腹腔镜腹壁切口疝补片修补临床分析

目的 探讨穿刺针及钩针在腹腔镜腹壁切口疝补片修补中的应用.方法 2006年1月至2008年12月我院应用穿刺针及钩针为23例腹壁切口疝患者行腹腔镜腹壁切口疝补片修补.结果 23例手术均顺利完成,用时60.0～210.0 min,平均(120.0±5.7)min;术后15.0～42.0 h,平均(28.0±2.3)h排气;2～3 d进食,住院5.0～10.0 d,平均(7.0±0.8)d.术后疼痛3个月以上5例,浆液肿4例,对症治疗后好转,随访10～36个月无疝复发.结论 应用穿刺针及钩针固定补片,方法简单,容易操作,可完成腹腔镜腹壁切口疝补片修补,值得在基层医院推广.     

A case of Spigelian hernia after laparoscopic incisional hernia repair

Laparoscopic ventral hernia repair with intraperitoneal onlay mesh reinforcement is often performed in clinical practice. We herein describe a patient who developed a Spigelian hernia at the edge of the mesh due to rupture of the muscular layer in the abdominal wall. A 69-year-old woman developed a left-sided abdominal bulge 15 months after laparoscopic ventral hernia repair. CT showed a 33-mm defect in the abdominal wall at the lateral edge of the left abdominal rectus muscle with an intestinal prolapse through the defect. She was diagnosed with a Spigelian hernia and underwent operation. The hernia orifice was located at the aponeurosis of the transverse abdominal muscle where the thread had been used to fix the mesh through all layers of the abdominal wall. This report details a case of a Spigelian hernia after laparoscopic ventral hernia repair.     

Current trends in laparoscopic groin hernia repair: A review

Hernia is a common problem of the modern world with its incidence more in developing countries. Inguinal hernia is the most common groin hernia repaired worldwide. With advancement in technology operative techniques of repair have also evolved. A Pub Med and COCHRANE database search was accomplished in this regard to establish the current status of laparoscopic inguinal hernia repair in view of recent published literature. Published literature support that laparoscopic hernia repair is best suited for recurrent and bilateral inguinal hernia although it may be offered for primary inguinal hernia if expertise is available.     

Single-incision laparoscopic surgery: hernia repair

In most countries, inguinal hernia repair is the most frequent procedure performed in a surgical practice. Different approaches have been developed during the last decades, with a strong tendency towards tension-free techniques. The laparoscopic approach offers advantages in terms of less postoperative pain and faster recovery with a low incidence in recurrence. In the last few years, single-incision laparoscopic surgery (SILS) has been introduced to further improve surgical outcome and cosmetic results. For SILS inguinal hernia repair, there is little data available so far, but both totally extraperitoneal hernia repair and transabdominal preperitoneal hernia repair have been succesfully performed without complications in a limited number of patients. In our experience, totally extraperitoneal hernia repair seems to be an ideal indication for the application of SILS.     

47例造口旁疝腹腔内修补术患者的围手术期护理

报道了47例造口旁疝腹腔内修补术患者的围手术期护理经验.术后出现2例切口感染、2例皮下积液,均治愈.随访6-24个月,造口旁疝均未复发.3例局部出现较明显的慢性疼痛或异物感,在术后3-6个月症状消失.认为术前对症护理、做好肠道准备、术后严密观察病情变化、给予正确的出院指导是护理的关键内容.     

竞争风险模型在肠造口旁疝发病风险及影响因素分析中的应用

目的：应用竞争风险模型评估肠造口旁疝的发病风险及影响因素分析。方法：回顾性分析2015年至2019年735例行肠造口术患者的临床资料。通过Cox模型评估PSH的累积发生率。当死亡和回纳作为竞争事件出现时，采用Fine-Gray模型进行分析。结果：在中位随访17.1（9.0, 36.5）个月期间，136例（18.5%）发生PSH，PSH出现的中位时间为10个月。单因素Cox回归分析和单因素Gray检验显示，年龄、术前BMI、术后BMI、高血压、前列腺肥大、造口途径与PSH的发生相关。多因素Cox回归分析和多因素Fine-Gray模型均显示，年龄≥60岁、BMI≥25kg/m2和经腹膜外造口术是PSH发生的独立影响因素。此外，多因素Fine-Gray模型显示乙状结肠造口也是PSH的独立影响因素。使用Kaplan-Meier法时，肠造口患者随访1年、2年和5年的PSH累积发生率分别为20.5%、29.8%和37.6%；使用Fine-Gray模型时分别为13.69%、20.07%和25.31%。与Kaplan-Meier或Cox法相比，Fine-Gray模型对PSH累积发生率的估计始终较低。结论：在存在竞争风险的情况下，相比于Kaplan-Meier和Cox模型，Fine-Gray模型能够更准确地评估与PSH发生相关的高危因素以及PSH的累积发生率。这些结果可能为临床医护人员更客观评估PSH的发生提供参考价值。     

腹膜前间隙疝修补术与疝环充填式疝修补术治疗老年腹股沟疝患者的临床效果比较

目的比较腹膜前间隙疝修补术与疝环充填式疝修补术治疗老年腹股沟疝患者的临床效果。方法将80例老年腹股沟疝患者根据手术方案不同分为观察组与对照组,各40例。观察组采取腹膜前间隙疝修补术治疗,对照组采取疝环充填式疝修补术治疗。比较两组的治疗效果。结果观察组的手术时间、术后离床活动时间、术后疼痛持续时间、住院时间均短于对照组,术中失血量少于对照组(P<0.05)。观察组的异物感、切口感染发生率低于对照组(P<0.05)。观察组的术后复发率低于对照组(P<0.05)。结论腹膜前间隙疝修补术治疗老年腹股沟疝患者的临床效果显著,有利于降低并发症发生率及复发率,同时能够减少手术创伤并优化围术期指标。     

两种腹带治疗肠造口旁疝的效果观察

目的比较两种腹带治疗肠造口旁疝的效果.方法将36例肠造口旁疝患者分为两组,造口腹带组20例,普通腹带组16例.比较治疗后1个月的效果.结果造口腹带组有15例(75.0%)、普通腹带组有3例(18.8%)1个月后能坚持使用腹带.造口腹带对于减轻造口周围不适症状、防止体形改变、减少造口袋渗漏等均优于普通腹带(P<0.01).结论肠造口旁疝非手术治疗时,佩戴造口腹带比佩戴普通腹带更有效.     

Laparoscopic parastomal herniorrhaphy utilizing transversus abdominis release and a modified Sugarbaker technique: A case report

A 69-year-old woman was referred to our department with complaints of abdominal discomfort in the standing position. She had undergone robot-assisted radical cystectomy and ileal conduit urinary diversion for bladder cancer 10 months earlier. Abdominal CT revealed a parastomal hernia. Laparoscopic parastomal hernia repair using the Pauli technique was performed successfully with no recurrence after a 4-month follow-up. Although there are concerns about potential mesh-related complications and long-term results, this novel approach can be a successful option for parastomal hernia repair. As far as we know, this is the first English-language report on the application of Pauli parastomal hernia repair combined with a pure laparoscopic approach.     

腹腔镜经腹腔腹膜前疝修补术治疗复发性腹股沟疝的效果及安全性

目的 探讨腹腔镜经腹腔腹膜前疝修补术治疗复发性腹股沟疝的效果及安全性。方法 回顾性选取2018年1月至2021年1月本院收治的72例复发性腹股沟疝患者,依据手术方法将其分为对照组（疝环充填式无张力疝修补术）和研究组（腹腔镜经腹腔腹膜前疝修补术）,每组36例。比较两组的手术相关指标、疼痛程度、应激反应指标及术后并发症发生情况。结果 研究组的术中出血量少于对照组,首次下床时间、疼痛持续时间及住院时间均短于对照组（P<0.05）。术后1、3 d及1周,研究组的SF-MPQ评分均低于对照组（P<0.05）。手术后,两组的β-EP、Cor、CRP水平均较手术前明显升高,但研究组低于对照组（P<0.05）。研究组的术后并发症总发生率为5.56%,低于对照组的25.00%(P<0.05)。结论 与疝环充填式无张力疝修补术相比,采用腹腔镜经腹腔腹膜前疝修补术治疗复发性腹股沟疝可减轻疼痛程度及应激反应,促进患者恢复,安全性更高。     

Development of a novel training system for laparoscopic inguinal hernia repair

Background: Laparoscopic inguinal hernia repair is considered technically difficult. Although a simulation-based curriculum has been developed to help trainees, access to simulation training outside North America is limited. This study aimed to develop an educational system for the transabdominal preperitoneal (TAPP) approach based on the TAPP checklist, an assessment tool we had developed and validated earlier.

Material and methods: Consensus within the TAPP education working group consisting of local TAPP experts, hernia experts and a surgical educator to develop educational tools and the educational system based on the TAPP checklist. The system was piloted in several institutes, and participants were surveyed on its efficacy.

Results: We systematically developed an educational video and training manual explaining each item of the TAPP checklist and conveying basic knowledge of the procedure. We integrated the training tool with evaluation and feedback to develop an educational system. In a pilot study, seven trainees at five hospitals were trained using this system and found it very useful for mastering the TAPP procedure.

Conclusions: We have developed a training system for TAPP procedure and successfully implemented it in several hospitals. Further research will focus on the educational value of this tool.     

Inguinoscrotal hernia containing the urinary bladder successfully repaired using laparoscopic transabdominal preperitoneal repair technique: A case report

We report herein a patient with an inguinoscrotal hernia containing the urinary bladder. The hernia was safely repaired using the laparoscopic transabdominal preperitoneal repair technique. A 76‐year‐old man was admitted to our hospital with abdominal pain, vomiting, and diarrhea. His scrotum was swollen to fist size. Abdominal CT showed herniation of the sigmoid colon and the bladder into the right inguinal region, and his abdominal pain was attributed to incarceration of the sigmoid colon; this was manually reduced. About 1 month later, we performed transabdominal preperitoneal repair. After the direct hernial orifice was identified, the bladder was noted to be sliding from the medial side of the hernia; this was reduced. Peeling on the medial side was carried out to the middle of the abdominal wall, and the myopectineal orifice was covered with mesh. The patient was discharged on postoperative day 1.     

应用疝环充填式无张力疝修补术治疗腹股沟疝

目的 探讨疝环充填式无张力疝修补术治疗腹股沟疝的特点。方法 采用美国巴德（Bard）公司生产的PerFixplug产品，治疗56例腹股沟疝，观察手术时间、切口疼痛、活动能力恢复、并发症和复发率。结果 手术时间：平均50min，切口无明显疼痛，术后下床活动时间：单侧疝平均3～10h；双侧疝平均24h。2周恢复正常工作。并发症主要是尿潴留5例，伤口积液1例，无切口感染；随访2～32个月，无一例复发。结论 疝环充填式无张力疝修补术操作简单，损伤少，恢复快，复发率低，适用范围广，是理想有效的疝修补术。