Паховые грыжи – эпидемиология, факторы риска, методы лечения (обзор литературы)

Паховые грыжи (ПГ) широко распространены в популяции человека и встречаются у 27–43 % мужчин и 3–6 % женщин. Многие факторы риска ПГ в последнее десятилетие были переоценены: ведущим фактором считается мужской пол (соотношение между мужчинами и женщинами составляет примерно 1:7); менее значимыми факторами являются наследственность (наиболее значима для женщин), физическая нагрузка (более значима для мужчин), возраст (пик распространённости ПГ приходится на возраст 5 лет и 70–80 лет), врождённая или приобретённая дисплазия соединительной ткани, простатэктомия в анамнезе, низкий индекс массы тела. Наиболее популярной методикой хирургической коррекции ПГ остаётся герниопластика с использованием синтетических сетчатых протезов. Выполнение герниопластики без использования протезов рекомендуется только в том случае, если сетчатые протезы недоступны, например, в бедных странах.
При открытой герниопластике с использованием сетчатых протезов сегодня применяются разные методики: Plug & Patch, Prolene Hernia System, Parietene Progrip, бесшовная пластика по Trabucco, Stoppa, предбрюшинные техники TIPP (trans-inguinal pre-peritoneal), TREPP (transrectus pre-peritoneal), TEP (total extraperitoneal), однако ни одна из них не показала существенных преимуществ перед золотым стандартом открытой герниопластики – ненатяжной пластикой по Лихтенштейну.
Лапароскопическая коррекция ПГ представлена методикой TAPP (transabdominal preperitoneal), выполняющейся через брюшную полость, и TEP (total extraperitoneal) – внебрюшинной протезирующей герниопластикой. Ни одна из них не обладает существенным преимуществом в лечении ПГ, поэтому при выборе метода лечения хирург должен руководствоваться стоимостью операции и уровнем владения той или иной техникой герниопластики.

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