改良Kugel腹股沟疝修补术治疗腹股沟疝的探讨

目的 探讨改良Kugel腹股沟疝修补术在腹股沟疝治疗中的理论基础和临床应用价值。方法采用Bard Modified Kugel Hernia Patch（内存记忆弹力环改良Kugel补片）行改良Kugel腹股沟疝修补术腹股沟疝102例，以手术时间、术后患者自主能力的恢复、并发症的发生、复发率及术后住院时间作比较。结果手术时间45～110min，平均55min。术后2～6h患者即可起床活动和进食，切口疼痛和不适轻，无明显异物感，活动时腹股沟区无牵拉感，无并发症，平均住院时间5d。随访无1例复发。结论改良Kugel腹股沟疝修补术是应用经腹股沟管前入路行腹膜前腹股沟疝修补的技术，针对耻骨肌孔进行修补，利于解决耻骨肌孔结构薄弱及缺损这一腹股沟疝发生的解剖学基础，具有手术彻底、术后恢复快、并发症少、复发率低的优点，从根本上解决腹股沟疝患者多种疝并存及容易复发的病理生理特点，是目前腹股沟疝治疗中较理想的手术方式。     

Kugel补片在老年复发性腹股沟疝修补术中的应用

目的探讨Kugel补片在治疗老年复发性腹股沟疝中的应用价值。方法回顾性分析2004年12月～2006年12月收治的27例使用Kugel补片的复发性腹股沟疝患者的临床资料，观察手术时间、术后并发症、留院时间及随访的情况。结果全部患者治愈出院。手术时间40—70min，平均45min。术后平均1天下床活动，平均住院天数6．5天。术后伤口均一期愈合，无切口感染。术后疼痛轻微，仅2例使用止痛剂。术后并发尿潴留4例，切口脂肪液化2例。随访6～30个月，无复发。结论应用Kugel补片治疗老年性复发性腹股沟疝操作简便，并发症少，效果良好。     

改良Kugel 补片修补腹股沟疝106 例临床诊治分析

目的：总结改良式Kugel 补片法前、后入路行腹膜前修补腹股沟疝的临床操作体会及疗效。 方法：回顾性分析2008 年9 月—2010 年6 月采用改良式 Kugel 补片前、后入路腹膜前修补腹股 沟疝106 例临床资料。其中采用局部麻醉30 例, 连续硬膜外麻醉手术76 例。前入路42 例,后入 路64 例。 结果：平均手术时间(50±12) min,切口全部一期愈合,平均住院时间(4.3±1.5)d。手术后随访 1~12 个月, 无复发。 结论：采用改良式 Kugel 补片前后入路行腹膜前腹股沟疝修补术安全有效、术后恢复快、并发症少, 复发率低。并且开放式后入路较前入路方法更优。该手术方法较腹腔镜经腹腔途径腹膜前补片置 入术及全腹膜外补片修补术更具有推广意义。     

改良Kugel补片前入路腹膜前修补腹股沟疝(附35例报告)

目的 探讨改良Kugel补片前入路腹膜前修补腹股沟疝效果. 方法 2004年5月～2006年6月,应用改良Kugel补片修补腹股沟疝35例.手术要点：疝囊高位游离后将其翻转还纳腹腔,围绕内环口游离一个10 cm×10 cm的腹膜前间隙,将改良Kugel补片置于游离的腹膜前间隙,用2-0的Prolene线将固定带的上瓣固定于联合腱,下瓣固定在腹股沟韧带反折处. 结果 手术时间（47±10）min,术后均未使用止痛剂,术后住院天数（6±4）d.全组伤口一期愈合,无伤口浆液肿及感染发生.35例术后随访1～25个月,平均13.2月,其中26例随访＞12个月,无复发. 结论 改良Kugel补片修补腹股沟疝具有伤口疼痛和肿胀轻的优点, 特别适合Ⅲ、Ⅳ型疝修补.     

腹股沟疝治疗中改良Kugel修补术与Lichtenstein修补术的选择

目的探讨腹股沟疝手术中改良Kugel修补术与Lichtenstein修补术的临床选择。方法回顾性分析2014年2月~2015年8月149例腹股沟疝患者临床资料,其中Ⅰ型2例,Ⅱ型12例,Ⅲ型119例,Ⅳ型16例;直疝50例,斜疝99例;均采用改良Kugel修补术(改良Kugel组)。以同期行Lichtenstein修补术治疗的171例腹股沟疝患者(Lichtenstein组)作为对照,其中Ⅰ型4例,Ⅱ型13例,Ⅲ型141例,Ⅳ型13例;直疝60例,斜疝111例。结果两组患者均顺利完成手术。改良Kugel组手术时间较Lichtenstein组短,差异有统计学意义(P0.05);而两组术后补片感染率、阴囊水肿率比较均无统计学差异(P0.05)。所有患者均获随访,随访时间平均13.5(6~24)个月。改良Kugel组与Lichtenstein组腹肌沟疝复发率分别为0.67%和4.68%,均为Ⅲ、Ⅳ型患者,组间比较差异有统计学意义(P0.05)。结论对于Ⅰ、Ⅱ型腹股沟疝患者,改良Kugel修补术与Lichtenstein修补术均可达到满意的疗效,而对于Ⅲ、Ⅳ型患者则更宜选择改良Kugel修补术。     

局部神经阻滞下腹膜前修补治疗有并发症的老年腹股沟疝40例

目的探讨局部神经阻滞麻醉下使用巴德改良Kugel补片对伴有并发症的老年腹股沟疝患者行前入路腹膜前间隙无张力修补的临床经验和疗效。方法回顾分析2012年1月至2014年6月华中科技大学同济医学院附属协和医院胃肠外科收治的40例伴有并发症的老年腹股沟疝使用巴德改良Kugel补片进行局部神经阻滞麻醉下前入路腹膜前间隙无张力修补的病例资料。结果本组患者局部神经阻滞麻醉均成功,麻醉效果满意,手术过程顺利,单侧疝手术时间30~55 min,平均40 min。术后平均住院时间4.5 d,术后随访8~38个月,无感染、慢性疼痛及复发。结论对于术前评估不能耐受全身麻醉或合并有多种基础疾病的老年患者,局部神经阻滞麻醉下应用改良Kugel补片行前入路腹膜前间隙修补是一种安全、有效的手术方式,患者耐受性好,并发症少、术后恢复快、复发率低,值得推广。     

改良Kugel手术在复发性腹股沟疝中的应用

目的探讨改良Kugel手术在复发性腹股沟疝中的应用。方法采用改良Kugel手术治疗34例复发性腹股沟疝,观察手术时间,住院时间,术后并发症等。结果所有患者均完成改良Kugel手术,其中33例在局麻下完成,1例在持续硬膜外麻醉下完成,平均手术时间(54.3±13.6)min,平均住院时间(5.2±1.9)d,1例术后出现尿潴留,3例出现阴囊积液,所有患者随访时间内无复发及伤口感染。结论采用改良Kugel补片进行复发疝修补术安全、有效,是一种值得推广的手术方式。     

改良Kugel补片治疗再发股疝的价值探讨

目的探讨改良Kugel补片在无张力斜疝修补术后再发股疝中的应用价值。方法对21例无张力斜疝修补术后再发股疝患者采用改良Kugel补片修补,观察手术时间、术后并发症及复发情况。结果本组患者均治愈,平均手术时间69（60—120）min。术后疼痛轻,2例出现阴囊积液,经多次穿刺抽吸后缓解。术后无切口感染,平均随访18．6（2～24）个月,无疝复发。结论改良Kugel补片腹膜前修补术治疗无张力斜疝修补术后再发股疝是一种安全、有效的手术方式,值得推广。     

局麻下应用改良Kugel补片治疗腹股沟疝34例体会

目的总结局麻下改良Kugel补片在腹股沟疝修补术中的应用体会。方法对2007年6月至2009年6月应用改良Kugel补片在局麻下行腹股沟疝无张力修补术34例患者的临床资料进行回顾性总结。结果本组患者手术过程顺利,麻醉效果好,术后疼痛轻,手术时间35～70min,平均45min,术后住院天数3～7d,平均4d。术后随访无复发。结论局麻下应用改良Kugel实施腹股沟疝无张力修补术可行性好,该方式具有简单、安全、患者耐受性好、并发症少、术后恢复快等优点,局麻下手术尤其适合于合并其它慢性疾病的老年腹股沟疝患者。     

局部麻醉下腹股沟疝腹膜前间隙Kugel补片无张力修补术的疗效

目的总结局部麻醉下Kugel补片用于腹股沟疝腹膜前间隙无张力修补术的临床疗效。 方法回顾性分析2014年1月至2016年12月,台州市立医院收治的146例成人Kugel补片无张力修补腹股沟疝病例,观察手术时间、术后离床活动时间、进食时间、术后并发症、术后住院天数等。 结果本组患者手术平均时间单侧为52 min（32～96 min）,双侧为90 min（70～125 min）。术后回病房后即可进食,伤口无明显疼痛,手术当天即可离床活动。平均住院日4.5 d。术后尿潴留6例,切口感染1例,血清肿2例,腹股沟慢性疼痛1例,均经对症处理痊愈。无补片感染、下肢深静脉血栓等并发症发生。随访4～40个月无复发。 结论局部麻醉下应用Kugel补片实施腹膜前间隙腹股沟疝无张力修补术安全可行,适合进行日间手术。     

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??Modified Kugel patch anterior preperitoneal repair of inguinal hernia SHEN Yang??XU Han-bin??LV Ren-geng??et al. Department of General Surgery, Hubei Xinhua Hospital, Wuhan 430015, China
Corresponding author??HE Xiao-jun??E-mail??393919518@qq.com
Abstract Objective To explore the effect and experience of modified Kugel patch anterior preperitoneal repair of inguinal hernia. Methods The clinical data of 280 cases of modified Kugel patch anterior preperitoneal tension-free repair of inguinal hernia performed from March 2008 to October 2012 in Hubei Xinhua Hospital were analyzed retrospectively. The operation time, wound pain, hospitalization time, complications and recurrence rate were studied. Results The operation time was 35-65min, and the average was 45min. Out of bed activity occurred in postoperative 1 day. Ten cases used analgesics postoperatively. Postoperative hospitalization time was 3-5 days. The whole group of incision was primary healing without infection. There were 12 cases of scrotal edema and 2 cases of cyanosis around incision. During the follow-up of 6 months to three years no complaints occurred and recurrence occurred in 1 case. Conclusion Because the weak and defective pectineus pore structure is the anatomic cause of inguinal hernia??the modified Kugel technique for inguinal hernia repair is the ideal mode of operation at present.     

前入路腹膜前Kugel补片修补治疗腹股沟疝

目的 探讨腹膜前Kugel补片修补腹股沟疝的疗效。方法 总结2004年4月至2005年5月应用Kugel补片行开放性腹膜前修补治疗腹股沟疝24例的临床资料。结果 手术时间35-55m,平均40m。术后6-12h下床活动,无尿潴留、切口积血、切口感染等并发症。术后随访1～12个月,无复发。结论 腹膜前放置Kugel补片修补腹股沟疝技术是一种创伤小、无张力、安全、术后恢复快的治疗方法。     

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??Clinical analysis of lumbar hernia tension-free repair through retroperitoneal space: A report 7 cases LIN Rong-gui, HUANG He-guang, CHEN Yan-chang, et al. Department of General Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China
Corresponding author: HUANG He-guang, E-mail??koomp@sina.com
Abstract Objective To evaluate the clinical experience of lumbar hernia tension-free repair with a Kugel patch through retroperitoneal space. Methods The clinical data of 7 cases of lumbar hernia tension-free repair with a Kugel patch through retroperitoneal space performed from December, 2008 to December, 2015 in Department of General Surgery, Union Hospital, Fujian Medical University were analyzed retrospectively. Follow-up was performed through outpatient service or telephone interview till June, 2016. Postoperative complications were summarized and the clinical effectiveness of the procedure was analyzed. Results Seven cases underwent lumbar hernia repair smoothly under general anesthesia, 5 cases with a 11 cm×14 cm Kugel patch and 2 cases with a 14 cm×17 cm one. Transfixing stitches were adapted in order to ensure the positioning of the mesh. The mean operative time was 65.2 min. Mean blood loss was 45.5 mL. A closed drainage tube was routinely placed in front of the patch with a mean removal time of 3.6 days. Early ambulation was encouraged with no limit to anesthesia. A semi-liquid diet was then restored 6 hours after the operation and pressure dressing was routinely adapted till 3 months after the operation. The mean length of postoperative hospitalization was 2.8 days. All patients were followed up for 6 to 78 months (average 32.7 months). A previous mesh was removed in a recurrent lumbar hernia before repair. An ipsilateral inguinal indirect hernia was repaired with Kugel procedure, and an ipsilateral lumbar cyst with the hernia was resected during the operation. No postoperative complication occurred, including seroma, hematoma, recurrence, incisional infection, chronic pain, and foreign body sensation. Conclusion Lumbar hernia tension-free repair with a Kugel patch through retroperitoneal space, adapting transfixing stitches for fixation, is a safe and useful technique, which is associated with effective repair, few postoperative complications, rapid recovery and good clinical results.     

前入路腹膜前Kugel补片治疗无张力腹股沟疝修补术后复发疝

目的探讨前入路腹膜前Kugel补片治疗无张力腹股沟疝修补术后复发疝的有效性和安全性,并分析其并发症和复发率。 方法回顾性分析2006年1月至2016年1月,广州中医药大学附属东莞中医院40例腹股沟疝复发患者,记录复发疝类型、手术时间、并发症和复发率,采用视觉模拟评分（visual analogue scale,VAS）记录术前术后慢性疼痛的发生率。手术采取前入路,切除手术瘢痕和取出卷曲挛缩的合成补片。创建腹膜前间隙后,将Kugel补片置入腹膜和腹横筋膜之间加强耻骨肌孔。 结果平均手术时间50 min（50～65 min）。术中有8例腹膜轻度损伤,发现后立即修补。无切口感染,3例皮下血肿、1例血清肿,5例术后尿潴留需插尿管。术前慢性疼痛率77.5%,术后12个月后下降至12.5%。随访时间24个月（12～50个月）,无复发患者。 结论前入路腹膜前Kugel补片治疗无张力腹股沟疝修补术后复发疝安全有效、操作简单,尤其适合平片或网塞修补术后有慢性疼痛的复发患者。     

应用Kugel补片和Modified Kugel补片治疗腹股沟疝

目的探讨应用Kugel补片和Modified Kugel补片治疗腹股沟疝的临床效果。方法分析2004年11月至2007年9月，应用Kugel补片和ModifiedKugel补片，开放式腹膜前置入治疗307例322侧腹股沟疝的效果。结果单侧手术时间25—90min，平均（45．2±14．8）min，术后疼痛轻，可早期下床活动和进食，血肿2例，无术口感染，早期复发2例。结论Kugel补片和ModifiedKugel补片适合修复各型腹股沟疝，并发症少，恢复快。两种补片修复各有优势。     

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??Comparison of aparoscopic transabdominal preperitoneal hernia repair and herniorrhaphy via internal ring approach (Kugel patch) for inguinal hernias WANG Qi, HUANG He-guang, CHEN Yan-chang, et al. Department of General Surgery, Union Hospital, Fujian Medical University, Fuzhou 350001, China
Corresponding author??HUANG He-guang, E-mail:heguanghuang2@163.com
Abstract Objective To compare the effect between transabdominal preperitoneal hernia repair(TAPP) and herniorrhaphy via internal ring approach (Kugel patch)in treating adult inguinal hernia??Methods Patients(458 cases,594 sides) who were admitted to Department of General Surgery from Jan. 2015 to Oct. 2016 were divided into two groups depending on the surgical style. TAPP group included 203 patients (275 sides) and Kugel group included 255 patients(319 sides). The data of patients were analyzed retrospectively to compare the clinical effect between two groups. Results For unilateral inguinal hernia, the operation time of TAPP group was longer than that of Kugel group (65.5±14.5)min vs.(57.5±18.1)min??P<0.05, while the operation time of bilateral inguinal hernia was not significant statistically between two groups(107.4±25.3)min vs (112.1±29.1)min??P>0.05. TAPP group is superior to Kugel group in postoperative VAS score??unilateral (2.0±0.5) vs. (2.5±0.5)??bilateral (2.4±0.6) vs. (2.8±0.7), P<0.01. Total hospitalization costs in Kugel group was lower than that in TAPP group,unilateral (9882.9±1112.1) yuan vs. (12177.1±1701.3) yuan, bilateral (14706.6±4706.5)yuan vs. (16952.4±2245.6) yuan, P<0.01. In addition, there were 31 cases (43% of its bilateral inguinal hernia patients) in TAPP group found the lateral occlusion hernia on the other side by intraoperative examination, which were repaired at the same time. The follow-up period ranged from 3 to 24 months (median 13 months).Follow-up rate was 96.6% (TAPP group, 196 cases) and 97.3% (Kugel group, 248 cases),each group missed 7 patients.All patients were cured, recurrent case was not found within the follow-up period . Kugel grouphad lower incidence of postoperative seroma??0.8% vs 6.1%, P<0.01??.No significant difference was found between the two groups in the rate of returning to daily activities within 2 weeks ,chronic pain, foreign body sensation and total postoperative complications(P>0.05). Conclusion Both TAPP and Kugel are safe and effective. TAPP has the advantage of reducing postoperative pain, minimizing scarring and discovering occult hernia. The Kugel is more economical and suitable for all types of anesthesia.     

疝环充填或改良Kugel术治疗腹股沟疝的回顾性对比研究

目的:回顾性比较疝环充填术与前入路改良Kugel腹膜前疝修补术治疗腹股沟疝在时间、住院时间、恢复工作时间、手术并发症及复发率等方面,评价两种术式的疗效及优缺点。方法:采用回顾性非随机对照方法,将2003年7月至2009年7月期间的987例1 065侧腹股沟疝病人(其中78例为双侧)分为疝环充填修补组(网塞组,521侧)和改良Kugel修补组(MK组,544侧)。网塞组采用BARD公司的Plug-Mesh进行无张力修补,MK组采用BARD公司的Modified Kugel(MK)补片修补。结果:平均随访时间3～40(20.0±5.3)个月。两组病人的平均手术时间、住院时间、手术并发症和术后复发率差异圴无统计学意义。MK组术后腹股沟区疼痛不适的发生率显著低于网塞组(P0.05)。结论:与临床广泛采用的疝环充填式无张力疝修补术相比,前入路改良Kugel腹膜前疝修补术同样操作简单,疗效可靠,同时可显著降低术后病人疼痛不适的发生率,具有较好的临床应用价值。