腹膜前Marlex网片植人法修补腹股沟复发疝

采用腹膜前Markx网片植入法对21例腹股沟复发疝进行了修补。手术应用原切口入路的简化腹膜前修补法。显露腹股沟管壁结构。游离腹膜前间隙。植入Marlex网片。既能傲到无张力修补．又能加强管壁结构。本组2l例除l例术后皮下血肿，2例发生局部感觉异常外无其它并发症。随访2～5年无1例复发。作认为．复发疝解剖层次改变、组织缺损重、瘢素组织无弹性．采用传境方法修补易致复发；而采用人工假体植入则能有效防止复发。     

下腹正中切口开放式腹膜前修补术治疗腹股沟复发疝的临床研究

目的 探讨下腹正中切口开放式腹膜前修补术治疗腹股沟复发疝的安全性及有效性.方法 回顾性分析200r7年1月至2010年1月腹股沟复发疝患者48例临床资料,其中行下腹正中切口开放式腹膜前修补术(实验组)28例,前入路修补术(对照组)20例.对阴囊血肿、缺血性睾丸炎、平均手术时间、术后疼痛、异物感、复发进行研究.结果 经统计学分析,二组在平均手术时间、术后复发率、阴囊血肿等方面差异均无统计学意义(P>0.05),在缺血性睾丸炎、术后疼痛、异物感方面差异有统计学意义(P<0.05).结论 开放式腹膜前修补术治疗腹股沟复发疝可明显减少各种并发症和术后不适的发生率,疗效肯定,值得临床推广应用.     

腹腔镜经腹腹膜前疝修补术治疗腹股沟复发疝30例效果分析

目的探讨腹腔镜经腹腹膜前疝修补术(TAPP)治疗腹股沟复发疝的效果。方法回顾性分析2017-12—2019-06间在郑州市第七人民医院普外科接受TAPP治疗的30例腹股沟复发疝患者的临床及随访资料。结果 30例患者均成功完成TAPP。手术时间(48.20±6.40)min,术后下床活动时间(16.16±3.18)h,住院时间(5.70±2.10) d。术后出现尿潴留2例,阴囊血清肿1例,未发生切口感染、异物反应、顽固性疼痛等并发症。术后随访6～24个月,无复发病例。结论腹腔镜TAPP治疗腹股沟复发疝,创伤小、并发症少,术后恢复快、复发率低,但远期效果仍需更长时间的随访结果予以验证。     

经腹腹膜前腹腔镜疝修补术治疗腹股沟复发疝

目的：探讨经腹腹膜前腹腔镜疝修补术（ transabdominal preperitoneal inguinal herniorrhaphy ,TAPP）在治疗腹股沟复发疝中的效果。方法回顾性分析我院2010年6月～2013年12月TAPP治疗腹股沟复发疝28例的临床资料。单侧疝25例,双侧疝3例（2例为术中发现）。斜疝13例,直疝15例。结果28例均获成功,无中转手术。手术时间（60＆#177;15） min,术中出血量（30＆#177;5）ml,术后住院时间（4＆#177;1）d。3例术后腹股沟区轻微疼痛不适,口服非甾体止疼药后缓解;4例血清肿,2例自行吸收,2例经多次穿刺抽液后治愈。随访时间1～24个月,平均17个月,其中20例＞12个月,均未见复发。结论 TAPP治疗腹股沟复发疝避免了传统前入路的解剖复杂性,手术安全、有效。     

经腹腹膜前疝修补术在腹股沟复发疝中的临床应用

目的:探讨腹股沟复发疝行腹腔镜经腹腹膜前疝修补术(transabdominal preperitoneal,TAPP)的手术技巧及临床效果。方法:回顾分析2010年3月至2014年3月为37例腹股沟复发疝患者行TAPP的临床资料。其中斜疝21例,直疝16例;单侧疝31例,双侧6例(术中发现对侧隐匿疝3例)。结果:37例手术均获成功,无一例中转开放手术。手术时间38~75 min,平均(55±13)min;术中出血量15~50 ml,平均(25±10)ml;术后住院2~5 d,平均(3±1)d。术后排尿困难3例,经留置导尿3~5 d后好转。阴囊血清肿5例,4例自行吸收,1例经数次穿刺抽液好转,阴囊气肿7例,均于24 h内自行吸收;腹股沟区疼痛感2例,经口服解热镇痛药物后好转。术后随访24~36个月,平均(30±5)个月,未发现复发。结论:TAPP治疗腹股沟复发疝具有患者创伤小、康复快、并发症少的特点,是安全、可行的。     

完全性腹膜前无张力疝修补治疗腹股沟复发疝临床分析

目的：探讨完全性腹膜前无张力疝修补治疗腹股沟复发疝的优越性和临床应用价值,分析疝复发的原因及预防措施。方法回顾性分析2010年3月至2013年3月,仙桃市第一人民医院收治的腹股沟复发疝患者64例,采用完全性腹膜前无张力疝修补术,对其复发的原因、初次手术方式、手术时间,术后并发症及处理方法进行分析。结果64例手术全部成功,初次手术采用传统手术修补56例,无张力修补8例。手术时间平均70 min。术后出现脂肪液化3例,阴囊水肿6例,伤口区疼痛3例,经对症处理后痊愈出院。随访3个月至3年,无一例复发。结论完全性腹膜前无张力疝修补术具有创伤小,并发症少,复发率低的特点,是治疗复发疝的首选术式,值得临床推广。     

成人腹股沟复发疝行腹腔镜经腹膜前间隙修补术疗效分析

目的探讨并分析腹腔镜经腹膜前间隙疝修补术（TAPP）治疗成人腹股沟复发疝的临床效果及手术技巧。 方法回顾性分析2016年5月至2019年4月于徐州市中心医院血甲疝微创外科行TAPP手术的52例复发性腹股沟疝患者的临床资料。统计并分析患者手术时间、住院时间及术后并发症发生情况等数据。 结果所有患者均顺利完成手术,无中转开放。手术用时35～110 min,平均（61.7±13.8）min;术中出血量5～40 ml,平均（13.1±4.7）ml;术后住院时间为1～7 d,平均（2.5±0.9）d;术中误伤腹壁下血管者1例（1.9%）,经缝扎止血后好转。术后出现阴囊血清肿者5例（9.6%）,3例经保守治疗后治愈,2例经穿刺抽吸后治愈。阴囊及腹股沟区气肿者2例,自行吸收好转。尿潴留者3例（5.8%）,经留置导尿管2 d过渡后恢复自行排尿。术区异物感者2例（3.8%）,经口服神经营养及止痛药后好转。术后随访6～41个月,无再次复发、补片感染、持续性疼痛、肠梗阻等严重并发症发生。 结论TAPP治疗成人腹股沟复发疝具有疗效确切、安全性高、术后恢复好、复发率低的优势,但要求术者必须在熟练掌握腹腔镜技巧、腹股沟区解剖及复发疝的治疗要点的前提下,才能充分发挥TAPP的优势,取得临床最佳疗效。     

腹腔镜腹股沟疝修补术后复发疝再次腹腔镜经腹腹膜前疝修补术的经验

目的总结腹腔镜腹股沟疝修补术（laparoscopic inguinal hernia repair,LIHR）后复发,应用腹腔镜经腹腹膜前疝修补术（laparoscopic trans-abdominal preperitoneal,TAPP）进行再次修补的临床经验。 方法回顾性分析2010年3月至2018年6月,广西医科大学第二附属医院收治的既往LIHR术后复发55例患者的临床资料,均行TAPP再次修补。术中在高位T型离断疝囊,旷置远端疝囊及既往补片,重新放置补片。 结果手术均顺利完成,无中转手术,平均手术时间（60.2±18.1）min,术后住院时间1～5 d,术后尿潴留3例（5.5%）,腹股沟区血清肿3例（5.5%）;无肠道损伤、膀胱损伤,无补片感染;电话或信件随访4～28个月,无再次复发患者。 结论T型离断疝囊、旷置补片的TAPP术治疗既往LIHR术后复发的腹股沟疝患者是可行的,由于高位T型离断疝囊,避免剥离既往手术创面,旷置原补片,使得手术更为安全。     

腹腔镜腹膜前疝修补新方法

目的:探讨腹腔镜腹膜前疝修补新方法的临床应用价值。方法:采用自行设计的腹腔镜腹膜前疝修补术治疗5例腹股沟疝患者,经腹腔在腹腔镜下旷置疝囊,在疝环口内外侧纵行切开并潜行游离腹膜,于腹膜前放置补片,覆盖疝环口,再用脐外侧韧带覆盖补片。结果:手术均获成功,无并发症发生,随访1年未见复发。结论:腹腔镜腹膜前疝修补新方法安全,可靠,方便易行,术后患者康复快、疼痛轻、效果好。     

善愈网片腹膜前修补法在腹股沟复发疝治疗中的应用

目的探讨“善愈”聚丙烯网片在复发性腹股沟疝手术中的应用。方法分析使用“善愈”无张力腹膜前修补法治疗26例腹股沟复发疝的临床与随访资料。结果手术时间30～40min,术后8h下床,8—10d伤口痊愈后出院。随访至今,无复发病例,无明显异物感,无射精痛。阴囊积液1例,穿刺抽液后治愈,无其他并发症。结论“善愈”聚丙烯网片治疗复发性腹股沟疝兼有治疗疝和预防疝的作用,具有操作简便、手术时间短、修补范围大、复发率低的优点,是治疗复发性腹股沟疝较为良好的手术方式,值得进一步推广。     

LAPAROSCOPIC MESH REPAIR OF RECURRENT INGUINAL HERNIA

Background: Pre-peritoneal mesh repair has been a long-standing technique for recurrent hernias. Laparoscopic technique has been applied to this operation with the aim of assessing its results at early follow up of 1 year. Methods: The outcome in 56 patients was reviewed and all patients contacted 12 months after surgery. Results: There was one immediate failure at 1 week, needing a further operation. There were no other recurrences at 1 year. Ten patients had minor postoperative complications. Conclusions: At early follow up, this is a satisfactory technique for recurrent hernias.     

REPAIR OF GIANT INGUINOSCROTAL INGUINAL HERNIA USING MARLEX MESH AND SCROTAL SKIN FLAPS

A new technique for the repair of giant inguinoscrotal hernia is described. It consists of: reduction of the hernia; repair of the hernial orifices with marlex mesh; creation of a midline anterior wall defect to increase intra-abdominal capacity; covering this defect with marlex mesh; then covering the midline marlex mesh with a rotation flap of inguinoscrotal skin. This technique increases intra-abdominal capacity and allows reduction of the hernia without compromising respiratory function, in patients with chronic airflow limitation, by using skin that would otherwise be discarded.     

A TECHNIQUE FOR LAPAROSCOPY THROUGH THE DEEP RING DURING EMERGENCY OPEN INGUINAL HERNIA REPAIR

This techinque describes a simple, safe and reliable method of assessing intra-abdominal pathology during open inguinal hernia repair.     

Quadrapod mesh for posterior wall reconstruction in adult inguinal hernias

Inguinal hernia repairs are the most frequently carried out operations worldwide, and open-mesh herniorrhaphies have gained wide acceptance for advantages of little tension, less pain and lower recurrence rates. Even so, potential drawbacks of original open-mesh repairs exist, and we accordingly make some modifications, suggesting a new 'quadrapod' marlex mesh as an alternative. From July 2002 to March 2004, we carried out 288 consecutive inguinal hernia repairs using quadrapod mesh in 273 patients, all of them were male and aged older than 35 years. Patient demographics, operative parameters, morbidity and outcomes were collected in detail. After surgery, patients were followed up every 6 months at one surgeon's clinic and any major abnormality was recorded. Mean age of the 273 patients was 58.7 years. Twenty-eight patients had recurrent hernias and 15 bilateral hernias. Mean surgical duration was 50.7 min. One patient suffered from major wound infection and needed prolonged hospitalization for parenteral antibiotics. Owing to old age and benign prostatic hyperplasia, 11 patients receiving spinal anaesthesia had temporary postoperative urine retention and needed short-term urinary catheter insertion. Most patients were discharged 1 day following surgery. Acute wound pain generally improved within days, and no patients complained of chronic pain or debility necessitating special interventions. With a mean follow up of 40.7 months, no case of recurrent herniation was detected to date. Open-mesh herniorrhaphy using quadrapod mesh provides a cheap, feasible and effective alternative choice in centres with limited resources. Preliminary results are encouraging, and a formal prospective study may be warranted.     

LAPAROSCOPIC EXTRAPERITONEAL INGUINAL HERNIA REPAIR USING A BALLOON DISSECTION TECHNIQUE

A laparoscopic extraperitoneal approach using a balloon dissection technique was used to repair 40 inguinal hernias in 35 patients. The initial experience with this method is presented. Thirty-four of these hernias were indirect, five direct and one sliding. Three were recurrent hernias. The operation time ranged from 40 to 135 min. Thirty-two of the patients stayed overnight in the hospital; Three stayed 2 nights. Return to normal activities ranged from 3 to 21 days. None of the patients had problems with nerve entrapment and to date there have been no recurrences of the hernias following the repairs. The procedure has been very well-tolerated by all patients.     

INGUINAL HERNIA REPAIR BY LAPAROSCOPIC SURGEONS: EARLY EXPERIENCE AND ATTITUDES

The introduction of laparoscopic inguinal hernia repair (LIHR) has been controversial. A questionnaire was sent to all general surgeons in New Zealand to document the early experience with LIHR and attitudes towards it. Of the 118 replies (response rate 55%). 74 were from laparoscopic surgeons. 26 of whom had performed 564 (201 public. 363 private) LIHR (23 bilateral) until January 1994. Only nine (35%) of these surgeons had assisted an experienced surgeon before performing an LIHR. and only four (15%) were supervised by an experienced surgeon during their first case. The transabdominal preperitoneal technique of LIHR was used by 14 (54%) surgeons. the extraperitoneal technique by eight (31%), and the tronsabdominal onlny technique by four (15%). There were 29 (5%) recurrences, 17 (3%) neuropathies. seven (1.2%) conversions, four (0.7%) miijor perforations. and one (0.17%) death. Of the 26 surgeons who performed LIHR, 20 (77%) were concerned about the absence of long-term results. 14 (54%) considered that the optimal technique had not been established. 13 (50%) were concerned about the unique complications associated with LIHR. 11 (42%) were less enthusiastic about performing LIHR than previously. 10 (38%) were doubtful about its advantages, and six (23%,) were uncertain about its future and considered that it should only be performed within the context of a controlled trial. This study highlights a number of issues that need to be addressed before the role of LIHR can be determined.     

无张力性腹股沟疝修补术

采用聚丙烯(Prolene)网片对59制较大的腹股沟疝进行无张力性修补。与传统的修补方法比较，本方法不破坏正常的解剖结构，没有缝合处的张力．并且操作简单、安全；患者疼痛较轻，可很快恢复正常的体力活动。本组除发生切口浅表血肿和硬结各一例外．未发生手术或网片材料引起的并发症。作者认为无张力性疝修补求是一有效的治疗腹股沟疝的方法，特别对复发性或较大的腹腔沟疝效果更为明显。     

INGUINAL HERNIA REPAIR: A COMPARISON BETWEEN LOCAL AND GENERAL ANAESTHESIA

Background : A comparative analysis of outcomes of inguinal hernia repair performed under local (LA) and general anaesthesia (GA) by a single surgeon using a standardized technique of anterior transversalis repair was performed. Ninety-three cases were examined, 56 of which were cases of LA hernia repair. Methods : A retrospective analysis of the patient hospital record was performed with particular attention to intra-operative and postoperative analgesia requirements. Results : An overall series complication rate of 6.5% (6/93) is reported. Only one of 56 LA patients (2%) required more than 24 h of narcotic analgesic injections compared to 11% (4/37) in the GA group (P < 0.05). The mean total postoperative parenteral narcotic requirement in the LA group was 86 ± 14 mg of pethidine as compared to the GA group who had a mean total requirement of 121 ± 17 mg of pethidine (P > 0.08). Conclusions : The LA infiltration technique is an effective method for inguinal hernia repair. This series demonstrates benefits in terms of length of hospital stay and a lower incidence of postoperative parenteral narcotic analgesic requirement although when postoperative parenteral narcotics were required by the LA group of patients, the difference in mean total pethidine requirement was not statistically significant.     

EVALUATION OF THE SAFETY OF INGUINAL HERNIA REPAIR IN THE ELDERLY USING LIGNOCAINE INFILTRATION ANAESTHESIA

Repair of inguinal hernia using local anaesthesia is becoming increasingly popular as it avoids many of the systemic side effects associated with general or spinaVepidural anaesthesia and provides excellent early postoperative pain relief. Dosages of local anaesthetic approaching the recommended maximum are frequently required for adequate anaesthesia of the inguinal region. The present study describes the disposition and safety of lignocaine with adrenaline in 14 elderly patients to ascertain its safety with a view to more widespread application of the technique in more complicated hernia repairs. Serial plasma lignocaine concentrations were determined for up to 24 h following doses approaching the recommended maximum for infiltration (7 mg/kg). Peak lignocaine concentrations (normalized to 7 mg/kg) ranged from 0.23 to 0.90mg/L (mean of 0.54mg/L): that is, the maximum recorded concentration was less than one-fifth the toxicity threshold for lignocaine of 5 mg/L. The study suggested that the majority of patients tolerated the local anaesthetic approach very well and that the wide safety margin allowed ample scope to develop the local anaesthetic approach for the repair of more complex hernia repairs (e.g. large, bilateral or strangulated herniae, or those in obese patients) without risk of exposing patients to lignocaine concentrations which may cause toxic side effects.     

MESH HERNIOPLASTY USING A STAPLER

Background: The recent development of laparoscopic hernioplasty has evoked extensive re-examination of the safety and effectiveness of using synthetic mesh materials in hernia surgery. We have investigated the efficacy of anterior stapling mesh repair in the treatment of inguinal hernia. Methods: From July 1993 to June 1994. a modified open mesh hernioplasty using staples for anchorage has been performed in 127 patients. Results: The mean age of patients was 61.4 13.0 years. Over 90% of them were operated on under local anaesthesia. The operation time ranged from 30 to 95 min with a median of 39 min. Only sixteen patients (12.6%) required postoperative parenteral analgesics and the median time for resuming daily activities was 7 days. Apart from two patients with reactionary haemorrhage, there was no other significant complication observed. Only one recurrence was encountered over the 26-month median follow-up period. Conclusions: We conclude that the modified mesh hernia repair with a stapling device is a feasible, inexpensive and safe procedure that is well tolerated under local anaesthesia by most patients.