腹膜前间隙补片疝修补术与疝环填充式无张力疝修补术的对比研究

目的通过对腹膜前间隙补片疝修补术和疝环填充式无张力疝修补术两种术式及疗效的对比，总结出两种手术方法优缺点。方法采用随机分组方法，将患者分为2组，每组24例，分别施行腹膜前间隙补片疝修补术和疝环填充式无张力疝修补术，观察两组之间疗效差别。结果腹膜前间隙补片疝修补术组在手术时间、局部异物感、伤口麻木感等方面优于疝环填充式无张力疝修补术组。结论腹膜前间隙补片疝修补术能更好地缩短手术时间，减少术后不适。     

完全腹膜外腹腔镜下疝修补术132例

完全腹膜外腹腔镜疝修补术不进入腹腔,在腹膜前间隙进行修补,是腹腔镜下腹股沟疝修补的首选术式,具有创伤小、术后疼痛轻、康复快、复发率低等优点。2009年3月—2010年12月我院采前用正中入路完全腹膜外腹腔镜下通用3D补片植入术治疗腹股沟疝132例,总结报道如下。     

腹腔镜完全腹膜外腹直肌后间隙成人脐疝修补术

目的探讨全腹腔镜下将补片置于腹膜前腹直肌后间隙进行脐疝修补效果。 方法沈阳军区总医院2015年6月至2017年11月,共完成腹腔镜完全腹膜外肌后间隙脐疝补片修补术9例,其中男性5例,女性4例,平均年龄48.2（28～70）岁,术中采用全腹腔镜在腹直肌后方分离腹膜前间隙及脐疝缺损区,关闭缺损后将补片置于腹直肌后间隙内进行修补,对患者的临床资料进行回顾性分析。 结果9例患者均顺利完成手术,平均手术时间100 min（73～130 min）,术后平均住院时间1.8（1～3）d,发生脐部皮肤小面积坏死感染1例,脐部积液1例。无出血、肠梗阻、肠瘘等严重并发症,无复发及慢性疼痛。 结论采用腹腔镜完全腹膜外肌后间隙放置补片的方法进行脐疝修补是可行的,避免了腹腔内补片修补手术的不足,限于病例数原因,尚需进一步观察后续结果。该术式为脐疝的腔镜治疗提供了一个新的方法。     

不同补片植入方法在腹腔镜腹股沟疝修补术的疗效

目的探讨腹腔镜下腹腔内补片植入（intraperitoneal onlay mesh,IPOM）与腹膜前间隙补片植入[腹腔镜经腹腹膜前疝修补术（laparoscopic transabdominal preperitoneal hernia repair,TAPP）和腹腔镜完全腹膜外疝修补术（laparoscopic totally extraperitoneal,TEP）]治疗腹股沟疝的临床效果。比较TAPP和TEP术式的治疗费用和卫生资源利用率。 方法回顾性分析2014年6月至2015年12月,徐州市中心医院收治的153例腹腔镜腹股沟疝修补术（laparascopic inguinal hernia repair,LIHR）患者的临床资料,其中IPOM 102例,TAPP 30例,TEP 21例。比较腹腔镜下IPOM与腹膜前间隙补片植入患者的基本信息与术后临床症状等资料。 结果IPOM组和腹膜前间隙补片植入组慢性疼痛患者分别为18例和1例,差异有统计学意义（P<0.05）;IPOM组血清肿患者8例,腹膜前间隙补片植入组2例,差异有统计学意义（P<0.05）;2组患者在感觉障碍、术后感染、住院时间和复发率等方面差异无统计学意义（P>0.05）。2组患者治疗后其血清基质金属蛋白酶2（matrix metalloproteinase,MMP）-2（97.55±10.26、98.34±11.06）、MMP-9（128.57±10.26、130.94±10.71）水平均有明显降低,与治疗前对比（201.51±14.61、203.61±16.84）、（198.64±12.64、199.07±11.57）,差异有统计学意义（P<0.05）,组间对比差异无统计学意义（P>0.05）。TAPP和TEP在检查费用、手术费用、药品费用、护理费用、间接成本和总成本上差异无统计学意义（P>0.05）。TAPP和TEP治疗腹股沟疝的疗效相同,但TEP通过减少材料费用提高了资源利用率。 结论腹腔镜下IPOM与腹膜前间隙补片植入都是治疗腹股沟疝的有效手术方式,腹膜前间隙补片植入术治疗效果优于腹腔镜下IPOM。     

腹腔镜下完全腹膜外补片植入术与开放无张力疝修补术的对照研究

腹腔镜下完全腹膜外补片植入术（totally extra-peritoneal prosthesic,TEP）是在无张力疝修补术的基础上,应用腹腔镜微创技术从完全腹膜前间隙用补片修补肌耻骨孔治疗腹股沟疝。整个操作不进入腹腔,因而降低内脏损伤和腹内粘连的发生率,疼痛轻、康复快,CO2气腹对腹腔的影响轻及肠粘连发生率低,是目前疝修补术中较理想的方法。此术式与传统     

腹腔镜腹膜前疝修补新方法

目的:探讨腹腔镜腹膜前疝修补新方法的临床应用价值。方法:采用自行设计的腹腔镜腹膜前疝修补术治疗5例腹股沟疝患者,经腹腔在腹腔镜下旷置疝囊,在疝环口内外侧纵行切开并潜行游离腹膜,于腹膜前放置补片,覆盖疝环口,再用脐外侧韧带覆盖补片。结果:手术均获成功,无并发症发生,随访1年未见复发。结论:腹腔镜腹膜前疝修补新方法安全,可靠,方便易行,术后患者康复快、疼痛轻、效果好。     

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。     

腹腔镜经腹腹膜前补片植入术治疗复发性腹股沟疝技术探讨

复发性腹股沟疝尤其是无张力疝修补术后复发疝的治疗依然是疝外科医师必须面对的难题。腹腔镜疝修补术凭借其“后入路”的手术特点和直视下操作的技术优势逐渐成为处理开放手术后复发疝的优选术式而被外科医师所接受和应用。因为复发疝情况复杂多变,目前尚无规范化的复发疝腹腔镜手术操作规范和指南。应用腹腔镜经腹腹膜前修补术（TAPP）治疗复发疝时绝大多数病人可以完整游离腹膜前间隙,部分病人须选择梭形或“T”形切口切开腹膜。原有补片一般不建议去除,在补片固定方面建议适当放宽指征,在特殊情况下可以选择局部修补法、腹腔内补片植入术（IPOM）或经腹部分腹膜外修补术（TAPE）修补缺损。     

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.     

3 DMax补片应用于前入路腹膜前间隙疝修补术

目的：探讨3 DMax补片用于前入路腹膜前间隙疝修补术的应用技巧。方法回顾性分析2012年10月至2013年10月,江苏省中西医结合医院收治的23例腹股沟疝患者,均在连续性硬膜外间隙阻滞麻醉下行前入路腹膜前间隙疝修补术,分析总结其手术时间、术后并发症、随访术后复发等情况。结果手术时间45～70 min,术后手术区域有轻微的坠胀感6例,未发生切口感染、血清肿、腹膜前间隙血肿等情况。随访1～13个月,未发生慢性疼痛及复发。结论3 DMax补片用于前入路腹膜前间隙疝修补术是安全可行的。     

完全腹膜外腹腔镜腹股沟疝修补术38例报告

目的:探讨应用Bard3DMax免钉合补片行完全腹膜外腹腔镜腹股沟疝修补术(totally extraperitoneal prosthesis,TEP)的安全性及有效性,总结其临床应用经验。方法:回顾分析2008年9月至2009年9月应用Bard 3DMax补片免钉合行腹腔镜TEP治疗38例腹股沟疝患者的临床资料。38例中斜疝21例,直疝7例,复合性疝6例,双侧疝3例,复发疝1例。结果:38例手术均获成功,无一例中转开放手术,手术时间40～150min,术后住院3～7d,平均4d。3例发生血清肿,2例抽液后治愈,1例自行吸收,所有病例术后均无疼痛及阴囊血肿发生。术后随访8～20个月,无复发病例。结论:应用Bard 3DMax补片免钉合TEP安全有效,具有术后患者康复快,并发症少,复发率低等优点,值得临床推广和应用。     

腹腔镜食管裂孔疝修补术

目的探讨腹腔镜下应用补片(Bard CruraSoft PTFE/ePTFE Mesh)行食管裂孔疝修补和部分胃底折叠术治疗食管裂孔疝的临床效果。方法2006年8月~2007年4月,对13例食管裂孔疝(Ⅰ型6例,Ⅲ型7例)腹腔镜下用超声刀进行食管裂孔疝游离、腔内缝合器行补片固定完成食管裂孔疝修补术并同期行部分胃底折叠术。结果13例手术全部获得成功,无中转开腹手术。手术时间115~185min,平均142min;术中出血量25~120ml,平均75ml。术后平均32h(26~37h)排气并开始进流质饮食。术后住院3~6d,平均4d。13例术后随访4~11个月,平均6.5月,术后1个月临床症状完全消失,13例手术后3个月行钡餐造影检查未见疝复发。结论腹腔镜下应用补片行食管裂孔疝修补和部分胃底折叠手术是一种安全有效的微创方法,具有临床推广的价值。     

应用巴德3DMax补片行无钉合腹腔镜完全腹膜外疝修补术28例

目的总结应用巴德3DMax补片行无钉合腹腔镜完全腹膜外疝修补术（TEP）治疗腹股沟疝28例的经验技巧体会。方法回顾分析2006年8月至2007年2月共28例腹股沟疝患者的临床资料，患者全部在全麻下行TEP手术，术中应用巴德3DMax补片，且不作钉合固定。结果28例患者共进行32侧TEP手术，手术时间25～90min，平均手术时间单侧40min，双侧75min。术后无需使用镇痛剂，术后住院时间1～4d，平均2．5d。术后并发阴囊血清肿1例，无术后腹股沟区疼痛及异物不适感病例。随访9～13个月，无术后复发。结论应用巴德3DMax补片并行无钉合TEP手术安全可靠，操作简单方便，可使手术时间缩短，减少手术并发症，并有术后疼痛轻，恢复快，复发率低的优点。     

腹腔镜下腹壁切口疝修补术(附41例报告)

目的探讨腹腔镜下采用聚丙烯和膨化聚四氟乙烯复合补片（Bard Composix Mesh）修补腹壁切口疝的效果。方法2004年10月～2005年8月，对41例切口疝（腹壁缺损长径3～25cm，宽径3～18cm）腹腔镜下用超声刀进行腹腔内粘连松解和采用强生疝修补用缝合器行补片固定修补术。结果41例均顺利完成，无中转开腹。手术时间60～182min，平均85min。术后疼痛轻微，术后排便、排气时间25～41h，平均32h。术后第2天进食。术后住院5～7d，平均6d。41例随访6～16个月，平均9个月，未见切口疝复发。结论腹腔镜下采用复合补片修补腹壁切口疝是一种安全、有效的方法，值得临床推广应用。     

3DMax补片在腹腔镜腹股沟疝修补术中的应用（附68例报告）

目的 评价3DMax补片在腹腔镜腹股沟疝修补术中的应用价值。 方法 回顾性分析2006年10月至2008年7月第二军医大学附属长海医院微创外科应用3DMax补片行腹腔镜腹股沟疝修补术的临床资料。 结果 68例病人中Ⅰ型疝4例,Ⅱ型疝45例,Ⅲ型疝16例,Ⅳ型疝3例;斜疝53例,直疝13例,股疝2例。67例完成腔镜下修补,经腹腹膜前网片疝修补术（TAPP）19例,腹腔镜下全腹膜外修补术（TEP） 48例;1例因疝囊过大疝内容物无法还纳中转开放修补。手术时间30~65min,平均40min。术后排气时间1~2d,术后平均住院2d。术后发生阴囊血清肿2例,小肠梗阻再手术1例。随访3~24个月,无复发病例。 结论 腹腔镜腹股沟疝修补术具有创伤小、恢复快及复发率低等优点,采用预先成型的3DMax补片使手术操作更加简便、并发症发生率更低。     

腹腔镜手术治疗食管裂孔疝的42体会

目的探讨使用腹腔镜行食管裂孔疝修补术的疗效和安全性。方法对42例食管裂孔疝患者行腹腔镜食管裂孔疝修补术,其中32例行胃底360°折叠术(Nissen术),10例行胃底270°部分折叠术(Toupet术)。39例采用4号丝线缝合修补疝缺口,3例应用补片修补疝缺口。结果42例腹腔镜食管裂孔疝修补术全部成功。手术时间平均(138±22)min,失血平均(62±16)ml;无术后并发症;术后平均住院(5.2±1.9)d。术后症状完全消失32例(76%),好转10例(24%)。结论腹腔镜食管裂孔疝修补术具有疗效确定、安全和创伤小的优点,值得进一步推广应用。     

The effect of preincisional periportal infiltration with ropivacaine in pain relief after laparoscopic procedures: a prospective, randomized controlled trial.

BACKGROUND AND OBJECTIVES: It is essential to minimize pain after laparoscopic surgery. This study examined the effect of wound infiltration by a long-acting local anesthetic. METHODS: This prospective, randomized study includes 190 laparoscopic procedures carried out by the same surgeon. The patients were randomly allocated into 2 groups. The control group comprised 75 cases of laparoscopic cholecystectomy (LC) and 20 cases of laparoscopic inguinal hernia repair (LIHR) without the use of a local anesthetic; only saline was used. The study group comprised 75 cases of LC and 20 cases of LIHR with preincisional periportal infiltration with 20 mL of ropivacaine (10 mg/mL). The postoperative pain scores at 3, 6, 12, and 24 hours determined with a visual analogue scale (VAS), nausea, and the kind and amount of analgesic drugs were assessed. RESULTS: In the study group in 41% of LC cases and 85% of LIHR cases, no analgesia was required at all; likewise, in the control group in 20% of LC cases and 44% of LIHR cases, no analgesia was required. The difference was statistically significant (P<0.05). In the remainder, pain at 3 and 6 hours and total analgesic requirements in the study group were less than that in the control group (P<0.05). The postoperative nausea and shoulder pain remained statistically unchanged (P>0.05). CONCLUSIONS: It seems that wound infiltration with ropivacaine in laparoscopy provides satisfactory postoperative analgesia, diminishing or reducing the need for opioids.     

Laparoscopic totally extraperitoneal inguinal hernioplasty: The use of a contoured three‐dimensional mesh

Recent literature on laparoscopic inguinal hernia repair (LIHR) has shown that laparoscopic hernioplasty is associated with reduced postoperative pain and wound infection, and an earlier return to normal daily activities. The technique of LIHR is still evolving. We descibe our technique and experience in performing laparoscopic hernioplasty using a contoured three‐dimensional mesh without the application of endoscopic staples.     

Laparoscopic treatment of abdominal wall hernias: prosthesis material comparison

Hernia is due to abdominal wall weakening. This allows the contents of the abdomen to protrude from normal boundaries. Hernias are repaired by implanting a sterile surgical mesh to strengthen the weakened abdominal wall. Aim of this study is to compare the results obtained by bard Composix? L/P mesh or Dualmesh Plus Gore? implanting. The mesh has various beneficial characteristics. It is a reinforcing material for the abdominal wall, even when in the direct contact with the intestinal tract does not cause adhsion problems. The use of biocompatible materials is necessary in laparoscopic hernia repair. e-PTFE prosthesis and Dual Mesh? were the first to be used for laparoscopic treatment of the abdominal wall defects. These prosthesis are the result of many improvements, actually they are 1-mm thick and the two surfaces have different characteristics. Compound meshes are composed by e-PTFE and polypropylene with different percentage of the two materials and methods of interactions. The incidence of early complications were poor in relation to both types of implants, only seroma cases e-PTFE treated showed a prevalence of complication, in agreement with literature. About relapses in our experience we found that e-PTFE cases were predominantly. Dual Mesh? has better adaptability than Bard Composix?, which allows easier placement of the prosthesis as well as a better adaptation to the wall surface. The Bard Composix?, thanks to rigidity due to the polypropylene component has better handling than the Dual Mesh?, as it promotes a rapid and easy deployment of the prosthesis inside the abdominal cavity, favoring its positioning. The use of both prosthesis depends also on the experience specific to each operator, moreover, a rigorous surgical technique remains fundamental for the application of the mesh used.     

INGUINAL HERNIA REPAIR BY LAPAROSCOPIC SURGEONS: EARLY EXPERIENCE AND ATTITUDES

The introduction of laparoscopic inguinal hernia repair (LIHR) has been controversial. A questionnaire was sent to all general surgeons in New Zealand to document the early experience with LIHR and attitudes towards it. Of the 118 replies (response rate 55%). 74 were from laparoscopic surgeons. 26 of whom had performed 564 (201 public. 363 private) LIHR (23 bilateral) until January 1994. Only nine (35%) of these surgeons had assisted an experienced surgeon before performing an LIHR. and only four (15%) were supervised by an experienced surgeon during their first case. The transabdominal preperitoneal technique of LIHR was used by 14 (54%) surgeons. the extraperitoneal technique by eight (31%), and the tronsabdominal onlny technique by four (15%). There were 29 (5%) recurrences, 17 (3%) neuropathies. seven (1.2%) conversions, four (0.7%) miijor perforations. and one (0.17%) death. Of the 26 surgeons who performed LIHR, 20 (77%) were concerned about the absence of long-term results. 14 (54%) considered that the optimal technique had not been established. 13 (50%) were concerned about the unique complications associated with LIHR. 11 (42%) were less enthusiastic about performing LIHR than previously. 10 (38%) were doubtful about its advantages, and six (23%,) were uncertain about its future and considered that it should only be performed within the context of a controlled trial. This study highlights a number of issues that need to be addressed before the role of LIHR can be determined.