局麻下超普网片Lichtenstein无张力疝修补术治疗腹股沟疝合并肝硬化腹水的体会

目的 探讨局麻下用超普网片行Lichtenstein无张力疝修补术治疗合并肝硬化腹水腹股沟疝患者的安全性及有效性.方法 回顾分析我院2007年3月至2011年7月用超普网片行Lichtenstein无张力疝修补术治疗合并肝硬化腹水腹股沟疝患者25例,对其手术效果进行分析评估.结果 所有患者均顺利完成手术,平均手术时间52.3min.术后2例出现阴囊血肿,1例切口皮下积液,没有出现较严重并发症如腹水漏出及感染.术后平均住院时间9.1d.术后随访12～35个月,平均17.6个月,随访期内无手术部位疝复发,但有2例新发生其他部位腹壁疝.结论 局麻下用超普网片行Lichtenstein无张力疝修补术治疗合并肝硬化腹水腹股沟疝患者安全、有效,可以明显提高生活质量.     

轻量网片对于无张力疝修补术后慢性疼痛的影响(超普网片与传统聚丙烯网片的比较)

目的比较轻量网片(UltraPro超普)和传统聚丙烯网片对疝修补术后慢性疼痛的影响。方法采用单盲法,对60例原发双侧腹股沟疝患者,实施Lichtenstein平片无张力疝修补术,一次性治疗双侧腹股沟疝,术中随机选取超普网片与聚丙烯网片分别植入患者双侧腹股沟区。在术后1、3、6、12个月进行随访,对比两侧腹股沟区的疼痛感。结果相对于传统聚丙烯网片,超普网片在术后3个月和6个月时慢性疼痛的发生率低,疼痛的程度更轻。结论超普网片可以减轻短期内(1年内)的慢性疼痛感,从而改善患者生活质量。     

腹股沟疝Lichtenstein修补法的技术要点

目的：总结Lichtenstein修补法修补腹股沟疝的经验。方法：应用聚丙烯网片修补术（Lichtenstein法）为104例各型成人腹股沟疝修补115次，其中男99例，女5例。双侧11例。结果：均治愈（2例复发除外，复发率＜2％）；术后切口痛减轻；无近期切口感染。结论：Lichtenstein法是修补成人腹股沟疝的有效方法，复发率低。     

Prolene网片在成人腹股沟疝前路修补中的应用

目的　评价成人腹股沟疝Prolene网片修补的方法和疗效。方法　对89例腹股沟疝病人进行Pro lene网片修补。手术的基本方法是游离疝囊到疝环处并将疝囊推回腹腔,然后将自制的锥形网塞经疝环口塞入反向疝囊内,并在精索后置入网片或仅以网片修复后壁。结果　89例共施术98例次,1例术后2d死于脑血管意外。出现阴囊血肿3例,抽吸数次后痊愈。对62例随访6～45个月,1例3个月后出现阴囊鞘膜积液;2例术后残留腹股沟区疼痛超过2个月,无复发。结论　Prolene网片是修补腹股沟疝的优质人工材料,对较大的腹股沟疝和复发疝尤为适宜。精细的解剖、认真仔细的操作、腹横筋膜的修复和人工网片使用是疝手术成功的重要保证。     

Shouldice和Lichtenstein疝修补的前瞻性随机比较

Shouldice手术被称为无张力迹修补术,Lichten－stein手术则用聚丙烯网片（2．5X10cm）以加强腹股沟区后壁,也属无张力性疝修补术。前者是腹股沟疝Bassini4层修复方法的改良,后者是用网片覆益腹横筋膜,下缘缝合在腹股沟韧带上,人工制成一内环,并缝合在耻骨结节和腹内斜肌表面上。作者前瞻性分析这两种手术的效果,在672例腹股沟疝病例中,45例为双侧,一侧采用Shouldice手术修补,另一间则用Lichtenstein手术修补,每一例何侧采用什么方法均由抛币随机法决定。在672例病人共行修补术717次。337次Shouldice手术发生7例早期疝复发（2…     

神经切断及网片取出术治疗腹股沟疝无张力修补术后慢性疼痛1例报告

目的总结神经切断网片取出术治疗腹股沟疝无张力修补术后慢性疼痛的经验。方法右侧腹股沟疝疝环填充式无张力网片修补术1例,术后出现右腹股沟区慢性疼痛,经保守治疗不能缓解。在连续硬膜外麻醉下行髂腹下、髂腹股沟、生殖股神经生殖支切断及网片取出术。结果随访3个月,病人在术后2个月出现下蹲时手术区疼痛,但无跛行和静息性疼痛。结论腹股沟疝无张力修补术后慢性疼痛在不能确定原因时,行网片取出、神经切断可获得较为满意的效果。     

腹股沟疝Lichtenstein法无张力网片修补术

目的　探讨成人腹股沟疝Lichtenstein法无张力网片修补术及其并发症。方法　对3 81例成人腹股沟疝行Lichtenstein法无张力修补 40 5例次。结果　本组随访 89%的病例 ,平均随访 4年 ,仅 1例复发 ,伤口浅表感染 4例 ,术后疼痛轻微。结论　Lichtenstein无张力修补术适用于各型成人腹股沟疝 ,术后疼痛轻微、复发率低     

超薄轻质聚丙烯网片在Lichtenstein无张力疝修补术中的应用

目的 总结应用超薄轻质聚丙烯网片在Lichtenstein无张力疝修补术(Lichtenstein手术)中的疗效.方法 局麻下采用超薄轻质聚丙烯网片行Lichtenstein无张力疝修补术230例(264例次).对麻醉、手术时间、手术适应证、手术方法、术后腹壁顺应性、自主能力的恢复、伤口疼痛、术后并发症、术后切口的异物不适感、住院时间及复发率进行观察.结果 手术时间平均35 min(20～50 min).术后2～4 h即可离床活动.术后未出现尿潴留.围手术期无死亡病例,术后患者未出现切口积液、血肿及切口感染等并发症.14例患者术后仅服用止痛药泰诺林1片;术后1～2 d出院.随访6～18个月,无疝复发、手术切口无慢性疼痛和局部皮肤紧缩发硬等异常.结论 应用超薄轻质聚丙烯网片行Lichtenstein无张力疝修补术, 除具有腹股沟无张力疝修补术的优点外,还具有植入补片的量减少、术后并发症低、人工材料费用低、术后腹壁顺应性好和运动不受限、减轻切口异物感和疼痛等优点,极大地优化了Lichtenstein手术,明显提高患者满意度.     

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。     

腹腔镜腹股沟疝修补术中的若干问题探讨

腹腔镜腹股沟疝修补术目前在国内外得到广泛应用 ,本文就其术中存在的若干问题作一探讨。一、手术方式的演变1 987年腹腔镜胆囊切除术的成功开展以及1 989年Lichtenstein[1] 提出的“无张力修补”概念为腹腔镜疝修补术提供了理论基础。 1 990年Ger[2 ] 在腹腔镜下用钉合器对 1 5只患腹股沟斜疝的狗进行了内环口关闭术 ,被看作是腹腔镜腹股沟疝修补术的雏形。这种方法因未对腹股沟管后壁进行修补 ,仅适用于小儿腹股沟斜疝。 1 990年Schultz[3] 报道了 2 0例腹股沟斜疝的腹腔镜网片填塞术 ,以后又有术者将网片改为网栓以减少移位。由于植入…     

无张力腹股沟疝修补术后疝复发的临床分析

目的　探讨无张力腹股沟疝修补术后疝复发的原因、预防及治疗。方法　结合 11例无张力腹股沟疝修补术后复发疝的临床资料 ,分析其复发的原因 ,并提出改进手术的方法及对复发疝的治疗。结果　本组 10例 ,其中疝环充填式无张力疝修补术后复发 6例 ,平片修补术后复发 4例。复发原因为平片修补术后因补片过小复发 1例 ,补片卷曲、移位 1例 ,补片精索孔留得过大 2例 ,疝环充填式无张力疝修补术后充填之网塞未牢靠固定在疝环口周围的坚韧组织上复发 2例 ,疝环口过大 ,与充填之网塞不匹配 2例 ,充填的 2个网塞之间未固定 ,留有间隙 1例 ,网塞间断缝合固定 ,但网片未固定 1例。结论　无张力腹股沟疝修补术后复发疝的原因主要是术中操作失误即对网塞和补片的置入和固定不当 ,其治疗方法仍为开放的无张力腹股沟疝修补术 ,主要是疝环充填式无张力疝修补术。     

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.     

Recurrent inguinal hernia after mesh hernioplasty. An emerging problem?]

BACKGROUND: In spite of the successful results of tension free hernioplasties, recurrent inguinal hernias are not an uncommon finding in the clinical practice. METHODS: The authors report their experience in 24 patients observed from January 1994 to December 2000 (23 men, 1 women, min. age 28 yrs, max 78 yrs, mean 58 yrs) who had recurrent inguinal hernia after a tension free hernioplasty. In 22 patients a tension free hernioplasty (Lichtenstein technique 5 patients, Trabucco 7 patients, unclassifiable 10 patients) through an anterior approach was performed while in two, respectively, a Stoppa procedure and a laparoscopic hernioplasty were the first operations; mean recurrence time was 17 months. RESULTS: Mesh and/or plug dislocation was the most frequent cause of recurrence (15 patients), followed by a failure of the internal ring reconstruction (6 patients) and loss of the pubic stitch (2 patients); in 1 patient the mesh was of reabsorbable type. CONCLUSIONS: Mesh hernioplasties represent a valuable progress in inguinal hernia therapy, but increasing clinical experience shows that, together with the experience of the surgeon in the surgical technique, suture of a wide mesh to the surrounding tissues and a adequate inguinal ring reconstruction are critical condition for good results.     

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.     

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。     

Chronic groin pain following lichtenstein mesh hernioplasty for inguinal hernia. Is it a myth?

Background  

The Lichtenstein mesh hernioplasty is currently the most popular operative technique for open repair of inguinal hernia. The incidence of chronic groin pain (CGP) following this procedure is reported to be high. However, since our experience did not support this observation, this study was undertaken at our centre, to assess the incidence of CGP following Lichtenstein mesh hernioplasty.     

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.     

三种开放式无张力疝修补术的疗效比较

目的:比较三种开放式无张力修补术式(Lichtenstein,Rutkow,PHS)的疗效,探讨复发原因及复发疝的治疗方法.方法:分别采用上述三法治疗腹股沟疝病人710例(759例次),比较各组手术时间、总费用、下床活动时间、住院时间及近远期并发症.对引起术后复发的各种相关因素进行分析.结果:平均随访率80.1%.Lichtenstein组与Rutkow组平均手术时间显著低于PHS组.平均住院费用Lichtenstein组明显低于Rutkow与PHS组.复发率、近期并发症、下床活动时间、住院时间及慢性疼痛三组无明显差异.Ⅲ型及Ⅳ型疝的术后复发率显著高于Ⅰ型及Ⅱ型疝病人.结论:我国疝学会分型中的Ⅲ及Ⅳ型疝术后更易复发,而对于复发疝的治疗应遵循"个体化"原则.三种术式均具有复发率低,疼痛轻、创伤小、异物感轻的优点,其中Lichtenstein术更具有手术时间短、费用低廉的优势.     

腹膜前间隙腹股沟疝修补术65例临床治疗体会

目的探讨善愈补片经腹膜前间隙腹股沟疝修补术的技术操作要点,并评价其疗效。方法回顾分析我院2006年8月至2009年8月用国产善愈补片行开放性前入路腹膜前间隙腹股沟疝修补术共65例的临床资料。结果手术时间45—55min,平均50min。全组患者伤口一期愈合,无浆液肿及感染发生。术后随访2—24个月,无复发。结论应用国产善愈补片治疗腹股沟疝安全有效,术后恢复快,近期疗效满意。     

无张力疝修补术疗效分析

目的通过对Lichtenstein、疝环充填式、PHS三种无张力疝修补手术方式、术后复发率以及并发症发生率等方面进行比较，寻找一种易于掌握，疗效确切的术式。方法对我院自2002年2月至2007年12月463例实施无张力疝修补术患者的临床资料进行回顾性地分析。结果所有患者均行无张力疝修补术，根据手术方式分为叁组：聚丙烯材质充填式组（218例），膨体聚四氟乙烯平片组（221例），普理灵疝补片（PHS）组（24例）。术后复发率：聚丙烯材质充填式组为0．5％（1／218），膨体聚四氟乙烯平片组为0．5％（1／221），PHS组为0（0／24），三组差异无显著性。术后疼痛发生率：聚丙烯材质充填式组为9．0％（19／218），膨体聚四氟乙烯平片组为4．0％（9／221），PHS组为4．0％（1／24），聚丙烯材质充填式组与膨体聚四氟乙烯平片组和PHS组差异显著，有统计学意义（P〈0．05）。术后阴囊血肿发生率：聚丙烯材质充填式组为1．8％（4／218），膨体聚四氟乙烯平片组为2．0％（5／221），PHS组为4．0％（2／24），PHS组与聚丙烯材质充填式组和膨体聚四氟乙烯平片组差异，有统计学意义（P〈0．05）。结论膨体聚四氟乙烯平片无张力疝修补术是一种疗效确切，术后并发较少，适宜广泛推广的一种术式。