应用无张力疝修补术治疗老年腹股沟疝

腹外疝是普外科领域里的常见病,腹股沟疝则是腹外疝中发病率最高的一种类型,占90%以上,多见于老年人.目前国内尚无完整的统计数字,美国的流行病学统计显示,其腹外疝的发病率每年超过70万人.为此国内有关外科专家做了一个最为保守的推算,我国的腹外疝发病率会超过每年一百万人.根据国内多所医院的统计,在前往医院就诊的腹股沟疝患者中,男性患者占绝大多数,男女比率约为15:1或更高,随着社会的不断老龄化,老年患者的比率不断上升,年龄在60岁及以上的患者约占60%～80%.而最后接受手术治疗的老年患者的比例则更高.可以说腹股沟疝是一种老年人的多发病.     

疝环充填式无张力疝修补术在治疗老年腹股沟疝中的体会

自2000年6月至2001年1月我院应用疝环充填式无张力疝修补术治疗老年腹股沟疝26例.该手术方法操作简单,手术损伤小,术后疼痛轻、恢复快,并发症少,复发率低,其治疗效果是令人满意的.现将应用该手术治疗老年腹股沟疝的体会介绍如下.     

腹腔镜完全腹膜外腹股沟疝修补术与开放无张力腹股沟疝修补术治疗老年腹股沟疝的临床效果

目的探讨老年腹股沟疝患者接受腹腔镜完全腹膜外腹股沟疝修补术与开放无张力腹股沟疝修补术的治疗效果及对胃肠动力的影响。方法选取96例老年腹股沟疝患者,随机分为观察组对照组各48例,观察组采用腹腔镜完全腹膜外腹股沟疝修补术,对照组采用开放无张力腹股沟疝修补术,比较两组手术相关情况及胃泌素(GAS)、胃动素(MTL)的变化。结果观察组治疗费用显著高于对照组;手术时间、术中出血量、术后疼痛持续时间及住院时间显著低于对照组(均P0.05)。两组并发症总发生率差异有统计学意义(P0.05)。术前,两组GAS、MTL水平差异均无统计学意义(P0.05);观察组术后1 d明显降低(P0.05),术后3 d与术前相比差异无统计学意义(P0.05);对照组术后1、3 d GAS、MTL水平比术前降低,且低于同期观察组,差异有统计学意义(P0.05)。结论腹腔镜完全腹膜外腹股沟疝修补术与开放无张力腹股沟疝修补术治疗老年腹股沟疝各有利弊,但创伤轻、安全性佳、有利于胃肠动力恢复是腹腔镜完全腹膜外腹股沟疝修补术的显著优势。     

腹股沟疝传统修补术与疝环充填式无张力疝修补术、平片式无张力疝修补术的临床对比

腹股沟疝的手术治疗经历了传统疝修补术、低张力疝修补术、无张力疝修补术几个阶段，现在无张力疝修补术已在国内外普及。主要有平片修补（Lichtenstein）、疝环充填式修补（mesh—plug＆patch）以及双层补片修补技术（Gilbert）等。这些技术均获得了非常满意的治疗效果。我国自1997年开始推广无张力疝修补术，以疝环充填式无张力疝修补术为主要术式。本文通过对传统疝修补术、平片无张力疝修补术、充填式无张力疝修补术治疗腹股沟疝的术后效果进行对比研究，旨在探求选择更合理的个体化腹股沟疝手术治疗方法。     

疝环充填式无张力疝修补术治疗老年腹股沟疝32例体会

腹股沟疝在老年人中的发病率较高,而且治疗上亦较为困难.由于老年患者的生理解剖和病理生理特点,应用传统的疝修补方法治疗,术后并发症较多,复发率高.因此近年来新型的无张力疝修补手术正在逐步取代传统的手术方法.我院自1999年7月至2000年4月应用疝环充填式无张力疝修补术治疗老年腹股沟疝共32例,效果良好,现报告如下:     

无张力腹股沟疝修补术58例治疗体会

2003年2月～2004年9月,我院采用普理灵疝补片（PHS）和疝环充填式补片（Mesh—Plug）两种无张力疝修补手术方法治疗腹股沟疝58例。现将手术治疗体会报告如下。     

疝环充填式无张力疝修补术治疗老年腹股沟疝

目的　评价疝环充填式无张力疝修补术治疗老年腹股沟疝的效果。方法　对 42例老年腹股沟疝患者进行疝环充填式无张力疝修补术 ,并与同期的 38例行传统手术的老年腹股沟疝患者进行比较。结果　与传统修补术相比 ,疝环充填式无张力疝修补术有很大优越性 ;手术指征宽 ,手术操作简便 ,术后并发症少 ,恢复快 ,复发率低。结论　疝环充填式无张力疝修补术符合老年人的解剖学特点 ,适合于治疗老年腹股沟疝 ,可作为首选术式     

无张力疝修补术治疗腹股沟疝212例体会

2001年1月～2006年12月,我们为212例腹股沟疝患者行无张力疝修补术,效果满意。现将报告如下。 临床资料：本组212例腹股沟疝患者,男194例,女18例;年龄45～78岁,平均62岁;斜疝182例,直疝22例,复发疝8例;按中华外科学会疝与腹壁学组分型法（2003年8月）,Ⅰ型20例,Ⅱ型119例次,Ⅲ型64例,Ⅳ型9例。     

疝环充填式无张力疝修补术36例临床应用体会

腹股沟疝是外科临床的最常见疾病之一.虽然疝修补的手术方式众多,但治疗效果均不理想.我院自1999年4月起采用疝环充填式无张力疝修补术治疗腹股沟疝,至2001年1月已治疗了36例腹股沟疝患者,取得了较满意的效果,现报告如下:     

无张力疝修补术治疗成人疝气的临床效果观察

目的观察无张力疝修补术治疗成人疝气的临床效果。方法选取2013-05~2015-11该院110例成人腹股沟疝的患者,按手术方式不同分为A组和B组,A组58例行无张力疝修补术,B组52例行传统疝修补术。比较两组的手术时间、疼痛持续时间、住院时间、术后并发症(切口感染、尿潴留、阴囊血肿)等资料。出院后6个月对两组患者进行电话随访,了解其复发情况。结果 A组手术时间较B组长(P0.05),但A组的疼痛持续时间及住院时间较B组短,差异有统计学意义(P0.05)。A组虽然尿潴留、阴囊血肿的发生率与B组比较差异无统计学意义(P0.05),但其并发症的总发生率明显低于B组(P0.05),两组复发率差异无统计学意义(P0.05)。结论无张力疝修补术治疗成人疝气,疗效值得肯定,术后并发症少,可在临床推广应用。     

老年腹股沟疝开放式无张力疝修补术后随访结果分析

目的评价开放式无张力修补术在老年腹股沟疝患者中的疗效。方法2003年1月～2004年8月,复旦大学附属华东医院对440例60岁及以上腹股沟疝患者实施了开放式无张力修补术,其中I型疝48例,Ⅱ型疝220例,III型疝82例,IV型疝90例。结果术后405例得到随访,平均随访36．3月,术后共3例复发,20例尿潴留,36例阴嶷积液,1例肠梗阻,4例切口感染,18例慢性疼痛及异物不适感,1例皮肤麻木感。结论开放式无张力疝修补术对老年腹股沟疝患者安全有效,术后复发率低、并发症少,应根据个体化情况选择合适的术式进行治疗。     

无张力疝修补术的临床分析

目的 探讨无张力疝修补术在治疗疝中的临床应用价值.方法 采用美国美外公司的疝环充填物及网状补片行无张力疝修补术治疗腹外疝100例.结果 全组病例切口均Ⅰ期愈合,术后3～7 d出院,随访至今无复发.结论 无张力疝修补术是一种快捷、无痛、复发率低的手术方法.     

无张力疝修补术治疗成人腹股沟疝与传统术式的效果比较

目的探讨对比无张力疝修补术与传统手术治疗成人腹股沟疝的疗效。方法对1999～2008年成人腹股沟疝进行回顾性分析,将行无张力疝修补术166例患者作为观察组,将采取传统手术治疗的178例患者作为对照组,比较两组疗效及术中出血量、术后排气时间、住院时间、术后复发率等。结果观察组术中出血量、术后肛门排气时间和术后住院时间均优于对照组(P=0.001)。观察组术后复发率为0.30%,对照组术后复发率为10.6%,两组比较差异有统计学意义(P0.001)。结论无张力疝修补术治疗成人腹股沟疝与传统手术方法比较,具有出血少、术后恢复快、住院时间短、术后复发率低的特点,适于在基层医院推广应用。     

应用三维超普疝修补装置行无张力疝修补术治疗嵌顿性腹股沟斜疝的疗效分析

目的探讨应用三维超普疝修补装置(UHS)行无张力疝修补术治疗嵌顿性腹股沟斜疝的临床疗效。方法回顾分析应用三维UHS行无张力疝修补术治疗14例嵌顿性腹股沟斜疝患者的临床资料。结果全组病例均治愈出院,随访8个月～3年未见复发。结论在严格掌握适应证的前提下可以应用无张力疝一期修补术治疗嵌顿性腹股沟斜疝。     

Triple-combined herniorrhaphy for inguinal hernia repair: experience of 1411 cases

BACKGROUND/AIMS: The optimum method for inguinal hernia repair has not yet been determined. Triple-Combined Herniorrhaphy, using the combined methods of McVay, Shouldice and Halsted repairs, was developed in our hospital over the past years in order to improve the overall results of treatment of inguinal hernia. The aim of this study was to verify the value of this surgical technique for primary inguinal hernia in a specialized hospital setting. METHODOLOGY: We describe our experience of 1411 consecutive patients for whom Triple-Combined Herniorrhaphy was performed for inguinal hernia repair at our hospital between September 2000 and August 2003, under local anesthesia with a "one-day surgery" regimen. RESULTS: The type of hernias included 342 direct inguinal hernias, 913 indirect inguinal hernias, and 156 pantaloon (mixed) type inguinal hernias. No mortality or major intraoperative complications were observed. The median duration of operation time was 25 min. Wound infection and hematoma formation requiring drainage was observed in 9 and 16 patients, respectively. Patients had fast convalescence with rapid resumption of working activity. The postoperative recurrence rate was 1.2%. CONCLUSIONS: Triple-Combined Herniorrhaphy is a simple, safe, comfortable, and effective method with low early and later morbidity and recurrence rate. The good results of this procedure constitute a good alternative to mesh or other open inguinal repairs.     

局麻下吉尔伯特手术治疗老年人腹股沟疝的临床分析

目的总结局麻下吉尔伯特手术治疗老年人腹股沟疝的临床应用经验。方法回顾性分析2003年4月至2004年4月在局麻下行吉尔伯特手术治疗的76例老年人腹股沟疝的临床资料，观察手术时间、术后并发症、住院天数及复发率。结果本组76例全部治愈。手术平均时间25．7min。术后2-5h即可下床活动。术后切口疼痛8例，切口异物感4例，发生阴囊积液3例。住院平均时间2．3d。术后随访1～12个月，未见疝复发及切口感染。结论局麻下吉尔伯特疝修补术是一种对人体生理功能干扰小、术后恢复块、并发症少的理想术式，尤其适合于治疗老年人腹股沟疝。     

Surgical outcomes of laparoscopic total extraperitoneal (TEP) inguinal hernia repair compared with Lichtenstein tension-free open mesh inguinal hernia repair: A prospective randomized study

Inguinal hernia repair is one of the most frequently performed surgery. The ideal procedure for inguinal hernia repair remains controversial. Open Lichtenstein tension-free mesh repair (LMR) is one of the most preferred open techniques with satisfactory outcomes. Laparoscopic approach in inguinal hernia surgery remains controversial, especially in comparison with open procedures. In this study, we have reported a comparison of laparoscopic total extraperitoneal (TEP) inguinal hernia repair with LMR. Postoperative pain, operative time, complications like seroma, wound infection, chronic groin pain, and recurrence rate were parameters to evaluate the outcome.One hundred seventy-four patients were included in the study by consecutive randomized prospective sampling. The patients were divided into 2 groups: group A, laparoscopic TEP inguinal hernia repair, and group B, LMR. The procedures were performed by experienced surgeons. The primary outcomes were evaluated based on postoperative pain and recurrence rate. Secondary outcomes considered for evaluation were operative time, complications like seroma, infection, and chronic groin pain.Severe pain was reported in group A (7.9%) compared to group B (15.1%), which was statistically significant (P < .001). Moderate pain was reported more in group B (70.9%) compared to group A (29.5%) (P < .001). The mean operative time in group A was 84.6 ± 32.2, which was significantly higher than that in group B, 59.2 ± 14.8. There was no major complication in both groups. The chronic pain postoperatively was significantly in higher number of patients in group B vs group A (22.09% vs 3.4%). The postoperative hospital stay period was significantly lesser for group A vs for group B (2.68 ± 1.52 vs 3.86 ± 6.16). Time duration taken to resume normal activities was significantly lower in group A (13.6 ± 6.8) vs (19.8 ± 4.6) in group B (P < .001).Although there is definite evidence of longer operative time and learning curve, laparoscopic TEP has added advantages like less postoperative pain, early resumption of normal activities, less chronic groin pain, and comparable recurrence rate compared to open Lichtenstein repair. Laparoscopic TEP can be performed with acceptable outcomes and less postoperative complications if performed by experienced hands.