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.     

经尿道前列腺电切术同时行腹股沟疝修补28例报告

目的 :探讨良性前列腺增生 (BPH)合并腹股沟疝的一次性手术方法。　方法 :经尿道前列腺电切术(TURP)治疗前列腺增生 ,同时采用聚丙烯网片 (PPM)无张力修补腹股沟疝 ,一次性手术治疗BPH合并腹股沟疝病人 2 8例。　结果 :手术效果良好 ,随访 6个月～ 4年 ,无疝复发、手术切口感染及其他手术并发症。术后最大尿流率 (Qmax)均 >15ml/s,国际前列腺症状评分 (IPSS)为 0～ 7分。平均术后住院时间为 4 .2d。　结论 :同期行TURP及腹股沟疝修补术 ,方法简单、疗效肯定 ,可避免二次手术的痛苦 ,尤其对老年病人具有特别意义。     

PKRP联合无张力疝修补术同期治疗BPH合并腹股沟疝78例

总结经尿道等离子电切术(PKRP)联合无张力疝修补术治疗良性前列腺增生(BPH)合并腹股沟疝的临床效果。回顾性分析本院2013年5月—2015年1月行PKRP联合无张力疝修补术同期治疗的78例BPH合并腹股沟疝患者的临床病例资料,统计分析手术情况、手术前后尿动力学指标、前列腺症状、生活质量及并发症情况。78例患者均顺利完成手术,67例(85.90%)患者随访6个月、58例(74.36%)患者随访1年。手术时间64~147min,平均88.3±19.8min;膀胱冲洗时间27.5±6.7min,前列腺切除质量43.9±8.9g,手术出血量189.4±57.5mL,尿管留置时间4.8±1.1d,术后住院时间6.3±1.8d。78例患者术后6个月复查前列腺症状评分(IPSS)、生活质量评分(QOL)、最大逼尿肌压、残余尿量(RUV)较术前均显著降低(P0.05),膀胱顺应性、最大尿流速(Qmax)较术前均显著提高(P0.05)。PKRP联合无张力疝修补术同期治疗BPH合并腹股沟疝临床效果可靠,手术并发症较少。     

成人腹股沟疝无张力修补术治疗体会

目的探讨Lichtenstein无张力疝修补术治疗26例成人腹股沟疝的疗效。方法回顾分析26例成人腹股沟疝Licht-enstein无张力疝修补术的临床资料。结果本组患者切口均Ⅰ期愈合,手术时间35～80 min,平均(42.2±3.15)min,住院时间5～8d平均6 d,术后切口出现轻度疼痛5例尚能耐受,均未使用止痛药物。未发现补片排异反应,全部患者均获随访1～3年,无复发病例。结论 Lichtenstein无张力疝修补术操作简单、创伤小、复发率低,治疗成人腹股沟疝疗效肯定。     

无张力疝修补术治疗腹股沟疝965例分析

目的观察无张力疝修补术治疗成人腹股沟疝的疗效。方法采用网塞填充法疝修补术和Lichtenstein疝修补术治疗965例次腹股沟疝,总结临床资料,评定疗效。结果965例手术时间30～60min,平均39min,术后住院3—8d,平均5d。术后随访6～24个月,复发4例,补片感染2例,无顽固性疼痛。结论无张力疝修补术复发率低、住院时间短、并发症少,是治疗腹股沟疝安全、有效的手术方法。     

局麻下Lichtenstein无张力平片疝修补术治疗腹股沟疝797例分析

目的评估Lichtenstein无张力疝修补术治疗腹股沟疝的结果并总结临床经验。方法回顾分析797例腹股沟疝患者Lichtenstein无张力疝修补术的临床资料。结果平均住院时间65min,术后并发症发生率为24.1%(194例次),复发率0.1%(1例)。结论成人腹股沟疝采用在局麻下Lichtenstein手术恢复快,复发率低并且适合在日间门诊开展。     

良性前列腺增生开放手术同时行经腹膜前腹股沟疝修补术21例报告

目的 :评价在良性前列腺增生 (BPH)开放手术的同时行经腹膜前腹股沟疝修补术的疗效。　方法 :2 1例伴有可复性腹股沟疝的BPH患者 ,取耻骨上纵行切口 ,在盆腔内先行腹膜前腹股沟疝修补术 ,其中 4例疝囊较大的采用聚丙烯网片修补 ,然后按常规方法行经耻骨上或耻骨后前列腺摘除术。　结果 :2 1例均获随访 ,随访时间为 6个月～ 7年 ,2例疝复发 ,复发率为 9.5 %。另外 19例无感染和疝复发。　结论 :在BPH开放手术同时行经腹膜前腹股沟疝修补术是可行的 ,手术方法简单 ,效果肯定 ,对老年患者更有意义     

高龄高危良性前列腺增生患者合并腹股沟疝的同期手术治疗体会

目的 探讨高龄高危良性前列腺增生(BPH)合并腹股沟疝的同期手术方法及其治疗效果并总结经验.方法 回顾性分析2006年8月至2011年10月收治的46例高龄高危良性前列腺增生合并腹股沟疝患者的临床资料,采用前列腺选择性绿激光汽化术(PVP)联合经尿道前列腺电切术(TURP)处理增生的前列腺组织,选用聚丙烯单丝补片(美国巴德公司)进行腹股沟疝无张力修补术.结果 本组46例随访5～48个月,无一例疝复发,无切口感染、尿失禁、经尿道电切综合征及尿道狭窄.3例出现腹股沟区不适感,2例切口脂肪液化,6例轻度尿路刺激征,4例短暂排尿困难,上述并发症对症处理后治愈.结论 PVP联合TURP加无张力疝修补术处理高龄高危良性前列腺增生患者合并腹股沟疝,一期手术完成,创伤小,出血少,手术时间短,避免了二次麻醉风险和手术打击.     

TUVP联合腹股沟疝无张力修补术同期治疗老年BPH并腹股沟疝的疗效观察

目的：探讨经尿道前列腺汽化电切联合腹股沟疝无张力修补术同期治疗老年BPH合并腹股沟疝的方法和可行性。方法：2006年1月-2012年6月,共65例患者纳入本研究,平均年龄76岁。术前评估患者国际前列腺症状评分（IPSS）、生活质量（QOL）评分,行血清前列腺特异抗原、经直肠超声、剩余尿量以及尿流动力学检查。所有患者均先行经尿道前列腺手术再行疝修补术,其中61例行开放无张力修补术（疝环填充法）,4例行腹腔镜疝修补。术后定期随访。结果：65例患者中,腹股沟斜疝48例（单侧41例、双侧7例）,腹股沟直疝17例。手术顺利,平均耗时95min,未发生严重术中、术后并发症。术后IPSS评分平均为（8．0±1．2）,与术前（24．7±4．5）相比明显下降（P〈0．05）;最大尿流率（Qmax）平均为（18．0±1．2）ml／s,较术前（6．5±0．7）ml／s明显增高（P〈0．05）;剩余尿量减少至0～35ml。腹股沟疝手术切口均为I／甲愈合。未发生手术切口感染,术后远期无腹股沟疝复发。结论：同期经尿道前列腺电切联合腹股沟疝无张力修补术对BPH合并腹股沟疝患者具有较为满意的治疗效果,是老年患者较为理想的手术方式。在临床应用过程中,需要严格掌握同期手术的适应证,选择合适的患者,注意严格规范的无菌操作,推荐先进行腔内前列腺手术。     

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.     

腹腔镜经腹腹膜前疝修补术联合腹股沟区小切口在腹股沟疝治疗中的应用

目的探讨腹腔镜经腹腹膜前疝修补术（TAPP）联合腹股沟区小切口治疗难复性及嵌顿性腹股沟疝患者的临床疗效。 方法回顾性分析2016年1月至2019年4月，常熟市第二人民医院62例一期行疝修补手术的单侧难复性或嵌顿性腹股沟疝患者的临床资料，其中行腹股沟区小切口联合TAPP修补术患者16例，行TAPP修补术患者21例，行开放无张力修补术患者25例。 结果TAPP联合腹股沟区小切口组与TAPP组住院时间、手术时间、切口并发症、排尿困难及睾丸坏死发生率等方面比较，差异无统计学意义（P>0.05）；而在住院费用及术后阴囊/会阴肿胀发生率方面比较，差异有统计学意义（P<0.05）。TAPP联合腹股沟区小切口组与开放组比较，在住院时间、术后切口并发症发生率及排尿困难发生率比较，差异有统计学意义（P<0.05）；而在住院费用、手术时间、其他术后并发症发生率比较，差异无统计学意义（P>0.05）。 结论TAPP联合腹股沟区小切口治疗难复性或嵌顿性腹股沟疝行可缩短住院时间或减少术后并发症的发生，值得在临床中应用推行。     

A hernia in the inguinal region is not always an inguinal hernia

A male patient of 60 years presented with a swelling in the left groin of 10 months duration. Past records showed bilateral lumbar sympathectomy and omentopexy done 20 and 6 years back, respectively, for Buerger’s disease. Abdominal examination revealed a huge hernial swelling in the left groin extending from the symphysis pubis to anterior superior iliac spine measuring 25 × 18 cm. On exploration, the contents were intestines and omentum, which were coming out through a defect of 5 × 3 cm in the lower fibers of the conjoint muscle 4 cm cephalad to the deep ring, a finding which made the final diagnosis as an incisional hernia. We present this interesting case as a very rare complication of omentopexy, probably not reported previously, and an unusual case of an incisional hernia presenting as an inguinal hernia which is very difficult to diagnose unless encountered before. Its rarity and clinical challenge is highlighted.     

腹膜前无张力修补术与传统疝修补对比研究

目的：探讨腹膜前间隙无张力疝修补术在治疗腹股沟疝中的临床价值。方法回顾性分析2008年3月至2012年8月,山东省即墨市中医医院收治的腹股沟疝患者130例,随机分为二组。观察组（68例）实施腹膜前间隙无张力疝修补术,对照组（62例）实施传统疝修补术。对二组患者手术时间、住院时间、并发症和复发情况、疼痛程度进行评价。结果观察组手术时间（42±5）min,对照组手术时间（71±4）min,差异有统计学意义（t＝4．862,P＝0．049）。观察组住院时间（5．4±1．0）d,对照组住院时间（7．8±0．9）d,差异有统计学意义（t＝4．830,P＝0．038）。对照组复发2例,发生率为3．22％,观察组无一例复发,差异有统计学意义（χ2＝4．115,P＝0．029）。观察组并发症发生率8．8％（6／68）,对照组并发症发生率14．5％（9／62）,差异有统计学意义（χ2＝5．081,P＝0．020）。结论腹膜前无张力疝修补术更符合局部解剖和生理,可以减轻患者痛苦,是一种安全、有效的手术方式。     

Lichtenstein repair of inguinal hernia with Surgisis inguinal hernia matrix soft-tissue graft in immunodepressed patients

While polypropylene mesh remains the preferred prosthesis material for hernioplasties, there are some problems with infections, intestinal obstruction and fistulization, and migration particularly in immunodepressed patients. A new degradable and reabsorbable material, the porcine small intestinal submucosa (Surgisis) has been developed for hernia repairs in humans. This prospective study evaluated the safety and efficacy of Lichtenstein hernioplasty using the Surgisis inguinal hernia matrix soft-tissue graft as a mesh in ten immunodepressed subjects. Six subjects were HIV-positive in the immunodepressive phase, and the other four had undergone transplantation (three kidney, one liver). There were no intraoperative or postoperative complications, recurrences, or wound infections. Thus Lichtensteins hernioplasty using the Surgisis inguinal hernia matrix soft-tissue graft in immunodepressed patients promises safety and efficacy.     

Schwannoma in the inguinal canal masquerading an inguinal hernia

Benign neoplasms originating from the neuronal sheath are usually found along the distribution of the cranial nerves and in the flexor surfaces of the upper and lower extremities. We herein present a case of a 65-year-old man with a schwannoma located in the inguinal canal, which presented as an irreducible hernia. This is the first reported case in the English literature of a schwannoma with such a presentation.     

Laparoscopic inguinal hernia repair by the hook method in emergency setting in children presenting with incarcerated inguinal hernia

Background

The development of laparoscopic hernia repair has provided an alternative approach to the management of incarcerated inguinal hernia in children. Different laparoscopic techniques for hernia repair have been described. However, we hereby review the role of laparoscopic hernia repair using the hook method in the emergency setting for incarcerated inguinal hernias in children.

Methods

A retrospective review was conducted of all children who presented with incarcerated inguinal hernia and underwent laparoscopic hernia repair using the hook method in emergency setting between 2004 and 2010.

Results

There were a total of 15 boys and 1 girl with a mean age of 30 ± 36 months (range, 4 months to 12 years). The hernia was successfully reduced after sedation in 7 children and after general anesthesia in 4 children. In 5 children, the hernia was reduced by a combined manual and laparoscopic-assisted approach. Emergency laparoscopic inguinal hernia repair using the hook method was performed after reduction of the hernia. The presence of preperitoneal fluid secondary to recent incarceration facilitated the dissection of the preperitoneal space by the hernia hook. All children underwent successful reduction and hernia repair. The median operative time was 37 minutes. There was no postoperative complication. The median hospital stay was 3 days. At a median follow-up of 40 months, there was no recurrence of the hernia or testicular atrophy.

Conclusions

Emergency laparoscopic inguinal hernia repair by the hook method is safe and feasible. Easier preperitoneal dissection was experienced, and repair of the contralateral patent processus vaginalis can be performed in the same setting.     

老年初发非嵌顿性腹股沟疝开放性手术患者的麻醉

目的研究老年原发非嵌顿性腹股沟疝开放性手术患者的最佳麻醉方式及临床意义。 方法选取2014年11月至2016年11月,湛江市第二人民医院接受手术治疗的老年原发非嵌顿性腹股沟疝患者662例,其中男性604例,女性58例,平均年龄（68.8±5.4）岁。将全部患者随机分为3组并各自采用全身麻醉（全麻组221例）、椎管内麻醉（椎管内组221例）以及局部麻醉（局麻组220例）。对比3组患者的手术时间、手术加麻醉时间和术中出血量;对比3组患者术后并发症发生情况及并发症率;对比3组患者的术后住院时间以及住院总费用。 结果全麻组、椎管内组、局麻组手术时间分别为（95.32±32.07）、（90.24±28.17）、（89.41±27.52）min,差异无统计学意义（P>0.05）;手术加麻醉时间上局麻组（101.29±32.71）min则显著低于椎管内组的（129.62±39.75）min和全麻组的（149.67±51.38）min,差异有统计学意义（P<0.05）;局麻组的尿潴留发病率3.63%（8/220）显著低于椎管内组13.12%（29/221）和全麻组23.53%（52/221）,差异有统计学意义（P<0.05）;局麻组在术后住院时间及住院总费用（4.35±2.41）d、（6 259.76± 773.59）元显著低于椎管内组（6.53±3.25）d、（7 653.26±861.27）元和全麻组（6.82±2.94）d、（9 135.32±896.81）元,差异均有统计学意义（P均<0.05）。 结论局部麻醉是老年原发非嵌顿性腹股沟疝开放性手术患者最佳的麻醉方式。     

Concerning the treatment of patients with inguinal hernia

The author considers the current state of inguinal herniology. Under analysis are the author's personal materials of many years experiences with surgical treatment of inguinal hernias. An original method of hernioplasty is described which was used in 169 patients. For the results of treatment of hernias to be improved the author proposes and substantiates the necessity of organize herniological Centers with the departments for in- and out-patients.     

Giant inguinal hernia

Giant inguinal herniae present a major challenge in management. This case details clinical features of an enormous inguinoscrotal hernia associated with septic gangrene and elephantiasis of the scrotum. Two initial operations were required for control of sepsis, followed by a two-staged hernial repair, involving a total colectomy and a subsequent neoscrotal repair. The problems of loss of domain within the abdominal cavity and the special features presented by this case are discussed.