个体化无张力疝修补术在老年腹外疝中的应用

目的评价个体化无张力疝修补手术治疗老年人腹外疝的疗效。方法回顾性分析医院1999年～2002年间113例老年人行无张力疝修补术的临床资料。结果113例老年病人共施行了131次无张力疝修补术，其中83例行疝修环充填式无张力疝修补术，48例行Lichtenstein手术，单侧疝、双侧疝及切口疝修平均手术时间分别为36、73和92min。术后并发症包括小的皮下血肿，1例巨大切口疝术后出现腹胀，无切口感染，无国手术期死亡。腹股沟疝及切口疝修病人分别于3～9d和8～19d出院。73％(82／113)病人获得随访。随访时间5～50个月，无术后复发，1例有腹股沟区疼痛。结论采用无张力疝修补手术治疗老人腹外疝是安全的。其并发症少，复发率低；对老年性腹外疝修病人施行个体化无张力疝修补术有利于减少疝复发；对双侧腹股沟疝修的病人可同期进行手术，避免再次手术；对腹壁巨大缺损者。可选用防粘连补片。避免腹腔高压。     

超声检查在腹外疝诊断中的应用

目的:探讨超声检查在腹外疝诊断中的价值。方法:应用超声检查对临床怀疑腹外疝的36例患者进行术前超声检查,明确有无疝的存在及类型。结果:本组36例患者,超声诊断腹外疝33例,其中,腹股沟斜疝30例,直疝2例,切口疝1例。另外3例中,未见疝2例,腹股沟区淋巴结肿大1例。全部病例经手术或长期随访证实。结论:超声对腹外疝的诊断有重要临床价值,不但可明确有无疝的存在,还可明确疝的类型。     

External strangulated hernia in Khartoum, Sudan

OBJECTIVES: To determine the pattern of presentation and outcome of strangulated external hernia, to predict the risk factors of strangulation, and to draw the attention towards the incidence of strangulation and its sequelae which are preventable by early repair. DESIGN: A prospective study over a two year period. SETTING: Khartoum Teaching Hospital, Casualty Department during the period May 2002 to May 2004. SUBJECTS: Sixty four patients with strangulated external hernias. RESULTS: The mean age was 42 years and the age range was between 0.5-72 years. The male: female ratio was 5:1 and males dominated all types of hernia except in incisional hernia where more females were noted. Strangulated inguinal hernia was the most common type in 35 patients, being more common on hernias of a relatively short history (<1 year). Pre-strangulation symptoms like change in size, irreducibility and pain were reported by 57 (90%) patients few days to few weeks prior to strangulation. More than half of the patients presented to the hospital 24 hours after developing the symptoms. All patients were surgically explored, 52 through an inguinal incision and 12 via formal laparotomy. The total number of bowel resection was 24 (37.5%), mainly in those presenting after 48 hours and 12 of them were between the age of 51-60 years. There were four (6.25%) deaths. CONCLUSION: Early diagnosis of patients with hernia and elective surgical treatment may offer the best way to minimise the relatively high morbidity and mortality associated with emergency operations.     

食管胃底静脉曲张合并腹外疝内镜下治疗分析

目的 探讨食管胃底静脉曲张合并腹外疝患者内镜下治疗的临床特点以及疝修补术手术时机的选择。方法 回顾2000 -2013 年我院收治的11 例食管胃底静脉曲张合并腹外疝患者,其入院时疝的部位、类型、诊断时间,以及行内镜下食管胃底静脉曲张治疗术中、术后疝的临床特点。结果 11 例均为腹股沟斜疝,左侧3 例,右侧7 例,双侧1 例。可复性疝10 例,难复性疝1 例且合并脐疝、右侧睾丸鞘膜积液。除1 例为已行疝修补术后复发,余10 例均无手术史。患者行胃镜检查平均1.6次,内镜下治疗平均3.6 次。内镜诊治过程中采用助手压迫疝环或腹带包扎固定方式防止疝复发。术中无发生嵌顿者,术后发生3 人次,平均为术后（10±8.29） d 发生,均采用手法还纳成功。结论 合并腹外疝的食管胃底静脉曲张内镜下治疗因操作疗程多且术中过多注气等因素,增加了发生嵌顿疝的风险,内镜治疗前应评估是否可先行疝修补手术。     

Bilateral Hernias in the Female

An experience with 216 bilateral hernias in female patients is reviewed. The condition is rare, occurring only once in every 250 patients admitted for a hernia repair. Bilateral primary indirect inguinal hernias were the most frequent type. Bilateral primary femoral hernias were quite rare while bilateral primary direct inguinal hernias were even more uncommon. Other rare bilateral combinations are briefly described. The incidence in children is given.

Etiological factors are discussed, emphasizing the strong posterior wall of the inguinal canal in females.

Two per cent of patients developed a recurrent hernia; one per cent of hernias recurred. No recurrence following a bilateral primary indirect inguinal hernia repair and no “femoral” recurrence following inguinal repair were recorded.

     

HSCT在腹外疝中临床应用价值

目的探讨MSCT对腹外疝的临床应用价值。方法对回顾性分析76例经手术或临床诊断证实的腹外疝的MSCT资料,并对每位患者的MSCT资料进行多平面重建（MPR）,着重于定位、定性诊断,分析其疝内容物、腹壁缺损区大小、形态,腹外疝的并发症,对制定手术治疗方案具有很好的指导意义。结果76例腹外疝患者中腹股沟疝53例,股疝8例,闭孔疝7例,膀胱疝1例,切口疝4例,腹壁疝2例,脐疝1例。有34例患者出现不同程度肠梗阻症状。MSCT对腹外疝的并发症肠梗阻敏感性达90％一100％[1]。结论MSCT结合多平面重建（MPR）对腹外疝的定位、定性诊断,及其并发症的显示具有重要的临床应用价值。     

赫美补片治疗腹外疝108例

[背景]探讨赫美补片治疗腹外疝的适应症及临床效果.[病例报告]应用4种类型的赫美补片对108例不同类型腹股沟疝及切口疝进行无张力疝修补术,随访观察3个月~2年,未见复发病例;应用网塞加平补片患者中2例术后出现轻微异物感,1例术后出现切口皮下积液,1例切口疝术后14 d时发生腹直肌前鞘裂开,经补片固定后效果良好,未出现疝复发.[讨论]赫美补片适用于各种类型的腹股沟疝及切口疝的治疗,效果良好.     

疝环充填式无张力修补术疗效观察及手术体会(附170例报告)

目的：观察聚丙烯网，网片修复腹股沟疝的疗效。方法：回顾分析本院1999年1月到2002年1月收治的170例腹股沟疝病人，其中左腹股沟斜疝27例，右腹股沟斜疝118例，左腹股沟直疝11例，右腹股沟直疝10例，双侧腹股沟斜疝4例，所有病人均采用美国巴德公司提供的丙聚烯锥形网，网片作为修补材料。结果：所有病人切口均一期愈合，随访病人150例，随访时间从2个月到3年，无一复发。结论：疝环充填式无张力修补术近期疗效满意，值得推广。     

无张力疝修补术治疗老年腹股沟疝的临床分析

目的 评价无张力疝修补手术治疗老年人腹股沟疝的疗效。方法 回顾性分析105例老年腹股沟疝行无张力疝修补手术的临床资料。结果 105例老年患者共施行了123次无张力疝修补术，其中83次行疝环充填式无张力疝修补术，40次行Lichtenstein手术，单侧疝及双侧疝平均手术时间分别为36min，73min。术后并发症仅1例小的皮下血肿，无切H感染，无围手术期死亡。腹股沟疝患者均于术后3～9d痊愈出院。75％(79／105)病例获得随访，随访时间5～50个月，无术后复发，仅1例有腹股沟区疼痛。结论 采用无张力疝修补手术治疗老年人腹股沟疝是安全的，其并发症少，复发率低；对双侧腹股沟疝的患者可同期进行手术，避免再次手术。     

小儿腹股沟滑疝的病因、发病机理、诊断和鉴别诊断

目的探讨小儿腹股沟滑疝的病因、发病机理、诊断和鉴别诊断。方法从我院收治290例腹股沟斜疝中选取确诊滑疝13例住院资料，结合国内外文献，着重分析其病因、发病机理和诊断鉴别诊断。结果发现女婴腹股沟滑疝发病率比男婴高得多，且女婴均属卵巢、输卵管伞端滑出，男婴滑出器官均为盲肠、阑尾和／或乙状结肠。其原因除患者腹股沟内环腹膜壁层先天发育不良外，与卵巢、输卵管伞接近腹股沟内环、卵巢悬韧带和盲肠、乙状结肠系膜较活动有关。小儿腹股沟滑疝的临床表现与其他腹股沟斜疝相似，易发生误诊。结论小儿腹股沟滑疝是由于腹股沟内环先天性发育不良和腹腔内较活动的器官滑出所致。临床表现与一般常见的腹股沟斜疝相似，必须仔细鉴别。从其病因发病方面加以考虑，有助于明确诊断。     

PHS无张力修补114例腹股沟疝的临床体会

目的探讨普理灵疝修补装置（PHS）在腹股沟疝无张力修补术中的应用。方法回顾性分析我院2006年6月-2010年12月应用PHS腹膜前置入治疗腹股沟疝114例的临床资料。结果本组均痊愈,手术时间为35-100min,平均54min,住院时间3-8d。术后24h下床活动,术后疼痛较少,2例出现尿潴留,3例出现阴囊积液。切口均一期愈合,无1例切口感染。随访3月-3年,无明显慢性疼痛、局部异物感及复发。结论 PHS无张力疝修补术集各种修补术优点于一身,适应证广,更符合腹股沟管的解剖和生理,具有术后异物感小、疼痛轻、损伤轻、术后恢复快及复发率低等特点,显著提高了患者的生活质量,值得临床推广应用。     

First results of Lichtenstein hernia repair with Ultrapro-mesh as cost saving procedure--quality control combined with a modified quality of life questionnaire (SF-36) in a series of ambulatory operated patients

There are about 200,000 hernia repairs per year in Germany and about 770,000 in the U.S. In the United States most hernia repairs (80-90%) are performed as day surgery procedure; 90% of operations are open herniorrhaphies with mesh. Quality control includes the registration of complications, recurrence, and quality of life. In a prospective study 50 consecutive patients with inguinal hernia eligible for open mesh repair (modified Lichtenstein hernia repair), mostly Nyhus III and IV classification, were operated using light-weight Ultrapro-mesh (monocryl-prolene-composite, Ethicon Products), and interviewed 10 days after the operation according to a modified SF-36 questionnaire. Patients were examined three months later. There were 29 direct hernias, 21 combined (direct and indirect) hernias, 8 indirect hernias; 8 patients had hernias on both sides. 8 patients (16%) presented with recurrent hernias, mostly suture or laparoscopic repairs before. There were no intra-operative complications. 2 patients suffered from a moderate haematoma, which did not necessitate a surgical repair, after accidental intake of aspirin preoperatively in one case and after preoperative low-molecular-weight heparin prophylaxis. There were no other complications. All 50 patients (100%) had returned the questionnaire. 38 patients (78%) reported no or mild pain; only one patient (2%) suffered from severe pain, none had very severe pain. 32 patients (64%) applied no pain medication or only for 48 hours; only one patient (2%) used pain medication for more than 14 days. 34 patients (68%) admitted that their health status improved after the operation; 11 patients (22%) with good or very good health status indicated no change in health. Follow-up examination of the patients three months after the operation did not detect any recurrence. 49 patients (98%) were free of pain or restriction; one patient (2%) continued to have chronic pain which developed after two laparoscopic herniotomies performed at a different clinic before. There was no sign of mesh-related complication. The Ultrapro-mesh has been well accepted by the patients. In conclusion, open mesh repair according to Lichtenstein is safely done in specialised ambulatory day surgery clinics. Most patients benefit from this form of treatment according to a quality of life audit. The new light-weight mesh Ultrapro contributes to the improvement of hernia repair. There is evidence that ambulatory open mesh repair should be the method of choice for primary inguinal hernia. If in Germany an equal proportion of hernia repair as in the United States would be done as ambulatory procedure (80-90%), there would be an annual cost saving of several hundred million Euro.     

腹腔镜治疗复发腹股沟疝术后并发症影响因素分析

<正>腹股沟疝是普通外科学常见的一种疾病,目前治疗方案以手术为主,其术后复发率达8%～16%^[1-3],对于复发腹股沟疝术后再复发率可高达11.7～30.0%^[4-5]。腹股沟复发疝由于涉及上次手术,其治疗难度较大,腹腔镜经腹腔腹膜前疝修补术(laparoscopic trans-peritoneal preperitoneal repair,TAPP)治疗复发性腹股沟疝有独特优势,     

无张力疝片在腹股沟疝修补术中的应用研究

目的 探讨腹股沟疝治疗的新方法.方法 总结自2001年3月至2004年9月对56例腹股沟疝的病人采用无张力疝片进行腹股沟疝修补术.结果 56例病人手术均成功,术后疼痛小,无腹股沟紧缩感,随访病人无一例复发.结论 利用无张力疝片进行腹股沟疝修补术,因其损伤小、手术时间短、痛苦小、恢复快、低复发率,易被病人接受.     

老年腹股沟疝腹膜前间隙无张力疝修补术不同麻醉方式的对比研究

目的比较局部神经阻滞麻醉和持续硬膜外麻醉在老年腹股沟无张力疝修补手术中的应用效果。方法临床选取2007年2月～2010年2月我院普外二科收治的腹股沟疝无张力修补手术的患者134例患者,共165侧疝,分为两组,一组使用经局部神经阻滞麻醉,一组使用持续硬膜外麻醉,比较两组的镇痛效果、手术时间、手术近期和远期并发症。结果两者麻醉效果同样肯定,但局部神经阻滞麻醉操作时间较短,手术时间短,手术后麻醉相关并发症及尿潴留发生率较低。结论综合比较显示,在腹股沟疝无张力修补手术中局部神经阻滞麻醉方法优于持续硬膜外麻醉,建议在临床推广使用。     

Morbidity and mortality of inguinal hernia in the newborn

In an 11 year period, 17 newborns aged < or = 42 days had repair of 21 inguinal hernias. Eleven 52%) of the hernias were incarcerated or strangulated, necessitating bowel resection in 4 (36%) and orchidectomy for testicular infarction in 2 (18%). Only 4 babies with 7 hernias had elective herniotomy for uncomplicated hernia. In one baby with Hirschsprung's disease (bilateral hernia) and another with anorectal malformation, herniotomy was performed at the time of initial colostomy. Postoperatively, wound infection occurred in 4 (36%) of the 11 incarcerated or strangulated hernias (3 had bowel resection). One baby who had intestinal resection died from overwhelming infection. The median hospital stay in babies with uncomplicated hernia was one day and 4 days in those with complicated hernia. The morbidity of incarcerated and strangulated inguinal hernia in newborns is high, with attendant risk of bowel gangrene and testicular infarction. The principle of early referral and repair of inguinal hernias should be encouraged to avoid such morbidity and possible mortality.     

腹股沟疝患儿腹腔镜经皮腹膜外闭合术后疝复发及对侧腹股沟疝发生的危险因素分析

目的 探讨腹股沟疝患儿腹腔镜经皮腹膜外闭合术后疝复发及对侧腹股沟疝发生的危险因素.方法 选取2011年7月—2017年12月湖南省人民医院胃肠小儿外科诊治的腹股沟斜疝患儿225例,入选206例.其中,男性120例,女性86例;平均随访(48.12±1.23)个月;手术时平均年龄(3.88±1.01)岁.手术期间常规观察...     

前入路Kugel补片治疗腹股沟疝的临床体会

目的总结前入路腹膜前Kugel补片治疗腹股沟疝的体会，确定此技术的安全性和有效性。方法2003年至2008年作者使用美国巴德公司生产的Kugel补片，进行前瞻性开放式前入路腹膜前修补67例71侧腹股沟疝的临床研究，并记录手术时间、术后并发症、复发率等。结果在71侧腹股沟疝中，原发疝68例，其中左侧斜疝27例和直疝1例，右侧斜疝29例，双侧斜疝3例，双侧直疝1例，股疝3例。复发斜疝3例。手术时间30～60min，平均50min；术后6-24h下床活动；术后出院时间4-8d（平均6d）。切口甲级愈合，无感染、皮下血肿、阴囊积液。随访7～48个月（平均28个月）无复发。结论前入路Kugel补疝修补术不仅具有微创、无张力，术后并发症少等原来的特点，而且还有安全有效、操作简单、学习曲线短、手术适合症广、利于青年医生学习和掌握等优点。     

Femoral Hernia in the Female

A study of 384 consecutive femoral herniorrhaphies performed upon female patients admitted to Shouldice Hospital, Toronto, during a 19-year period was carried out. Its main purpose was to describe the techniques used and to evaluate the results obtained. A careful 10-year follow-up plan for all cases existed.

Two hundred and ninety-three operations were performed for the repair of simple femoral hernia; 91 were performed for the repair of femoral hernia which had developed following an initial ipsilateral inguinal or femoral repair performed previously, either in this hospital or elsewhere.

The basic repair was subinguinal. Four modifications are described, one entirely subinguinal and three combined with exploration of the inguinal canal.

The recurrence rate for simple femoral hernia in the female was 1.3% and for “recurrent” femoral hernia in the female, 5.5%.

     

Digital imaging by parents: an aid to the diagnosis of inguinal hernia in infants and children

INTRODUCTION: The aim of the study is to see the feasibility of utilisation of digital imaging by parents in the diagnosis of inguinal hernia in children, and reduce the rate of occasional negative groin exploration. METHODS: During a two and a half year period, 155 inguinal hernias were diagnosed and operated on in our university teaching hospital. The diagnosis was based on the history and physical examinations of all patients. In 21 patients, the diagnosis was made based on the examination of history alone, as they did not demonstrate the hernia at presentation. In the last year, digital imaging by parents was utilised to aid in the diagnosis of difficult cases. There were ten cases, in addition to the history and physical examinations, that were confirmed by this method. All hernias were confirmed at exploration during surgery. RESULTS: Out of 155 inguinal hernias, 21 (13.5 percent) were diagnosed by history alone, of which four (2.5 percent) had negative exploration, eight (5.1 percent) were positive for hernia, supported with digital imaging by parents' pictures, and nine (5.8 percent) were positive at exploration, without any additional means of diagnosis. CONCLUSION: History-taking and physical examinations are the mainstay of diagnosis of inguinal hernia in children. The capture of a digital image of the presenting complaint by the patients' parents, can be used as an additional aid in the diagnosis of difficult cases to demonstrate inguinal hernia, as demonstrated in a selected group of children.