“颈-肩技术”在腹股沟斜疝Lichtenstein修补术中的临床应用

目的:探讨颈-肩技术在腹股沟斜疝Lichtenstein修补术中的应用。方法:87例Lichtenstein修补术,将其分为两组,一组使用颈-肩技术,另一组使用传统方法。比较两组手术时间、血肿/血清肿、术后随访6个月的慢性疼痛及复发率。结果:颈-肩技术组手术时间为(48.5±4.8)min,血肿/血清肿5例,1例复发,术后1、3个月慢性疼痛分别为5、3例;传统方法组手术时间为(54.3±6.8)min,血肿/血清肿8例,2例复发,术后1、3个月慢性疼痛分别为7、4例。两组手术时间比较,差异有统计学意义(t=4.67,P=0.00);血肿/血清肿发生率、复发率、术后1、3个月慢性疼痛两组间差异均无统计学意义(P0.05)。结论:颈-肩技术在Lichtenstein术中创伤小、解剖清晰、节省手术时间,安全、有效。     

颈肩技术在前入路腹股沟疝UHS无张力疝修补术中的应用

目的:探讨颈肩技术在前入路腹股沟疝UHS无张力疝修补术中的应用。方法:回顾性分析2013年5月—2016年5月行前入路腹股沟疝UHS无张力疝修补术的205例患者的临床资料,其中传统方法组110例(传统组),颈肩组95例(颈肩组)。对比分析两组的手术时间,术中出血量,住院时间,术后随访6个月有无术后并发症及复发率。结果:两组患者手术过程顺利,无大出血以及严重并发症发生。颈肩组手术时间、术中出血量均优于传统组[(53.84±10.64)min vs.(58.52±10.15)min,(6.34±3.02)mL vs.(7.60±2.90)mL,均P0.05]。颈肩组术后复发3例(3.2%),术后血肿6例(6.3%),切口感染2例(2.1%),慢性疼痛9例(9.5%),尿潴留3例(3.2%);传统组术后复发7例(6.4%),术后血肿11例(10.0%),切口感染4例(3.6%),慢性疼痛15例(13.6%),尿潴留5例(4.5%);两组间术后复发率、术后血肿发生率、切口感染率、慢性疼痛发生率及尿潴留发生率比较,差异均无统计学差异(均P0.05)。结论:应用颈肩技术可缩短前入路UHS无张力疝修补术的手术时间,减少术中出血,是腹股沟疝前入路中较安全实用的手术方式。     

充填式无张力疝修补术治疗高龄腹股沟斜疝150例临床体会

目的探讨疝环充填式无张力性疝修补术治疗老年人腹股沟斜疝的临床经验。方法2002年1月至2008年4月对150例高龄腹股沟斜疝采用疝环充填式无张力疝修补术。结果门诊随访131例,失访19例,随访时间1～3年复发2例（1．53％）,其中术后切口脂肪液化2例,阴囊水肿3例。结论充填式无张力疝修补术具有创伤小、恢复快、复发率低等优点,是目前较理想的疝修补方法。     

无张力充填式疝修补术治疗腹股沟斜疝86例报告

目的探讨无张力充填式疝修补术治疗腹股沟斜疝的临床效果。方法回顾性分析无张力充填式疝修补术86例患者的临床资料。结果手术时间平均35min,术后6h病人能下床活动,伤口轻微疼痛时间2~3d。术后排尿困难5例,伤口异物感4例,均经对症处理后痊愈。无切口感染。术后78例随访2~32个月(中位时间18个月),无复发及其他并发症发生。结论无张力充填式疝修补术符合人体解剖结构和疝的病理生理,操作简便、损伤轻、恢复快、术后复发率低,值得推广。     

APOM技术在腹股沟前路疝修补术中的应用体会

无张力疝修补技术经历了数十年的发展,特别是材料学的进展与普及,逐渐形成了以Lichtenstein手术方式为代表的无张力疝修补术,被称为是20世纪疝修补术的里程碑。这种手术方式不但适用于绝大多数的腹股沟疝（Ⅰ～Ⅳ型成人腹股沟疝,包括复合疝）,且疗效确切,国内外报道复发率为0．6％～1．6％。回顾性分析2011年5月至2013年6月,乐山市人民医院使用自固定半吸收补片（ProGrip）进行APOM手术,共完成73例,效果满意,现报道如下。     

腹腔镜腹股沟斜疝修补术

2005年4月—2006年7月笔者应用腹腔镜行疝内环口高位结扎和腹膜外置补片法对11例腹股沟斜疝实施腹腔镜疝修补术。结果示平均手术时间100~200 min。术中、术后无并发症，术后5~7d出院。随访6~15个月，无复发。提示腹腔镜腹股沟疝修补术具有安全、并发症少、恢复快、复发率低等优点，值得推广使用。     

无张力疝修补术治疗腹股沟嵌顿疝体会

目的:探讨无张力疝修补术在成人急性嵌顿性腹股沟疝中的应用.方法:回顾性分析我院2005年1月至2011年12月128例急性嵌顿性腹股沟疝患者行无张力疝修补术的临床资料.结果:128例手术过程顺利,平均手术时间55min,无切口感染和排异反应,随访3月至6年,无复发.结论:无张力疝修补术可以安全、有效的应用于嵌顿性腹股沟疝患者.     

腹腔镜下捆绑式锥形补片修补腹股沟疝的临床研究

目的探讨腹腔镜下采用捆绑式锥形补片修补腹股沟疝的方法及临床疗效。方法 2003年1月-2009年12月收治成人腹股沟疝1215例1363侧。男1132例1268侧,女83例95侧;年龄18～89岁,中位年龄58岁。原发疝1187例1329侧,复发疝28例34侧。病程1～9d,平均3.8d。腹股沟斜疝728例786侧,直疝416例499侧;股疝43例45侧;特殊类型疝28例33侧。根据疝分型标准,Ⅰ型31例38侧,Ⅱ型683例754侧,Ⅲ型403例452侧,Ⅳ型98例119侧。采用捆绑式锥形补片植入内环口,3点固定于疝环前壁肌肉、筋膜处;通过疝环口腹膜荷包缝合包埋补片,修补腹股沟疝。结果患者均顺利完成手术;手术时间18～32min,平均22min。术后出现腹股沟区牵拉性疼痛19例21侧,急性尿潴留8例,疝囊远端积液2例2侧,均经对症处理后治愈。术后切口均Ⅰ期愈合,无发热、感染和血肿发生。术后1095例1182侧获随访,随访时间1～7年,中位时间3年9个月。术后1～3年5例因内科疾病死亡。3例直疝复发,经再次腹腔镜手术治愈;其余患者无复发。存活患者均未发生肠粘连及肠梗阻。结论腹腔镜下捆绑式锥形补片修补腹股沟疝具有创伤小、手术操作简便、术后恢复快、并发症少及复发率低等优点。     

Clinical value of the laparoscopic transabdominal preperitoneal technique in recurrent inguinal hernia repair

ObjectiveTo assess the clinical value of the laparoscopic transabdominal preperitoneal (TAPP) technique in recurrent inguinal hernia repair.MethodsThe clinical data of 354 patients with recurrent inguinal hernia who underwent TAPP surgery from June 2010 to June 2016 at the Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, were retrospectively analyzed.ResultsLaparoscopic surgery was successfully completed in all 360 patients. Among them TAPP were finished in 354 patients, while TAPP repair were attempted but finally converted to open or TAPE repair in 6 patients. The mean operation time was 54.7 ± 19.4 min (range 30–90 min), mean duration of hospitalization was 4.7 ± 2.1 days (range 2–14 days), and mean duration of follow-up was 37.7 ± 12.4 months (range 12–60 months). The rate of intraoperative injury was 4.5% (16/354), and the rate of postoperative complications was 13.6% (48/354). No patient developed a foreign body sensation, wound infection, intestinal obstruction, mesh infection, or chronic pain. Two patients (0.6%) developed re-recurrence requiring reoperation, with no further recurrence.ConclusionWhen performed by an experienced surgeon with excellent technique, the TAPP technique is safe and effective for recurrent hernia after surgical treatment via the anterior repair, and maybe a good alternative for recurrent hernia after surgical treatment via the posterior repair.     

无张力补片修补治疗腹股沟嵌顿疝的临床观察

目的探讨无张力疝修补术治疗腹股沟嵌顿疝的临床效果。方法回顾采用无张力补片修补治疗的患者50例（观察组）和应用传统手术方法治疗的患者42例,分析两者的手术一般情况、术后并发症和复发率。结果两组患者的手术时间比较,差异无统计学意义（P〉0．05）,但是观察组患者术后下床活动时间、术后疼痛时间和住院时间均短于对照组,存在统计学差异（P〈0．05）。观察组患者并发症发生率为12．00％,明显低于对照组的35．71％,差异具有统计学意义（P〈0．05）。两组患者术后均随访18～24个月．观察组患者复发l例,复发率为2．00％,对照组复发8例,复发率为19．05％;传统手术的复发率明显高于无张力补片修补治疗者,差异有统计学意义（P〈0．05）。结论无张力补片修补治疗腹股沟嵌顿疝具有手术痛苦小、术后恢复快、复发率低、安全可靠．值得临床推广应用。     

Anterior preperitoneal repair of extremely large inguinal hernias: An alternative technique

INTRODUCTIONStandard open anterior inguinal hernia repair is nowadays performed using a soft mesh to prevent recurrence and to minimalize postoperative chronic pain. To further reduce postoperative chronic pain, the use of a preperitoneal placed mesh has been suggested. In extremely large hernias, the lateral side of the mesh can be insufficient to fully embrace the hernial sac. We describe the use of two preperitoneal placed meshes to repair extremely large hernias. This ‘Butterfly Technique’ has proven to be useful. Hernias were classified according to hernia classification of the European Hernia Society (EHS) during operation. Extremely large indirect hernias were repaired by using two inverted meshes to cover the deep inguinal ring both medial and lateral. Follow up was at least 6 months. VAS pain score was assessed in all patients during follow up. Outcomes of these Butterfly repairs were evaluated. Medical drawings were made to illustrate this technique. A Total of 689 patients underwent anterior hernia repair 2006–2008.PRESENTATION OF CASESeven male patients (1%) presented with extremely large hernial sacs. All these patients were men. Mean age 69.9 years (range: 63–76), EHS classifications of hernias were all unilateral. Follow up was at least 6 months. Recurrence did not occur after repair. Chronic pain was not reported.DiscussionOpen preperitoneal hernia repair of extremely large hernias has not been described. The seven patients were trated with this technique uneventfully. No chronic pain occurred.CONCLUSIONThe Butterfly Technique is an easy and safe alternative in anterior preperitoneal repair of extremely large inguinal hernias.     

无张力疝修补术和传统疝修补术在腹股沟疝修补中的疗效与安全性

目的探讨无张力疝修补术和传统疝修补术在腹股沟疝修补中的疗效与安全性。方法将2004-01—2007-12收治的266例腹股沟疝患者按数字表法随机分为2组,141例行无张力修补,125例行传统修补,比较分析2组临床资料。结果无张力疝修补术后疼痛程度、下床活动时间、复发率均明显少于传统疝修补术组(P<0.05)。2组患者住院时间、并发症发生率差异无统计学意义(P>0.05)。结论无张力疝修补术是安全有效的理想术式,具有安全、疼痛轻、下床活动早、术后复发率低等优点。     

Comparison of Stoppa and Lichtenstein techniques in the repair of bilateral inguinal hernias

Summary The feasibility of tension-free repairs in bilateral inguinal hernias has not been well documented. In this prospective randomized study patients' characteristics, intra- and postoperative parameters including pain, return to daily activity and work, were assessed in patients undergoing bilateral hernia repair by means of either the Stoppa or the Lichtenstein techniques. A total of 45 patients having bilateral inguinal hernia repairs were randomly assigned to one of the two treatment groups. Patients in Group I had operations with the simultaneous Lichtenstein technique (n23) and were further randomized to either spinal (n11) or local anesthesia (n12) subgroups. Those in Group II underwent a Stoppa hernioplasty (n22). Complications and recurrences were sought for two years postoperatively. Patients with bilateral Lichtenstein repairs under local anesthesia had lower pain scores at rest and leg-raising test, and returned to pain-free normal daily activity and work on the 15th and 30th days, respectively. Although smaller than those of other groups, none of these parameters were statistically significant. The only prominent difference was seen in the operating time. The Stoppa repair took significantly less time than the Lichtenstein repairs (51 vs. 65 min, p < 0.01). In this study we were unable to demonstrate the superiority of either technique or type of anesthesia used in the repair of bilateral hernias. Both techniques were capable of producing favorable postoperative results, and were well accepted by most of the patients.     

Treatment of primary inguinal hernias by “held in mesh repair”: our experience related to 3,520 cases

In the last 15 years, a rapid evolution occurred from the traditional hernioplasties toward prosthetic techniques, in Italy. Outpatient procedures under local anaesthesia are now most commonly performed. We report our experience with a personal modification of the sutureless mesh repair, called “held in mesh repair”. From 1990 to 2003 we treated 3,520 cases of primary hernia with the “held in mesh repair”. 2,370 patients were affected by a unilateral hernia and 575 by a bilateral one. Local anaesthesia was used in 92% of the cases, loco-regional in 6% and general in 2%. Sixteen (0.4%) hernias recurred after 2 years, while two further recurrences (total 0.5%) were observed after 3 years; three femoral pseudo-relapses (0.08%) occurred before the first postoperative year. An overall incidence of 1.3% of major complications were observed. One mortality case (0.02%) occurred 3 days after the operation for cardiovascular complications. The favourable results of the “held in mesh repair” and the simplicity of the procedure suggest that it can be considered a safe and reliable technique for most primary inguinal hernias.     

无张力疝修补术在老年腹股沟疝患者中应用的临床体会

目的总结善释腹膜前专用网塞在老年腹股沟疝无张力疝修补术中的治疗效果和临床价值。方法采用善释腹膜前专用网塞对210例老年腹股沟疝患者施行无张力疝修补术,观察手术时间、伤口疼痛、术后自主能力的恢复、并发症及复发率。结果 210例手术过程均顺利.术后出现尿潴留2例;阴囊积液1例;伤口持续疼痛2例;伤口区有异物感2例;伤口区积液2例;随访3～30个月,无复发。结论善释腹膜前专用网塞行无张力疝修补术是一种老年腹股沟疝理想的手术方式,具有手术简便,创伤小,无张力,省时,复发率低,并发症少等优点。是疗效确切的无张力疝修补方法。     

Proposal for an originally conceived prosthesis in the Rives operation for inguinal hernia

Summary The authors describe an originally conceived prosthesis to be used in the Rives operation for inguinal hernia, with an anterior approach and the prosthesis placed deeply, in order to render the operation more simple and rapid. Its technical aspects and the results obtained in 155 patients are illustrated.     

An updated traditional classification of inguinal hernias

The traditional classification of inguinal hernias is the most widely used system today; however, it does not categorize all inguinal hernias nor their levels of complexity. The named systems of Gilbert, Nyhus, and Schumpelick are reviewed, and their common features are analyzed. A simple updating of the traditional classification along with the use of common modifiers creates a system that is all-inclusive and easy to use for data registries. The traditional classification of inguinal hernias (indirect, direct, and femoral) has withstood the test of time for almost 150 years. In this interval, inguinal hernia repairs have experienced significant evolution from simple ligation of the sac or suturing of the muscular defect to improved primary tissue repairs (e.g., Bassini, McVay, Shouldice) based upon better anatomic principles. Also during the past 30 years, two major revolutions in operative repairs have occurred. First, there is the use of mesh and, second, its placement laparoscopically. As a consequence, hernia surgeons today must choose among multiple competing operative techniques. No one operative technique has proven to be best for all inguinal hernias. Also different levels of complexity and severity exist among inguinal hernias, and thus it is essential that we accurately classify the various inguinal hernias, such that we surgeons can provide the best operative solution for each patient. As Fitzgibbons [1] states, The primary purpose of a classification for any disease is to stratify for severity so that reasonable comparisons can be made between various treatment strategies.Presented at the Seventh Annual Scientific Meeting of the American Hernia Society, Orlando, Fla. USA February 24–28, 2004