探讨成人巨大腹股沟疝手术时横断疝囊位置选择。

选择2014年9月至2016年12月，重庆医科大学附属第一医院巨大腹股沟疝患者127例，通过纳入排除标准，共纳入患者106例，均采用开放Lichtenstein术式，根据疝囊处理的不同方式分为2组：A组紧贴内环处解剖分离并横断疝囊，B组靠近外环附近横断疝囊。观察比较2组手术时间、术中出血量、术后精索及阴囊肿胀、伤口引流、术后慢性疼痛等。

2组均顺利完成手术，B组患者术后精索肿胀[12（23.1%）]、阴囊肿胀[2（3.8%）]、伤口引流量[（69.21±32.16）ml]明显高于A组[4（4.7%）、0、（51.23±25.48）ml]，差异均有统计学意义（P均<0.05）；2种方式手术时间、术中出血、术后慢性疼痛比较，差异均无统计学意义（P均>0.05）。

减少术后腹股沟疝的复发风险，减少患者术后并发症，成人巨大腹股沟疝术中解剖分离及横断疝囊时尽量靠近内环，远端疝囊旷置。

To investigate where is the suitable anatomical locations to cut off in the surgical treatment of adult inguinal hernia with giant hernia sac.

127 patients with giant inguinal hernia sac were selected in the First Affiliated Hospital of Chongqing Medical University from Mar 2014 to Aug 2016. Finally, 106 patients were included. All of them were divided into two groups randomly. All of the selected patients underwent the Lichtenstein's operation. In the group one with 54 patients, we cut off the hernia sac closed to the internal inguinal ring. And in the group two with 52 patents, we cut off the hernia sac closed to the external inguinal ring. Then the operation duration, bleeding volume, edema degree of scrotum, volume of drainage of the incision, and postoperative chronic pain were compared.

All of the operations were completed successfully. Group one had less complications in edema degree of scrotum and volume of drainage of the incision than group two. The result had statistical significance (P<0.05). But the differences of operation duration, intraoperative bleeding and postoperative chronic pain had no statistical significance (P>0.05).

In the operation of inguinal hernia with giant hernia sac, it can result in less complication by cutting off the hernia sac closed to the internal inguinal ring and leaving the distal part of the sac where it was.