Adult Bochdalek hernia simulating left pleural effusion: a review and a case report

The authors present a rare case of congenital diaphragmatic Bochdalek hernia in an adult stimulating left pleural effusion. The diagnosis of left pleural effusion was made on the basis of conventional chest X-ray and ultrasonography. The definitive diagnosis of Bochdalek hernia was made by left video-assisted thoracoscopy. The patient was successfully treated operatively by conventional surgery--a combination of left thoracotomy and median laparotomy. The reported case supported the view that Bochdalek hernia in adults presents usually with atypical chronic abdominal and respiratory symptoms. Surgical treatment should best be performed, according to the authors, by competent surgeons with good command of both the thoracic and abdominal approaches to the diaphragm.     

选择性腹腔镜单纯内环口结扎治疗成人腹股沟疝的应用

目的：介绍有选择的腹腔镜下单纯内环口结扎在治疗成人腹股沟疝的应用。方法：临床上选择成人腹股沟疝不伴有明显的腹股沟区薄弱或缺损的病例,采用带线穿刺针行腹腔镜下单纯内环口腹膜外环形结扎,治疗成人腹股沟疝40例。结果：40例手术均获得成功,随访2年以上无复发,无任何不适。结论：该方法对于成人腹股沟疝不伴有明显的腹股沟区薄弱的病例,具有更加简便、经济、安全有效的优点。     

赫美补片应用于成年人脐疝修补治疗12例分析

目的 探讨赫美补片在成年人脐疝治疗中的应用.方法 回顾性分析2007年1月至2009年3月收治的12例成年人脐疝的资料,分析成年人脐疝采用赫美Oval Patch 0812型补片进行无张力疝修补术治疗的方法、特点及效果.结果 全部病例均治愈出院,平均住院时间(54±2)d,术后无一例发生并发症.随访1-25个月无复发.结论 对于疝环直径≤4cm的成年人脐疝采用赫美Oval Patch 0812型补片修补是一种简单、安全、可靠的方法.     

腹腔镜与开放腹膜前疝修补术治疗成人腹股沟疝的对比分析

目的:探讨腹腔镜疝修补术与开放腹膜前间隙疝修补术治疗成人腹股沟疝的临床疗效。方法:选取本院2018年1月~2018年12月收治的90例成人腹股沟疝患者,随机分为观察组与对照组。观察组45例行腹腔镜疝修补术,对照组45例行开放腹膜前间隙疝修补术。比较两组平均手术时间、术中出血量、住院天数、术后疼痛时间、血肿、血清肿、切口感染、复发率。结果:观察组平均手术时间、术中出血量、住院天数、术后疼痛时间等方面,均明显优于对照组,差异有统计学意义(P<0.05)。两组术后血肿、血清肿、切口感染、复发率相比,差异无统计学意义(P>0.05)。结论:腹腔镜疝修补术创伤小,恢复快,比开放腹膜前间隙疝修补术更具优势。     

实施临床路径及按病例支付改革后的效果评估——以成人腹股沟疝为例

以成人腹股沟疝为例,评估县级医院在实施临床路径及支付方式改革试点后,医疗质量、费用、住院日和抗生素使用方面的效果.结果显示:实施临床路径及支付方式改革试点降低了医疗费用,缩短了住院天数,在保证医疗质量的同时,提高了医院效率.     

腹股沟疝应用Lichtenstein术式42例体会

目的:探讨成人腹股沟疝Lichtenstein术式的疗效.方法:对42例腹股沟疝病人行Lichtenstein术式无张力修补术的临床资料进行回顾性分析.结果:患者平均住院天数6.7天.42例均得到随访,平均随访7个月,有1例复发.病例术后疼痛较轻,术后发生阴囊肿胀6例,并发尿潴留10例,无切口感染及其它并发症.结论:Lichtenstein无张力修补术适用于各型成人腹股沟疝,术后疼痛轻微,复发率低.     

腹膜前间隙修补术对成人腹股沟疝患者术后恢复及并发症的影响

目的研究腹膜前间隙修补术对成人腹股沟疝患者术后恢复及并发症的影响。方法选择2013年1月至2019年3月我院收治的300例成人腹股沟疝患者,随机分为两组各150例。A组行腹腔镜全腹膜外疝修补术(TEP)治疗,B组行腹腔镜腹膜前腹股沟疝修补术(TAPP)治疗。比较两组的术后恢复指标、术后并发症及复发情况。结果 A组的下床活动时间、胃肠功能恢复时间均显著短于B组(P<0.05);两组的术后最高体温、住院时间、术后并发症发生率及复发率比较,差异无统计学意义(P>0.05)。结论 TAPP与TEP治疗成人腹股沟疝均有较好的临床效果,术后并发症发生率及复发率均较低,但TEP更利于术后快速恢复,临床可根据患者的实际情况选择合适的手术方式。     

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。     

局麻、硬膜外麻开放式无张力疝修补术与腹腔镜全腹膜外疝修补术的疗效对比研究

目的：研究局麻、硬膜外麻下开放式无张力疝修补术与腹腔镜全腹膜外疝修补术（TEP）治疗成人腹股沟疝的疗效对比。方法：回顾性分析本院2009年8月-2014年3月诊治的87例成人腹股沟疝患者的临床资料,根据患者的经济情况和病情等选择不同术式,其中23例行局麻下疝修补的患者作为局麻组,36例硬膜外麻下行无张力疝修补术的患者作为硬膜外麻组,28例行腹腔镜全腹膜外疝修补的患者作为腹腔镜组。观察比较三组患者的手术时间、术后下床时间、总住院时间、术后疼痛时间、住院费用、术后并发症和术后复发率等指标。结果：三组患者手术均成功。手术时间以硬膜外麻组时间最短,腹腔镜组时间最长（P〈0.05）;术后下床活动时间以局麻组最短,硬膜外麻组最长（P〈0.05）;总住院时间以腹腔镜组最短,局麻组最长（P〈0.05）;术后疼痛时间以腹腔镜组最短,局麻组最长（P〈0.05）;住院费用以腹腔镜组最高,局麻组最低（P〈0.05）;三组的术后并发症发生率比较差异无统计学意义（P〉0.05）;三组均无近期复发病例。结论：三种术式各有最佳适应证和优缺点,应个体化选择疝修补术,腹腔镜腹股沟疝修补术有良好的发展前景。     

25例腹股沟疝Lichtenstein法无张力修补术治疗体会

目的探讨Lichtenstein无张力疝修补术方法、原则、安全性及有效性。方法回顾分析25例成人腹股沟疝Lichtenstein无张力疝修补术的临床资料。结果手术时间35-80min,所有病例随访1-18个月,无1例复发。结论 Lichtenstein无张力疝修补术是一种操作简单、创伤小、疗效满意及复发率低的疝修补术。     

无张力疝修补术治疗40例老年人腹股沟复发疝的临床应用

目的 总结无张力疝修补术治疗老年人腹股沟复发疝的经验.方法回顾性分析无张力疝修补术在治疗40例老年人腹股沟复发疝中的应用.结果 40例患者手术顺利,平均手术时间45 min,平均住院时间70 d.术后并发症：尿潴留6例,阴囊积液3例,对症治疗均痊愈,无切口感染及液化.40例患者均随诊1~4年,无再复发.结论 无张力疝修补术应作为治疗老年人腹股沟复发疝的首选术式.     

Congenital Mesenteric Defect: An Uncommon Cause of Bowel Obstruction

Congenital mesenteric defects can lead to internal hernias which may result in a bowel obstruction. They are very rare among the adult population, comprising only 0.2%–0.9% incidence rate of all small bowel obstructions. A 40 year old woman presented to the Emergency Department with abdominal pain.Computed tomography scan was obtained and showed a small bowel obstruction.After failed conservative management with bowel rest and nasogastric tube decompression, the patient underwentdiagnostic laparoscopy.An internal hernia was identified though a congenital mesenteric defect at the level of the sigmoid colon. The hernia was reduced and the defect closed. When a patient presents with abdominal pain the diagnosis of a congenital mesenteric defect with internal hernia should be considered with subsequent emergent surgical exploration.     

腹股沟疝无张力修补术是否应用抗生素的对比研究

目的探讨腹股沟疝无张力修补术是否需要常规预防性应用抗生素。方法选择204例成年人腹股沟疝患者,根据入院先后顺序按1：3比例随机分为治疗组（51例）和对照组（153例）,治疗组术前使用第一代头孢菌素1次;对照组术前、术后均不使用抗生素,对比两组术后早期切口感染发生情况。结果204例腹股沟疝患者中5例发生术后切口感染,其中治疗组1例,感染率2．0％（1／51）,对照组4例,感染率2．6％（4／153）,两组比较差异无统计学意义（r=0．000,P=1．000）。两组术后第3天白细胞计数、嗜中性粒细胞百分比及住院时间、住院费用比较差异无统计学意义（P〉0．05）。结论无高危因素的成年人腹股沟疝无张力修补术常规应用抗生素预防术后切口感染无实质性必要。     

窝沟封闭预防儿童第一恒磨牙龋齿效果的meta分析

目的 评价窝沟封闭预防儿童第一恒磨牙龋齿的效果。方法 通过电子检索2009—2019年公开发表的窝沟封闭预防儿童第一恒磨牙龋齿的相关文献,根据循证医学方法建立纳入和排除标准并筛选文献,采用R3.6.1和metafor 2.1软件包进行meta分析。结果 共纳入文献24篇,涉及研究牙数122 180颗,其中封闭组牙数72 746颗,对照组49 434颗。窝沟封闭后第1、2、3年随访结果显示,封闭组患龋率均明显低于对照组,3年的合并RR值分别0.12、0.19和0.26。结论 窝沟封闭对预防5～9岁儿童第一恒磨牙龋齿效果明显。     

Lymphoma Diagnosed at Inguinal Hernia Repair

Tumors presenting in the inguinal hernia sac are considered to be extremely rare, with the more common neoplasms metastasizing from the gastrointestinal tract, ovary and prostate. We report the case of Mantle cell lymphoma identified in the inguinal hernia sac following hernia repair. While the hernia sac appeared normal to the surgeon, evaluation by the pathologist showed subtle gross irregularities, with subsequent histologic and immunochemical diagnosis of Mantle cell lymphoma. Twelve previous cases of a lymphoma diagnosed during hernia repair have been described in the English literature. This is the first report of Mantle cell lymphoma found in the hernia sac. This case illustrates the value of routine microscopic evaluation of hernia sacs found from inguinal/femoral herniorrhaphies, as it may be the primary presentation of an asymptomatic metastatic lymphoma. Additionally, it underscores the importance of the surgeon''s role in screening hernia sacs if the practice of submitting only macroscopically abnormal specimens for microscopic evaluation is adopted.     

The 'Inguinal Hernia' guideline of the Association of Surgeons of the Netherlands

The 'Inguinal hernia' guideline was written over a period of two years by nine surgeons (including one epidemiologist) from all regions of the Netherlands with demonstrable clinical and scientific expertise in the area of inguinal surgery after a training course on 'The development of evidence-based guidelines'. A draft of the guideline was on the website of the Association of Surgeons of the Netherlands for a period of three months, during which time the members of the society could comment on its contents interactively. The guideline comprises chapters on risk factors and prevention, diagnostics, indications for treatment, treatment, day surgery, antibiotics, thrombosis prophylaxis, training, anaesthesia, postoperative pain control, complications, costs, aftercare, and specific aspects of inguinal hernia in children. For the treatment of adult patients a mesh technique is recommended. The Lichtenstein technique is recommended as the first choice for uncomplicated primary inguinal hernia. Laparo-endoscopic techniques can be used by trained teams for specific indications. Other techniques have not been compared with the current methods of treatment sufficiently. It is recommended that the operations be carried out in daycare and that the use of local anaesthesia should be considered more often. The diagnosis of inguinal hernia in a child is based on the physical examination. It is recommended that the surgeon should not rely solely on the history but confirm the presence of a hernia personally. The treatment of a paediatric inguinal hernia is always operative. Generally, the younger the child, the more urgent the operation because of the increased risk of incarceration in infants, particularly premature babies. There is no indication for routine exploration of the contralateral groin. If an incarcerated hernia cannot be reduced, emergency operation is necessary and referral to a paediatric surgical centre must be considered. The implementation and effectiveness of the guideline will be measured by taking an inventory of all inguinal hernia operations performed in the Netherlands before and after its publication.     

Handlebar hernia: a rare type of abdominal wall hernia

Traumatic abdominal wall hernias are a type of acquired hernia secondary to blunt trauma Caused, by direct trauma from handlebar like objects. This rare hernia is named 'Handlebar hernia'. We report a case of such hernia without any significant intra-abdominal injury. The abdominal wall defect was repaired in layers by Jones technique. Postoperative course was uneventful. The authors recommend clinical suspicion for traumatic hernia in all patients with traumatic abdominal wall injury. Definitive treatment includes surgical exploration with primary repair of all tissue layers of the abdominal wall.     

16层螺旋CT在食管裂孔疝诊断中的应用

目的：探讨16层螺旋CT在食管裂孔疝诊断中的应用价值。方法：回顾25例经胃镜、手术或上消化道造影证实的食管裂孔疝患者的16层螺旋CT资料并加以分析。结果：16层螺旋CT可以清晰显示食管裂孔疝的疝囊大小、部位、形态、密度、膈肌裂孔情况及病变与邻近结构的关系。结论：16层螺旋CT通过薄层断面和多平面重建技术（MPR）可以多角度显示疝囊及内容物,可为肿瘤性病变及其他不明原因膈肌膨隆的鉴别诊断提供有价值的诊断信息。     

Right paraduodenal hernia: a case report]

Paraduodenal hernia is a rare etiology of intestinal obstruction. Its preoperative diagnosis can only be made by a well-performed upper gastrointestinal series. We report a case of a 19 years old man with abdominal pains and recurrent Koenig's syndromes. The upper gastrointestinal series and CT scan showed a right paraduodenal hernia. we reviewed the anatomy. physiopathology, symptoms and radiographic criteria for the diagnosis of the paraduodenal hernia.     

婴幼儿嵌顿性疝181例临床分析

目的总结小儿嵌顿性腹股沟斜疝的诊治经验及体会。方法回顾性分析181例小儿嵌顿性腹股沟斜疝住院患儿的临床资料。结果非手术治疗15例，手术治疗166例，其中肠坏死6例，右睾丸坏死4例，左卵巢坏死1例，肠坏死和左睾丸坏死1例，均需手术切除，1例肠浆膜修补，1例右睾丸缺血损伤。全部病例均治愈出院，无死亡病例。结论对小儿腹股沟斜疝发生机制和特点的充分认识，有助于对小儿,嵌顿疝作出及时正确的处理，随着微创技术及一日监护外科模式的发展，提倡小儿腹股沟斜疝为限期手术。