预防成人腹股沟疝修补术后复发策略

复发是腹股沟疝修补术后常见的并发症之一,引起腹股沟疝修补术后复发的原因包括病人自身的因素和医源性因素,其中部分因素可通过临床干预而改变。重视对腹股沟疝修补术后病人宣教和管理随访,尤其是治疗引起的腹内压增高相关疾病;加强外科医师的系统学习和技术培训,提高理论和技术水平,规范手术准入制度,强调手术质量控制;根据病人的具体情况和术者的技术经验选择合适的手术方式;术中游离充足的空隙并选择相匹配大小的补片,严格遵守无菌操作和确切止血,减少术后发生感染和出血。采取上述措施可有效减少腹股沟疝术后复发的危险因素。     

补片重建腹壁后再次手术存在的问题和处理策略

利用合成材料治疗腹股沟疝和腹壁疝已成为疝外科领域的金标准,随着补片技术的流行,接踵而来的是这类病人的再手术问题。一方面,补片修补术后可能出现需要再次手术处理的并发症;另一方面,补片修补术后可能出现肠梗阻、肿瘤复发及其他腹部外科疾病,非补片因素的腹部手术也有可能进行。由于局部腹壁含有补片或者主要     

腹股沟疝手术治疗的转变及其意义

腹股沟疝的手术治疗是普外科最常见的手术。随着外科专家、学者对腹股沟区解剖的再认识、再熟悉,使腹股沟疝的手术方式经历了翻天覆地的变化。从传统的疝修补术到补片修补术再到腹腔镜修补术。开放手术到微创手术的蓬勃发展以及近年强调的针对不同层次的组织修复,势必更新外科医师们的腹股沟疝手术知识,服务于广大的疝疾病患者。本研究从如下五方面阐述腹股沟疝手术治疗转变。     

腹股沟疝无张力修补术后迟发性深部感染的外科治疗

目的总结腹股沟疝无张力修补术后迟发性深部感染的治疗体会。方法回顾性分析2010年7月至2014年8月,重庆医科大学附属第一医院行腹股沟疝无张力修补术后,出现迟发性深部感染8例患者的临床资料。8例患者均接受手术补片取出并采用外科治疗,术后采用负压封闭引流技术结合伤口局部特殊换药。结果 8例患者均完全取出补片,治愈出院,术后随访5~24个月,平均18个月,均无复发。结论通过手术完全取出补片,术后结合负压封闭引流技术及伤口换药治疗腹股沟疝无张力修补术后迟发性深部感染,取得较好效果。     

腹股沟疝无张力修补术后补片感染22例

目的总结腹股沟疝修补术后补片感染的外科处理方法与临床经验。方法回顾性分析2007年4月至2014年7月,抚顺市中心医院收治的腹股沟疝患者修补术后补片感染22例患者,通过手术取出补片的临床资料。结果 22例患者术后切口均一期愈合,术后住院时间12~28 d,平均20 d。术后随访12~24个月,平均18个月,无复发。结论腹股沟疝补片修补术后感染的外科处理非常棘手,最终均应该通过外科手术方式取出补片。     

植入补片法治疗成人腹股沟疝在基层医院的应用

目的总结聚丙烯补片治疗腹股沟疝的方法和经验。方法回顾性分析279例采用植入补片治疗腹股沟疝的临床资料，其中开放无张力疝修补术215例，腹腔镜疝修补术64例。结果多数病例1周内疼痛轻微，少数病例需止痛治疗1-3次。术后体温不超过38℃，无手术意外损伤，无切口感染病例。发生阴囊血肿、积液4例，急性尿潴留8例，复发2例。结论认真掌握植入补片技术，根据“个体化”选择不同的麻醉和手术方法，植入补片治疗成人腹股沟疝在基层医院使用是安全可行的。     

腹股沟疝修补术后补片相关感染的处理

目的研究分析腹股沟疝修补术后补片相关感染的治疗及预防。方法选取2015年1月至2017年12月在中山大学附属第六医院接受手术的20例腹股沟疝修补术后补片感染病人作为研究对象,分析总结腹股沟疝修补术后补片感染的外科处理方法与临床经验。结果 20例病人均成功手术治疗。开放手术17例中12例行一期缝合,术后切口感染6例,感染率为50%,其中1例补片残留感染再次手术取补片,5例取补片后伤口敞开引流,二期缝合;腹腔镜手术3例,其中1例放置补片后感染再次手术取补片,最后均治愈出院。全部病例随访3～29个月,平均随访15个月,均未出现伤口感染、补片残留感染,1例病人于术后3个月出现腹股沟疝复发,再次行疝修补。结论在行腹股沟疝无张力修补术后,补片感染影响因素众多,通过手术取出感染补片是补片感染的有效治疗手段。     

腹股沟疝无张力修补术后复发原因及再手术方法探讨（附108例报告）

目的讨论无张力疝修补术后腹股沟疝复发原因及再次手术方法。方法对2003年4月至2008年3月间收治的108例无张力疝修补术后腹股沟复发疝患者的资料进行回顾性分析。结果原修补部位复发73例，其中平片过小34例，网塞或补片移位19例，平片变形、卷曲14例，补片位置放置错误6例。在修补部位以外（术中遗漏疝miss hernia）复发35例，其中遗漏直疝16例，股疝11例，斜疝8例。再次手术均应用腹膜前间隙修补，采用PHS及Kugel补片，术后随访1个月～5年均未复发。结论无张力修补术后腹股沟疝复发与患者术中遗留疝、补片移位、补片大小及手术方式选择不当等因素相关；选择腹膜前间隙修补是治疗无张力疝修补术后腹股沟疝复发的有效方式。     

腹股沟疝无张力修补术后补片感染的外科处理

目的探讨腹股沟疝无张力修补术后补片感染的原因与外科处理方法。 方法回顾性分析2010年1月至2019年1月南京医科大学附属南京医院收治的12例腹股沟疝无张力修补术后补片感染患者的临床资料,研究其感染的原因并总结外科处理的方法。 结果12例患者均再次手术取出感染补片,患者全部治愈。术后随访9~36个月,无疝复发。 结论补片感染是腹股沟疝无张力修补术的严重并发症,一旦发生需再次手术取出补片,治疗不增加术后疝复发率。     

无张力腹股沟疝修补术对男性生殖功能影响的研究进展

<正>腹股沟疝是普外科常见及多发疾病。1989年,美国外科专家Lichtenstein等[1]将聚丙烯补片用于疝修补术,创新性提出无张力疝修补的概念并逐渐推广至临床。至今,补片修补已成为腹股沟疝手术的首选。美国每年约有80万人接受腹股沟疝手术治疗,其中大约90%的腹股沟疝患者采用了补片施行无张力疝修补术[2]。近年来,腹腔镜腹股沟疝修补术包括经腹腹膜前疝修补术(TAPP)及完全腹膜外疝修补术     

Chronic inguinal pain after laparoscopic intraperitoneal onlay mesh (IPOM) repair for inguinal hernia treated successfully with laparoscopic selective neurectomy: A case report

IntroductionLaparoscopic intraperitoneal onlay mesh (IPOM) repair is occasionally used for inguinal hernia repair. Here, we report a case of chronic neuropathic pain after laparoscopic IPOM repair for inguinal hernia, which was treated successfully with laparoscopic selective neurectomy.Presentation of caseA 59-year-old man with bilateral inguinal hernia underwent laparoscopic repair. Transabdominal preperitoneal repair was performed on the left side, whereas IPOM repair was performed on the right side due to a peritoneal defect. At postoperative month 1, he presented with severe pain and numbness distributed from the right inguinal region to the inner thigh region. The symptoms had persisted for 1 year despite medical treatment. We diagnosed that the symptoms might be due to the entrapment of nerves in the contracted mesh, and performed a second surgery via laparoscopic approach 13 months after the first surgery. On laparoscopic exploration, the lateral side of the mesh was contracted and involved nerve branches. We ligated and cut off these nerve branches. His symptoms resolved immediately after the surgery. At postoperative month 12, he has passed without any pain, numbness, and hernia recurrence.DiscussionLaparoscopic exploration would be useful to figure out chronic neuropathic pain after laparoscopic inguinal hernia repair.ConclusionLaparoscopic IPOM repair for inguinal hernia should be avoided as much as possible because it may cause chronic neuropathic pain. Laparoscopic selective neurectomy is an option for patients with chronic neuropathic pain after laparoscopic hernia repair.     

Day surgery for adult inguinal hernia

The mesh plug technique for adult inguinal hernia repair is easy to perform and results in a good postoperative quality of life. It allows inguinal hernia surgery to be performed as day surgery, but some problems may occur. We performed day surgeries tp repair 110 adult inguinal hernias, and the results are reported here. The procedures are as follows. Under local anesthesia, the inguinal canal and hernial sac are freed. Then the internal ring and the weakness of the posterior wall are estimated. The plug is inserted and then the mesh is on layed. As a result, all of our cases were successful under local anesthesia. After surgery, 5 subcutaneous hematomas occurred. Six patients required subsequent hospitalization: one because of subcutaneous hematoma; and 5 for pain control. In summary, the mesh plug technique under local anesthesia for adult inguinal hernia repair is a useful method for day surgery, but some an on-call system after surgery is necessary and hospitalization for postoperative complications may be required.     

Late complication of open inguinal hernia repair: Small bowel obstruction caused by intraperitoneal mesh migration

We describe a case of small bowel obstruction due to prosthetic mesh migration. A 67-year-old male, who had undergone prosthetic repair of inguinal hernia 3 years before, was admitted for a mechanical small bowel obstruction. Laparotomy revealed the penultimate ileal loop choked by an adhesion drawing it towards a polypropylene mesh, firmly attached to the parietal peritoneum of the inguinal region. The intestinal loop was released; the mesh was embedded deep with continuous whip suture after folding the parietal peritoneum. The patient was dismissed on the 11th postoperative day surgically healed. The "tension-free" technique is undoubtedly the gold standard for hernia repair. However, it is not free of complications, mostly due to technical errors, of which the surgeon must be aware, both when he is responsible for correcting defects in the wall, as well as when he has to face an occlusion in a patient who has undergone plastic surgery for inguinal hernia.     

超声检查在腹股沟疝围手术期的应用价值

目的 探讨超声检查对腹股沟疝手术前后评估的价值.方法 对30例32侧腹股沟疝患者于手术前后进行超声检查.术前观察内环位置、腹股沟管内径改变、疝囊大小及内容物并对腹股沟疝类型进行分类;术后观察补片位置、大小、形态及生物补片与四周组织的融合情况.结果 在32例侧中,有20个斜疝、4个直疝、3个股疝术前的超声诊断与手术结果相符.术后1个月内超声检查发现,其中28个手术部位可探及正常生物补片、未见其他异常回声,2个见补片外血肿,1个见补片外复发疝及1个补片变形.结论 在腹股沟疝手术前,通过超声检查能为临床医生提供腹股沟疝形态的详细参考数据并为腹股沟疝分类,为临床医生选择适合患者个体的生物补片提供了重要的客观依据.在腹股沟疝手术后,超声检查能观察生物补片的形态、位置及有无发生其他并发症.

Abstract：

Objective To evaluate the use of ultrasonography befor and after inguinal hernioplasty.Methods In 30 patients, 32 inguinal hernias were submitted to tension-free inguinal hernioplasty,ultrasonography was applied before the surgery and after one mother. Ultrasonography revealed the character of the hernia before the surgery and observed the situation of the mesh after the surgery.Results Diagnostic ultrasound detected 20 inguinal hernias,4 direct hernias, and 3 femoral hernias which were consistent with intraoperative findings. We identified 2 seromas, 1 recurrence of hernia and 1 folding mesh after hernia repair. Conclusion Ultrasonography is a useful examination in preoperative assessing inguinal hernia and demonstrating postoperative complications associated with mesh.     

腹腔镜下腹股沟疝手术失败后再手术原因分析

目的：分析腹股沟疝患者行腹腔镜手术失败的原因,探讨腹腔镜腹股沟疝手术中应注意的事项。方法回顾性分析2003年8月至2013年1月间收治的17例腹股沟疝行腹腔镜手术后失败再手术患者的临床资料。结果再手术原因：复发9例,补片感染1例,小肠漏1例,肠壁疝1例,线结反应2例,膀胱损伤1例,脐部切口裂开1例,阴囊血肿1例,髂血管损伤1例。6例再次行腹腔镜探查手术,11例行开腹手术,所有患者均手术成功,术后2～15 d痊愈出院。结论腹腔镜技术应用于腹股沟疝时,在严格掌握腔镜手术指征和遵循手术操作规范。对于病情特殊,手术有难度者应及时中转开腹。术后应密切注意并发症的发生,及时处理并发症。     

���︹�ɹ������Ʋ���

??Treatment strategy for emergency inguinal hernia CHEN Si-meng. Department of General Surgery??the First Affiliated Hospital of Nanjing Medical University??Nanjing 210029??China
Abstract Emergency inguinal hernia is a common acute abdominal pain in general surgery, which can be result in intestine necrosis and bowel perforation with high mortality and postoperative mortality. Traditional methods of manual reduction of the herniated segment of bowel can still relieve the emergency state of most patients. Laparoscopic explore can replace most of , even significantly reducing unnecessary open explore. On the basis of application of tension-free hernia repair and laparoscopic technique, improving the accuracy and effectiveness of emergency inguinal hernia treatment ,a special strategy based on its pathophysiology should be adopted. The progress of mesh materials has provided further security for emergency inguinal hernia repair. The application of new technique and operation is still controversial. The traditional concept and management strategy of emergency inguinal hernia are faced with severe challenges.     

Inguinal hernia: laparoscopic or open surgery?

BACKGROUND: Today, mesh repair is the preferred technique in surgery of inguinal hernia. Whether the mesh should be placed laparoscopically or by open techniques is still controversial. METHODS: A comparison of open mesh and laparoscopic techniques was made with the help of meta-analyses and prospective trials. Outcome variables analysed were recurrence, chronic pain, recovery, morbidity and costs. RESULTS: With regard to recurrence rates, both techniques gave comparable results. The laparoscopic technique shows advantages in terms of morbidity, recovery and especially a lower rate of chronic pain. Open mesh repair has the advantage of a lower risk of some rare severe intra-abdominal complications and seems to be more cost-effective. CONCLUSION: Both techniques of inguinal hernia repair are effective and safe. Each technique has its advantages and disadvantages. Therefore, today no single technique can be recommended as a gold standard.     

Simultaneous laparoscopic totally extraperitoneal repair for concurrent ipsilateral spigelian and indirect inguinal hernia

Simultaneous unilateral spigelian and inguinal hernia is uncommon. Majority of the approaches to repair of spigelian hernia is open surgery. We report our technique of a simultaneous repair of both spigelian and inguinal hernia using the totally extraperitoneal laparoscopic mesh repair.     

Laparoscopic Hernia Repair - Complications

Laparoscopic hernioplasty is a technique which can present a number of specific complications. This paper reviews the complications that can occur during laparoscopic hernia repair and ways to avoid them; it also describes the surgical technique used successfully in over 1000 cases. Initial experience suggests that complications can be avoided with adequate knowledge, attention to surgical anatomy and the proper technique of laparoscopic hernioplasty.Early recurrences are rare and invariably result from inadequate surgical technique. Inadequate fixation of the mesh, inadequate mesh size, and failure to cover unidentified wall defects (hernias which have never been repaired), are the main causes of early recurrence of hernia. Experience, knowledge of complications and how to avoid them, adequate training and attention to the anatomy of the inguinal region are the most important factors in correcting inguinal hernia successfully by laparoscopy.