小儿复发性腹股沟疝的手术治疗

目的探讨小儿腹股沟疝术后复发原因及治疗。方法分析小儿腹股沟部的解剖特点,探讨复发性腹股沟疝的原因。应用疝囊高位结扎、内环缩小及腹横筋膜修补等术式治疗。结果 30例均于手术后7～10 d出院,经平均3年以上临床随访无复发,治疗效果满意。结论小儿腹股沟疝手术中,高位结扎、内环缩小、腹横筋膜修补是疗效可靠、防止复发的关键。     

经腹腔腹膜前疝修补术在复发性腹股沟疝治疗中的应用

目的 探讨使用经腹腔腹膜前疝修补术(TAPP)在复发疝治疗中的方法 和效果.方法 采集2010年1月至2011年12月收治的复发性腹股沟疝患者87例,对其临床资料进行回顾性分析.结果 患者手术全部成功,平均住院时间3 d,切口无感染,术后出现阴囊积液16例,需穿刺抽液.切口无感染.术后随访3个月至2年,无复发.结论 应用TAPP行腹膜前疝修补治疗复发疝具有疗效确切、复发率低、并发症少的优势.     

The place of Shouldice operation in inguinal hernia repair

The Shouldice operation has been increasingly applied in our department since 1996. Between 1998-2000 its proportion has achieved 58% (Lichtenstein: 30%, laparoscopy: 2%, TEPP: 3%, other: 7%). A total of 343 patients have been operated on according to Shouldice. These patients were followed for 3-5 years in the mean. So far we observed 3 recurrences corresponding to a recurrence rate of 0.9%. The recurrence rate decreased compared to a historical control group from 10 to 0.9% using the Shouldice technique instead of Bassini. We conclude from this study that the surgeon must know several surgical techniques and choose the most applicable one during operation. The overwhelming majority of cases can be resolved by the Shouldice operation. For elderly patients, the Lichtenstein operation is an appropriate alternative. For cases with large defects of the posterior wall we can choose between Lichtenstein operation, the laparoscopic procedures and transinguinal preperitoneal mesh plasty.     

Out-patient operation of inguinal hernia in children

A retrospective review is presented of 496 children with a median age of 4 years (range 0-13 years) on whom a total of 527 hernia repairs were performed as out-patients. No wound infections were observed, and the rate of early surgical complications was 1.5 per cent. There were 15 (3.7 per cent) known recurrences. No complications from the anaesthetic were recorded. Owing to the negligible infection rate and the low surgical complication and recurrence rates it is concluded that children with inguinal hernia would benefit from operation as out-patients, and that they should be operated on immediately after diagnosis, irrespective of age. Besides probably minimizing the children's psychological trauma, out-patient surgery provided considerable savings to the health service in the present study.     

Thovara inguinal hernia operation. Results of follow-up in adults

A new procedure for inguinal hernia operations is described: the Thovara method, which is really a modified version of the plastic technique by Bassini-Kirschner-Lichtenstein. From 1985-1986 167 patients were operated on for inguinal hernia in our University Hospital, using this hernia plastic technique with a tension-free mesh. Though the rate of early complications is good, we should mention that there were 19 cases of testicle swelling. The number of early and late recurrences were very low: 2 cases (1.2%). Hospitalization averaged from 2 to 4 days. The procedure is easy to perform and almost painless.     

Millikan与Rutkow术式治疗腹股沟疝的比较

目的探讨改良型网塞疝修补术(Millikan术式)治疗腹股沟疝的临床价值及其力学原理。方法回顾性分析我院2004年4月～2006年10月收治的腹股沟疝294例的临床资料。其中,行网塞式无张力腹股沟疝修补术(Rutkow术式)136例,Millikan术式158例,比较两种术式的优劣。结果Millikan术式异物感更小。在术后复发率、手术时间、术后并发症等方面两组比较无显著性差异。结论Millikan术式治疗腹股沟疝与Rutkow术式相比舒适度更好,而疗效相同。     

应用网片腹股沟入路GPRVS手术修补单侧复杂性腹股沟疝

目的 探讨应用巴德15 cm×15cm网片行腹股沟入路GPRVS手术修补单侧复杂性腹股沟疝的应用价值.方法 回顾2000年3月至2006年3月应用巴德15 cm×15cm网片行腹股沟入路GPRVS手术修补单侧复杂性腹股沟疝20例的经验.结果 本组男性15例,女性5例.右侧17例,左侧3例.其中1例女性病例为腹股沟区肌纤维瘤切除术后形成疝,4例为嵌顿性股疝.男性病例中有8例复发疝,其中2例为填充式无张力修补术后复发,6例巨大原发疝,1例巨大滑疝.术后随访3～60个月,无复发.结论 巴德15 cm×15cm网片行腹股沟入路GPRVS手术修补单侧复杂性腹股沟疝是有效的,同时比较经济.     

局部麻醉下自裁剪免缝合无张力疝修补在腹股沟疝手术中的临床研究

目的 比较自裁剪补片与成型网塞补片在无张力疝修补术的临床效果及性价比.方法 回顾性分析2011年1月至2012年6月涿州市医院普外科施行单侧腹股沟疝患者140例,根据采用补片不同分为自裁剪补片组（试验组）与成型网塞补片组（对照组）各70例,比较二组患者手术时间、术后住院时间、住院费用、术后24 h的疼痛及术后3个月慢性疼痛VAS评分,术后异物感等并发症发生情况.结果 试验组手术时间（48±8）min,对照组手术时间（51±9）min,二组手术时间比较差异有统计学意义（t=-2.004,P=0.047）;试验组住院时间（2.1 ± 0.7） d,对照组住院时间（2.3 ± 0.8） d,二组住院时间比较差异无统计学意义（t=-1.414,P=0.160）;术后24 h疼痛VAS评分差异有统计学意义（t=-4.950,P=0.000）;术后3个月慢性疼痛比较差异有统计学意义（χ2=-4.025,P=0.000）;术后异物感差异有统计学意义（χ2=-4.084,P=0.000）;住院费用试验组明显低于对照组,差异有统计学意义（t=-19.095,P=0.000）.随访10～39个月,二组均无复发.结论 利用平补片进行个体化剪裁、免缝合、腹膜前修补的方法进行无张力疝修补术,临床效果与疝环充填式修补术相近,但具有材料价格低、手术时间短、术后疼痛轻及异物感低等优点.     

Laparoscopic inguinal hernia repair: a NICE operation

Published evidence comparing laparoscopic and open herniorraphy is controversial. NICE recommends that open techniques are used for first time repairs and that TEP be considered for bilateral/recurrent repairs undertaken in specialist units. We report a consecutive series of 224 patients undergoing 268 TEP repairs between 1996 and 2001. Operating time, complications, return to normal activity/full time employment and recurrence were examined. The median operating time was 30 minutes. There was one conversion. Ninety four percent of patients drove on the third post-operative day. The median time to normal activity was 4 days (1-10 days). The median time to return to professional employment in 82 patients was 3 days (range 2-9 days). Four patients (1.7%) had self-limiting minor groin pain. There were 3 recurrences (1.4%) and none since altering the surgical technique to use a larger anchored mesh. We have demonstrated TEP to be an easily learnt, safe, effective technique with low morbidity, and with sufficient experience, takes no longer than an open repair. It can be performed at little increased cost and restores selected patients to an early return to full-time employment. We believe that the choice between open and laparoscopic repair is a subjective decision for patient and surgeon     

Is the treatment of inguinal hernia an operation for beginners?

The early postoperative results of 1273 operations for inguinal hernia are reported. In addition, the late outcome of 688 operations of patients answering the questionnaires was analysed according to the surgeons stage of training. In group 1, the operator was in the first two years of his training, in group 2, he was older but had not yet achieved his title as a specialist for surgery and in group 3, all are fully trained surgeons. The postoperative complications are distributed equally among the 3 groups. Wound infection was leading in 37% to recurrent inguinal hernia. The overall figure of recurrent inguinal hernia was highest in group 2 with 7.8% (14 out of 179), followed by group 1 with 5.5% (22 out of 399) and group 3 with 4.5% (5 out of 110). Early post-operative recurrence was again highest in group 2 with 7 out of 14 compared with 9 out of 22 in group 1 and 2 out of 5 in group 3. We conclude from these results that inguinal hernia may be performed by a very young surgeon in training; supervision in those who are over the first steps, but have not completed their training has to be intensified and that asepsis has to be observed very carefully.     

Recurrent inguinal hernia.

An analysis of 584 operations for recurrent inguinal hernia was made in an attempt to determine the cause of the recurrence based on the anatomic findings. The recurrence was indirect in 300, direct in 241, and various other in 43 operations. The causes of the indirect recurrences appeared to be an unrecognized hernia, incomplete dissection or improper ligation of the sac, failure to narrow the cord, or inadequate reconstruction of the internal ring. No cause for the diffuse direct recurrences was apparent. Of the 241 hernias in Hesselbach's triangle, 144 were small localized defects, usually (112) just lateral to the symphysis. These were considered to be caused by the cutting action of a suture placed under tension. On the basis of these findings, suggestions are made for primary inguinal hernia operations.     

改良一孔法腹腔镜治疗小儿腹股沟斜疝

目的：探讨改良一孔法腹腔镜手术治疗小儿腹股沟斜疝的应用价值。方法：用普通外科缝针在腹腔镜下荷包缝合内环口治疗小儿腹股沟斜疝。结果：治疗小儿斜疝105例,单侧83例,双侧22例。其中隐匿性疝11例。单侧疝手术时间9～15min,平均12min,双侧疝26min,无阴囊水肿、感染、睾丸萎缩、医源性隐睾等并发症发生。术后随访3～24个月,无复发。结论：改良一孔法腹腔镜治疗小儿腹股沟斜疝安全、可靠、美观且操作简便,值得基层医院推广应用。     

腹股沟巨大疝术后应用芒硝外敷的临床观察

目的探讨芒硝外敷在防治腹股沟巨大疝无张力修补术后阴囊肿胀的作用。方法选择2007年1月至2009年12月在我院行腹股沟巨大疝无张力修补术患者78例,随机分为试验组(42例)和对照组(36例)。试验组术后6h即应用芒硝布袋持续外敷手术侧腹股沟区及阴囊区,伤口愈合拆线、无阴囊肿胀时停止;对照组术后不做特殊处理,如发生阴囊肿胀,则予垫高阴囊及红外线灯每天两次照射伤口。记录两组发生阴囊肿胀的例数及程度、住院的总天数。结果试验组(6例)比对照组(20例)发生阴囊肿胀的例数明显减少,程度较轻;住院天数减少。结论芒硝外敷可以显著减少腹股沟巨大疝无张力修补术后阴囊肿胀,值得在临床推广使用。     

The inguinal hernia today. Technical notes

Following a short introduction on Bassini's operation, alternative surgical techniques are discussed: Postempski, Halsted, Mugnai-Ferrari, Anson-McVay, Marcy, Ferguson, Shouldice with their indications, advantages and disadvantages. Personal experience in the surgical treatment of 516 patients suffering from inguinal hernia is then reported and stress is laid on the need for precise anatomic knowledge of the inguinal region and skill in one technique in particular to limit the risk of recurrences.     

The government and the inguinal hernia.

Our review of the incidence of inguinal hernias in children based on socioeconomic differences and their risk of incarceration with its subsequent complications, was prompted by a governmental decision to disallow elective herniorrhaphy in children over 1 yr of age. The review showed the following: The risk of incarceration, the failure of preoperative reduction and the potential gonadal injury is more than three times as high in the poor child, usually covered by Medicaid. Since operative and postoperative complications increase proportional to the incidence of incarcertain, the denial of an elective herniorrhaphy endangers the life of a child. Since the increased hospitalization after incarceration also increases the financial expenditure, this rule is not only medically but also economically unsound. This review suggests that unilateral governmental health care decisions, especially those aimed at cost containment, should be carefully scrutinized to determine what price not only the society, but the patient has to pay for the "cost containment". We feel that the price of the denial of a herniorrhaphy is too high.