良性前列腺增生开放手术同时行腹股沟无张力疝修补术26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股沟无张力疝修补术的疗效。方法26例伴有可复性腹股沟疝的BPH患者,采用补片修补,行经腹股沟无张力疝修补术,然后按常规方法行耻骨上经膀胱前列腺摘除术。结果26例患者均获随访,随访时间为6个月~10年,1例术后14个月出现腹股沟疝复发,复发率3.8%,其他25例未出现感染和腹股沟疝复发。结论在耻骨上经膀胱前列腺摘除术同时行经腹股沟疝无张力疝修补术的手术方法简单,效果肯定,对老年患者更有意义。     

无张力疝修补术后腹股沟疝复发原因及再手术方法探讨

目的探讨无张力疝修补术后腹股沟疝复发原因、再次手术策略。方法对1997年1月至2005年1月间收治的95例无张力疝修补术后腹股沟复发疝患者资料进行回顾性分析。结果第一次手术伴前列腺增生症者67例,慢性咳嗽15例,慢性便秘8例,糖尿病7例;手术时直疝患者40例,斜疝39例,记录不详16例;第一次手术单位中三甲医院16例,二甲医院64例,一甲医院15例;复发者Miss疝8例,原修补部位复发87例,其中有疝环缺损过大(>4cm)49例,网塞或补片移位24例,平片过小、变形、卷曲等14例。开放手术69例(后进路及单侧巨大补片加强内脏囊方法)和腹腔镜手术26例(TAPP和TEP),术后随访6~52个月均未复发。结论无张力修补术后腹股沟疝复发与患者腹内压增高、修补缝合技术、补片材料选择等因素相关;选择开放后径路、单侧巨大补片加强内脏囊方法及腹腔镜下修补是治疗无张力疝修补术后腹股沟疝复发的主要方法。     

聚丙烯补片应用于完全腹膜外腹腔镜腹股沟疝修补术治疗体会

目的 探讨完全腹膜外腹腔镜腹股沟疝修补术(TEP)应用聚丙烯补片治疗腹股沟疝的临床疗效.方法 采集我院2008年12月至2011年6月收治的腹股沟疝患者12例,应用聚丙烯补片可吸收线缝合固定行完全腹膜外腹腔镜腹股沟疝修补术治疗腹股沟疝.结果 12例患者手术均顺利完成,手术时间45~70 min,平均60 min.术中无明显出血,术后无腹股沟区疼痛、麻木、阴囊肿胀等并发症,术后48 h出院.1例男性患者术后7 d即行重体力劳动后复发,遂行开放手术,术中探查发现补片移位至内侧联合腱处,取出补片,然后使用锥形疝环充填物及补片行无张力修补术,术后随访12个月未见复发.其他患者随访3~18个月,未出现疝复发.结论 应用聚丙烯补片行完全腹膜外腹腔镜腹股沟疝修补术治疗腹股沟疝是完全可行的,免钉合、费用低、无需特殊器材,有利于该术式的推广和应用.     

腹股沟疝无张力修补术后复发原因及再手术方法探讨（附108例报告）

目的讨论无张力疝修补术后腹股沟疝复发原因及再次手术方法。方法对2003年4月至2008年3月间收治的108例无张力疝修补术后腹股沟复发疝患者的资料进行回顾性分析。结果原修补部位复发73例，其中平片过小34例，网塞或补片移位19例，平片变形、卷曲14例，补片位置放置错误6例。在修补部位以外（术中遗漏疝miss hernia）复发35例，其中遗漏直疝16例，股疝11例，斜疝8例。再次手术均应用腹膜前间隙修补，采用PHS及Kugel补片，术后随访1个月～5年均未复发。结论无张力修补术后腹股沟疝复发与患者术中遗留疝、补片移位、补片大小及手术方式选择不当等因素相关；选择腹膜前间隙修补是治疗无张力疝修补术后腹股沟疝复发的有效方式。     

无张力疝修补术在腹股沟复发疝中的应用价值

目的评价无张力疝修补术在腹股沟复发疝中的应用价值。方法对1993年1月至2002年12月163例腹股沟复发疝修补术的临床资料进行回顾性分析。163例复发疝患者中,男138例,女25例,年龄34～76岁,平均(54±11)岁。既往手术方式:传统疝修补术142例(87．1％),其中Bassini术65例、McWay术35例和Shouldice术42例;无张力疝修补术12例(7．4％),其中包括3例腹腔镜无张力疝修补术,另有9例(5．5％)既往手术方式不明。第一次术后疝复发时间3个月至10年,平均(36±14)个月。结果再次手术的方式:Shouldice术71例(43．6％),无张力疝修补术92例(56．4％),其中包括腹腔镜无张力疝修补术3例。随访率100％,随访时间30个月至12年,平均(56±21)个月,Shouldice术后复发率为16．1％(11／71),无张力疝修补术后复发率为2．2％(2／92),两者差异有统计学意义(x2=8．327,P<0．01)。结论无张力疝修补术应作为腹股沟复发疝的首选手术方式。     

腹股沟复发疝104例开放式手术治疗体会

目的探讨腹股沟复发疝的原因及治疗方法。方法回顾性分析2012年1月至2014年6月,郑州大学第一附属医院收治的104例腹股沟复发疝患者的临床资料。结果本组104例再次实施无张力疝修补术,其中68例行单纯疝环补片修补,28例行常规无张力修补,8例行Stoppa方法修补。均痊愈出院,无切口感染。术后随访0.5~2.5年,无复发患者。结论腹股沟疝传统式修补复发的主要原因是不同组织间的张力性缝合;无张力修补复发的主要原因是手术操作不规范,疝补片选择及放置不当。再次开放式无张力修补是治疗复发疝的主要有效措施,应遵循个体化治疗原则,选择单纯疝环补片修补、常规无张力修补、Stoppa式修补等不同的手术方法。     

无张力修补术后腹股沟复发疝再手术的探讨

目的探讨腹股沟疝无张力修补术后复发的原因及再手术治疗的原则。方法对2007年1月至2009年6月间31例腹股沟疝无张力修补术后复发患者的资料进行回顾性分析。复发时间为前次术后3个月至10年,平均(32±10)个月。既往手术方式:疝环填充式修补术14例,平片修补术10例,腹腔镜无张力疝修补术5例(TAPP、TEP、IPOM术后分别有2例、2例、1例),开放式腹膜前修补术2例。结果手术时间28～86 min,平均(38±6)min。首次复发行开放式全腹膜外无张力修补12例,平片修补6例,腹腔镜下修补4例(TEP2例、TAPP2例),巨大补片加强内脏囊(GPRVS)3例。多次复发者中2例行腹腔镜下修补(包括1例TEP和1例IPOM),2例行开放式完全腹膜外无张力修补,2例GPRVS。随访时间8～52个月,平均(29±8)个月,再复发1例。结论无张力腹股沟疝修补术后复发的原因主要是术中操作不当或患者复发的高危因素处理不当。应根据复发疝的类型和性质,选择个体化的治疗方案和手术路径。     

腹腔镜疝修补术对腹股沟疝患者手术效果分析

目的探讨腹腔镜疝修补术对腹股沟疝患者手术效果、术后并发症及复发率的影响。方法选取本院2015年4月至2018年4月收治的80例腹股沟疝患者,依据治疗方法将这些患者分为腹腔镜疝修补术组(腹腔镜组,n=40)和开放无张力疝修补术组(开放组,n=40)两组,开放组患者接受开放无张力疝修补术治疗,腹腔镜组患者接受腹腔镜疝修补术治疗,然后对两组患者的手术效果、术后并发症发生情况及复发情况进行统计分析。结果腹腔镜组患者的疼痛持续时间显著短于开放组(P0.05),住院时间显著短于开放组(P0.05),住院费用显著高于开放组(P0.05)。结论腹腔镜疝修补术治疗腹股沟疝患者手术效果较开放无张力疝修补术好。     

腹腔镜与开放手术治疗腹股沟嵌顿疝的对比研究

对比腹腔镜腹股沟疝修补术与开放式无张力疝修补术治疗腹股沟嵌顿疝的手术效果。分析2009年7月—2015年1月31例腹股沟嵌顿疝患者行腹腔镜疝修补术(腔镜组)的临床资料;并与同期38例开放式无张力疝修补术(开放组)进行对比分析。腔镜组术后疼痛持续时间、住院时间及尿潴留发生率均少于开放组(P0.05),两组手术时间及术后阴囊血肿发生率无统计学差异(P0.05)。两组患者均未见复发及感染。腹腔镜治疗腹股沟嵌顿疝安全、可行,具有创伤小、恢复快等优点,但费用较高,可根据患者的具体情况选择。     

腹腔镜腹股沟疝修补术并发症的防治（附124例）

目的探讨腹腔镜下腹股沟疝修补术手术效果与并发症防治。方法回顾性分析我院2007年10月至2010年12月接受经腹腔腹膜前疝修补术（TAPP）和完全腹膜外腹腔镜疝修补术（TEP）患者的临床资料,治疗效果和并发症发生率。结果本组腹腔镜下腹股沟疝修补术124例全部治愈。术式TAPP81例,TEP43例。单侧腹股沟斜疝38例,直疝21例;双侧腹股沟斜疝44例,直疝14例;一侧斜疝一侧直疝5例,双侧腹股沟斜疝并右直疝2例。手术时间40～187min,平均104min。住院时间5～13d,平均7d。随访1个月至33个月,平均随访15个月。手术并发症7例,占5．6％;4例为腹股沟区血肿,其中1例经手术清除后治愈;2例为阴囊气肿,术后第二天自愈;1例直疝术后2个月复发。结论TAPP／TEP治疗腹股沟疝是安全有效的,并发症及复发率可以接受,规范操作并正确把握手术指征对顺利开展腹腔镜下腹股沟疝修补术具有重要意义。     

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.     

Anterior tension - free repair versus posterior preperitoneal repair for recurrent hernia

Objective: To compare anterior tension-free approach with posterior preperitoneal repair for complications and early recurrence. Design: A randomized clinical trial. Place and Duration of Study: Combined Military Hospital, Muzaffarabad and Rawalpindi, from March 1997 to December 2002. Patients and Methods: Sixty-seven patients with unilateral recurrent inguinal scrotal and irreducible hernias, were randomized to either anterior tension-free or posterior preperitoneal repair. Patients with primary inguinal hernia, patients with class11/111 obesity (BMI > 35) and ASA grade 3 and beyond were excluded. For posterior repair, preperitoneal space was entered through a transverse lower abdominal incision placed 3 cms above inguinal ligament. Anterior repair was done by standard Lichtenstein technique. Forty-two patients were operated under spinal anesthesia while 25 patients had general anesthesia. Follow-up was on 7th and 12th postoperative day, at third month, and then yearly for two years. Main outcome measures were postoperative pain and recovery; postoperative complications related to wound, testicles, sensory nerves; and recurrence. Results: Thirty-four patients had anterior tension-free hernioplasty while 33 patients had posterior preperitoneal repair. Mean operating time was longer for anterior preperitoneal repair as compared to posterior repair (70.1min vs. 62.6 min, p = 0.1). Pain score and hospital stay was same for both groups. Return to normal activity was not significantly different being 14.1 days for anterior and 13 days for posterior repair (p= 0.07). Heavy duties were also resumed after statistically non-significant interval, 34.6 days for anterior, and 33 days for posterior repair (p = 0.09). Complication rate in anterior hernioplasty group was 17.6% while in preperitoneal group it was 3% ( p=0.001). There was no recurrence in either group after a mean follow-up of 2 years. Conclusion: Open preperitoneal repair and anterior tension-free repair were equivalent in terms of postoperative pain, recovery and early recurrence rate. Considering fewer testicular complications with posterior repair, it should be the procedure of choice for repair of recurrent groin hernia in men.     

Inguinal hernia repair with polypropylene mesh during radical retropubic prostatectomy: an easy and practical approach

OBJECTIVE: To report the results of the simultaneous inguinal hernia repair during radical retropubic prostatectomy (RRP) with the preperitoneal tension-free Stoppa technique, using a polypropylene mesh. PATIENTS AND METHODS: During 855 consecutive RRPs, 40 (5%) patients (median age 66.9 years, range 52-81) with 49 inguinal hernias had a simultaneous inguinal hernioplasty. The RRP was performed according to the Walsh modified technique. After the prostate and seminal vesicles were removed and the urethrovesical anastomosis completed, a polypropylene mesh of maximum size 15 x 7.5 cm and a small slit on its medial side was then created and placed in the preperitoneal space, embracing the spermatic cord and covering the myopectinal orifice. Preoperative risk factors, e.g. constipation, pulmonary disease or urinary obstructive symptoms, were collected retrospectively from the files. Complications after surgery, including wound infection, pelvic collections, urinary fistula and recurrence of the hernia, were assessed. RESULTS: Preoperative risk factors for hernia development were identified in 23 (58%) patients; three had recurrent hernias. With a median 23.1 months of follow-up period two (4%) hernias recurred. There were no complications after surgery. CONCLUSION: Preperitoneal hernia repair with polypropylene mesh is safe, effective and practical. The procedure simultaneous with RRP gave a 96% success rate and with no significant increase in operating time or additional complications.     

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。     

Outcomes of Lichtenstein Hernioplasty for Primary and Recurrent Inguinal Hernia

Introduction The Lichtenstein hernioplasty for the repair of primary inguinal hernia in male patients is well established and constitutes the current gold standard. However a gold standard technique for the repair of recurrent inguinal hernia has not been established. The aim of this study was to analyze the outcomes of Lichtenstein hernioplasty for the repair of primary inguinal hernia and recurrent inguinal hernia, applying for that purpose the Qualitative and Quantitative Measurement Instrument (QQMI). Methods We studied 75 recurrent inguinal hernia patients and 287 primary inguinal hernia patients with a follow-up period ranging from 60 to 107 months. Results The final QQMI score demonstrated that most patients in both groups reached scores between 8 and 11 points, with a significant difference in the maximum score (11 points) favoring primary hernia patients. Conclusions All evaluated parameters showed better outcomes in primary hernia patients. Applying the QQMI, we have demonstrated that the outcomes of Lichtenstein hernioplasty are not similar between primary and recurrent inguinal hernia; there is a tendency toward better outcomes for primary inguinal hernia patients, although the Lichtenstein hernioplasty stands as a safe option for repair of recurrent inguinal hernias.     

开放式腹膜前疝修补术在复发性疝中的临床研究(附23例报告)

目的 研究开放式腹膜前腹股沟疝修补术在复发性腹股沟疝中的手术效果.方法 回顾性分析我院2009年6月至2010年4月对23例复发性腹股沟疝患者应用椭圆形补片(OP)行开放式腹膜前置入无张力疝修补术的手术方法和治疗效果.结果 患者均一期愈合,随访6~13个月,无复发.结论 正确认识腹横筋膜层,充分游离腹膜前间隙是手术的关键,开放式腹膜前腹股沟疝修补术治疗复发性腹股沟疝效果良好.     

四种手术方法治疗巨大小儿疝的临床对比分析(附412例报告)

目的 探讨不同腹腔镜方法 治疗巨大小儿疝的疗效.方法 2007年5月至2009年8月我院对412例巨大小儿疝随机分成4组进行腹腔镜修补,主要通过术后复发率来比较疗效.A组:单纯疝囊高位结扎(147例);B组:疝囊高位结扎并用脐内侧韧带覆盖内环口(94例);C组:双重结扎内环口(82例);D组:疝囊高位结扎同时将髂耻束与弓状缘缝合缩窄内环(89例).结果 患者均随访2～4年,A组复发3例,分别于术后6、7、9个月;B组术后1年复发1例;C组及D组均无复发患者.A、B组与C、D组的复发率比较差异有统计学意义(P＜0.05).结论 对于巨大小儿疝腹腔镜单纯高位结扎疝囊是不可靠的,腹腔镜下修补是有必要的,而且将髂耻束与弓状缘缝合缩窄内环作修补的方法 更可靠.     

Repeated laparoscopic treatment of recurrent inguinal hernias after previous posterior repair

Background

The reported recurrence rates after laparoscopic inguinal hernia repair are 0–4 %. It is unclear which technique could best be offered to a patient with a recurrent hernia after a previous posterior repair. The purpose of this retrospective study was to determine the safety, feasibility, and reliability of a repeated laparoscopic repair (TAPP) for a recurrent hernia after a previous posterior inguinal hernia repair.

Methods

The study group contains 2,594 consecutive transabdominal inguinal hernia repairs (TAPP). Of these, 53 repairs were attempted in 51 patients for recurrent hernias after a previous posterior repair. During the follow-up period, patients were examined for recurrences and for presence of a port-site hernia. Pain was scored by the visual analogue pain scale (VAS).

Results

Fifty-one patients underwent a TAPP repair for a recurrent inguinal hernia after previous posterior hernia repair. Two patients presented a bilateral recurrent inguinal hernia. In two thirds of the patients, the recurrence was located caudally or medially from the previously placed mesh. Two attempted repairs had to be converted to an open technique due to severe adhesions. One intraoperative complication was encountered when the vas deferens was ligated during surgery due to adhesions of the previous placed mesh. Nine patients encountered an adverse event postoperatively, but none of them were serious events. No mesh infections were reported. The mean follow-up was 70 (range, 1–198) months. At follow-up, no recurrences were found at physical examination. Four patients developed a port-site hernia. Four patients had complaints of postoperative pain and were restricted in daily activities due to groin pain. The mean VAS score (scale 0–100), including the four patients with persistent pain, was 5.7 (range, 0–61).

Conclusions

It is concluded that repeated laparoscopic hernia repair (TAPP) is a definite repair for recurrent inguinal hernias. The procedure is feasible, safe, and reliable.     

无张力疝修补术在复发疝治疗中的应用体会

目的探讨无张力修补术在复发疝中的应用价值。方法对38例腹股沟复发疝修补术的临床资料进行回顾性分析。38例腹股沟复发疝中，男36例，女2例，年龄42—80岁，平均56岁。传统手术37例，其中Bassini术18例、Ferguson术17例、McVay术2例、无张力手术1例。第1次术后疝复发时间2个月至15年，平均52个月。再次手术方式均采用无张力修补术。其中疝环充填式33例，三合一补片式5例。结果术后8～10d痊愈出院，术后出现4例急性尿潴留、2例阴囊积液、1例疼痛。全部患者随访2-14个月未见复发。结论无张力疝修补术应作为腹股沟复发疝的首选手术方式。