平片式修补术无张力疝修补术治疗腹股沟复发疝65例体会

目的 探讨Lichtenstein无张力疝修补术对腹股沟复发疝的疗效和优点.方法 采用人工疝补片对65例82侧腹股沟复发疝行Lichtenstein无张力修补术的手术要点及临床效果进行回顾性分析.结果 本组单侧疝手术时间为45～110 min, 平均75 min.无切口感染、硬结、疼痛、异物反应等并发症;术后并发短暂尿潴留3例;阴囊血肿1例、积液3例4侧.术后5～8 d(平均6.5 d)出院.随访6～96个月,再复发1例.结论 Lichtenstein无张力疝修补术是一种简单、安全、痛苦小、恢复快、效果好的疝修补法,适用于大多数成人复发腹股沟疝.     

改良Lichtenstein术治疗腹股沟疝

目的总结改良式Lichtenstein术治疗腹股沟疝的临床效果。方法自2004年3月至2007年3月采用旨在加强腹横筋膜修补的改良式Lichtenstein术对65例各型腹股沟疝患者行无张力疝修补术。结果全部65例术后次日下床活动，术后未使用镇痛泵者4例出现切口疼痛而使用镇痛剂。并发尿潴留9例，无阴囊肿胀或积液。无切口感染及手术区域慢性疼痛。随访2个月至3年无近期复发。结论加强腹股沟后壁即腹横筋膜层的改良式Lichtenstein术是老年腹股沟疝较好的经济式手术方法。     

无张力疝修补术治疗腹股沟嵌顿疝45例体会

目的:探讨无张力疝修补术治疗成人腹股沟嵌顿疝的临床效果。 方法：回顾性分析无张力疝修补术治疗45例腹股沟嵌顿疝患者（包括平片式修补Lichtenstein术12例、疝环充填式Rutkow术31例及经腹股沟切口Kugel腹股沟疝修补术2例）的临床资料。 结果：45例手术过程均顺利。无切口感染和排异反应，无术后死亡。所有患者术后3个月获得门诊随访，未见复发。 结论：无张力疝修补术在治疗成人腹股沟嵌顿疝有良好效果。     

肝硬化并腹股沟疝无张力疝修补术（42例临床分析）

目的探讨无张力疝修补术在肝硬化并腹股沟疝患者中的应用价值。方法回顾性分析42例肝硬化并腹股沟疝患者的临床资料,应用Lichtenstein修补术15侧,疝环充填式无张力疝修补术31侧。结果术后出现阴囊积液2例,腹股沟伤口渗腹水1例,切口疼痛和异物感3例,轻度肝性脑病1例,无切口血肿、感染发生,均经对症支持治疗治愈。随访6个月到3年患侧疝无复发,但有2例分别于术后11和23个月出现对侧疝,经再次手术治愈。结论无张力疝修补术是治疗肝硬化并腹股沟疝患者的理想手术方法,良好的围手术期处理是手术成功的关键。     

无张力疝修补术2种的比较分析

目的探讨两种无张力疝修补术的优缺点。方法采用美国Bard公司的疝环充填物及网状补片，对各类型腹股沟疝行无张力修补118例，其中疝环充填式(Rutkow手术)69例，单纯补片法(Lichtenstein手术)49例。结果Rutkow手术平均手术时间48min，手术30mim。术后并发尿潴留Rutkow手术17例，Lichtenstein手术6例，Rutkow手术切口血肿、瘘管形成各1例，Lichtenstein手术复发1例。结论腹股沟直疝及疝环较大的斜疝，尤其是复发疝者，应尽量选用Rutkow手术，疝环较小的斜疝可选用Lichtenstein手术。     

无张力疝修补术在腹股沟嵌顿疝中的应用

目的探讨无张力疝修补术治疗腹股沟嵌顿疝的可行性和有效性。方法回顾性分析2010年1月至2013年6月,芜湖市第二人民医院收治腹股沟嵌顿疝35例患者的临床资料,其中行无张力疝修补术14例（包括Lichtenstein术3例和Rutkow术11例）,传统疝修补术6例（Bassini术）,高位结扎疝囊15例,观察手术后的局部疼痛、切口感染以及术后复发等情况。结果35例患者手术均顺利完成,术后无切口感染、手术死亡。所有患者术后门诊随访3～6个月,未见复发。结论无张力疝修补术治疗腹股沟嵌顿疝安全、有效,值得临床应用。     

女性腹股沟疝无张力修补术原则探讨

目的通过三种无张力疝修补术疗效分析探讨女性腹股沟疝无张力修补术的原则。方法选取我院2001年1月至2007年5月行腹股沟斜疝或直疝无张力修补术的女性患者54例进行回顾性分析,应用Lichtenstein平片无张力修补术16例,应用疝修补装置(PHS)无张力修补术20例,应用疝环充填式(Mesh plug)无张力修补术18例。结果应用疝装置修补术效果好,无复发及遗漏疝病例,平片无张力修补术及网塞修补术较疝修补装置,遗漏股疝的发生率高。结论女性腹股沟疝应当选用全耻骨肌孔修补的无张力修补术式。     

腹股沟无张力疝修补术后补片感染12例

目的探讨和总结腹股沟疝无张力修补术后感染致补片去除术的治疗体会。方法回顾性分析2005年5月至2014年2月,新疆维吾尔自治区人民医院收治的腹股沟疝无张力修补术后出现感染患者12例,其中9例患者均行手术取补片。结果9例患者均行手术切口治愈,疝无复发,均随访中。结论腹股沟无张力疝修补术预防感染为重,采用个体化治疗方法。     

无张力修补术在嵌顿性腹股沟疝中的临床分析

目的探讨无张力疝修补术在嵌顿性腹股沟疝中的临床应用方法及价值。方法回顾性分析2005年1月至2012年8月,四川省大竹县人民医院收治的107例腹股沟嵌顿性疝行无张力疝修补术的临床资料,并对其临床效果及并发症进行分析。结果所有患者均治愈,7—9d出院,术后出现急性尿潴留36例,阴囊积液13例,切口红肿、皮下积液1例,均经治疗后痊愈。全部患者随访3个月至6年,无复发。结论嵌顿性腹股沟疝无肠坏死患者可以安全、有效地应用无张力疝修补术。对有小肠坏死,无穿孔、肠管形态良好、周围组织无感染、一般情况良好的患者,可行一期无张力疝修补术。     

改良Lichtenstein无张力疝修补术治疗股疝的临床观察

目的探讨改良Lichtenstein无张力疝修补术治疗股疝的临床应用方法及价值。方法回顾性分析2010年1月至2014年12月间四川省大竹县人民医院对收治的67例股疝采用自行设计的改良Lichtenstein无张力疝修补术的临床资料。对其临床效果及并发症进行分析。67例中,男性3例,女性64例,其中无肠坏死嵌顿性股疝12例。结果本组67例病人全部治愈,7~9 d出院,术后出现急性尿潴留6例,1例术后出现切口红肿、皮下积液,经及时引流、换药、抗感染治愈。全部病人随访3个月至5年,无复发及慢性疼痛病例。结论改良Lichtenstein无张力疝修补术应用于股疝修补,具有安全、可靠、操作简单的特点,符合现代疝修补的耻骨肌孔理念。     

Modified Lichtenstein Procedure for Repair of Direct or Indirect Inguinal Hernia by Triangulation of the Inguinal Canal

A modified Lichtenstein hernioplasty procedure was performed, by triangulating the inguinal canal, for indirect or direct inguinal hernia. A series of 276 patients is reported, who underwent a modified Lichtenstein procedure for surgical repair of the indirect or direct inguinal hernia, 32 of which were recurrent hernias. Because of the presence of bilateral hernia in 28 of the cases, the total number of modified Lichtenstein procedures performed was 304. The Lichtenstein hernioplasty procedure was modified by placement of the polypropylene mesh between the Poupart's ligament and the intersection line of the aponeuroses of the external oblique and internal oblique abdominal muscles. The main aim of this modification is to provide stabilization of the inguinal canal. Postoperative pain, and hematoma or seroma formation were very rare in the postoperative period. No recurrence was observed. Based on these results, a modified Lichtenstein hernioplasty procedure with inguinal canal triangulation should be considered for surgical stabilization of the inguinal canal, especially in the case of recurrent hernia.     

Outcomes of Lichtenstein Hernioplasty for Primary and Recurrent Inguinal Hernia

Introduction The Lichtenstein hernioplasty for the repair of primary inguinal hernia in male patients is well established and constitutes the current gold standard. However a gold standard technique for the repair of recurrent inguinal hernia has not been established. The aim of this study was to analyze the outcomes of Lichtenstein hernioplasty for the repair of primary inguinal hernia and recurrent inguinal hernia, applying for that purpose the Qualitative and Quantitative Measurement Instrument (QQMI). Methods We studied 75 recurrent inguinal hernia patients and 287 primary inguinal hernia patients with a follow-up period ranging from 60 to 107 months. Results The final QQMI score demonstrated that most patients in both groups reached scores between 8 and 11 points, with a significant difference in the maximum score (11 points) favoring primary hernia patients. Conclusions All evaluated parameters showed better outcomes in primary hernia patients. Applying the QQMI, we have demonstrated that the outcomes of Lichtenstein hernioplasty are not similar between primary and recurrent inguinal hernia; there is a tendency toward better outcomes for primary inguinal hernia patients, although the Lichtenstein hernioplasty stands as a safe option for repair of recurrent inguinal hernias.     

Lichtenstein法无张力疝修补术治疗120例成人腹股沟疝体会

目的总结Lichtenstein法治疗成人腹股沟疝的疗效。方法120例腹股沟疝患者,采用Lichtenstein法行无张力疝修补术,其中斜疝93例（包括复发性斜疝14例,双侧斜疝3例）;直疝27例。结果120例患者手术过程顺利,手术时间平均50（45-60）min,术后住院5-7 d。伤口感染1例,经抗生素治疗及局部换药痊愈;阴囊积液4例,经阴囊穿刺1-2次治愈;局部疼痛2例,术后1-3月逐渐好转。术后96例获随访,平均14个月,无一例复发。结论Lichtenstein法治疗成人腹股沟疝效果确切,符合解剖生理特点,操作简单,术后并发症少,值得推广。     

Day-case endoscopic totally extraperitoneal inguinal hernioplasty versus open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males

Background Endoscopic totally extraperitoneal inguinal hernioplasty (TEP) is an accepted technique for the repair of recurrent and bilateral inguinal hernia, but its role in the management of unilateral primary inguinal hernia remains controversial. The current randomized trial was undertaken to compare the postoperative and 1-year outcomes of day-case TEP and open Lichtenstein hernioplasty for unilateral primary inguinal hernia in males. Methods From January 2002 to January 2004, a total of 200 male patients were randomized to undergo either day-case unilateral TEP or open Lichtenstein hernioplasty under general anesthesia. The primary outcome measures included postoperative pain score, time until return to work, incidence of chronic groin pain, and recurrence rate 1 year after the operation. Results All TEP procedures were successfully performed without conversion. The mean operation time for TEP (50±13.2 min) was significantly shorter than for open Lichtenstein hernioplasty (58 ± 17.6 min) (p < 0.001). The pain score at rest was significantly lower in the TEP group than in the open group on postoperative days 0, 1, 4, 5, and 6. On the average, the patients returned to work 8.6 days after TEP and 14 days after Lichtenstein hernioplasty (p = 0.006). Postoperative recovery and morbidity rates were otherwise comparable between the two groups. The incidence of chronic groin pain 1 year after TEP (9.9%) was significantly lower than after open surgery (21.7%) (p = 0.032). None of the patients in either group showed recurrence at the last follow-up assessment. Conclusions Day-case TEP was superior to open Lichtenstein hernioplasty for the repair of unilateral primary inguinal hernia in males. The benefits of day-case TEP included less postoperative pain, a faster return to work, and a lower incidence of chronic groin pain.     

Tension free hernioplasty in the treatment of recurrent inguinal hernia. Our experience

BACKGROUND: Despite the new surgical approach with "tension free" techniques, recurrent inguinal hernia repair remains a difficult surgical problem. METHODS: Personal experience in 61 cases of recurrent inguinal hernia is reported; in all patients a new hernioplasty with a "tension free" technique was performed. Medium follow-up of the study was 27 months (min 6 mm, max 56 mm); 3 recurrences were observed, 2 in Lichtenstein "plug" hernioplasty and 1 with the Trabucco technique. RESULTS: No recurrences were observed in Lichtenstein "mesh" hernioplasty group. CONCLUSIONS: Lichtenstein "mesh" hernioplasty can solve every anatomical situation in hernia recurrence and good results, with little or any complications, are achievable; "plug" technique is easier but recurrences in other sites of a weak inguinal wall are possible.     

Concurrent radical retropubic prostatectomy and inguinal hernia repair through a modified Pfannenstiel incision

OBJECTIVE: To describe a technique for concurrent radical retropubic prostatectomy (RRP) and inguinal hernioplasty, using a modified Pfannenstiel incision. PATIENTS AND METHODS: RRP is usually done through a midline lower abdominal incision but some patients with localized prostate cancer have an inguinal hernia. Concurrent inguinal hernia repair at the time of RRP with the usual method is only possible by either a preperitoneal mesh repair or formal hernioplasty, requiring an additional incision(s). A 10-12 cm Pfannenstiel incision is made along the pubic hairline centred over the pubic symphysis, and a 'Y'-shaped incision in the rectus sheath. The rectus muscle is split vertically along the midline, followed by RRP. After removing the prostate and completing the anastomosis, the surgeon identifies the inguinal canal along the inferior and lateral aspect of the transverse incision and uses a formal tension-free hernioplasty with a 3 x 5 cm polypropylene mesh. We used this technique in fifteen concurrent inguinal hernioplasties (two bilateral hernias and thirteen unilateral) at the time of RRP, with no additional incisions, using the formal tension-free Lichtenstein technique. One patient with bilateral hernias had a right indirect inguinal hernia, and all the remaining men had a direct inguinal hernia. RESULTS: All patients were discharged 2 days after surgery, with no complications associated with the procedure and no recurrences; however, the follow-up was short (mean 5.5 months). CONCLUSION: A modified Pfannenstiel incision is ideal for concurrent RRP and inguinal hernioplasty, providing excellent exposure of the pelvic structures and allowing the surgeon to use a formal tension-free mesh hernioplasty through the same incision. Wound healing and cosmetic results are excellent.     

猪小肠黏膜下层脱细胞基质补片在不同术式治疗青壮年腹股沟疝中的应用效果

目的:探讨猪小肠黏膜下层脱细胞基质(SIS)补片用于腹腔镜经腹腹膜前(TAPP)疝修补术与开放无张力疝修补术(Lichtenstein手术)治疗青壮年腹股沟疝临床效果。方法:回顾性分析2015年2月—2018年2月期间首都医科大学附属北京朝阳医院疝和腹壁外科采用SIS补片行疝修补术的268例青壮年腹股沟疝的患者临床资料,其中152例行Lichtenstein手术(Lichtenstein组),116例行TAPP手术(TAPP)。比较两组患者的相关临床指标。结果:Lichtenstein组手术时间、住院费用明显少于TAPP组,但围术期疼痛评分明显高于TAPP组(均P0.05);两组在术中出血量、住院时间方面差异均无统计学意义(均P0.05)。Lichtenstein组术后1周及1、3个月血清肿的发生率均低于TAPP组(均P0.05)。所有患者均未发生异物感、肠梗阻、肠瘘等并发症。结论:SIS补片应用于青壮年腹股沟疝的开放和腹腔镜疝修补术均有确切的效果,但该补片用于两种术式均有各自的优缺点。     

Comparison of Kugel and Lichtenstein Operations for Inguinal Hernia Repair: Results of a Prospective Randomized Study

Introduction The aim of this prospective randomized clinical study was to compare the Lichtenstein hernia repair with Kugel’s patch hernia repair. Methods From September 1999 to August 2002, adult patients with inguinal hernia were randomized into two groups. Group I included patients with the Lichtenstein hernioplasty, and group II included patients with the Kugel hernioplasty. The duration of the operation, surgical findings, and postoperative complications were recorded for the patients in both groups. Results A total of 139 patients (134 men, 5 women) were randomized to either group I or group II. No significant differences were observed for the duration of the operation or the complication rates between the groups during the same follow-up time (53.06 ± 5.6 months vs. 53.41 ± 7.11 months in groups I and II, respectively). Conclusions Kugel herniorraphy is a minimally invasive method and as safe as the Lichtenstein hernia repair technique, with similar complication rates.     

不同修补方式治疗腹股沟疝的临床疗效

目的对比腹腔镜完全腹膜外疝修补术（laparoscopic totally extra-peritoneal,TEP）与平片式无张力疝修补术治疗腹股沟疝的临床疗效。 方法回顾性分析2015年5月至2017年5月,福建医科大学附属漳州市医院127例腹股沟疝患者的临床资料。按照手术方式不同分为2组,行TEP术式患者68例（TEP组）,行平片式无张力疝修补术患者59例（平片式组）。比较2组患者术中情况、术后恢复、并发症以及复发率,并评价2种修补手术的疗效及安全性。 结果TEP组的手术时间、术中出血量、术后进食时间、下床时间以及恢复正常活动所需时间均明显低于平片式组,差异有统计学意义（P<0.05）。2组的住院时间、并发症的发生率以及术后复发率比较,差异无统计学意义（P>0.05）。 结论TEP治疗腹股沟疝具有手术时间短、创伤小、术后恢复快的优点,值得临床推广与应用。     

The effects of different hernia repair methods on postoperative pain medication and CRP levels

Although tension-free techniques of hernia repair using synthetic meshes have yielded encouraging results, the best method of inguinal hernia repair is still unclear. The aim of this study was to compare the responses of inflammatory mediators and postoperative pain relief following laparoscopic total extraperitoneal (TEP) hernioplasty, open tension-free mesh hernioplasty (Lichtenstein), posterior preperitoneal mesh hernioplasty (Nyhus procedure), and Bassini procedure. Patients with primary inguinal hernia were randomized in the operating room to undergo one of these repair techniques. Group I comprised 24 patients treated by Lichtenstein procedure; Group II comprised 21 patients treated by Nyhus procedure; Group III comprised 19 patients treated by Bassini procedure; and Group IV comprised 20 patients treated by laparoscopic TEP mesh hernioplasty. Postoperative pain levels following hernia repair were compared by measuring the use of patient-controlled analgesia (PCA) during the 24 hours after surgery. Serum samples withdrawn before surgery and 48 hours after surgery were assayed for C-reactive protein (CRP) content. Patient characteristics, operating time, and operative and early complications were noted. Serum CRP levels rose markedly following Nyhus (184.5 +/- 41.6 mg/L), Lichtenstein (138.4 +/- 72.5 mg/L), and Bassini repair (137.2 +/- 55.9 mg/L) compared with that of patients who underwent TEP mesh hernioplasty (55.5 +/- 41.2 mg/L). There were also significant differences in the postoperative need for analgesics via PCA among patients undergoing Nyhus (382.9 +/- 189.1 mg), Bassini (303.2 +/- 173.7 mg), and Lichtenstein (253.9 +/- 129.3) procedures compared with 196.6 +/- 148.8 mg for the TEP mesh hernioplasty group. Patients in the Lichtenstein group also had significantly less need of analgesics than those in the Nyhus and Bassini groups. In conclusion, TEP mesh hernioplasty is less traumatic and yields less postoperative pain than the Nyhus, Lichtenstein, and Bassini procedures.