闭孔疝14例的诊断与治疗

目的：总结闭孔疝的诊断及治疗经验。方法：回顾本院收治经手术证实的闭孔疝１４例。分析闭孔疝的误诊及手术处误的原因，总结其临床表现信诊断、治疗经验。结果与结论：闭孔疝患者多为高龄、体弱、多产妇女；主要表现是出现不完全性低位小肠梗阻，Ｈｏｗｓｈｉｐ－Ｒｏｍｂｅｒｇ征对本病诊断有重要意义；怀疑孔闭疝病人均应及早手术检查以及降低本病病死率。     

创伤性、迟发嵌顿性膈疝的诊断与治疗

目的 探讨创伤性、迟发嵌顿性膈疝的正确诊断和治疗方法。方法 对11例创伤性、迟发嵌顿性膈疝的临床表现及治疗情况结合文献进行分析。结果 11例均手术治疗，9例治愈，2例死亡。结论 创伤性、迟发嵌顿性膈疝病情凶险，极易误诊；仔细检查，早期诊断，尽早手术治疗，效果良好。     

新生儿和婴幼儿膈疝的病因分析与治疗

目的 探讨提高婴幼儿、新生儿先天性膈疝(CDH)的早期诊断和治疗方法。方法 对38例CDH患儿的临床资料进行回顾分析。结果 全部患儿行X线检查，新生儿大部分显示胸腔内有含气的肠管。腹腔内无或少量气体；部分新生儿患有胃食管反流、吸入性肺炎或肺发育不全；9例新生儿血气分析示有严重的缺氧症，呼吸性酸中毒；消化道造影显示结肠或小肠位于胸腔内，腹腔内气体减少，婴幼儿则表现为食管裂孔旁有膈肌缺损，胃底疝入后纵隔有腹膜形成的疝囊，临床表现以呕吐为主，伴消瘦，营养不良。除2例新生儿放弃治疗外，余36例行手术治疗，术后5例死亡，29例术后恢复良好。结论 惠有先天性膈疝的新生儿和婴幼儿必须早期诊断和手术治疗，以提高治愈率。     

创伤性膈疝的诊断与治疗(附18例报告)

目的 探讨创伤性膈疝的诊断与治疗方法。方法 分析18例创伤性膈疝诊断相关因素和手术治疗结果。结果 经胸部X线检查或辅以消化道钡餐透视检查示：纵隔心影移位、膈肌升高、残缺或胸腹腔边界不清者10例，确诊率55．56％；经胸腔闭式引流观察示：胸闷、呼吸困难进行性加重，伴消化系症状者6例，确诊率33．33％；CT检查确诊1例，确诊率为5．56％；剖胸探查确诊1例，确诊率为5．56％，均经手术治疗证实。治愈17例，死亡1例。结论 X线检查、动态观察为本病基本诊断手段。一经确诊，应尽早手术治疗。     

创伤性膈疝17例分析

目的探讨创伤性膈疝的早期诊断和治疗方法。方法回顾性分析北京大学首钢医院1998-12-2008-12收治的17例创伤性膈疝的临床资料。结果 17例患者均急诊手术,16例治愈,1例死亡。结论提高对本病的认识,全面检查,早期诊断和及时手术,是抢救创伤性膈疝患者生命,提高其治愈率的关键。     

小儿神经母细胞瘤的外科治疗（附24例报告）

本文报告８年间收治２４例神经母细胞瘤。对本瘤的特点，早期诊断困难、误诊率高等问题进行了讨论。说明了Ｂ型超声波、尿ＶＭＡ检查、骨髓细胞学检查在早期诊断中的意义。重点讨论了外科手术治疗，并认为提高本病治愈率的关键是早期诊断、及时手术完整切除瘤体。对Ⅲ、Ⅳ期患儿只要积极争取手术治疗，也有治愈的可能。     

睾丸扭转的诊断和治疗(附11例报告)

目的：提高睾丸扭转的诊断和治疗水平。方法：回顾性总结11例睾丸扭转病人的诊治资料，结合文献进行分析。结果：2例经手法复位治愈，2例经手术复位治愈，7例行手术睾丸切除。结论：彩超能反映扭转睾丸的血流变化，对睾丸扭转的早期诊断很有帮助。早期诊断、早期治疗是提高本病疗效的关键。     

睾丸扭转延误诊断13例分析

目的：探讨睾丸扭转的早期诊断治疗。方法：对13例首诊未明确诊断的患者临床资料进行回顾性分析。结果：13例均经过手术治疗,3例10 h内手术者睾丸2例存活;6例10～24 h手术者1例睾丸存活;4例超过24 h手术者睾丸坏死。结论：提高对本病的认识,结合病史、体征及动态彩超探查是早期诊断的关键,手术复位是治疗本病的有效方法。     

创伤性膈疝的诊断与治疗

目的：探讨创伤性膈疝的病因，早期诊断，鉴别诊断与治疗的方法。方法：对12例创伤性膈疝患者临床资料进行回顾分析。结果：左侧11例，右侧1例；术前诊断10例，误诊2例；均行急诊膈肌修补术，10例经胸切口，2例经腹切口。12例均治愈出院。结论：创伤性膈疝术前应详细检查，结合X线、CT、MRI并于术中检查膈肌。对创伤性膈疝的治疗采用急诊手术，效果最佳。     

305例胃切除术后并发7例内疝分析

目的：探讨胃切除术后并发内疝的早期诊断和治疗。方法：笔者从1976年10月～2001年9月行Billrath氏Ⅱ式胃大部切除术305例，术后7例并发内疝，分析总结手术资料。结果：胃大部切除术后并发内疝的早期诊断条件：1)胃大部切除史；2)突发性上腹剧痛；3)恶心，呕吐，严重的有休克综合征；4)必要的X-Bay“流畅”钡餐摄片检查。结论：充分认识和重视胃切除术后并发内疝的有效诊断和治疗及预防方法，有利于提高疗效。     

Asymptomatic mesh infection 6 years after laparoscopic totally extraperitoneal inguinal hernia repair: A rare case report

This report aims to discuss a case of asymptomatic mesh infection 6 years after laparoscopic totally extraperitoneal (TEP) inguinal hernia repair and to reveal that the risk of mesh infection may occur after a long period of this surgery. This report is also intended to suggest surgeons pay more attention to the follow‐up of such patients and to be aware of the possibility of mesh infection to assist in early diagnosis and treatment. A 63‐year‐old male patient, who underwent TEP inguinal hernia repair 6 years ago for right inguinal hernia, fell down accidentally 2 weeks ago. Enhanced computed tomography(CT) showed right lower abdomen cystic lesions, so he underwent laparoscopic surgery during which abscess caused by delayed mesh infection was found. After removing the mesh and abscess, he was discharged. The risk of mesh infection after TEP inguinal hernia repair is low, but it can last for more than 6 years and can even be asymptomatic as long as the mesh remains in the body.     

Partial preoperative reduction of inguinal hernia through compression with an ultrasound transducer

Sonography and CT are effective tools in early diagnosis of asymptomatic inguinal hernia. Sonography can be used not only for the diagnosis of hernia but also for its treatment. Real-time sonographically guided hernia reduction may avoid tissue damage that can arise from misguided compression. We report a unique case in which an incarcerated omental hernia in a 50-year-old woman was diagnosed and subsequently reduced via compression with an ultrasound transducer.     

腹股沟斜疝与直疝的超声鉴别诊断

目的探讨腹股沟斜疝与直疝的超声鉴别方法及其在腹腔镜疝修补术中的应用价值。方法对我院普外科住院拟行腹腔镜腹股沟疝修补术的106例患者行术前高频超声检查,确认腹壁下动脉与腹股沟疝的关系,凡疝囊自腹壁下动脉外侧、前方通过者诊断为斜疝,而疝囊自腹壁下动脉内侧通过、将其向外前方推挤者诊断为直疝。超声诊断与腹腔镜疝修补术结果比较。结果腹股沟疝患者共106例。其中超声诊断腹股沟斜疝94例,直疝12例,纠正术前临床误诊3例。术前超声诊断明确,106例均经手术证实。结论高频超声能准确鉴别腹股沟斜疝与直疝,有效指导腹腔镜疝修补术。     

Testicular infarction becoming apparent after hernia reduction

Background: Testicular infarction from an incarcerated inguinal hernia is a rare event in children, often not considered in the initial evaluation. Objective: To report a case that describes the presentation, diagnosis, and management of testicular infarction in the setting of an incarcerated inguinal hernia. Case Report: A 2-month old boy was brought to the Emergency Department (ED) by his parents for vomiting, crying, and a left-sided scrotal swelling. An inguinal hernia was manually reduced successfully in the ED. Subsequently, scrotal ultrasound with color Doppler was obtained, demonstrating no blood flow to the left testis. The patient underwent a left orchiectomy and right orchiopexy with hernia repair. Discussion: Testicular injury can occur from torsion due to the effect of an incarcerated hernia or due to ischemia from cord compression. Delay in diagnosis and surgery risks testicular viability, therefore, surgery should not be delayed for imaging in the presence of strong suspicion of torsion. Conclusions: The diagnosis of testicular torsion is not always straightforward because many conditions may have a similar clinical presentation or may compromise testicular blood supply. This case is an unusual presentation of testicular infarction in the setting of an incarcerated inguinal hernia.     

超声诊断腹股沟隐匿性斜疝的应用价值

目的探讨超声对腹股沟隐匿性斜疝的诊断价值。方法腹股沟区可疑包块89例患者进行超声检查,分析其声像图特点,计算超声诊断腹股沟隐匿性斜疝的准确性、敏感性和特异性。结果超声显示疝内容物进出疝囊,与腹壁之间呈镜向运动者78例,包块与腹腔之间腹膜连续性中断者59例,包块形态回声各异。超声诊断隐匿性腹股沟斜疝80例,经手术证实超声正确诊断腹股沟隐匿性斜疝78例,漏诊及误诊5例。超声诊断腹股沟隐匿性斜疝的准确性94．4％、敏感性96．3％、特异性75．0％。结论高频超声对腹股沟隐匿性斜疝的诊断准确性高,可作为诊断隐匿性腹股沟斜疝的首选检查方法。     

超声对腹股沟疝的鉴别分型诊断与其病因学关系的研究

目的 探讨超声检查在腹股沟疝鉴别分型诊断中的价值,为临床选择最佳手术方式提供重要参考.方法 对176例临床可疑腹股沟疝患者进行超声检查,记录腹股沟区包块的声像特征、血供、血液运行情况,以及与周围组织、血管的位置关系等,并与手术结果进行对照分析.结果 经超声诊断腹股沟疝的176例患者中,与手术结果相符者173例,超声诊断符合率达98.3%.其中斜疝146例,疝门直径〈3 cm,疝内容物经内环、腹股沟管及皮下环至阴囊局部形成异常团状回声,可见局部腹壁变化,疝囊位于精索静脉前方,内侧可见腹壁下动静脉血流伴行,腹压增大时,疝内容物可见肠壁增厚,层次结构模糊;直疝27例,疝门直径〉4 cm,疝内容物经直疝三角右后向前不进入阴囊,仅于腹股沟区形成异常回声区,局部腹壁无明显改变,疝囊位于精索静脉内后方,疝囊外侧可见腹壁下动静脉血流束伴行,腹压增大时,疝内容物可见肠壁略变薄,层次结构尚清晰.结论 超声可根据疝门大小、腹压变化前后局部腹壁厚度、疝内容物及疝囊与腹壁下动脉位置关系等情况的观察,直观地鉴别斜疝与直疝,是术前诊断及鉴别腹股沟疝分型的首选影像学方法.     

Case of chronic pain after laparoscopic percutaneous extraperitoneal closure in an adolescent girl with inguinal hernia in which open repair was effective

Chronic pain after laparoscopic percutaneous extraperitoneal closure is very rare. Here, we report a case of chronic pain after laparoscopic percutaneous extraperitoneal closure in an adolescent patient with inguinal hernia who underwent open repair. A 15‐year‐old girl was diagnosed with a left indirect inguinal hernia, and laparoscopic percutaneous extraperitoneal closure was performed. However, 6 months later, after strenuous exercise, she developed localized pain around the hernia site. Her pain was well controlled by internal treatment but failed to completely resolve. The pain type was somatic, Tinel's sign was negative, and there was no recurrence of the inguinal hernia. Because she strongly wished to undergo surgery, the Potts procedure with removal of the ligature and excision of the round ligament was performed. Her pain improved after surgery, and further medical treatment was not required. The Potts procedure may be an effective treatment for chronic pain such as in this case.     

Laparoscopic repair of an incarcerated inguinal hernia containing the sigmoid colon with a colonoscope

Here, we report the first case of laparoscopic surgery to repair an incarcerated colonoscope in an inguinal hernia containing the sigmoid colon. After colonoscopy was performed on a 74-year-old man with positive fecal occult blood test results, the colonoscope could not be withdrawn. A bulge consistent with an incarcerated colonoscope was found on examination of the patient's left inguinal area. Computed tomography revealed and led to the diagnosis of an incarcerated colonoscope in the sigmoid colon within the inguinal hernia. After confirmation during emergency laparoscopic surgery, the incarcerated sigmoid colon was reduced, and the colonoscope was removed under radiographic and laparoscopic guidance. No ischemic changes or serosal injuries were observed, averting the need for resection. A transabdominal preperitoneal approach with a mesh was then used to repair the inguinal hernia laparoscopically. The patient's postoperative recovery was uneventful, and no recurrence was observed at the 1-year follow-up.     

De Garengeot hernia with avascular necrosis of the appendix: A case report

BACKGROUNDAn incarcerated hernia is a common cause of acute abdominal pain. There are various types of incarcerated hernias, including incarcerated hernias of the appendix. These hernias are often complicated by appendiceal inflammation, necrosis, and suppuration, which affect the outcome of surgical repair. A De Garengeot hernia is a femoral hernia that contains the appendix. This type of hernia has a low incidence. When a De Garengeot hernia is clinically suspected, emergency surgical treatment should be performed as soon as possible.CASE SUMMARYA 59-year-old man was admitted to the hospital with a painful right inguinal mass that had suddenly developed 6 hours earlier. Physical examination revealed a 4 cm × 2 cm palpable mass in the right groin. The mass was hard and could not be reduced due to tenderness. It did not descend into the scrotum. B-ultrasound revealed an incarcerated hernia. During surgery, the hernia was found to contain the appendix, which exhibited distal avascular necrosis. A De Garengeot hernia was diagnosed according to the classification criteria of this type of inguinal hernia. Laparoscopic reduction of the incarcerated hernia, appendectomy, and small-incision femoral hernia repair were performed in the emergency department, and cefuroxime was administered as anti-infection therapy for 2 d postoperatively. After treatment, the patient had no abdominal pain or infection and was discharged on postoperative day 4. He had no recurrence of the inguinal hernia after 16 months of follow-up.CONCLUSIONDe Garengeot hernias have a low incidence and are difficult to diagnose. Laparoscopy is useful for their diagnosis and treatment.     

Inguinal hernia repair: Toward Asian guidelines

Groin hernias are very common, and surgical treatment is usually recommended. In fact, hernia repair is the most common surgical procedure performed worldwide. In countries such as the USA, China, and India, there may easily be over 1 million repairs every year. The need for this surgery has become an important socioeconomic problem and may affect health‐care providers, especially in aging societies. Surgical repair using mesh is recommended and widely employed in Western countries, but in many developing countries, tissue‐to‐tissue repair is still the preferred surgical procedure due to economic constraints. For these reason, the development and implementation of guidelines, consensus, or recommendations may aim to clarify issues related to best practices in inguinal hernia repair in Asia. A group of Asian experts in hernia repair gathered together to debate inguinal hernia treatments in Asia in an attempt to reach some consensus or develop recommendations on best practices in the region. The need for recommendations or guidelines was unanimously confirmed to help overcome the discrepancy in clinical practice between countries; the experts decided to focus mainly on the technical aspects of open repair, which is the most common surgery for hernia in our region. After the identification of 12 main topics for discussion (indication, age, and sex; symptomatic and asymptomatic hernia: type of hernia; type of treatment; hospital admission; preoperative care; anesthesia; surgical technique; perioperative care; postoperative care; early complications; and long‐term complications), a search of the literature was carried out according to the five levels of the Oxford Classification of Evidence and the four grades of recommendation.