腹腔镜腹股沟疝修补术136例临床体会

目的:探讨腹腔镜腹股沟疝修补术的手术方式及特点。方法:回顾分析马鞍山市人民医院普外三科2013年10月至2015年6月收治的136例单侧(左/右)腹股沟疝患者的临床资料,患者行腹腔镜手术治疗,其中经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)83例,全腹膜外疝修补术(totally extraperitoneal,TEP)53例。分析两种腹腔镜疝修补手术方式及特点。结果:136例手术均获成功,未中转开腹。未出现血管、输精管及膀胱损伤。术后发生阴囊血清肿6例,尿潴留11例。手术时间TAPP平均(77.34±18.5)min、TEP平均(85.75±11.9)min。TAPP患者平均住院(4.2±1.6)d,TEP平均(4.5±1.4)d。出血量平均(6.7±2.1)ml。随访半年,均无复发。结论:TAPP手术操作空间较TEP大,技术容易掌握;TEP于腹腔外进行手术操作,保留了腹膜的完整性,但学习曲线较长。TAPP、TEP均安全有效,且较传统无张力疝修补术具有创伤小、康复快、复发率低等特点,适合在有条件的医院普及。     

腹腔镜治疗腹股沟疝的手术技巧和临床疗效分析

目的 探讨经腹腹膜前补片植入术(TAPP)和全腹膜外补片植入术(TEP)治疗腹股沟疝的手术技巧和临床效果.方法 回顾分析2007年7月至2008年10月期间我院实施腹腔镜腹股沟疝修补术23例(26侧)患者的临床资料,其中TAPP 9例(10侧),TEP 14例(16侧).结果 无一例中转为开放手术.1例TEP转行TAPP.平均手术时间(82.1±40.6) min,术中出血量(5.7±3.0) ml; TEP术中腹膜撕裂2例.术后并发症发生率为21.7%(5/23),其中术后血清肿1例,阴囊气肿2例,修补区暂时性神经感觉异常1例,尿潴留1例; 术后未出现慢性、持续性神经性疼痛、异物感,补片感染和切口感染.术后平均住院时间(4.3±0.9) d.术后随访1～15个月,平均(7.2±2.3)个月,无其他不适及复发病例.结论 腹腔镜腹股沟疝修补术安全、复发率低、并发症少、痛苦轻、住院时间短、恢复快.     

老年人腹腔镜腹股沟疝修补术(附56例报告)

目的:总结老年人腹腔镜腹股沟疝修补术的经验,分析术中和术后情况,了解该术式在老年病人中使用的安全性。方法:回顾分析2007年1月至2011年12月行腹腔镜腹股沟疝修补术56例64侧病人的临床资料,其中单侧腹股沟疝48例(斜疝34例,直疝10例,股疝4例),双侧腹股沟疝8例。术后平均随访时间(36±11)个月。结果:56例中完成经腹腹膜前(transabdominal preperitoneal,TAPP)补片植入术26例,完全腹膜外(totally extraperi-toneal,TEP)补片植入术30例。平均手术时间TAPP(78±14)min,TEP(64±10)min;术后平均住院时间(5.8±1.8)d;术后并发症依次为暂时性神经感觉异常37.5%(21/56)、慢性疼痛28.6%(16/56)和血清肿21.4%(12/56)。术后复发率1.8%(1/56)。结论:腹腔镜腹股沟疝修补在老年病人的使用中,有创伤小、恢复快、复发率低、安全性好等优点。     

腹腔镜腹股沟疝修补术的经验总结(附235例报告)

目的:评价腹腔镜腹股沟疝修补术的安全性和有效性,分析术后复发与并发症的原因;比较经腹腹膜前补片植入术(TAPP)与全腹膜外补片植入术(TEP)的手术疗效。方法:回顾性分析1997年1月至2005年1月行腹腔镜腹股沟疝修补术的235例(274例次)病人的临床资料,其中TAPP139例(163例次),TEP96例(111例次),随访时间1～24个月(中位时间15个月)。结果:手术无中转,术后复发率为1.46%(4/274),前3位并发症依此为血清肿5.11%(14/274),暂时性神经感觉异常4.74%(13/274)和尿潴留2.92%(8/274);平均手术时间为(57.1±18.6)min(25～140min),术后平均住院天数为(5.84±1.44)d,2周和4周内恢复非限制性活动人数分别为96.2%(226/235)和100%,术后无需应用镇痛剂;TAPP与TEP在手术时间、复发率、并发症率、术后住院天数、恢复非限制性活动时间上差异无显著性(P>0.05);Ⅲ型疝的血清肿发生率高于其他各型(P=0.041)。结论:TAPP和TEP都是安全有效的无张力修补方法,手术效果及术式选择取决于术者的临床经验。     

无张力修补术后腹股沟复发疝再手术的探讨

目的探讨腹股沟疝无张力修补术后复发的原因及再手术治疗的原则。方法对2007年1月至2009年6月间31例腹股沟疝无张力修补术后复发患者的资料进行回顾性分析。复发时间为前次术后3个月至10年,平均(32±10)个月。既往手术方式:疝环填充式修补术14例,平片修补术10例,腹腔镜无张力疝修补术5例(TAPP、TEP、IPOM术后分别有2例、2例、1例),开放式腹膜前修补术2例。结果手术时间28～86 min,平均(38±6)min。首次复发行开放式全腹膜外无张力修补12例,平片修补6例,腹腔镜下修补4例(TEP2例、TAPP2例),巨大补片加强内脏囊(GPRVS)3例。多次复发者中2例行腹腔镜下修补(包括1例TEP和1例IPOM),2例行开放式完全腹膜外无张力修补,2例GPRVS。随访时间8～52个月,平均(29±8)个月,再复发1例。结论无张力腹股沟疝修补术后复发的原因主要是术中操作不当或患者复发的高危因素处理不当。应根据复发疝的类型和性质,选择个体化的治疗方案和手术路径。     

腹腔镜完全腹膜外腹股沟疝修补术72例报告

目的 总结完全腹膜外腹腔镜疝修补术(TEP)的临床经验及效果.方法 回顾性分析我院2005年3月至2011年2月采用腹腔镜下完全腹膜外腹股沟疝修补术治疗成人腹股沟疝72例共84侧的临床资料,其中单侧腹股沟斜疝42例,单侧腹股沟直疝18例,双侧腹股沟疝12例;初发疝64例,复发疝8例.结果 72例患者共行84次TEP术,3例中转行经腹腔腹膜前腹腔镜疝修补术(TAPP).手术时间35～155 min,平均73 min,住院时间3～8 d,平均5.5 d.术后并发症5例(侧),占6.9%,均为腹股沟区或阴囊的血肿或血清肿,随访3～63个月,无复发.结论 TEP手术安全可靠,术后疼痛轻、恢复快、复发率低,且费用相对较低、易被患者接受,同其他腹腔镜疝修补术相比优势明显,应成为腹腔镜治疗腹股沟疝的主要术式.     

Analysis of laparoscopic inguinal hernia repair:A report of 153 cases

目的 探讨经腹腹膜前修补术(TAPP)和全腹膜外腹股沟疝修补术(TEP)治疗腹股沟疝的手术技巧和临床效果.方法 2006年6月至2011年6月间实施腹腔镜腹股沟疝修补术153例,其中TAPP 36例,TEP 117例,对其的临床资料进行回顾性分析.结果 无中转开放手术者,TEP转行TAP者1例.平均手术时间(65.3±25.6)min,术中出血量(6.4±2.0)ml;TEP术中腹膜撕裂12例.术后发生血清肿3例,阴囊气肿2例,修补区暂时性神经感觉异常1例,尿潴留1例;术后未出现慢性、持续性神经性疼痛、异物感,补片感染和切口感染.术后平均住院时间(3.5±0.6)d.术后随访3～24个月,平均(12.4±3.2)个月,无其他不适及复发病例.结论 腹腔镜腹股沟疝修补术安全、复发率低、并发症少、痛苦轻、住院时间短、恢复快.     

腹腔镜下行疝修补术的75例经验

目的：探讨腹腔镜腹股沟疝修补手术的方法、适应证及优缺点。方法：75例腹股沟疝用腹腔镜进行了疝修补术，其中斜疝53例，不完全性疝8例，直疝14例。行单纯疝囊高位结扎10例，经腹腔腹膜前补片植入术（TAPP）48例52例疝，完全腹膜外行补片植入术（TEP）者17例。结果：手术全部成功完成，平均手术时间62．5（10－180)min，无中转手术，8例病人同时行了阑尾切除术，4例病人同时行了胆囊切除术；术后平均5．4d出院。1例直疝于TAPP术后8月因补片过小而复发。结论：腹腔镜疝修补术是一种安全而先进的无张力疝修补手术，手术后恢复时间短，复发率低。     

腹腔镜腹股沟疝修补术64例的临床应用

目的 探讨腹腔镜在腹股沟疝修补术中应用的可行性和优缺点.方法 64例成人腹股沟疝采用不同的腹腔镜疝修补术式完成,随访观察临床疗效,对临床资料进行回顾性总结分析.结果 所有患者均成功完成腹腔镜腹股沟疝修补术,包括腹腔镜腹股沟疝腹腔内网片植入术(intraperitoneal onlay mesh,IPOM)术式34例,腹腔镜经腹腹膜外腹股沟疝修补术(transabdominal preperitoneal prosthetic, TAPP)术式7例,腹腔镜全腹膜外腹股沟疝修补术(totally extraperitoneal prosthetic, TEP)术式20例,IPOM同时对侧行TAPP者2例,IPOM同时对侧行TEP者1例.单侧平均手术时间为25～160 min,平均66 min;双侧手术时间为60～187 min,平均76 min.术中出血量为 5～100 ml, ,术后平均住院时间4.8 d.总体疗效满意,并发症发生率14.06%,全组复发率为3.12% .结论 腹腔镜腹股沟疝修补术安全可行,具有微创优势,但仍需积极防治并发症.     

腹腔镜腹股沟疝修补术的初期应用体会

目的:探讨初期开展腹腔镜腹股沟疝修补术的注意事项,术中、术后常见并发症及其处理措施。方法:回顾分析2012年10月至2013年5月为21例患者行腹腔镜腹股沟疝修补术的临床资料,其中19例行全腹膜外疝修补术(totally extraperitoneal,TEP),2例行经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)。结果:1例TEP患者中转行TAPP。手术时间TEP平均(92±41.38)min,TAPP平均(122±26.38)min,术中腹壁下血管损伤1例,腹膜撕裂5例,均无血清肿、内脏损伤、尿潴留及输精管损伤,未见切口及深部创面感染,术后未使用止痛剂。患者均于术后第1天恢复正常饮食并下床活动。患者术后第1、3、6个月获得电话随访,无腹股沟区慢性疼痛及复发。结论:熟悉、掌握腹腔镜下腹膜前间隙及其重要结构、选择合适的手术方式是避免腹腔镜腹股沟疝修补术中、术后并发症发生的关键。     

Inguinal hernia repair in the Amsterdam region 1994–1996

In the Netherlands, approximatey 30,000 inguinal hernia repairs are performed yearly. At least 15% are for recurrence. New procedures are being introduced creating discussion on which technique is the best. Currently it is not possible to choose on evidence alone because of the long follow-up that is needed.In 1996 an inventory was taken of all inguinal hernia repairs that were performed in the Amsterdam region (9 hospitals). These results were compared with the results from a similar study performed in 1994. Major changes in treatment strategy were noted. The Bassini repair was replaced by Shouldice and Lichtenstein techniques. There was a significant increase in the use of prostheses for both primary and recurrent inguinal hernias. There was no significant decrease in the percentage of operations performed for recurrent hernia from 19.5% to 16.8%. However, there was a significant decrease in operations performed for early recurrences (5.1%–3.4%) (p=0.05). These results suggest that the Shouldice and Lichtenstein repairs may be superior to the Bassini repair in terms of early hernia recurrence.     

全腹膜外补片植入术中补片不固定的实验研究

目的评价全腹膜外补片植入术中补片不固定的安全性和有效性。方法将50只SD大鼠建立疝缺损(3cm2)模型,按随机数字表分为2组,使用聚丙烯补片(12 cm2)采用腹膜外补片植入术进行修复。甲组为补片固定组,乙组为补片不固定组。大鼠于术后不同时间分批处死,记录补片的挛缩度、腹壁抗张强度以及组织细胞学变化。结果所有大鼠术后腹腔均无粘连。2组大鼠在术后7 d、14 d、30 d、60 d和90 d补片的挛缩度分别为6.7%±1.3%vs 7.3%±1.5%、12.3%±1.3%vs 12.4%±1.6%、14.0%±2.0%vs 14.5%±1.3%、17.4%±2.1%vs 18.4%±1.5%和18.9%±2.2%vs19.5%±2.6%(P>0.05);2组大鼠的腹壁抗张强度分别为(288.4±8.4)mm Hg vs(286.6±10.2)mm Hg、(300.4±11.2)mm Hg vs(298.8±11.4)mm Hg、(305.0±11.7)mm Hg vs(303.3±16.1)mm Hg、(309.0±10.8)mm Hg vs(307.6±8.9)mm Hg和(311.8±9.8)mm Hg vs(310.0±8.6)mm Hg(P>0.05);2组大鼠的组织细胞学变化一致。结论当补片面积是大鼠疝缺损的4倍以上时,不固定的腹膜外补片植入术是安全有效的。     

腹腔镜辅助下小切口巨大腹壁疝修补术

Objective To sum up the experience of performing a laparoscope-assisted hemiorrhaphy for huge ventral hernia through small incision.Methods Clinical data were retrospectively analyzed for 18 cases of huge ventral hernia admitted from Jan 2009 to Sept 2009 undergoing laparoscope- assisted hernia mpair through small incision.Data renewed including the operational duration,missed hernia,length of the incision,serumal cyst,the length of hospital stay,chronic pain and the recidivation.Results Surgery was successful in all of the 18 cases,the operational time was(129±19) main,the length of the incision was(5.6±1.0) cm.Missed hemia were identified in 3 cases during the operation.One case:suffered from postoperative serumal cyst,the postoperative length of hospital stay was(5.1±1.2) days,postoperative incisional pain lasting for more than 3 months was identified in 1 case,there was no incisional infection and nor injury to intraabdominal organs,there was no operative mortahty,all the cases were followed-up for(8.6 ±1.6)months and there was no recidivation.Conclusions The laparoscope hemia repair with the subsidiary of micro-incision is effective and safe,and it reshapes the abdominal wall.     

腹腔镜辅助下小切口巨大腹壁疝修补术

Objective To sum up the experience of performing a laparoscope-assisted hemiorrhaphy for huge ventral hernia through small incision.Methods Clinical data were retrospectively analyzed for 18 cases of huge ventral hernia admitted from Jan 2009 to Sept 2009 undergoing laparoscope- assisted hernia mpair through small incision.Data renewed including the operational duration,missed hernia,length of the incision,serumal cyst,the length of hospital stay,chronic pain and the recidivation.Results Surgery was successful in all of the 18 cases,the operational time was(129±19) main,the length of the incision was(5.6±1.0) cm.Missed hemia were identified in 3 cases during the operation.One case:suffered from postoperative serumal cyst,the postoperative length of hospital stay was(5.1±1.2) days,postoperative incisional pain lasting for more than 3 months was identified in 1 case,there was no incisional infection and nor injury to intraabdominal organs,there was no operative mortahty,all the cases were followed-up for(8.6 ±1.6)months and there was no recidivation.Conclusions The laparoscope hemia repair with the subsidiary of micro-incision is effective and safe,and it reshapes the abdominal wall.     

Hernia Surgery: From Guidelines to Clinical Practice

INTRODUCTION

Over the last 30 years, hernia surgery has developed into an evidence-based practice assisted by the development of guidelines.

MATERIALS AND METHODS

Prior to 1993, best practice in the UK was a nylon darn repair under general anaesthesia as an in-patient with prolonged recovery. The publication of The Royal College of Surgeons of England (RCSE) Guidelines on Groin Hernia Repair stimulated debate and coincided with the introduction of mesh hernioplasty and laparoscopic techniques. Further evolution of hernia management has occurred to enable the production of the European Hernia Society (EHS) guidelines in 2008.

RESULTS

The EHS guidelines cover all aspects of abdominal wall surgery including: indications for operation; investigations; organising surgical care; techniques; local anaesthesia; after-care, complications and outcome; and information for patients.

CONCLUSIONS

Surgeons have many choices when selecting an appropriate hernia operation for an individual patient. The EHS guidelines provide a basis for this decision-making.     

Founding the first hernia center in Turkey

For years, centers dedicated to hernia surgery have been operating in North America and Europe. However, such centers have not been available to patients in most other countries, including Turkey. In 2006, the first Turkish center devoted to hernia surgery, the “Ankara Hernia Center”, was opened. In this paper, we present general information about the center’s construction, staff, practice, patient profiles, and future goals.     

Underlay mesh repair for spontaneous lumbar hernia

INTRODUCTIONLumbar hernia is a rare condition with fewer than 300 cases reported in the literature. It arises through posterolateral abdominal wall defects, named the inferior triangle (Petit) and superior triangle (Grynfelt). It can be congenital or acquired, primary or secondary, peritoneal or extraperitoneal, reducible or complicated.PRESENTATION OF CASEWe report a 63 year old female patient who presented to our hospital with a reducible right superior lumbar hernia. She underwent repair with underlay mesh after inversion of the sac and had a smooth postoperative course.DISCUSSIONIn contrast to the classical procedure the underlay mesh modification saved us from enlarging the defect, and was quick and associated with minimal tissue injury.CONCLUSIONUnderlay mesh repair for spontaneous lumbar hernia is feasible when the defect is small.     

腹腔镜辅助下小切口巨大腹壁疝修补术

目的 探讨腹腔镜辅助下小切口巨大腹壁疝修补术的经验和体会.方法 分析2009年1月至2009年9月收治的18例采用腹腔镜辅助下小切口修补巨大腹壁疝的患者资料,观察手术时间、隐匿疝、小切口长度、浆液肿、住院时间、慢性疼痛、复发等情况.结果 18例患者均顺利完成手术,手术时间(129 ±19)min,切口长度(5.6 ±1.0)cm,发现隐匿疝3例,术后发生浆液肿1例,术后住院时间(5.1±1.2)d,术后疼痛持续大于3个月的1例,无切口感染和肠道及腹腔脏器损伤,无手术死亡.全组患者随访时间(8.6±1.6)个月无复发.结论 腹腔镜辅助下小切口修补巨大腹壁疝是一种安全可靠的手术方法,有效减少了术后并发症的发生,达到了腹壁塑形的效果.