腹腔镜下经腹腹膜前疝无张力修补术治疗隐匿性疝的临床研究

目的 探讨腹腔镜下经腹腹膜前疝无张力修补术治疗隐匿性腹股沟疝的临床疗效,减少单侧腹股沟疝术后对侧假性复发的发生率.方法 回顾性分析南昌大学第二附属医院胃肠外科2017年1 月至2019年7月收治的单侧腹股沟疝行手术治疗的2 155 例病人,其中1 105 例病人行开放性疝修补术,927例病人行腹腔镜经腹腹膜前疝修补术(...     

无张力疝修补术治疗腹股沟疝136例体会

目的探讨无张力疝修补术在腹股沟疝中的临床应用方法及价值。方法自2002年3月至2007年3月应用意大利HERNIAMESH公司赫美平片治疗腹股沟疝136例，观察手术时间、伤口疼痛、并发症及复发率。结果手术全部成功，平均时间50min，20例伤口轻度疼痛，9例出现阴囊积液，伤口感染1例，术后5～7d治愈出院。随访36—48个月未见复发病例。结论无张力疝修补术是治疗腹股沟疝的理想术式，具有创伤小，痛苦小，恢复快，复发率低等优点，但应遵循一定的手术操作规范。     

Inguinal hernia repair with the dynamic self-regulating prosthesis (PAD system). Recurrence and complications in 236 consecutive patients

We retrospectively analysed 236 consecutive patients with primary and recurrent inguinal hernia treated with the dynamic self-regulating prosthesis (PAD system). Parameters such as hernia type, operation time, type of anaesthesia, complications, hospital stay and recurrence were evaluated. Recurrence rates were determined by clinical examination. 254 PAD procedures were performed on 236 adult male patients. Inguinal hernias were unilateral in 218 patients, bilateral in 18 patients, and recurrent in 22 patients. There were 101 patients (43%) with Nyhus type II hernia, 113 (48%) with Nyhus type III hernia, and 22 (9%) with Nyhus type IV hernia; local anaesthesia was used in 149 (63%) patients, and epidural anaesthesia in the others. Haemorrhage occurred in 2 patients (0.8%) and required re-operation. After a median follow-up of 40 months (range: 21-56), there were only 2 (0.8%) recurrences, both in the same patient. Persistent inguinal pain at 1 year occurred in 3 patients (1.2%). There was no statistical correlation between preoperative comorbid disease, Nyhus type of hernia, operative time and recurrence (p < 0.2). We conclude that the PAD system is as effective as mesh repair with an acceptable recurrence rate and fewer complications.     

98例腹股沟疝无张力修补术治疗体会

目的探讨MycroMesh平片在腹股沟疝无张力修补术中的临床应用方法及价值。方法自2006年3月至2007年3月应用美国戈尔公司MycroMesh平片治疗腹股沟疝98例，观察手术时问、伤口疼痛、并发症及复发率。结果手术全部成功，平均时间60min，20例伤口轻度疼痛，9例出现阴囊积液，伤口感染1例，术后5～7d治愈出院。随访30～40个月未见复发病例。结论MycroMesh平片无张力疝修补术是治疗腹股沟疝的理想术式，具有创伤小、痛苦小、恢复快、复发率低等优点，但应遵循一定的手术操作规范。     

改良kugel 术治疗老年腹股沟疝：附386 例报告

目的：评价改良Kugel手术对老年腹股沟疝患者的临床疗效。 方法：回顾分析2006年2月—2013年6月386例行Kugel补片修补的60岁以上老年腹股沟疝患者临床及随访资料。 结果：所有患者均顺利完成手术。手术时间32~95 min,6例术中出血在50~150 mL,其他均<30 mL,术后下床时间7~16 h,术后住院时间5~18 d;无手术死亡、未出现睾丸炎、血清肿、阴囊血肿;术后切口裂开1例（0.25%）,切口感染1例（0.25%）,下肢深静脉血栓形成1例（0.25%）,术后中度慢性疼痛3例（0.78%）,术后2周内行走时有明显术区牵胀痛46例（11.9%）;术后349例获随访3~65个月,无术后复发。 结论：改良Kugel手术治疗老年人腹股沟疝安全有效;应用高质量补片,妥善安放固定,同时术区有效充分的引流,均有益于患者的术后恢复。     

Determinants of outcome of inguinal herniorrhaphy in Nigerian patients

Objective: To determine the clinical, operative and postoperative factors influencing the outcome of inguinal herniorrhaphy for inguinal and iguinoscrotal hernia. A protocol was drafted to carry out a prospective study of all patients who had herniorrhaphy for inguinal or inguinoscrortal hernia within a period of 7 years (February 1995–January 2002). The present study took place in a Teaching Hospital Complex Unit that serves a rural and semiurban Nigerian community. Patients and methods: A total of 425 consecutive patients who had inguinal herniorrhaphy were recruited for the current study. Only adult male and female patients were recruited and operated on either as emergency or elective status. Demographic, clinical, operative and postoperative patterns of the patients were documented and analysed using SPSS 7.5 for Window. Results: There were 391 (92%) male patients and the patients age ranged from 16 to 90 years, with a mean of 51.8 years. Duration of symptoms ranged 1 day?25 years, median of 1 years. There were 169 patients (39.8%) with 175 (37.6%) cases of inguinoscrotal hernia, 256 patients (60.2%) with 290 (62.4%) cases of inguinal hernia and 15 (3.5%) patients presented with recurrent hernia. Emergency operation was carried out in 112 (26%) patients, with a high incidence of scrotal complications, wound failure, mortality and a prolonged period of hospitalization. There were more scrotal complications among the elderly patients, with a high rate of inguinoscrotal hernia and those patients with systemic pathology. Wound infection and wound dehiscence were more common in patients with obstructive uropathy, longer duration of symptoms, inguinoscrotal hernia, presence of other hernia type and such operative findings as sliding hernia. Postoperative hernia recurrence and scrotal complications were associated with a high wound infection rate, while mortality rate was associated with age, hernia incarceration, inguinoscrotal hernia, suboptimal clinical status and operative findings of gangrenous intestinal segment. Conclusion: There were many preoperative, operative and postoperative factors that significantly influence the outcome of inguinal herniorrhaphy at the Teaching Hospital Complex. High postoperative morbidity and mortality were associated with old age, inguinoscrotal hernia and preoperative hernia complications.      

老年嵌顿性腹股沟斜疝36例报告

目的探讨老年嵌顿性腹股沟斜疝的诊断和治疗。方法回顾性分析2003年1月至2008年1月间手术治疗的老年嵌顿性腹股沟斜疝36例的临床资料。结果随访时间3个月～2年,本组无一例因手术死亡。出现伤口不适感5例,阴囊肿胀或硬结5例,无切口感染,行疝修补术者无疝复发。结论对于大多数患有嵌顿性腹股沟斜疝的老年病人行疝修补术是可行的,全身情况差和局部感染严重者可行疝囊高位结扎术。     

自固定补片与缝合补片在Lichtenstein无张力疝修补术修复腹股沟疝的效果对比

目的探讨Lichtenstein无张力疝修补术中应用自固定补片与缝合补片修复腹股沟疝的效果和安全性。 方法选择2017年1月至2018年7月湖北省公安县人民医院收治的腹股沟疝患者112例,均行Lichtenstein无张力疝修补术。采取随机数字表法将患者分为观察组（自固定补片）和对照组（缝合补片）各56例。比较2组患者手术时间、住院费用、术后异物感、术后疼痛[视觉模拟评分法（VAS）]、术后并发症（阴囊积液、切口感染）、复发率等临床指标差异性,观察手术前后生活质量[生活质量综合评定问卷-74（GQOLI-74）]变化情况。 结果观察组患者手术时间短于对照组,住院费用高于对照组（P均<0.05）;观察组患者术后1、3、6、9、12个月的异物感发生率明显低于对照组,术后3 d和1、3、6、12个月的VAS评分均低于对照组（P均<0.05）;2组患者术后阴囊积液、切口感染发生率比较差异无统计学意义（P>0.05）,随访12个月均未出现复发病例;术后3个月,2组患者GQOLI-74各维度评分均较术前升高（P<0.05）,观察组患者躯体功能评分高于对照组（P<0.05）。 结论Lichtenstein无张力疝修补术中应用自固定补片与缝合补片修复腹股沟疝的并发症均较少且无复发情况,使用自固定补片可缩短手术时间,减轻术后疼痛和异物感,有利于改善生活质量,但其住院费用相对较高。     

腹腔镜诊治老年嵌顿性腹股沟疝62例临床分析

目的:探讨腹腔镜技术诊治老年嵌顿性腹股沟疝的应用价值。方法:回顾分析2017年1月至2019年2月收治的62例老年嵌顿性腹股沟疝患者的临床资料,包括一般资料、手术成功率、并发症发生率、死亡率、复发率。结果:62例患者中斜疝59例,直疝1例,股疝2例,患者均完成腹腔镜探查及疝内容物还纳,其中5例行肠切除加内环口成形术,55例行腹腔镜经腹膜前疝修补术,2例中转李金斯坦术。手术时间平均(76.4±18.9)min;平均住院(5.9±1.8)d;术后发生血清肿发生率2例(3.2%),无切口感染、慢性疼痛发生;死亡率1.6%(1/62)。术后随访4~24个月,随访率78.7%(48/61),无复发病例。结论:腹腔镜技术具有探查优势,诊治老年嵌顿性腹股沟疝安全、有效。     

The role of laparoscopy in the management of suspected recurrent pediatric hernias

BACKGROUND: This report examines recurrent pediatric groin hernias and the role of diagnostic laparoscopy in the management of these recurrences. METHODS: A chart review of 19 children presenting with recurrent hernias was performed, analyzing the type of primary hernia, nature of recurrence, preexisting medical conditions, surgical complications at primary repair, and time to recurrence. Diagnostic laparoscopy (DL) was used during the remedial repair of the last nine patients. RESULTS: Seventeen indirect hernias were repaired during the primary repair, and 1 femoral hernia was identified. In one child, no inguinal hernia was identified at the initial operation. Overall, 11 recurrences were found to consist of indirect sacs, and 4 were found to have attenuation of the inguinal floor. Four additional recurrences were found to be femoral hernias. In only 1 patient was a wound factor (infection) thought to play a role in the recurrence. Diagnostic laparoscopy in 9 patients found 4 (44%) to have unsuspected intraoperative findings. Four femoral hernias were identified (3 with unsuspected contralateral femoral hernias). Additionally, 1 unsuspected recurrence of an indirect sac was identified. CONCLUSIONS: Laparoscopy accurately identifies the nature of the defect in children with recurrent groin hernias, detecting unsuspected contralateral indirect, direct, or femoral hernias in 44% of those undergoing laparoscopy.     

腹腔镜经腹腔补片修补术治疗腹股沟疝的评价

目的：探讨腹腔镜经腹腔腹膜前网片修补术（transabdominal preperitoneal prosthesis,TAPP）治疗腹股沟疝的特点及疗效。方法：回顾分析2004年11月至2007年4月19例男性患者单侧腹股沟疝采用TAPP手术治疗的临床资料。结果：19例手术均在腹腔镜下完成,无中转手术,手术时间50～76min,平均63min。术后24～48h患者下床活动,住院5～7d,无并发症发生,术后随访2～25个月,1例复发（5．2％）。结论：TAPP治疗腹股沟疝是安全可行的疝修补方法,遵循疝修补无张力的原则,具有患者痛苦轻,康复快等特点,是治疗腹股沟疝的有效手段。     

After 10 years and 1903 inguinal hernias,what is the outcome for the laparoscopic repair?

Background: The procedure of choice for inguinal hernia repair has remained controversial for decades. The laparoscopic approach has now been utilized for more than 10 years, and a significant volume of patient outcomes is now available for review. Methods: The hospital and office records of 1388 patients who underwent 1903 laparoscopic inguinal hernia repairs at Atlanta Medical Center during the past 10 years were retrospectively reviewed in order to determine demographics, recurrence rate, and complications. In addition, 123 hernia repairs were prospectively studied in 71 patients during this time period in order to accurately evaluate postoperative pain and return to activity. Results: Two hundred fifty-five (13.4%) hernias were recurrent and 1648 (86.6%) were primary. Five hundred and fifteen (37.1%) hernias were bilateral. The total extraperitoneal approach was utilized for 1561 (82.0%) of the 1903 repairs. The average operative time was 75.4 (14–193) minutes. Estimated blood loss was 22.0 (0–250) ml. Seventeen patients (1.2%) were converted to an open form of hernia repair. Minor complications occurred in 83 (6.0%) patients and major complications occurred in 18 (1.3%) patients. Conclusions: The laparoscopic approach is a safe form of inguinal hernia repair that offers the patient a shorter and less painful recovery with an extremely low recurrence rate.     

腹股沟疝日间手术患者护理模式的探讨与分析

目的探讨与分析日间手术治疗腹股沟疝患者的护理模式。 方法回顾性分析2017年1月至2019年1月,首都医科大学附属北京朝阳医院疝和腹壁外科就诊的3266例腹股沟疝日间手术患者。其中,儿童疝患者1111例（34.0%）,成人疝患者根据手术方式不同分为开放组和腹腔镜组。开放组患者1256例（38.46%）,腹腔镜组患者例899（27.54%）,记录全部患者围手术期护理的并发症与相应的处理对策。 结果所有患者手术过程顺利,儿童疝组围手术期出现尿浸湿伤口敷料24例（2.2%）,活动后出现伤口敷料脱落13例（1.2%）,急性疼痛21例（1.9%）;成人疝组围手术期出现排尿困难48例（2.2%）,急性疼痛69例（3.2%）,发热33例（1.5%）,体位性低血压12例（0.6%）,恶心呕吐20例（0.9%）;所有成人组患者围手术期出现特殊事件5例（0.2%）,术后转普通病房7例（0.3%）,夜间再次急诊就诊11例（0.5%）。所有患者随访期间均未出现伤口感染、液化等并发症。 结论在日间手术治疗腹股沟疝患者的围手术期中,良好的腹股沟疝日间手术护理模式,以及定期密切的随访,能显著提升临床治疗效率,有助于减少患者围手术期并发症的发生及早日康复。     

免钉合双网片交叠腹腔镜腹膜外腹股沟疝修补术的应用体会

目的:总结免钉合双网片交叠腹腔镜腹膜外腹股沟疝修补术的手术经验,并探讨其安全性、可行性、有效性及手术技巧.方法:回顾分析2008年8月至2010年12月19例腹股沟疝患者的临床资料,其中斜疝13例,直疝6例;右侧11例,左侧5例,双侧3例.结果:18例手术获得成功,1例中转开放手术.手术时间70～180 min,单侧平...     

Combined transurethral prostatectomy and inguinal hernia repair: a retrospective audit and literature review.

OBJECTIVE: To audit the results of combined transurethral resection of the prostate (TURP) and inguinal hernia repair, often carried out under the same anaesthetic (because bladder outlet obstruction from prostatic disease and inguinal hernia are both common conditions in elderly men), to avoid two separate operations. PATIENTS AND METHODS: The study included 85 patients who underwent primary inguinal hernia repair with TURP in the urology unit of Nottingham City hospital between 1989 and 1995, and who were recalled to a special clinic. The type of hernia and repair carried out were recorded and complications audited with specific reference to recurrence of hernia and wound infection. RESULTS: The 85 patients underwent 88 primary inguinal hernia repairs with TURP (three were bilateral). Maloney's darn repair was used on 55 and a Bassini repair on 33 occasions, respectively. Two patients developed mild wound infection after surgery, but only two patients (2%) had recurrence of hernia. CONCLUSIONS: The recurrence rate after primary inguinal herniorraphy with conventional methods of repair, performed with TURP, was comparable with published results of hernia repairs alone, before the introduction of Lichtenstein's mesh repair.     

免气囊分离器完全腹膜外腹腔镜腹股沟疝修补术的初步体会(附21例报告)

目的：探讨免气囊分离器完全腹膜外腹腔镜腹股沟疝修补术（totally extraperitoneal repair,TEP）的可行性、手术技巧和临床经验。方法：2005年6月至2007年5月为21例患者（23侧）行腹股沟疝免气囊分离器TEP,其中斜疝21侧,直疝、股疝各1侧。结果：所有患者均顺利完成手术,平均手术时间70min,术中平均出血16ml,术后平均住院5d。发生腹壁下血管游离5例次,腹壁气肿5例次,血肿或血清肿4例次,腹膜破损与神经感觉异常各3例次,膀胱损伤1例次。随访2—24个月,无复发。结论：免气囊分离器TEP安全可行,手术难点是正确分离腹膜外置入网片的腔隙。     

Differentiated approach to surgical treatment of inguinal hernia recurrence in accordance with morphologic characteristics of musculo-aponeurotic structures of inguinal channel

In 44 patients, ageing 39-73 yrs and suffering inguinal hernia recurrence, the investigation of musculo-aponeurotic structures of inguinal region was conducted. In 21 patients, suffering primary inguinal hernia recurrence, in concurrence with the connective tissue complex degeneration the pronounced atrophy of tissues was revealed. In 23 patients, suffering multiple inguinal hernia recurrence, the tissues degeneration and atrophy were manifested significantly. The results of investigation trust the necessity of additional plastic material application while performing hernioplasty for inguinal hernia recurrence. To optimize the primary inguinal hernia recurrence, the combined hernioplasty, applying polypropylene mesh, was performed, and for secondary recurrence--preperitoneal allohernioplasty, using operative access through the inguinal channel.     

疝环充填式无张力疝修补术在成人腹股沟疝的临床应用

目的　评价疝环充填式无张力疝修补术治疗腹股沟疝的临床价值。方法　应用聚丙烯网塞及网状补片治疗腹股沟疝 14 4例 ,对手术时间、手术方法、术式的优点、并发症及术中注意事项进行回顾性总结。结果　全组均痊愈 ,手术时间平均 43 .5min ,术后疼痛轻微 ,平均 6h后即可下床活动 ,无感染病例 ,主要并发症为 6例尿潴留和 5例阴囊积液。 63例出现术后低热。随访无复发病例。结论　该方法操作简便 ,符合腹股沟区生理解剖特点 ,术后疼痛轻 ,患者恢复快 ,复发率低 ,是治疗腹股沟疝的理想方法     

中高血栓风险患者李金斯坦手术围术期不停用抗血栓药物的安全性分析

背景与目的 术前长期服用抗血栓药物的患者,围术期如继续服药会增加手术出血风险,而停药则增加血栓栓塞事件发生的风险。对于腹股沟疝手术而言,围术期抗血栓药物的管理尚无共识或高质量临床研究。因此,本研究通过观察长期口服抗血栓药物的腹股沟疝患者围术期不停药行李金斯坦手术的安全性,初步探讨该类患者围术期抗血栓药物的管理策略。方法 采用前瞻性队列研究方法,连续纳入2018年11月—2022年2月间中南大学湘雅医院疝和腹壁外科中心收治的18例因中高血栓风险而长期口服抗血栓药物的腹股沟疝患者,围术期均不停用抗血栓药物,采取神经阻滞联合喉罩全身麻醉行李金斯坦手术。对患者术中及术后出血情况、术后第１天视觉模拟疼痛评分（VAS）、术后主要心脏不良事件（MACEs）、脑血管并发症、切口不良事件、疝复发和病死率进行观察与随访。结果 18例腹股沟疝患者均为男性,其中4例曾行心脏瓣膜置换手术、1例合并房颤、9例曾行冠状动脉支架植入术、1例曾行冠状动脉搭桥术、3例既往发作心肌梗死,均为中高血栓风险患者。其中,长期口服华法林患者5例,长期口服抗血小板药物13例,包括服用阿司匹林8例、服用氯吡格雷3例、服用阿司匹林联合氯吡格雷/吲哚布芬2例。18例患者的平均住院时间（9.61±2.59）d,术中平均失血量为（3.77±2.53）mL,手术平均时长为（70.13±13.44）min。术后1例患者出现伤口明显瘀青,1例患者出现伤口少许瘀青,16例患者伤口无明显出血。无1例需输血或发生需外科处理的出血事件。术后第1天中位VAS评分为1.72分。围术期无MACEs和脑血管并发症发生。所有患者均在术后1~5 d痊愈出院,出院后中位随访19.34个月,随访率为100%。随访期间无伤口不良事件、疝复发、MACEs、脑血管并发症及死亡发生。结论 对于具有中高血栓风险的腹股沟疝患者,在全方位的围术期管理前提下,围术期不停用抗血栓药物行李金斯坦手术这一策略是安全可行的,推荐作为选择。     

腹膜的窗帘化在腹腔镜经腹腹膜前疝修补术中的应用

目的探讨腹膜的窗帘化在腹腔镜经腹腹膜前疝修补术（TAPP）中的临床意义。 方法选择2016年1月至2019年12月安徽省合肥市第二人民医院普外科行TAPP手术的60例腹股沟疝患者,其中双侧疝患者15例,共75侧疝。采用随机数字表法分为2组,对照组37侧,未行腹膜窗帘化;试验组38侧,行腹膜窗帘化。 结果60例患者均行标准TAPP手术。全组患者手术时间70（50～120）min、术中出血量2（1～3）ml、术后住院时间5（2～7）d、无术中并发症。所有患者术后疼痛视觉模拟评分<3分。本组患者均完成1个月至2年随访,无复发、感染的病例,随访期内发生并发症6侧（8%）,均为术后血清肿的发生。 结论腹膜的窗帘化在TAPP中可明显易于补片展平及腹膜的关闭缝合,减少腹膜的破损,减少术后并发症的发生及腹股沟疝的复发,具有十分重要的临床意义。