高频超声对小儿腹股沟斜疝的诊断价值

目的 探讨高频超声对腹股沟斜疝的诊断价值.方法 应用高频超声对14名小儿腹股沟斜疝进行检查诊断,全部经手术证实.结果 14例患儿可复疝9例,嵌顿疝5例.结论 高频超声对小儿腹股沟斜疝的诊断有重要临床意义,可作腹股沟斜疝的首选诊断方法.     

高频超声对腹股沟斜疝诊断价值的探讨

目的:探讨高频超声对腹股沟斜疝诊断的临床意义.方法:对75例经手术证实的腹股沟斜疝的高频声像图特点进行回顾性分析.结果:高频超声对腹股沟斜疝的诊断符合率达96%,可清晰显示病囊及其内容物,并能对可复性疝与嵌顿性疝作出鉴别.结论:高频超声对腹股沟斜疝的诊断有很大的实用价值.     

高频超声在诊断腹股沟斜疝中的应用

目的 探讨高频超声在诊断腹股沟斜疝中的价值.方法 用高频超声探测立位至仰卧位腹股沟肿块情况,了解肿块大小、内部回声及蠕动、体位改变时的变化及腹壁下动脉的位置.结果 高频超声明确诊断腹股沟斜疝187例,典型斜疝、嵌顿疝、滑动疝、小斜疝分别164、16、2、5例.结论 高频超声诊断腹股沟斜疝方便、快捷、准确性高,可作为斜疝外科手术前首选的诊断方法.     

高频超声和彩色多普勒血流显像在诊断小儿腹股沟斜疝中的应用

目的：探讨高频超声和彩色多普勒血流显像对小儿腹股沟斜疝的诊断价值。方法：应用高频超声和彩色多普勒血流显像（color doppler flowimaging,CDFI）对186例腹股沟斜疝患儿进行检查。结果：本组186例腹股沟斜疝患儿均经手术证实。其中易复性疝104例,难复性疝42例,嵌顿性疝30例,绞窄性疝10例。而由CDFI诊断绞窄性疝其中4例为嵌顿性疝。结论：高频超声结合CDFI是诊断小儿腹股沟斜疝的首选方法,可为临床诊断及手术治疗提供可靠依据。     

应用高频超声诊断腹股沟斜疝及鞘膜积液的研究

目的探讨高频超声在诊断腹股沟斜疝及鞘膜积液中的价值。方法采用飞利浦公司生产的SONOS-5500型彩色多普勒高频超声对80例腹股沟斜疝、92例鞘膜积液、20例腹股沟斜疝伴鞘膜积液的患者进行探查。结果高频超声能够清晰显示腹股沟斜疝和鞘膜积液的病理解剖结构,诊断准确率达98.5%。结论高频超声对腹股沟斜疝和鞘膜积液有较高的诊断价值,能准确进行定性及定位。     

高频彩超在成人隐匿性腹股沟斜疝诊断中的临床应用价值

目的探讨高频彩超对隐匿性腹股沟斜疝的诊断价值。方法对39例不明原因的腹股沟区疼痛患者进行高频超声检查,诊断隐匿性腹股沟斜疝38例,手术证实为隐匿性腹股沟斜疝39例,并对其声像图进行回顾性分析。结果 39例不明原因腹股沟区疼痛患者中,超声诊断准确率为97%。超声显示腹股沟包块与腹壁之间在患者腹式呼吸时反向相对运动者38例。结论患者腹式呼吸时腹股沟包块与腹壁之间呈反向相对运动是隐匿性腹股沟斜疝的特征性声像图表现。高频彩超对成人隐匿性腹股沟斜疝诊断准确率高,可作为诊断隐匿性腹股沟斜疝的首选检查方法。     

应用高频超声诊断腹股沟斜疝及鞘膜积液的研究

目的探讨高频超声在诊断腹股沟斜疝及鞘膜积液中的价值。方法采用飞利浦公司生产的SONOS-5500型彩色多普勒高频超声对80例腹股沟斜疝、92例鞘膜积液、20例腹股沟斜疝伴鞘膜积液的患者进行探查。结果高频超声能够清晰显示腹股沟斜疝和鞘膜积液的病理解剖结构，诊断准确率达98．5％。结论高频超声对腹股沟斜疝和鞘膜积液有较高的诊断价值，能准确进行定性及定位。     

高频超声在隐匿性腹股沟斜疝诊断中的应用

目的 提高对隐匿性腹股沟斜疝的认识和诊断水平。方法 对临床高度怀疑隐匿性腹股沟斜疝的患者行高频超声检查。结果 对68例患者进行超声检查，发现24例(35％)符合斜疝超声声像图改变，均被手术证实。结论 高频超声是诊断腹股沟隐匿性斜疝首选检查方法。     

彩色多普勒超声诊断腹股沟斜疝的价值

目的:利用彩色多普勒超声诊断腹股沟斜疝,探讨其诊断的临床价值。方法:利用高频探头扫查腹股沟处包块,观察其大小、内部回声及有无蠕动或变化。结果:超声诊断腹股沟斜疝40例,均经手术证实,其中3例为嵌顿疝。结论:超声诊断腹股沟斜疝方便、快捷、准确性高,具有较高价值。     

腹外疝的超声诊断

目的：探讨高频超声及彩色多普勒血流显像对腹外疝的诊断价值。方法：应用高频超声及彩色多普勒血流显像对31例腹外疝的声像图进行分析诊断并经手术和随访结果证实。结果：本组31例腹外疝中,腹股沟斜疝20例,白线疝2例,脐疝1例,股疝1例,腰疝2例,切口疝2例,闭孔疝2例,直疝1例均与手术和临床随访相符。结论：高频超声可清晰显示疝囊壁和疝内容物,对腹外疝的诊断有重要的临床价值,可作为腹外疝的首选检查方法。     

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。     

高频超声在腹股沟疝鉴别诊断中的临床价值

目的探讨高频超声在腹股沟疝诊断及鉴别诊断中的临床价值。方法用高频超声于仰卧位及站立位时探测腹股沟疝情况,确定疝的发病部位,观察疝囊的外形、走向、与腹股沟韧带的关系、与精索的关系、与腹腔相通处、与阴囊的关系、疝囊颈与腹壁下动脉的关系。结果112例腹股沟疝全部经手术证实,其中斜疝98例,直疝6例。股疝8例。术前超声检出110例,检出率98．2％（110／112）,漏诊1例,占0．9％（1／112）,误诊1例,占0．9％（1／112）。结论高频超声能对腹股沟疝的类型作出较准确的鉴别,并能确定疝内容物、疝是否有嵌顿绞窄,还能将腹股沟疝与其他腹股沟区包块作出准确鉴别,可作为腹股沟疝首选影像学检查手段。     

腹腔镜下小儿疝囊高位结扎术58例临床价值探讨

目的 探讨应用腹壁缝合针腹腔镜下治疗小儿腹股沟斜疝的手术方法及手术效果,并对几个常见问题进行讨论.方法 用腹壁缝合针在腹腔镜下对58例腹股沟斜疝患儿施行疝囊高位结扎术.结果 本组2例近期复发,1例疝囊积液.手术时间10～30min,平均18min.2例近期复发者系11个月双胞胎双侧巨型疝合并脐疝患儿,1例再次腹腔镜下双重荷包结扎,1例行传统高位结扎术治愈.结论 应用腹腔镜技术治疗小儿腹股沟斜疝具有安全有效、简单快速、损伤小、无需缝线、不留疤痕等特点,优于传统高位结扎术,但应掌握好手术技巧、手术时机及麻醉方法,对于巨型疝患儿应慎重.     

以提睾肌为修补材料改良Halsted法治疗老年巨大腹股沟斜疝

目的探讨以提睾肌为修补材料治疗老年巨大腹股沟斜疝的疗效。方法总结我院自1998年以来施行以提睾肌为修补材料治疗老年巨大腹股沟斜疝的病例86例,并与同期78例使用补片行无张力修补的老年巨大腹股沟斜疝的数据进行对比。结果改良组有2例术后复发,分别为术后半年和1年复发,无张力组有1例复发。两组患者在术后并发症及复发率方面的差异无统计学意义(P>0.05)。结论以提睾肌为修补材料治疗老年巨大腹股沟斜疝的疗效可靠,经济简便,值得在基层推广。     

高频彩色多普勒超声诊断股疝的价值(附41例分析)

目的:总结股疝的声像图特点,旨在提高其超声诊断准确性。方法:回顾性分析41例共43侧经手术证实的股疝的临床资料与声像图表现。结果:依据病变包块是否与腹腔相通,包块的长轴走行及其与腹股沟韧带、股血管及耻骨结节的关系,将39侧包块诊断为股疝,并判断内容物性质,手术结果为单纯性股疝42侧,超声诊断符合率为93%(39/42),对疝内容物判断符合率为83%(24/29);1例双侧病变为右侧复合疝(右侧腹股沟斜疝伴股疝),左侧直疝,超声漏诊股疝,只提示了右侧腹股沟斜疝,左侧直疝;超声误诊3侧病变(2侧误诊为脂肪瘤,1侧误诊为囊性包块)。结论:高频彩色多普勒超声可准确显示疝块,通过识别疝块内部回声及疝块与周围组织结构解剖关系,能准确诊断股疝并判断疝内容物性质。     

彩色多普勒超声诊断腹外疝的临床价值

目的探讨彩色多普勒超声检查在腹外疝中的诊断及鉴别诊断价值。方法对临床怀疑腹外疝的58例患者进行彩色多普勒超声检查,超声检查结果与手术或穿刺活检病理对比分析。结果58例患者中,超声诊断腹外疝56例,其中腹股沟斜疝49例,腹股沟直疝3例,白线疝1例,腹壁切口疝2例,股疝1例;另2例诊断为腹股沟淋巴结肿大。超声诊断与病理诊断符合率为100%。结论彩色多普勒超声检查不仅能明确腹外疝的有无、类型,还能了解疝内容物及血供情况,具有非常重要的临床应用价值。     

Laparoscopic totally extraperitoneal repair of inguinal hernia using two-hand approach--a gold standard alternative to open repair

As laparoscopy gained popularity, minimal invasive approach was also applied for hernia surgery. Unfortunately the initial efforts were disappointing due to high early recurrence rate. Experience led to refinement of technique, with acceptable recurrence rates. This combined with the advantages of minimal invasive surgery resulted in a gradual rise in worldwide acceptance of this technique. Our preferred approach for inguinal hernia repair is laparoscopic totally extraperitoneal (TEP); only in complicated hernias (sliding or incarcerated inguinal hernias) we use the transabdominal preperitoneal repair (TAPP) technique. Records of all patients who underwent TEP repair for inguinal hernia at our centre in last 15 years were retrospectively analysed. We have done 8659 hernias in 7023 patients by TEP approach. We have developed minor modifications for the TEP repair over the years. Out of total 8659 hernias 5262 was right sided and 3397 left sided. Of these, 5387 hernias were unilateral and the remainder were bilateral; 324 cases of recurrent hernias following open repair underwent TEP. Most of the patients were males with a mean age of 46 years. Indirect hernias were most common, followed by direct hernias. Right-sided hernias were more common than left-sided hernias. In 39 cases conversion to TAPP was needed. There were intra-operative problems in 250 patients (3.56%).Postoperative complications were seen in 192 patients (2.73%), majority of which were minor complications. There was no mortality. Recurrence rate was 0.39%. The TEP technique is comfortable and highly effective. Our port placement maintains triangular orientation that is considered vital to the ergonomics of laparoscopy. Nearly 98-99% of inguinal hernias can be treated by TEP approach with excellent results.     

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。     

Inguinal Hernia: classification, diagnosis and treatment--classic, traumatic and Sportsman's hernia

Inguinal hernia repair is performed in more than 600,000 cases every year in the United States. However, the true prevalence may be even higher. Many groin hernias are not diagnosed, e.g., Sportmans' hernia, or are asymptomatic. The etiology of classic inguinal hernia, Sportsman's hernia or traumatic hernia may be different. The hernia repair is performed in agreement with a classification of the hernia, e.g., Nyhus classification. According to recent randomized controlled trials and meta-analyses open-mesh repair demonstrates several advantages in comparison to laparoscopic procedures. Laparoscopic procedures require more time and cost more, show a potential for serious complications and may be followed by an increased rate of recurrence. There may be a faster reconvalescence after laparoscopic procedures. However, there may be also a selection bias. Laparoscopic procedures are associated with specific complications, e.g., pneumomediastinum, pneumothorax, gas extravasation, trocar injuries, intraabdominal adhesions, bowel obstruction, which are rarely or never seen in open-mesh repair. In the United States we could observe an uncoupling of hernia repair from classification. In more than 90% of cases the treatment was open-mesh. In many hernia studies the hernias were classified as direct or indirect, primary or recurrent. The existing classifications are based on anatomical findings in relation to the development of the hernia: posterior floor integrity, enlarged interior ring and size of the hernia. However, the size of the hernia may not always be associated with the severity of the hernia and it may be difficult to estimate. The outcome of hernia repair may be influenced by other factors. There may be differences in the presentation of the hernia to the surgeon based on the damage done to the surrounding tissue in the inguinal canal, e.g., external ring, aponeurosis of the external oblique, inguinal ligament, which is most often accompanied by severe adhesions. Further factors influencing outcome of hernia repair may be patient-related factors, e.g., constipation, ASA classification, diabetes, smoking. A classification should be simple to use and easy to remember: (A) indirect hernia, (B) direct hernia, (C) scrotal or giant hernia, (D) femoral hernia. A and B can be classified as (0) uncomplicated, (1) posterior floor defect, (2) posterior floor defect plus defect in the anterior part of the inguinal canal. All four types (A-D) may be either primary or recurrent. In this classification combined femoral, indirect and/or direct hernias can be categorized by using the types A, B, C, or D as in a modular construction system. The category "other" is reserved for rare types of hernia, e.g., obturator hernia, Spieghelian hernia. Aggravating factors are included: Diabetes, obesity, age above 65, constipation, ASA III or more and cigarette smoking. This classification may be helpful to evaluate outcome of hernia repair with regard to patient related factors and the increased demands for the surgeon and the staff. In some health care systems the general belief is that all hernias are equal and be managed equally. However, groin hernias may be complex and need individual treatment.     

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.