腹腔镜下腹股沟疝修补术的临床应用与术式选择

目的:探讨腹腔镜腹股沟疝修补术的手术方法和术式选择,评价其手术并发症、术后复发率及远期慢性疼痛等临床效果。方法:回顾分析2004年11月至2005年12月全麻下施行的经腹腔及腹膜前腹腔镜腹股沟疝修补术184例(246侧)的临床资料。结果:245侧手术成功,1例中转开放手术。7例患者出现非严重并发症,占3.8%;平均随访(90%的患者)36个月,1例(2侧)复发,占0.54%,随访患者中无远期不适感。结论:腹腔镜腹股沟疝修补术安全,并发症发生率低,复发率低,且远期慢性疼痛发生率低。     

疝环充填式无张力疝修补术1826例治疗经验

目的总结疝环充填式无张力腹股沟疝修补术的临床疗效。方法回顾性分析2000年5月至2010年12月采用聚丙烯疝环充填物及补片修补的1826例腹股沟疝的临床资料。结果平均手术时间45min（34～84min）;术后平均住院时间6．4d（4～16d）;阴囊血肿发生率0．7％（13／1826）;伤口感染率0．2％（5／1826）;腹股沟区慢性疼痛发生率0．8％（15／1826）;获得随访1628例,随访率89．2％,随访时间平均78个月（3～127个月）,复发率为0．5％（8／1628）;无手术死亡。结论疝环充填式无张力腹股沟疝修补术是一种操作简单,效果确切,术后复发率低的理想术式。     

腹腔镜完全腹膜外法治疗腹股沟疝的临床研究（附32例报告）

目的总结完全腹膜外法腹腔镜疝修补（TEP）的初步经验及临床效果。方法回顾分析2005年1月至2007年10月我院采用TEP治疗腹股沟疝的临床资料。结果手术均获成功，无中转其他术式。手术时间40～175min，平均86min。住院时间5～9d，平均7d。手术并发症4例，占12．5％，均为腹股沟区或阴囊血肿或血清肿。随访1个月至2年9个月。早期开展时有3例短期内复发，经开放无张力修补术治愈，复发率为9％。结论TEP手术安全可靠，术后疼痛轻、恢复快、复发率低，同其他腹腔镜疝修补术相比优势明显，已成为治疗腹股沟疝的主要术式，具有推广价值。     

经腹腹膜前腹股沟疝修补术618例

目的：总结经腹腹膜前腹股沟疝修补术的临床经验。方法回顾性分析2011年10月至2014年1月,昆明医科大学第一附属医院运用腹腔镜行经腹腹膜前腹股沟疝修补术618例,其中包括双侧132例,无合并症及同步手术。随访4-48个月（中位时间16个月）。结果所有手术全部成功,主要并发症有血清肿或积液6．8％,尿潴留5．3％,异物感或不适感3．2％,436例随访时间＞12个月,术后3个月无复发,远期复发3例（侧）,总复发率0．485％（3/618）。结论经腹腹膜前腹股沟疝修补术治疗腹股沟疝是安全可行的,术后并发症及复发率等较传统开放手术有优势。     

免钉合补片腹腔镜经腹腔腹膜前疝修补术治疗腹股沟疝应用体会

目的探讨免钉合补片经腹腔腹膜前腹腔镜疝修补术(TAPP)治疗腹股沟疝的应用效果。方法回顾分析2010年6～9月全麻下施行的免钉合补片腹腔镜经腹腔腹膜前疝修补术25例(27侧)的临床资料。结果全组患者手术成功,无中转开放手术。2例患者出现非严重并发症,占8.0%;平均随访12个月,无复发,随访患者中无远期不适感。结论免钉合补片腹腔镜经腹腔腹膜前疝修补术安全,并发症发生率低,复发率低,且不明显增加患者的医疗费用。     

采用传统疝修补方法治疗腹股沟疝437例

目的：评价传统腹股沟疝修补术的效果。方法：1982年1月－2002年1月我科采用传统方法修补腹股沟疝437例，随访统计病人的年龄，性别，腹股沟疝的类型，合并症以及手术方式的选择，复发率，并发症发生率等临床资料。结果：437例病人中失随访25例，复发15例，复发率为3．4％，并发症；术后阴囊血肿1例，切口出血1例，神经痛2例，并发症发生率为0．92％。结论：在采用传统疝修补方法治疗腹股沟疝时，只要严格掌握手术适应证，选择恰当的手术方式并在术中强调操作要点同样能达到较低的复发率。     

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。     

腹腔镜腹股沟疝修补术:附176例报告

目的 探讨腹腔镜腹股沟疝修补术的可行性。方法 从1998年12月～2001年12月间采用腹腔镜下疝内环口荷包缝扎和腹膜内置网法对176例腹股沟疝患者实施腹腔镜疝修补术，其中腹股沟斜疝160例，腹股沟直疝l5例，复合疝1例。结果 平均手术时间30min，术中、术后无并发症发生，术后2～3d出院。全部患者均获随访1O～36个月，有2例复发，复发率1．2％。结论 腹腔镜腹股沟疝修补术是一种安全可行的疝修补新方法，具有操作简单、并发症少、术后疼痛轻、恢复快、复发率低等优点，值得临床推广应用。     

免钉合补片经腹腔腹膜前腹腔镜疝修补术治疗腹股沟疝应用体会

目的 探讨免钉合补片经腹腔腹膜前腹腔镜疝修补术(TAPP)治疗腹股沟疝的应用效果.方法 回顾性分析2010年6～9月全麻下施行的免钉合补片经腹腔腹膜前腹腔镜疝修补术25例(27侧)的临床资料.结果 全组患者手术成功,无中转开放手术.2例患者出现非严重并发症,占8.0%;平均随访12个月,无复发,随访患者中无远期不适感.结论 免钉合补片经腹腔腹膜前腹腔镜疝修补术安全,并发症发生率低,复发率低,且不明显增加患者的医疗费用.     

疝环填充式与普理灵疝装置无张力疝修补术的比较

目的对目前临床上广泛应用的疝环填充式（Perfix Plug-mesh）与普理灵疝装置（PHS）腹股沟疝无张力修补术的手术方式及临床效果进行比较。方法回顾性统计、分析我院自2003年7月至2005年7月所进行的208例腹股沟疝修补术的病例资料。结果疝环填充式无张力修补术156例，普理灵疝装置无张力修补术52例。两组在手术时间、术后短期疼痛、下地时间、并发症及远期不适发生率方面差异无统计学意义。术后平均随访20．3个月，疝环填充组复发率为1．3％；PHS组未见复发。结论疝环填充式与PHS修补均为理想的无张力疝修补术式，具有复发率低，手术操作简便，术后恢复快，术后疼痛轻等特点。相较而言，两种术式各有优势与不足。应对每位患者进行充分的检查与评估，根据具体情况选择适宜的疝修补术式。     

Endoscopic repair of bilateral inguinal hernias – short and late outcome

Background: In the last decade there have been dramatic changes in the treatment of inguinal hernia with the introduction of mesh techniques including laparoscopic repair. There is still some controversy regarding the treatment of bilateral inguinal hernia but simultaneous operation has gained popularity. The aim of this study was to evaluate the outcome of laparoscopic simultaneous bilateral hernia with regard to complications, recurrence rate, and late discomfort. Methods: A retrospective analysis was made of 168 patients operated simultaneously for bilateral inguinal hernia using the laparoscopic technique between October 1993 and December 1998. Complications were registered and a follow-up was performed using a combination of questionnaire and selective clinical examination. Results: Complications were seen in 23 patients (13.8%), the majority minor. Ninety-five percent of the patients were followed for a median of 36 months. The recurrence rate was 2.7%. Twenty-six of the follow-up patients (15.5%) reported some discomfort. Conclusions: We conclude that simultaneous laparoscopic operation for bilateral inguinal hernia is safe, with complications, recurrence rate and late discomfort are equivalent to those seen after unilateral operation. Electronic Publication     

善释补片在腹股沟疝无张力修补术临床分析

目的探讨善释补片在腹股沟疝无张力修补术中的临床疗效。方法回顾性分析我院2008年1月至2010年12月应用善释补片行腹股沟疝无张力修补术患者264例。结果手术时间平均65min,术后患者1d即下床活动,住院时间4～7d,切口疼痛轻,均一期愈合。术后出现排尿困难32例,阴囊积液3例,切口皮下积血1例,切口异物感6例,术后随访4～28个月,无复发。结论疝环充填式无张力疝修补术是一种安全可靠的腹股沟疝手术方法,具有创伤小,疼痛轻,恢复快,操作简单,住院时间短,复发率低等优点。同时国产善释补片价位低,适合基层医疗机构使用。     

腹腔镜完全腹膜外腹股沟疝修补术的临床体会(附85例报告)

目的:探讨腹腔镜完全腹膜外腹股沟疝修补术(totally extraperitoneal prosthesis,TEP)的可行性,并评价术中、术后并发症、复发率等临床效果。方法:回顾分析2012年1月至2012年6月全麻下为85例(96侧)患者行腹腔镜TEP的临床资料。结果:84例(95侧)手术获得成功,1例(1侧)中转开腹。1例术后发生远端疝囊血清肿,经穿刺抽吸治疗后好转,并发症发生率为1.2%。术后平均随访(7±0.8)个月,无复发,患者无明显不适感。结论:腹腔镜TEP安全、可行,并发症发生率低,复发率低,优势明显。     

腹腔镜经脐双孔治疗小儿腹股沟斜疝的疗效

目的观察采用经脐双孔法腹腔镜治疗小儿腹股沟斜疝的手术效果。 方法回顾分析2018年1~12月北京市通州区妇幼保健院154例经脐双孔法腹腔镜治疗小儿腹股沟斜疝临床资料，评估经脐双孔法腹腔镜治疗腹股沟斜疝临床疗效。 结果所有患儿顺利完成手术，其中单侧腹股沟斜疝71例（46.1%），双侧腹股沟斜疝6例（3.8%），术中发现对侧隐匿疝77例（50%），单侧腹股沟斜疝平均手术时间（32.7±10.1）min，双侧腹股沟斜疝平均手术时间（33.4±10.9）min。术后随访6个月，未发现复发、阴囊血肿、睾丸萎缩及脐疝等相关并发症。 结论经脐双孔法腹腔镜治疗小儿腹股沟斜疝疗效确切，术后瘢痕小，术后并发症低。     

开放式腹膜前间隙腹股沟疝修补术的临床经验

目的总结开放式腹膜前间隙腹股沟疝修补术的临床经验。 方法回顾性分析2014年1月至2016年12月,北京朝阳医院行开放式腹膜前间隙腹股沟疝修补术、无合并症及同步手术214例患者临床资料。随访3～24个月。 结果全组除1例复发疝因腹膜前间隙致密黏连改行Lichtenstein术外,其余均成功,主要并发症有血清肿或积液3.3%,尿潴留1.4%,异物感或不适感2.3%。200例随访时间>12个月,术后3个月无复发,远期复发2例,总复发率0.93%。 结论开放式腹膜前间隙腹股沟疝修补术治疗腹股沟疝是安全可行的,术后并发症及复发率等较传统开放手术有优势。     

Laparoscopic repair of inguinal hernia using Surgisis mesh and fibrin sealant.

OBJECTIVE: We tested the hypothesis that laparoscopic inguinal herniorrhaphy using Surgisis mesh secured with fibrin sealant is an effective long-term treatment for repair of inguinal hernia. This case series involved 38 adult patients with 51 inguinal hernias treated in a primary care center. METHODS: Between December 2002 and May 2005, 38 patients with 45 primary and 6 recurrent inguinal hernias were treated with laparoscopic repair by the total extraperitoneal mesh placement (TEP) technique using Surgisis mesh secured into place with fibrin sealant. Postoperative complications, incidence of pain, and recurrence were recorded, as evaluated at 2 weeks, 6 weeks, 1 year, and with a follow-up questionnaire and telephone interview conducted in May and June 2005. RESULTS: The operations were successfully performed on all patients with no complications or revisions to an open procedure. Average follow-up was 13 months (range, 1 to 30). One hernia recurred (second recurrence of unilateral direct hernia), indicating a 2% recurrence rate. CONCLUSIONS: Laparoscopic repair of inguinal hernia using Surgisis mesh secured with fibrin sealant can be effectively used to treat primary, recurrent, direct, indirect, and bilateral inguinal hernias in adults without complications and minimal recurrence within 1-year of follow-up.     

Repair of bilateral inguinal hernias--sequential or simultaneous?

INTRODUCTION: Surgery of inguinal hernia has changed dramatically with the introduction of tension-free hernia repair. There is still some controversy regarding the treatment of bilateral inguinal hernia, but simultaneous operation has gained popularity. The purpose of the present paper is to evaluate recent publications regarding treatment of bilateral inguinal hernia. METHODS: For this article, the "Cochrane Database of Systematic Reviews", "BMJ Clinical Evidence", "Pubmed" and "Embase" were searched using the search terms "simultaneous", "bilateral", "inguinal" and "hernia". Number of patients, recurrence rate, complications, study type and authors' conclusions were evaluated. Analysis of the literature showed relevant results in two reviews of the "Cochrane Database", 4 items in "BMJ Clinical Evidence" and 17 clinical studies. RESULTS: No study showed a difference between recurrence and complication rate (simultaneous bilateral vs. unilateral repair). Recurrence rates were from 0.3 to 19 % (bilateral) and from 0.7 to 15 % (unilateral). Complications were defined heterogeneously and were in a range from 2.5 to 26.7 % (bilateral) and from 3 to 21 % (unilateral). All operative procedures (open suture: Shouldice; open mesh: Lichtenstein, Stoppa; laparoscopic techniques: TAPP / TEP) are adequate for the repair of bilateral hernia. CONCLUSION: The simultaneous operation of bilateral hernia is safe and effective. Postoperative pain and length of reconvalescence are comparable to those of the unilateral operation. Only symptomatic bilateral groin hernias should be operated. If no difficulties such as obesity and giant hernia are expected, bilateral hernias should be repaired simultaneously. The choice of the operative method should be made in accordance to the centre's standard procedure. A special operation for bilateral hernias is neither necessary nor justified.