Defining the position of deep inguinal ring in patients with indirect inguinal hernias

A preliminary survey of surgeons of all grades in our hospital revealed confusion about the position of the deep inguinal ring. Standard teaching is that the deep inguinal ring is lateral to the femoral artery. The aim of this study was to define the position of the deep ring in patients undergoing elective inguinal hernia repair. Thirty consecutive male patients undergoing indirect inguinal hernia repair under local anaesthesia were studied. The following landmarks were marked on the patient with a felt pen: anterior superior iliac spine (ASIS), femoral artery (FA), deep inguinal ring (DR), pubic tubercle (PT) and pubic symphysis (PS). The distance of each point from the ASIS was measured in centimetres. The relation of the femoral artery to the deep inguinal ring was confirmed by palpation through the deep ring during surgery. The femoral artery was consistently identified midway between the anterior superior iliac spine and pubic symphysis (mid-inguinal point). The deep inguinal ring was located medial (22/30) or above (8/30) the femoral artery, but never lateral. The mean distances from the anterior superior iliac spine to the deep ring and femoral artery were 8.8 and 7.7 cm, respectively. Contrary to standard teaching, this study demonstrates that the deep inguinal ring lies medial, not lateral, to the femoral artery. This may clarify some of the variations in textbook anatomy, and explain the difficulty in distinguishing direct and indirect inguinal hernias pre-operatively.Presented at the Association of Surgeons of Great Britain and Ireland (ASGBI, April 2004 Harrogate)     

Surface marking of the deep inguinal ring

The surface marking of the deep inguinal ring (DIR) is commonly described as being located at either the middle of the inguinal ligament (MIL) or at the mid-inguinal point (MIP); there seems to be no consensus in previous studies in patients with inguinal hernias. The present study was carried out to determine a more accurate location of the DIR in individuals without inguinal hernias. Fifty-two cadavers without inguinal hernias were dissected and the positions of the DIR, MIL, MIP and femoral artery (FA) were determined. The mean distance from the anterior superior iliac spine (ASIS) to the DIR was 62 mm, where as the mean distance from the ASIS to the MIL, MIP, and FA were 55, 66, and 65 mm, respectively. The study showed that in individuals without inguinal hernias the DIR did not correspond to the MIL or MIP, but rather to an area between these two landmarks. The surface marking of the DIR may be best described as at the mid-inguinal region.     

腹腔镜腹股沟疝修补应用轻质3D Max补片与普通补片的效果比较

文题释义：轻质3D Max补片：是一种大网孔的轻质补片,适用于腹壁疝、腹股沟疝修补及软组织缺损重建当中。相较于传统的聚丙烯补片,轻质3D Max补片更轻,体内异物残留更少,且具有更佳的腹壁顺应性、更少的炎症反应,放置更容易,在减少创面、快速愈合、防止复发、易吸收等方面的优势明显。3D Max补片因其卓越的安全性、高效性、方便性,迅速受到临床医生的青睐。腹腔镜腹股沟疝修补术：是近十几年来发展起来的一种治疗腹股沟疝的新兴技术,较之于传统的开放式无张力修补术,腹腔镜下能将补片放在更深的位置,降低复发率。同时,腹腔镜腹股沟疝修补术还具有外观美观、创伤较小、患者痛苦感更轻、术后并发症少等诸多优点,近年来在临床腹股沟疝治疗中得到了推广应用。 背景：在腹股沟疝修补中基于单个补片特征的补片选择仍然存在争议,需要对疝气复发和补片特异性并发症的长期结局进行评估。 目的：比较腹腔镜腹股沟疝修补术中应用轻质3D Max补片与普通聚丙烯补片对手术结局和患者生活质量影响。方法：选择2013年2月至2016年1月河北省秦皇岛军工医院收治的无并发症腹股沟疝患者142例,其中男131例,女11例,年龄18-60岁,计算机软件随机分为轻质3D Max补片组(n=80)和聚丙烯补片组(n=62)进行腹腔镜腹股沟疝修补。收集患者的手术细节和结局、疝气复发率、并发症和住院费用等信息。分别于术前、术后2周及术后1,6,12和24个月采用卡罗来纳舒适量表评估患者的生活质量。试验已获得河北省秦皇岛军工医院伦理委员会批准,批准号：2013-002-02。结果与结论：①轻质3D Max补片组的手术时间、术后卧床时间和住院费用少于聚丙烯补片组(P < 0.05),术后血清肿发生率低于聚丙烯补片组(7.5%,21.5%,P < 0.001);两组疝气复发率与其他并发症发生率比较差异无显著性意义(P > 0.05);②轻质3D Max补片组术后2周、1个月的疼痛感觉评分少于聚丙烯补片组(P < 0.05),两组术后2周及1,6,12,24个月的总生活质量评分与疝气感觉、运动受限等评分比较差异无显著性意义(P > 0.05);③结果表明与聚丙烯补片相比,轻质3D Max补片可有效缩短疝修补手术时间,降低住院费用和术后短期慢性疼痛的发生率。ORCID: 0000-0001-5676-0824(侯海生) 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

Shouldice法修补腹股沟疝手术体会（附105例报告）

目的 探讨Ｓｈｏｕｌｄｉｃｅ疝修补术的疗效及手术治疗经验。方法 自１９９１年１月～１９９８年１月应用Ｓｈｏｕｌｄｉｃｅ法修补成人腹股沟疝１０５例并进行回顾性的总结和分析。结果 术后随访１～７年,无一例复发。结论 Ｓｈｏｕｌｄｉｃｅ法是目前修补成人腹股沟疝的最佳方法之一,值得推广。     

An evidence-based approach for laparoscopic inguinal hernia repair: lessons learned from over 1,000 repairs

In this educational article, we aim to provide a literature review on laparoscopic anatomy of the inguinal region. We share the lessons learnt from the 1,194 laparoscopic hernia operations we have performed in 16 years of experience, trying to provide an anatomical and physiological basis for surgeons. The current study reports a personal experience with a transabdominal preperitoneal (TAPP) hernioplasty procedure. A literature review using the keywords "hernia," "laparoscopic approach," and "hernia repair" was performed using the electronic biomedical database PubMed, Medline Extra, Embase, Biosis, Science Citation Index, Ovid and text books. Between January 1994 and December 2010, a total of 1,194 patients, males and females (average age, 56.7 years), underwent laparoscopic TAPP inguinal hernia repair. Following reduction of the hernia sac and creation of the preperitoneal flap, a polypropylene mesh (10 × 16) and four spiral tacks were placed. TAPP is easy to learn and perform. Through this approach, a much better view from the inguinal anatomy is achieved, and the procedure also offers a brief learning curve. Our patients reported minimal postoperative pain and returned to work after 5-10 days, which is in accordance with the general anesthesia series. During the follow-up period, 10% of seromas, 3% of scrotal hematomas, 1% of hemorrhages, and 3% of recurrent hernias were observed. It should be emphasized that we have not observed abscess formation or acute infection related to the presence of mesh.     

腹腔镜手术同时治疗腹股沟疝与精索静脉曲张的可行性研究

目的探讨腹腔镜手术同时治疗腹股沟疝与精索静脉曲张的可行性及预防其并发症发生的有效方法。方法选取宜昌市第二人民医院2014年1月至2018年12月共86例腹腔镜下同时行腹股沟疝修补术(TAPP)与精索静脉曲张手术的患者作为观察组,选取同时段96例分期行TAPP和精索静脉曲张手术的患者作为对照组,比较2组患者的手术时间、住院时间、住院费用、术中出血量、并发症发生率、复发率及患者满意度。结果观察组患者手术时间(45.5±12.8)min,住院时间(3±0.3)d,住院费用(3856±132.5)元;对照组患者手术时间(79.2±10.3)min,住院时间(5±0.7)d,住院费用(6018±743.6)元,2组比较差异均有统计学意义(P<0.05)。患者术中出血量比较,2组差异无统计学意义(P>0.05)。观察组慢性疼痛发生率低于对照组,差异有统计学意义(P<0.05);其余并发症发生率比较,2组差异无统计学意义(P>0.05)。术后随访3~18个月,2组满意度比较差异无统计学意义(P>0.05)。结论同时行腹股沟疝与精索静脉曲张腹腔镜手术安全可靠,有利于缩短患者住院时间,减少住院费用,具有较好的临床效果。     

腹股沟区腹膜前解剖和疝修补术

目的：重新认识腹股沟区腹膜前解剖的特点，探讨腹膜前腹股沟疝无张力修补术的技术要点。方法：（1）对5具新鲜尸体进行腹股沟区解剖研究；（2）2005年6月-2006年5月行开放式腹膜前腹股沟疝无张力修补术共330例次（292例病人），2002年11月至2006年5月行腹腔镜下无钉合全腹膜外疝修补术（TEP）共240例次（211例病人），进行术中的观察及术后随访。结果：腹股沟区存在两层腹横筋膜，腹膜前间隙在两层腹横筋膜之间，补片即置于腹膜前间隙并覆盖肌耻骨孔。开放式腹膜前腹股沟疝无张力修补术平均手术时间43min，并发症率7．3％（24／330），复发率0．91％（3／330），平均住院时间1．7d。TEP平均手术时间57min，并发症发生率6．7％（16／240），无复发病例，术后平均住院时间2．8d。结论：从腹股沟区腹膜前解剖学特点来看在肌耻骨孔后方用足够大的补片覆盖修补符合压力学原理，腹膜前腹股沟疝无张力修补术具有合理性和可行性。     

无张力疝修补术在复发性腹股沟疝中的应用

腹股沟疝术后复发率在10％-20％，传统的疝修补术对复发疝的治疗基本已经被弃用，国内自90年代开始接受并推广的无张力疝修补术的疗效已得到了肯定。现回顾性总结我院及外院自1999年12月至2006年12月采用无张力疝修补术治疗的复发性腹股沟疝23例，疗效确切，现报告如下。     

The effects of the critical pathway for inguinal hernia repair

This study was conducted to develop a case management program using the critical pathway (CP) as an intervention method for patients with an inguinal hernia for a herniorrhaphy, and to determine the effects of the CP on the period of hospitalization, medical costs, the rates of postoperative complaints, patient satisfaction and the nurses' job satisfaction. One hundred patients (60 in the experimental group, 40 in the control group) who were admitted to a general hospital in Seoul for inguinal herniorrhaphy were enrolled in this study. The results showed that the period of hospitalization and the postoperative hospital stay were significantly reduced in the CP group. In addition, the total medical cost, was lowered significantly by use of the CP for patients undergoing an inguinal herniorrhaphy. The rates of postoperative complaints, patients' satisfaction and the information on the treatment were enhanced after implementing the CP. These results suggests that the CP may be a useful tool for enhancing the health care outcome by decreasing the period of hospitalization, overall medical costs and by improving the quality of care, all of which can benefit the patients, the patients' family, caregivers and the hospital.     

疝环填充式修补术治疗腹股沟斜疝的体会

腹股沟疝手术后复发率为10%～15%,为解决腹股沟疝术后的复发问题,同时减少手术后患者的痛苦,Lichtenstein等采用聚丙烯补片进行“无张力”腹股沟疝修补手术[1]。本文回顾分析并比较了疝环填充式修补术和传统的Bassini疝修补术治疗腹股沟斜疝的效果。1资料与方法1.1临床资料我科1996年3月至2006年6月收治成人腹股沟疝118例,均为男性,其中腹股沟斜疝(术中证实)98例,平均年龄(51.1±23.4)岁,均为初发疝,行疝环填充式修补术68例。行传统的Bassini疝修补术30例。其余行无张力腹股沟斜疝修补术。1.2手术方法手术采用美国Bard公司生产的Meshrefix…     

应用疝环充填式无张力疝修补术治疗腹股沟疝168例临床分析

目的 总结疝环充填式无张力疝修补术的治疗效果。方法 采用美国巴德公司的聚丙烯疝环充填物及成型补片，对168例腹股沟疝病人进行无张力修补治疗，对手术时间、伤口疼痛、术后自主能力的恢复、住院时间、并发症及复发率等进行观察。结果 与传统疝修补手术相比，具有方法简便，术后疼痛轻，恢复快，住院时间短，并发症少，复发率低和更宽的手术指征等优点。结论 疝环充填式无张力疝修补术是一种治疗腹股沟疝的理想手术方法。     

不同类型补片修补腹股沟疝的析因分析

背景：目前疝修补片的种类较多,包括不可吸收疝修补材料、可吸收疝修补材料、复合型疝修补材料等,为能针对患者的实际情况选用恰当的疝修补材料,需要医生熟悉并掌握各种生物材料的特点。 目的：根据本院病例进行析因分析,评测不同材料在腹外疝修补中的应用效果,旨在了解各种疝修复材料的性能,实现个体化治疗的原则。 方法：以补片种类、腹外疝种类为考察因素,选择聚丙烯、膨体聚四氟乙烯和脱细胞真皮基质片3种补片,腹外疝种类为常见的腹股沟斜疝和腹股沟直疝,利用析因试验设计方法,按照2×3型析因实验设计行不同治疗方案,以平均手术时间、复发率、修补并发症为指标,利用SPSS 10.0统计软件进行析因分析。 结果与结论：以平均手术时间、修补并发症发生率为指标,脱细胞真皮基质片、聚丙烯补片和膨体聚四氟乙烯补片的差异有显著性意义(P< 0.05),不同腹外疝类型差异无显著性意义(P > 0.05)。由于不同疝种类患者的住院时间差异无显著性意义,那么医生在选用合适疝修补材料时,主要考虑疝修补材料的特性以及患者的临床特点等因素,从而获得最佳临床修补效果。     

老年腹股沟疝的无张力修补术

目的 观察60岁以上老年腹股沟疝患者无张力修补术的临床疗效。方法 126例老年腹股沟疝患者均采用无张力修补术，术后随访1～3年，观察恢复情况。结果 术后患者平均36h下床活动，平均住院8d，没有发生尿潴留，阴囊水肿及切口感染，复发率为0．7％。结论 无张力修补术对老年患者治疗效果良好。     

3Dmax轻量型疝补片和Prolene重量型网片腹膜前修补腹股沟疝的比较

文题释义： 快速康复外科理念：是通过优化围术期处理降低患者并发症,减轻围手术期痛苦,从而加速患者康复时间和质量,缩短住院时间,节省治疗费用。快速康复外科强调多学科技术优势整合合作,包括快速通道麻醉、微创手术技术、合理的材料选择、良好的镇痛及优质的术后护理等,是一系列多学科优势技术紧密合作的体现。 腹腔镜全腹膜外腹膜前疝修补：是腹腔镜全腹膜外腹膜前修补技术,全部操作不进入腹腔,在腹膜外完成,不会对腹腔内脏器产生干扰,可以降低腹腔内脏器损伤或出现术后切口疝的风险,无需缝合腹膜,可缩短手术时间,从技术角度来看最为合理,具有较好的临床疗效。 背景：腹腔镜全腹膜外腹膜前疝修补腹股沟疝具有较好的临床疗效,但是术中选择哪种补片能够加速患者康复时间,提高患者术后康复质量有待于进一步探讨。 目的：对比3Dmax轻量型疝补片和Prolene重量型网片修补腹股沟疝的效果。 方法：选择2016年1月至2018年12月辽宁省人民医院收治的110例腹股沟疝患者,其中男97例,女13例,年龄18-70岁,均接受腹腔镜全腹膜外腹膜前疝修补,其中67例采用3Dmax轻量型疝补片,43例采用Prolene重量型网片,记录术后并发症发生情况。术后随访12个月,对比两组目测类比评分、SF-36生活质量评分。试验获得辽宁省人民医院伦理委员会批准。 结果与结论：①3Dmax补片组非感染性发热例数少于Prolene网片组(P < 0.05),两组切口感染、尿潴留、血肿发生情况比较差异无显著性意义(P > 0.05);②3Dmax补片组术后3,6,12个月的目测类比评分均低于Prolene网片组(P < 0.05);③术后7 d的SF-36生活质量评分显示,3Dmax补片组健康状态、生活能力与社会功能3个方面的评分及总分均高于Prolene网片组(P < 0.05);④术后3,6,12个月的SF-36生活质量评分显示,3Dmax补片组走路、抬重物与体育活动等日常生活受限程度轻于Prolene网片组(P < 0.05);⑤结果表明对比Prolene重量型网片,采用3Dmax轻量型疝补片行腹腔镜全腹膜外腹膜前疝修补可减少不良反应、降低疼痛程度、加速患者康复时间、提高患者术后康复质量。ORCID: 0000-0003-1857-3897(范中宝)中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程