurrence[J]. Laparoendose Adv Surg Tech A, 1998, 8(1): 3-10
33 Bringman S, Blomqvist P. Intsetinal obstruction after ingulinal and femoral heinia repair a study of 33275 operations during 1992-2000. Sweden.Hemia, 2005, (2): 178-183
34 李健文，郑民华．腹腔镜腹股沟疝修补术的临床应用与评价．中国用外科杂志，2005，25(10)：602-604
35 Kald A, Anderberg B, Smedh K, et al. Transperitoneal or totally extraperitoneal approach in laparoscopic hernia repair: results of 491 consecutive herniorrhaphies. Surg Laparoscendosc, 1997, 7:86-91
36 郑民华，李健文．腹腔镜腹股沟疝修补术中的若干问题探讨．腹部外科，2004，17(1)：11-12
37 Philips EH, Rosenthal R, Fallas M, et al. Reasons for early recurrence following laparoscopic hernioplasty. Surg En-dose, 1995, 9(2): 140-145
38 赵甦，张豫峰．腹腔镜下复发性腹股沟疝修补术体会．中原医刊，2006，33(7)：30-31
39 刘嘉林，周汉新，余小舫，等．腹腔镜腹股沟疝修补术的应用解剖学研究．中国临床解剖学杂志，2005，23(6)：620-622
40 Neumayer L, Jonasson O. Open mesh versus laparoscopic mesh repair of inguinal hemia. N Engl J Med, 2004, 350(18): 1819-1827
41 Lal P, Kajla PK.Laparoscopic total extraperitoneal (TEP) inguinal hernia repair overcoming the learning curve. Surg Endose, 2004, 18(4): 64-64
42 Stoppa R, Moungar F, Henry X. The repair of inguinal hemia with a large Dacron-mesh prosthesis and the preperitoncal approach. Ann-Ital Chir, 1993,64(2): 69-75
43 Wantz-GE. Giant puosthetic reinforcement of the visceralsac. Surg-Gyneecil-Obstet. 1989, 169(5): 408-417
44 Rutlow-IM. The recurrence rate in hernia suigery. How important is it? Arch-Surg, 1995, 130(6): 575-576
45 Ferrante F, Rusconi A, Galimberti A, et al. Hernia repair in the Lombardy region in 2000: Preliminary results[J]. Hernia, 2004, 8(3): 247-251
46 Deysine-M. Hernia repair with expanded polytera fluoroethylene. Arn-J-Surg.1992, 1634(4): 422-424
47 李忠德，陈剑锋．自身筋膜补片，无张力腹股沟疝修补术．临床经验谈，2006，8(130)：34
2 王涛，黎沾良．腹股沟疝手术神经损伤的预防和治疗．中国实用外科杂志，2001，21(2)：68-70．
3 Lichtenstein IL, Shulman AG. The"tension free" herniorrhaphy. Am J Surg, 1989, 157(2): 188-193
4 Robbins AW, Rutkow IM. Mesh plug repair and groinhemia surgery. Surg Clin NorthAm, 1998, 78(6): 1007-1021
5 Ger R.The management of certain abdominal herniae by intra-abdominal closure of the neck the sac. Ann R Coll Surg ENGL, 1982, 64(95): 342-344
6 吴肇汉．无张力疝修补术-疝修补手术的新趋势．中国实用科杂志，2001，21(2)：65．
7 徐华．手术应激反应研究进展．《国外医学》麻醉学与复苏分册，2003，24(5)：278-281
8 YO shilhagga,Toru Beppu, Kouichi Doi,et al. Systemic inflam-matory response syndrome and organ dysfunction following gastrointestinal surgery. Crit Care Med, 1997, 25:1994-2000
9 张加林，沙树贞，南芳芳．白介素26及相关因子在腹部手术损伤中的变化．滨州医学院学报，2002，25(3)：205-206
10 Palosuo T, Husman T, Koistinen J, et al. C - reactive protein in population samples. Acta Med Scand ,1986, 220:175
11 毕涉，高骥援主编．炎症与抗炎症药．北京：人民卫生出社，1993，379-382．
12 陈国强，于方，刘宏．C-反应蛋白水平的变化及其在监测骨科术后感染中的临床意义．铁道医学，1999，27(2)：74-76
13 Takahara T, Uyama I, Ogivara H, et al. nflammatory responses in open versus laparoscopic hemiorrhaphy [J]. Laparoendosc Surg, 1995, 5:317
14 Edwards C C, Bailey RW. Laparoscopic Hernia Repair the Learning. Curve[J].Surg Laparosc Endosc Perutan Tech, 2000, 10(3): 149-153
15 Sayad P, Hallak A, Ferzli G. Laparosocopic herniorrhaphy: revidw of complications and recurrence. Laparoendose Adv Surg Tech A, 1998, 8(1): 3-10
16 谢汝伦，高海雄，马华兴．腹腔镜与腹股沟切口行无张力疝修补术的疗效对比．海南医学，2005，16(120)：17-19
17 宝庆，傅振彬，王海东．疝环充填式无张力疝修补术治疗腹股沟会．黑龙江学，2006，30(4)：265-266
18 Chumpelick V, Klinge U, Welty G, et al. Meshes inder Bauchwand. Chirurg, 1999,70(8): 265-266
19 Bilich RC, Mcsherry CK. Spermatic granuoma an uncommon complication of the tension-free hennia repair. Surg Endosc, 1996, 10:537-539
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21 陈伟，孙毅群，艾雪松等．腹股沟疝无张力修补术后睾丸血流和男性功能的观察．天津医药，2006，34(4)：276-277
22 时德，赵渝．疝环充填式无张力腹股沟疝修补术后复发原因探讨[J]．外科理论与实践，2002，7(6)：456-458
23 侯东生，刘衍民，孙北望．腹腔镜下腹股沟疝修补术．中国内镜杂志，1998，4(4)：57
24 Ger R. The management of certain abdominal herniae by intra-abdominal closure of the neck the sac. Ann R Coll Surg ENGL 1982, 64(5): 342-344
1 Rutkow IM. Epidemicol giceconomic and sociologica spects of United States in the 1990. Surg Clin North Am, 1998, 78(7): 941
2 Rutkow IM ,Robbin AW. Classification systems and groin hernias.Surgical Clinics of North America, 1998, 78:11-17.
3 马颂章．腹股沟疝的分类和临川意义．腹部外科，2004 17(1)：6-8
4 Stoppa R, Hee RV. surgical anatomy of the grain region. Acta Char Belg, 1998, 98:124-126
5 Fruchard H. Anatomie chirurgicale des hernies de I'aine. Paris: G. Doin, 1956
6 Spaw AT, Ennis BW, Spaw LP. Laparoscopic hernia repair: The anatomic basis. J Laparoendosc surg, 1991, 1 (5): 269-277
7 Bendavid, Jack Abrahamson, Arregui ME, et al. eds, Sbdominal wall heniasprin and management M. Mew York: Springer Verlag, 2001:133-141
8 陈双，朱亮民，傅玉如．成人腹股沟区腹横筋膜胶原含量变化与腹股沟疝发病及复发的关系[J]．外科理论与实践，2002，7(6)：423-425
9 陈双．谈腹股沟疝成因学说的新认识．外科理论与实践，2005，10(2)：115-116
10 Lilly MC, Arregui ME. Lipomas of the cord and round ligam-ent[J]. Ann Surg, 2002, 235(4): 586-590 .
11 Lichtenstein IL, Shulman AG. The"tension free"herniorraphy. Am J Surg, 1989, 157(2):188-193
12 吴肇汉．无张力疝修补术--疝修补手术的新趋势．中国实用科杂志，2001，21(2)：65
13 Lichtenstein IL, Herniorrhaphy: a personal experience with 6321 case. Am J Surg, 1987, 153(6): 553-559
14 Rutkow IM, Robbins AW. "Tension free" inguinal herniorrahaphy: a preliminary report on the "mesh-plug" Technique. urgery, 1993, 114(1): 3-8
15 Stoppa RE. The treatment of complicated groin and incisional hernias. Wotrld [J] Surg, 1989, 13(5): 545-554
16 Robbins AW, RutkowIM. Mesh plug repair and groin hernia surgery. Surg Clin North Am, 1998, 78(6): 1007-1021
17 朱健．腹股沟疝无张力修补的认识进展．实用医学杂志，2005，21(2)：215-216
18 姜海平，汤汉林，杨冠群，等．腹股沟疝的个体化治疗与疝环充填式无张力疝修补术．中国综合临床，2003，19(7)：652-653
19 代永金．填充填充式无张力腹股沟疝修补术31例临床体会．基层医学论坛，2006，10(3)：259
20 Ger R. The management of certain abdominal herniae by intra-abdominal closure of the neck the sac. Ann R Coll Surg ENGL, 1982, 64(5): 342-344
21 Shultz L S, Graber J, P ietrafitta J, et al. L aser laparoscopic herniorrhaphy: A clinical trial preliminary results. Laparoendosc Surg, 1990, 1 : 41-45
22 李宇洲，梁健升，姚干，等．腹腔镜疝环口缝扎附加网片复盖治疗成人疝．中国微创外科杂志，2002，2(4)：224-225
23 姜希宏，张楠，胡三元．腹腔镜疝修补术的进展和评价．腹腔镜外科杂志，1998，3(1)：54-55
24 Mckerna JB, Laws HL. Lapatoscopic repair of inguinal herias using a totally extraperitoneal prosthetic approach. Surg Endosc, 1993, 7(1): 26-28
25 刘宁．腹腔镜疝修补术．腹部外科，1999，12(1)：47-48
26 王存川，胡友主，等．完全腹腔外腹腔镜疝修补术16例报告．中国微创外科杂志，2002，2(6)：404-405
27 王存川，乔巨峰，李谦，等．腹腔镜腹股沟疝修补术50例临床分析．中国实用外科杂志，2002，21(2)：88-90
28 滕小平，洪晓明，周连帮，等．腹腔镜成人腹股沟疝修补术28例报告．中国实用医学，2006，18(2)：94-95
29 常晓健，师天雄，何荣佳，等．腔镜下腹腔内植入式与开放无张力疝修补术的对比研究．医师进修杂志，2005，28(6)：16-18
30 麻勇．腹腔镜腹股沟疝手术治疗研究进展．中国微创外科杂志，6(2)：150-152
31 李健文．腹腔镜技术在腹股沟疝修补术中的应用．外科理论与实践，2005，15(2)：121-123
32 Sayad P, Hallak A, Ferzli G. Laparosocopic herniorrhaphy: revidw of complications and recurrence[J]. Laparoendose Adv Surg Tech A, 1998, 8(1): 3-10
33 Bringman S, Blomqvist P. Intsetinal obstruction after ingulinal and femoral heinia repair a study of 33275 operations during 1992-2000. Sweden.Hemia, 2005, (2): 178-183
34 李健文，郑民华．腹腔镜腹股沟疝修补术的临床应用与评价．中国用外科杂志，2005，25(10)：602-604
35 Kald A, Anderberg B, Smedh K, et al. Transperitoneal or totally extraperitoneal approach in laparoscopic hernia repair: results of 491 consecutive herniorrhaphies. Surg Laparoscendosc, 1997, 7:86-91
36 郑民华，李健文．腹腔镜腹股沟疝修补术中的若干问题探讨．腹部外科，2004，17(1)：11-12
37 Philips EH, Rosenthal R, Fallas M, et al. Reasons for early recurrence following laparoscopic hernioplasty. Surg En-dose, 1995, 9(2): 140-145
38 赵甦，张豫峰．腹腔镜下复发性腹股沟疝修补术体会．中原医刊，2006，33(7)：30-31
39 刘嘉林，周汉新，余小舫，等．腹腔镜腹股沟疝修补术的应用解剖学研究．中国临床解剖学杂志，2005，23(6)：620-622
40 Neumayer L, Jonasson O. Open mesh versus laparoscopic mesh repair of inguinal hemia. N Engl J Med, 2004, 350(18): 1819-1827
41 Lal P, Kajla PK.Laparoscopic total extraperitoneal (TEP) inguinal hernia repair overcoming the learning curve. Surg Endose, 2004, 18(4): 64-64
42 Stoppa R, Moungar F, Henry X. The repair of inguinal hemia with a large Dacron-mesh prosthesis and the preperitoncal approach. Ann-Ital Chir, 1993,64(2): 69-75
43 Wantz-GE. Giant puosthetic reinforcement of the visceralsac. Surg-Gyneecil-Obstet. 1989, 169(5): 408-417
44 Rutlow-IM. The recurrence rate in hernia suigery. How important is it? Arch-Surg, 1995, 130(6): 575-576
45 Ferrante F, Rusconi A, Galimberti A, et al. Hernia repair in the Lombardy region in 2000: Preliminary results[J]. Hernia, 2004, 8(3): 247-251
46 Deysine-M. Hernia repair with expanded polytera fluoroethylene. Arn-J-Surg.1992, 1634(4): 422-424
47 李忠德，陈剑锋．自身筋膜补片，无张力腹股沟疝修补术．临床经验谈，2006，8(130)：34