肾移植术后腹股沟疝患者12例临床诊治分析

目的探讨应用不同补片进行无张力修补术治疗肾移植术后腹股沟疝的临床应用体会。方法对温州医科大学附属第一医院2008年7月至2014年7月期间收治的12例肾移植术后腹股沟疝患者临床资料进行回顾性分析。结果 12例患者肾移植术后出现腹股沟疝的中位时间为72个月;腹股沟疝类型包括斜疝9例,直疝2例,斜疝合并直疝1例,均为单侧。患者均在疝确诊后6~12个月内手术治疗,10例使用聚丙烯疝补片行Lichtenstein平片修补术,2例使用超普疝修补装置(UHS)行疝环充填式无张力修补术,平均手术时间(54±26)min。1例UHS修补斜疝合并直疝术中损伤移植输尿管,行移植输尿管膀胱再植。术后切口疼痛3例,阴囊积液1例。截至2014年7月,术后随访12~32个月,肾功能均无明显变化,未观察到切口感染、疝复发、异物不适感、睾丸萎缩、射精痛及慢性疼痛等并发症。结论肾移植术后腹股沟疝患者使用传统聚丙烯疝补片行Lichtenstein平片修补术对移植肾影响较小,应用UHS行疝环充填式无张力修补术中易损伤移植输尿管。     

三种不同腹股沟疝手术修补方案的临床有效性及安全性对照探究

目的:比较平片(Lichtenstein)、疝环充填式(Rutkow)、腹膜前(Kugel)三种腹股沟疝无张力修补术的疗效。方法:2010年7月—2012年7月收治的成人腹股沟疝患者198例分为3组各66例,即:平片无张力疝修补组(Lichtenstein组)、疝环充填式疝修补组(Rutkow组)、腹膜前修补术(Kugel组);比较三组治疗效果。结果:三组手术时间、术后下床时间、住院时间、早期并发症均无统计学差异(均P>0.05);Rutkow组术后1个月、6个月VAS评分(3.15±0.92,1.92±1.52)明显高于Lichtenstein组(2.31±0.41,1.02±0.97)和Kugel组(2.25±0.57,0.96±0.84)(均P<0.05);三组复发率无统计学差异(P>0.05);Rutkow异物感发生率(18.18%)高于Lichtenstein组(1.52%)和Kugel组(3.03%)(P<0.05)。结论:平片疝修补术、疝环充填式修补术和腹膜前修补术疗效及并发症几乎接近,宜根据不同病例采用不同方案。     

改良Lichtenstein法前路修补治疗168例腹股沟复发疝体会

目的探讨改良Lichtenstein法前路修补治疗腹股沟复发疝的临床效果。方法168例复发性腹股沟疝患者行改良Lichtenstein法前路修补,术中分离或离断部分提睾肌,清楚显露内环及其周围间隙,根据腹股沟管后壁不同程度的缺损分别于腹膜外及精索后放置合适大小的网片。结果168例共行无张力疝修补185例次,术后恢复良好,切口下积液2例,切口区红肿7例,阴囊积液4例。151例获随访0.5-5年,无一例复发。结论应用改良Lichtenstein法前路修补行腹股沟疝无张力修补术,符合腹股沟疝的解剖特点和＂个体化＂要求,操作简便、安全和经济,易于广泛推广。     

充填式无张力疝修补术与lichtenstein修补术治疗腹股沟疝的对比研究

目的探讨Lichtenstein修补术治疗腹股沟疝的应用价值。方法对腹股沟疝患者施行Lichtenstein修补术115例，充填式无张力疝修补术（Rutkow修补术）135例；比较两组患者的手术时间、术后恢复情况及复发率。随访中位数19个月。结果两组手术时间差异无统计学意义（P〉0．05）。在术后下床活动时间、生活自理时间、住院天数、恢复日常工作天数方面，Lichtenstein组与充填式无张力疝修补术组差异无统计学意义（均P〉0．05）。Lichtenstein组、Rutkow组的手术均无明显并发症，复发率分别为0％、0．7％，差异无显著性。结论Lichtenstein修补术是腹股沟疝的良好修补法。     

疝环充填式无张力疝修补术与腹膜前入路疝修补术的比较分析(附89例报告)

目的 比较腹膜前入路平片及疝环充填式无张力修补治疗腹股沟疝的疗效.方法 回顾性分析应用平片及疝环充填式无张力修补术两种方法 的手术时间、术后恢复时间、术后并发症及复发率.结果 均获随访,前入路腹膜修补组随访24.7个月,疝环充填式修补组随访25.9个月,两组平均手术时间、住院时间、术后疼痛、阴囊积液及恢复日常生活时间差异无统计学意义(P>0.05),术后异物感疝环充填式3例,腹膜前入路1例,疝环充填式复发1例,前入路腹膜前修补复发3例(P<0.05).结论 在腹股沟疝无张力修补治疗中,提倡治疗的个体化,选择性应用平片及疝环充填式无张力疝修补术.     

善释D10补片与善释网塞修补腹股沟疝的临床分析

目的探讨应用善释D10补片及善释网塞修补腹股沟疝的临床疗效。方法回顾性分析2006年4月至2010年1月127例应用善释补片修补腹股沟疝患者的情况。57例腹股沟疝患者应用善释D10补片行开放式腹膜前置入无张力疝修补术;70例腹股沟疝患者应用善释网塞行疝环充填式无张力修补术。结果善释D10补片疝修补术组在手术时间、手术操作、创伤程度、术后疼痛、阴囊积液、局部异物感、伤口麻木感等方面优于善释网塞修补术组。结论善释补片修补腹股沟疝的临床疗效是安全可靠的,善释D10补片腹膜前修补术更具有创伤小、操作简单、手术时间短、术后不适少的优点。     

腹壁、腹膜、肠系膜、腹膜后

腹腔镜在dHL腹股沟嵌顿疝手术中的应用；腹膜外平片法无张力疝修补术在复杂腹股沟疝中的应用;腹腔镜下腹股沟疝修补术的并发症及其防治方法;Millikan与Rutkow术式治疗腹股沟疝的比较；择期腹股沟疝无张力修补术围手术期预防性抗生素的合理性；疝环充填式无张力修补术治疗438例腹股沟疝；     

肾移植和腹股沟疝修补同期手术的研究

目的探讨肾移植和腹股沟疝修补同期手术的可行性和安全性。方法回顾性分析1997年4月至2010年4月,首都医科大学附属北京朝阳医院因尿毒症合并腹股沟疝行肾移植手术的患者资料,对患者的年龄、性别、原发病、合并症、透析方式、手术时间、住院时间和术后肾功能等资料进行观察。结果共有7例尿毒症合并腹股沟疝患者接受了肾移植手术,患者全部为男性,中位年龄63岁,均为腹股沟斜疝,其中4例患者肾移植手术同期行疝修补术,其余3例患者中,2例采取分期手术,一期肾移植,二期疝修补,1例单纯行肾移植术。分期手术患者中有1例于疝修补术后5个月复发,再次行腹腔镜无张力疝修补术。平均随访时间6.8年(4.5~12.5年),腹股沟疝无复发患者。结论肾移植合并腹股沟疝患者,分期手术和同期手术都是可行的,同期手术安全可行,值得推广。     

腹壁、腹膜、肠系膜、腹膜后

腹壁造瘘口旁疝44例防治体会；腹膜假性黏液瘤36例临床分析；局部麻醉下普理灵疝修补装置在腹股沟疝无张力修补术中的应用；平片无张力腹股沟疝修补术280例分析；腹股沟疝腹腔镜下全腹膜外补片植入术与Shouldice术、Lichtenstein术的比较；自体疝囊带蒂补片无张力修补治疗腹股沟疝；腹腔镜经腹膜腹股沟斜疝无张力修补手术方式的体会（附23例报告）；腹膜后肿瘤术中腹主动脉及下腔静脉的切除与重建     

无张力腹股沟疝修补术后疝复发的临床分析

目的　探讨无张力腹股沟疝修补术后疝复发的原因、预防及治疗。方法　结合 11例无张力腹股沟疝修补术后复发疝的临床资料 ,分析其复发的原因 ,并提出改进手术的方法及对复发疝的治疗。结果　本组 10例 ,其中疝环充填式无张力疝修补术后复发 6例 ,平片修补术后复发 4例。复发原因为平片修补术后因补片过小复发 1例 ,补片卷曲、移位 1例 ,补片精索孔留得过大 2例 ,疝环充填式无张力疝修补术后充填之网塞未牢靠固定在疝环口周围的坚韧组织上复发 2例 ,疝环口过大 ,与充填之网塞不匹配 2例 ,充填的 2个网塞之间未固定 ,留有间隙 1例 ,网塞间断缝合固定 ,但网片未固定 1例。结论　无张力腹股沟疝修补术后复发疝的原因主要是术中操作失误即对网塞和补片的置入和固定不当 ,其治疗方法仍为开放的无张力腹股沟疝修补术 ,主要是疝环充填式无张力疝修补术。     

Transurethral prostatectomy and inguinal hernia repair in a single session

INTRODUCTION: We aimed at evaluating the outcomes of transurethral prostatectomy and inguinal hernia repair performed in a single session. PATIENTS AND METHODS: Fifty-six patients (mean age 68+/-8.3 years) in whom transurethral prostatectomy was performed combined with an inguinal hernia repair were included into the study. Type of anesthesia, technique of inguinal hernia repair, hospitalization time, and the complications encountered were recorded. Cost comparisons were made using the official price-lists of the Turkish Medical Association. All patients were asked whether they were satisfied with the outcome of both operations performed in one session. The data obtained from the patients who underwent both operations in one session were compared with those obtained from 56 patients who underwent transurethral prostatectomy only (control group). Statistical analysis was performed using the chi-square test corrected for continuity according to the Yates or the Fisher exact test. RESULTS: The operations were performed in 19 patients under general, in 20 patients under epidural, and in 14 patients under spinal anesthesia. Three patients were given general anesthesia and spinal anesthesia combined. In 6 patients bilateral and in 50 patients unilateral hernia repair was performed. In 11 repairs, polyprolene mesh grafts were utilized; in 2 repairs, a laparoscopic method was used, and in the remaining 49 repairs, one of the conventional techniques (McVay, Bassini, or Shouldice) was employed. There were no significant differences with regard to early and late postoperative complications and satisfaction between study group and control group (p>0.05). Combined prostatectomy and hernia repair allows approximately 30% cost profit. CONCLUSIONS: Performing transurethral prostatectomy and inguinal hernia repair in one session decreased the number of the operations and anesthesias, hospital stay, and thus health costs and did not cause an increase in operative and postoperative morbidity.     

Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison

OBJECTIVE: To study the long-term recurrence rate and other complications after conventional and laparoscopic inguinal hernia repair. SUMMARY BACKGROUND DATA: Reliable long-term follow-up of patients with inguinal hernias treated by laparoscopic repair techniques is lacking. METHODS: The authors performed a randomized, multicenter trial in which 487 patients with inguinal hernia were treated by totally extraperitoneal laparoscopic repair and 507 patients were treated by conventional anterior hernia repair. Patients were followed and examined for recurrence and chronic inguinal pain 2, 3, and 5 years after surgery. Risk factors for recurrence and chronic inguinal pain were assessed. RESULTS: Patients who underwent conventional repair had a high risk for recurrence compared to patients who underwent laparoscopic repair. Risk factors for recurrence were operative time and type of conventional repair. Predictive independent risk factors for chronic inguinal pain were conventional repair (Bassini repairs and non-bassini repairs), inguinal pain before surgery, and perioperative lesion of the ilioinguinal nerve. CONCLUSIONS: Patients with inguinal hernia who undergo laparoscopic repair have fewer recurrences and less chronic inguinal pain than those who undergo conventional open repair. The Bassini repair produces unacceptably high recurrence rates.     

Combined transurethral prostatectomy and inguinal hernia repair: a retrospective audit and literature review.

OBJECTIVE: To audit the results of combined transurethral resection of the prostate (TURP) and inguinal hernia repair, often carried out under the same anaesthetic (because bladder outlet obstruction from prostatic disease and inguinal hernia are both common conditions in elderly men), to avoid two separate operations. PATIENTS AND METHODS: The study included 85 patients who underwent primary inguinal hernia repair with TURP in the urology unit of Nottingham City hospital between 1989 and 1995, and who were recalled to a special clinic. The type of hernia and repair carried out were recorded and complications audited with specific reference to recurrence of hernia and wound infection. RESULTS: The 85 patients underwent 88 primary inguinal hernia repairs with TURP (three were bilateral). Maloney's darn repair was used on 55 and a Bassini repair on 33 occasions, respectively. Two patients developed mild wound infection after surgery, but only two patients (2%) had recurrence of hernia. CONCLUSIONS: The recurrence rate after primary inguinal herniorraphy with conventional methods of repair, performed with TURP, was comparable with published results of hernia repairs alone, before the introduction of Lichtenstein's mesh repair.     

免气囊分离器完全腹膜外腹腔镜腹股沟疝修补术的初步体会(附21例报告)

目的：探讨免气囊分离器完全腹膜外腹腔镜腹股沟疝修补术（totally extraperitoneal repair,TEP）的可行性、手术技巧和临床经验。方法：2005年6月至2007年5月为21例患者（23侧）行腹股沟疝免气囊分离器TEP,其中斜疝21侧,直疝、股疝各1侧。结果：所有患者均顺利完成手术,平均手术时间70min,术中平均出血16ml,术后平均住院5d。发生腹壁下血管游离5例次,腹壁气肿5例次,血肿或血清肿4例次,腹膜破损与神经感觉异常各3例次,膀胱损伤1例次。随访2—24个月,无复发。结论：免气囊分离器TEP安全可行,手术难点是正确分离腹膜外置入网片的腔隙。     

Conversion to Stoppa Procedure in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair

Background and Objectives:

Conversion to open surgery is an important problem, especially during the learning curve of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair.

Methods:

Here, we discuss conversion to the Stoppa procedure during laparoscopic TEP inguinal hernia repair. Outcomes of patients who underwent conversion to an open approach during laparoscopic TEP inguinal hernia repair between September 2004 and May 2010 were evaluated.

Results:

In total, 259 consecutive patients with 281 inguinal hernias underwent laparoscopic TEP inguinal hernia repair. Thirty-one hernia repairs (11%) were converted to open conventional surgical procedures. Twenty-eight of 31 laparoscopic TEP hernia repairs were converted to modified Stoppa procedures, because of technical difficulties. Three of these patients underwent Lichtenstein hernia repairs, because they had undergone previous surgeries.

Conclusion:

Stoppa is an easy and successful procedure used to solve problems during TEP hernia repair. The Lichtenstein procedure may be a suitable option in patients who have undergone previous operations, such as a radical prostatectomy.     

Inguinal hernia repair by surgical trainees at a Malaysian teaching hospital

OBJECTIVE: To assess the outcome of inguinal hernia repaired by surgical trainees at Universiti Kebangsaan Malaysia Hospital. METHODS: Retrospective review of 103 patients who underwent surgery between November 2001 and October 2002. RESULTS: The mean age of patients was 50 years and the male-to-female ratio was 20:1. Most hernias (60%) were right-sided inguinal hernias. Admissions consisted of 60% elective, 31% day-case and 9% emergency. General anaesthesia was administered in 66% of cases, spinal anaesthesia in 33% and local anaesthesia in 1%. Ten inguinal hernia repairs were performed by first-year trainees, 61 by third-year trainees and 19 by fourth-year trainees. First-year trainees did more darning (60%) and fewer mesh (40%) repairs. Third-year trainees still used darning (57%) but also performed more mesh repairs (43%). Fourth-year trainees performed 68% darning (mainly to teach the first-year trainees) and 32% mesh repairs. Senior surgeons assisted in 13 difficult cases where mesh repair was preferred (92%) to darning repairs (8%). Prophylactic antibiotic was more frequently used in patients undergoing mesh repair (p < 0.001). The mean operative time was the same for both types of repair. There were no significant differences in complications between the two types of repair. One hernia recurred after darning repair but none after mesh repair. CONCLUSIONS: Mesh repair of inguinal hernia is effective. Trainees easily acquire this skill and it becomes their preferred method of repair.     

Does resident post graduate year influence the outcomes of inguinal hernia repair?

INTRODUCTION: We evaluated the effect of the postgraduate medical education level (PGY) of surgery residents on recurrence of inguinal hernia, complications, and operative time. METHODS: Post hoc analysis was performed on prospectively collected data from a multicenter Veterans Affairs (VA) cooperative study. Men were randomly assigned to open or laparoscopic inguinal hernia repairs with mesh. Surgery residents performed repairs with designated attending surgeons present throughout all procedures. PGY level of the resident was recorded for each procedure. All patients were followed for 2 years for hernia recurrence and complications. PGY levels were grouped as follows: group I = PGY 1 and 2; group II = PGY 3; group III = PGY >/= 4; rates of recurrence, complications and mean operative time were compared. RESULTS: A total of 1983 patients underwent hernia repair. group III residents had significantly lower recurrence rates for open repairs when compared with group I (adjusted odds ratio = 0.24, 95% confidence interval [CI], 0.06, 0.997). The recurrence rate was similar among the groups for laparoscopic repair (P > 0.05) Complication rates were not different for either repair (P > 0.05). Mean operative time was significantly shorter for group III compared with group I for both open (-6.6 minutes; 95% CI, -11.7, -1.5) and laparoscopic repairs (-12.9 minutes; 95% CI, -19.8, -6.0) and between group II and group I for laparoscopic repair (-15.0; 95% CI, -24.3, -5.7). CONCLUSIONS: Despite the presence of an attending surgeon, open hernia repairs performed by junior residents were associated with higher recurrence rates than those repaired by senior residents. Lower resident level was associated with increased operative time for both open and laparoscopic repair.     

Hernia repair in elderly patients

Background This study evaluates a 5-year experience of the management of the most frequent abdominal wall hernias in an elderly population. Methods From April 1990 to December 1995, 231 inguinal, 12 femoral and seven umbilical hernias were repaired in 221 patients (mean age 74 (range 66–93) years). Concomitant diseases were present in 157 patients, A mesh repair was performed with ‘tension-free’ or ‘plug’ techniques in all but 23 inguinal and two femora! hernia repairs, in which the Bassini or Shouldice procedures were adopted. Ten emergency hernia repairs were performed for strangulation. A total of 232 operations, including four emergency hernia repairs, were carried out under local anaesthesia. Results There was no perioperative mortality. Acute intestinal bleeding occurred 2 days after surgery in a patient with colonic diverticular disease. Urinary retention occurred once following emergency hernia repair under general anaesthesia and twice after elective hernia repair under local anaesthesia. Local complications included four scrotl haematomas (2 per cent), three wound infections (1 per cent) and one case of orchitis with atrophy after repair of a recurrent hernia. There was one recurrence after a Bassini repair and one after Shouldice inguinal herniorrhaphy. No recurrence was observed after mesh repair. Conclusion Local anaesthetic mesh hernia repair is safe and effective in elderly patients. Age should be no bar to elective hernia repair. This policy should avoid the complications of emergency operation.     

腹腔镜小儿疝自体组织修补术的临床观察(附190例报告)

目的 探讨腹腔镜自体组织修补术治疗小儿腹股沟斜疝的临床应用价值.方法 回顾分析近5年行腹腔镜疝囊高位结扎术加自体组织修补术治疗190例小儿腹股沟斜疝的临床资料,单侧斜疝153例,双侧斜疝(包括对侧隐性疝)37例;其中平诊斜疝183例(包括复发疝11例),急诊嵌顿性斜疝7例.结果 190例均手术成功.平均手术时间单侧10 min,双侧18 min,术后平均住院为1 d,无术后并发症发生.全组病例术后均获得随访,随访时间为6个月～5年,复发5例.结论 腹腔镜自体组织修补术治疗小儿腹股沟斜疝疗效满意,手术时间短,创伤小,复发率低,并发症少,术后恢复快,同时可用于处理对侧腹股沟隐性疝或者用于双侧腹股沟疝修补术.     

After 10 years and 1903 inguinal hernias,what is the outcome for the laparoscopic repair?

Background: The procedure of choice for inguinal hernia repair has remained controversial for decades. The laparoscopic approach has now been utilized for more than 10 years, and a significant volume of patient outcomes is now available for review. Methods: The hospital and office records of 1388 patients who underwent 1903 laparoscopic inguinal hernia repairs at Atlanta Medical Center during the past 10 years were retrospectively reviewed in order to determine demographics, recurrence rate, and complications. In addition, 123 hernia repairs were prospectively studied in 71 patients during this time period in order to accurately evaluate postoperative pain and return to activity. Results: Two hundred fifty-five (13.4%) hernias were recurrent and 1648 (86.6%) were primary. Five hundred and fifteen (37.1%) hernias were bilateral. The total extraperitoneal approach was utilized for 1561 (82.0%) of the 1903 repairs. The average operative time was 75.4 (14–193) minutes. Estimated blood loss was 22.0 (0–250) ml. Seventeen patients (1.2%) were converted to an open form of hernia repair. Minor complications occurred in 83 (6.0%) patients and major complications occurred in 18 (1.3%) patients. Conclusions: The laparoscopic approach is a safe form of inguinal hernia repair that offers the patient a shorter and less painful recovery with an extremely low recurrence rate.