耻骨肌孔在腹膜前间隙无张力疝修补术中的临床意义

目的复习耻骨肌孔的解剖学特点,探讨其在腹膜前间隙无张力疝修补术中的临床意义。方法回顾性分析2009年6月至2013年6月,石家庄市第一医院收治腹股沟疝患者110例,均行腹膜前间隙无张力疝修补术治疗,对其临床资料进行回顾性分析。结果患者手术时间50~120 min,平均(70±17)min,住院时间2~5 d,平均(4.0±0.8)d。全组患者无切口感染,无腹膜前血清肿及切口皮下积液。110例均获随访,随访时间6~24个月,随访期间无复发,无腹股沟区硬化、皮下脓肿及补片周围深部脓肿等发生,慢性疼痛3例,腹股沟区麻木感4例,异物感1例。结论腹膜前间隙无张力疝修补术是一种针对耻骨肌孔修补的手术,易于掌握,安全有效,术后恢复快,不易复发,值得在临床上加以推广。手术时对耻骨肌孔及腹膜前间隙解剖结构要深入了解,将补片完全覆盖耻骨肌孔是手术成功的关键。     

善释腹膜前修补装置在腹股沟疝修补术中的应用

目的探讨腹膜前疝修补装置在腹股沟疝修补术中的应用及技术要点。方法使用善释腹膜前修补装置修补耻骨肌孔缺损,观察和随访术后情况。结果本组23例患者,手术时间30～50min,平均38min;切口均甲级愈合,患者术后12h下地活动,切口疼痛轻微,无皮下血肿、阴囊积液、切口感染等并发症;住院时间4～6d。术后随访6个月无腹股沟疝复发。结论根据腹股沟区的腹膜前解剖学特点,在耻骨肌孔后方使用足够大的补片进行覆盖修补,更加符合力学原理,手术操作简单安全,效果肯定。     

二次内环重建双平片全腹股沟疝修补

目的：探讨自制双平片二次内环重建全腹股沟疝修补的应用价值。方法：选取2007年1月—2009年1月收治的125例腹股沟疝患者,根据手术方式不同分为3组：内环重建组35例,平片组45例,疝环充填组45例。对3组患者术中情况、术后并发症以及恢复情况进行比较。内环重建组将一张自行裁剪的10 cm×10 cm的平片直视下放置于肌耻骨孔的腹膜前间隙,并进行第一次内环重建,加强肌耻骨孔上1/3薄弱区域,封闭肌耻骨孔的缺损;另一张5 cm×5 cm的平片放置于腹横筋膜之上,并行第二次内环重建,着重加强了精索旁薄弱区域。结果：经对比发现,内环重建组在平均手术时间、切口下积血/液、阴囊血肿、局部异物感、术后疼痛感、每例材料消耗及复发例数方面与其他2组比较差异有统计学意义（P〈0.05）;3组在平均手术时间、平均下床活动时间、平均住院时间、切口裂开及感染、瘘道形成方面比较差异均无统计学意义（P〉0.05）。结论：自制双平片二次内环重建达到全腹股沟疝修补,从手术学和人体工程学理论上,符合全腹股沟肌耻骨孔疝修补,具有可操作性,该方法可广泛推广应用。     

改良Kugel腹股沟疝修补术治疗腹股沟疝的探讨

目的 探讨改良Kugel腹股沟疝修补术在腹股沟疝治疗中的理论基础和临床应用价值。方法采用Bard Modified Kugel Hernia Patch（内存记忆弹力环改良Kugel补片）行改良Kugel腹股沟疝修补术腹股沟疝102例,以手术时间、术后患者自主能力的恢复、并发症的发生、复发率及术后住院时间作比较。结果手术时间45～110min,平均55min。术后2～6h患者即可起床活动和进食,切口疼痛和不适轻,无明显异物感,活动时腹股沟区无牵拉感,无并发症,平均住院时间5d。随访无1例复发。结论改良Kugel腹股沟疝修补术是应用经腹股沟管前入路行腹膜前腹股沟疝修补的技术,针对耻骨肌孔进行修补,利于解决耻骨肌孔结构薄弱及缺损这一腹股沟疝发生的解剖学基础,具有手术彻底、术后恢复快、并发症少、复发率低的优点,从根本上解决腹股沟疝患者多种疝并存及容易复发的病理生理特点,是目前腹股沟疝治疗中较理想的手术方式。     

局麻下善愈补片在腹股沟疝腹膜前修补术中应用的体会

目的探讨局麻下国产善愈补片腹膜前修补腹股沟疝的临床经验和疗效。方法回顾性分析68例患者经腹股沟切口腹膜前间隙置入国产善愈补片进行腹股沟疝修补术的病例,观察麻醉效果、手术时间、住院时间、住院费用及随访观察术后并发症及复发情况。结果全部采用局麻,单侧手术时间30～45min,平均35min,术后切口疼痛较明显的3人,均为年轻患者。住院时间2—3d。术后平均随访10个月无复发,无明显异物感,阴囊积液2人。结论应用国产善愈补片腹膜前间隙修补腹股沟疝手术针对耻骨肌孔进行修补,具有手术修补范围大、术后恢复快、并发症少、住院时间短、术后复发率低等优点,与传统手术相比是一种更为理想的手术方式。     

解剖标志定位在男性腹股沟疝手术的效果

目的 分析术中定位和测量解剖标志在腹腔镜下腹膜外疝修补术中的临床价值。方法 选取本院2021年1月至2021年8月收治的221例行腹腔镜下腹膜前疝修补术（TAPP或TEP）患者,术中将内环口内侧作为中心点,分别测量其距离腹直肌（直疝三角顶点）、耻骨结节、耻骨梳韧带、耻骨结节、髂前上棘等的距离,进而估算补片大小。结果 三种类型腹股沟疝的内环口至耻骨联合、内环口至髂前上棘、内环口至耻骨梳韧带、内环口至直疝三角顶点距离相比不具有统计学差异（P>0.05）。结论 根据术中定位及测量解剖标志可获取适合患者尺寸的疝补片,补片边缘覆盖的解剖位置。     

善释D10补片前入路微创化手术修补腹股沟疝临床体会(附118例报告)

目的探讨应用善释D10补片前入路微创化手术修补腹股沟疝的治疗效果。方法回顾性分析2010年12月至2011年12月应用善释D10补片通过前入路微创化腹膜前修补治疗腹股沟疝118例(124例次)的患者资料,观察麻醉效果、手术时间、患者满意度、术后并发症及复发情况。结果全组患者平均手术时间40min,术后2.5d出院。伤口均一期愈合,未发现术后浆液肿及阴囊血肿。术后随访3～12个月,平均随访8个月,无复发。全组患者自觉术后舒适,满意率达100%。结论国产善释D10补片前入路微创化手术修补腹股沟疝是一种针对耻骨肌孔修补的微创手术,恢复快,麻醉与手术效果满意,易于掌握,适合广大基层医院推广应用。     

腹壁切口疝补片修补术后复发的再手术治疗

目的总结腹壁切口疝补片修补术后复发再次手术治疗的经验。方法回顾性分析我院2007年1月至2010年12月期间收治的16例腹壁切口疝补片修补术后复发再次手术患者的资料。结果所有患者均再次采用补片进行修补,其中13例除去旧补片置入新补片修补,2例新补片与原补片重叠并扩大范围修补,1例在原补片上直接重叠新补片修补。术后所有患者切口均Ⅰ期愈合,3例发生补片上方积液,经穿刺加压后治愈。术后住院时间7～16 d,平均9 d。术后引流管拔除时间2～7 d,平均4 d。所有患者均获随访,随访时间5～36个月,平均20个月,1例有轻微腹壁异物感,无修补区慢性疼痛,无疝复发。结论补片修补术后复发性切口疝再次手术时需综合考虑复发疝的位置以及既往选用的补片类型和修补方法,再次手术需选用合适的补片及修补方法方可取得满意效果。     

肌后筋膜前补片植入手术治疗腹壁切口疝28例临床分析

目的：探讨应用肌后筋膜前补片植入手术（retromuscular prefascial,Sublay）修补法对腹壁切口疝的治疗。方法：2002年1月-2009年7月应用聚丙烯补片修补切口疝28例,其中男10例,女18例,年龄47～78岁,平均年龄65.2岁。疝环直径3～28cm,平均15.5cm。均采用肌后筋膜前补片植入手术修补法。结果：全部患者顺利完成手术,无严重并发症,手术时间75～140min,平均100min,术后住院时间9～21d,平均12.8d,随访3～60个月,平均35个月,无肠梗阻,无复发。结论：应用聚丙烯补片肌后筋膜前补片植入手术修补法修补切口疝是一种安全、有效的方法。     

局麻下应用3DMax补片前入路修补腹股沟疝30例

目的 探讨在局部麻醉下应用前入路置入3DMax补片施行腹股沟疝无张力修补术的可行性及优越性.方法 回顾性分析2008年12月至2010年12月,在局部麻醉下施行的3DMax补片的无张力腹股沟疝修补术30例,对患者手术时间、手术方式、术后镇痛药应用、术后并发症、术后住院天数进行综合分析.结果 30例患者均成功施行局麻下腹膜前3DMax补片置入术,手术时间平均(63.1 ±2.6) min.术后即可进食水,无尿潴留.术后无痛或轻微疼痛患者23例,中度疼痛6例,重度疼痛1例.30例伤口均一期愈合,2例发生皮下淤血,2例发生补片上方少量血清肿,1例患者大腿内侧皮肤感觉麻木,4个月后好转.3例患者下蹲时腹股沟区有异物感,1～5个月后消失.30例患者均获得随访,平均(11±7)个月,无复发.结论 局麻前入路应用3DMax补片覆盖耻骨肌孔修补腹股沟疝是一种安全有效、创伤轻的方法,能提高多发疝的术中诊断,避免遗漏疝的发生.     

经外环精索静脉结扎术与腹腔镜高位结扎治疗精索静脉曲张的评价

目的评价开放手术经外环小切口精索静脉结扎术与腹腔镜高位结扎术两种术式对治疗精索静脉曲张(varicocele,VC)的临床应用价值。方法70例病人中经外环结扎术38例,腹腔镜高位结扎术32例。结果两组在手术时间和住院时间上均无明显差异(P>0.05),住院费用有明显差异(P<0.05);术后6个月随访,经外环低位结扎者无1例复发,腹腔镜高位结扎者中5例复发,占15.63%,两组间差异有显著性(P<0.05);精子质量均有明显改善,两组间差异无显著性(P>0.05)。结论经外环小切口精索静脉低位结扎比腹腔镜精索静脉高位结扎有明显的优点,是一种治疗单侧VC的经济、有效的方法。     

前路病灶清除人工椎体植入单节段固定治疗腰椎结核

目的 探讨前路病灶清除人工椎体植入单节段内固定治疗脊柱结核的临床疗效。方法 手术治疗单运动节段腰椎结核患者20例,术前常规有效抗结核治疗4-8周,术中行病灶清除、人工椎体植入、单节段椎体钉棒内固定,术后常规抗结核12-18个月。观察患者的手术时间、术中出血量、住院天数以及视觉模拟评分（VAS）、神经功能恢复情况。结果 术后VAS评分较术前明显改善（P〈0.01）,至末次随访时,神经功能Frankel分级全部恢复至E级,均未出现结核复发,无内固定失败发生。结论 腰椎结核前路病灶清除、人工椎体植入、单节段内固定可有效恢复和维持脊柱的稳定性,创伤较小,为一种值得推广的术式。     

长重建钢板结合MIPPO技术固定骨盆前环骨折

目的: 探讨长重建钢板结合微创经皮钢板内固定术(minimally invasive percutaneous plate osteosynthesis,MIPO)技术治疗不稳定骨盆骨折前环骨折疗效。方法: 自2013年1月至2019年2月收治16例不稳定骨盆骨折患者,其中男12例,女4例;年龄20~60岁,平均46.5岁。骨盆骨折依据Tile分型,B1型4例,B2型6例,C1型4例,C2型2例。所有骨折为闭合性,受伤至手术时间7~10 d,平均6.2 d。术后对16例患者手术时间、术中出血量、骨折复位质量、骨折愈合时间、并发症情况及肢体功能进行评价。结果: 16例患者均获得随访,时间12~23个月,平均19.1个月。手术时间60~180 min,平均107.8 min;术中出血量120~600 ml,平均368.1 ml;骨折愈合时间12~20周,平均16.3周。依据Matta标准对骨折复位情况进行评价,优6例,良8例,可2例。1例患者术中股外侧皮神经损伤,术后出现大腿外侧感觉减退,6个月后恢复;1例患者由于自觉髂窝处内固定物刺激疼痛,内固定取出后症状改善,16例患者骨折均取得满意愈合,无内固定物松动。末次随访Majeed评分67~95分,优10例,良4例,可2例。结论: 运用长重建钢板结合MIPPO技术通过前方入路闭合复位固定骨盆前环骨折,损伤小,术中出血时间少,节省手术时间,术中安全性及骨折愈合率高,术后可早期功能锻炼,能有效治疗骨盆前环骨折。     

Surgical treatment of cryptorchidism in children with deep inguinal ring translocation]

Results of surgical treatment of 83 boys with cryptorchidism were analyzed. Three-stage approach of simultaneous descendence of testicle was proposed: performance of m. cremaster plasty, using muscular flap, excised from m. obliquus internus abdominis, transposition of anulus inguinalis profundus in medial direction and to tuberculum pubicum, securing necessary elongation of elements of funiculus spermaticus for the testicle descendence in 98% of observations.     

Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results

Fifty consecutive patients with intractable sciatic pain, positive root tension signs, correlative myelography, and neurological impairment were treated by percutaneous lateral discectomy (PLD). Under local anesthesia and C-arm fluoroscopy control, an 18-gauge needle, introduced into the intervertebral disc dorsolaterally, entered the skin at approximately 9 cm from the midline. A Kirschner wire replaced the stylet of the needle, and the needle was withdrawn. The introduction of a specially designed cannulated trocar over the K-wire facilitated precisional insertion of the instruments. This step was followed by the introduction of a sheath with an internal diameter of 4.9 mm over the trocar. The sheath was held against the annulus fibrosis, and the cannulated trocar was removed. The annulus was windowed and the herniated disc material evacuated by instruments and suction. Evaluations were made with Macnab's criteria. Excellent and good results were obtained in 88% of patients. The mean length of hospital stay after operation was 2.3 days. The operative time, blood loss, and morbidity were minimal, and no serious complications were encountered. In carefully selected patients, PLD appears to be safe, effective, and cost-efficient.     

切开复位内固定治疗耻骨联合浮动伤

 目的 探讨耻骨联合浮动损伤的临床特点及采用切开复位内固定治疗的效果。方法 回顾性分析2008年1月至2013年1月采用切开复位内固定治疗48例耻骨联合浮动损伤患者资料,男31例,女17例;年龄20~61岁,平均36.5岁;车祸伤35例,坠落伤8例,挤压伤5例。骨盆骨折AO分型: B型13例,C型35例。其中45例合并骨盆后环骨折,14例合并髋臼骨折,17例合并四肢骨折,11例合并胸腹部损伤,6例合并泌尿生殖系统损伤。受伤至手术时间3~25 d,平均7 d。骨盆前环固定方法：重建钛板固定双侧耻骨支骨折41例,微创空心钉固定7例。同时固定后环损伤41例,其中12例采用骶髂前钢板固定,5例采用骶髂螺钉固定,18例采用髂骨后“M”型板固定,6例采用髂腰固定。结果 44例获得随访,随访时间12~36个月,平均16个月,骨折全部临床愈合,愈合时间10~16周,平均12.6周。采用Matta标准评价骨折复位情况,其中优21例,良16例,可7例,优良率为84.1%（37/44）。末次随访时Majeed评分为65~100分,平均81.5分,其中优30例,良10例,可4例,优良率为90.9%（40/44）。术后3天,2例患者发生脂肪液化,经换药2~3周后治愈;术后5~15 d,平均10 d,8例发生下肢深静脉血栓,经给予低分子肝素等保守治疗1~6个月,平均3.5个月后血栓治愈;术后5~7 d,平均6 d,3例出现耻骨疼痛,给予抗炎止痛药物、理疗等治疗1年后疼痛解除。无一例发生钢板断裂脱出、感染及医原性神经、血管损伤等并发症。结论 耻骨联合浮动伤是一类严重的骨盆骨折,多数合并后环损伤,影响骨盆稳定性,切开复位内固定可以稳定骨盆,有助于早期活动及功能锻炼,从而获得良好临床效果。     

Flexor tendon ruptures secondary to hamate hook fractures

Four patients with flexor tendon ruptures secondary to hook of the hamate fracture are described. None of the patients had the diagnosis of fracture made before tendon rupture. All patients were treated with excision of the fractured hook and tendon repair. The tendon repair was usually an end-to-side (Y junction) of the profundus of the small to the profundus of the ring finger. After operation, all patients were free of pain and returned to their preinjury activity levels, but most had some limitation of motion in the digit with the tendon repair. The complication of tendon rupture not uncommonly follows basilar hook of the hamate fractures. Treatment by excision of the fracture and end-to-side tendon repair produces satisfactory results. Range of motion after tendon repair seems to depend more on the patient's age and the amount of inflammation at the site of repair rather than on the method of tendon repair.     

The Pericardium Reinforced Suture Annuloplasty: Another Tool Available for Mitral Annulus Repair?

From May 1985 to May 1992, 169 patients underwent surgery for mitral valve repair. In 87% of these patients, the valve reconstruction involved the mitral annulus. At the beginning, in an effort to preserve systolic movement of the annulus and avoid the implant of prosthetic materials inside the heart, we mainly used simple suture annuloplasty in 66 patients. When we reoperated upon three patients only a few months after reconstruction of the mitral valve for a dehiscence of the suture annuloplasty, we decided to perform ring annuloplasty with the Carpentier ring in 23 patients. Though we have not seen any problems with the Carpentier ring in our series, we performed a suture annuloplasty reinforced with a strip of autologous pericardium to eliminate all prosthetic material. Since introducing this technique in 1989, we have used this annuloplasty in 58 patients. We have not observed any dehiscence of the suture or other complications related to this procedure. Three patients with a pericardial annuloplasty underwent reoperation for other reasons; the autologous pericardium was perfectly attached to the annulus, covered by a smooth layer of fibrous tissue without calcification. After this encouraging initial experience, we believe that long-term follow-up is necessary to confirm that autologous pericardium is an effective method of mitral annulus repair.     

Reevaluation of limited side-to-side portacaval shunt

Results of limited side-to-side portacaval shunt is better than other shunts, but, post-operative encephalopathy was still observed in 10.2% of the patients. Therefore, animal experiments and clinical observations were carried out to determine the relationship between the changes in size of anastomotic stomas and the development of post-operative encephalopathy. It was shown that significant augmentation of the size of anastomotic stomas developed in 50% of experimental animals in a period of three months after limited side-to-side portacaval shunt and in all post-operative patients with post-operative encephalopathy. In an effort to prevent the enlargement of the anastomotic stoma caused by blood flow under high pressure, a limiting ring of 10 mm in internal diameter was put around the anastomotic site during operation in 9 patients with portal hypertension. These patients now have been followed up to 5-11 months without evidence of post-operative encephalopathy and rebleeding. A ring of the same kind was put around the enlarged anastomotic stoma during exploration in 6 patients with post-operative encephalopathy, and all the cerebral symptoms and signs disappeared completely soon after the procedure.