INGUINAL HERNIA IN FEMALES

9 patients of inguinal hernia in females were diagnosed in a total of 50 patients who presented with congenital groin problems, 8 of these were managed surgically. There were 6 small children, 1 young girl and 2 elderly ladies. All children were managed by herniotomy and herniorrhaphy was done in women. 2 patients under one year presented with irreducible hernia, one of them on exploration was found to be having sliding hernia with incarcerated ovary and tube as contents while other one had incarcerated loop of small intestine. Contents were reduced in both the patients after division of external ring as there was no sign of strangulation. One of our patients never turned up for surgery. All the operated patients were asymptomatic during the follow up period of 6 months to one year with no recurrence or wound infection. None presented on the contralateral side on follow up. Repair of inguinal hernia in females should be carried out at the earliest after a diagnosis is made, because incarceration occurs more frequently in the first year of life, as seen in this study.KEY WORDS: Females, Herniotomy, Incarcerated, Inguinal hernia     

Morbidity and mortality of inguinal hernia in the newborn

In an 11 year period, 17 newborns aged < or = 42 days had repair of 21 inguinal hernias. Eleven 52%) of the hernias were incarcerated or strangulated, necessitating bowel resection in 4 (36%) and orchidectomy for testicular infarction in 2 (18%). Only 4 babies with 7 hernias had elective herniotomy for uncomplicated hernia. In one baby with Hirschsprung's disease (bilateral hernia) and another with anorectal malformation, herniotomy was performed at the time of initial colostomy. Postoperatively, wound infection occurred in 4 (36%) of the 11 incarcerated or strangulated hernias (3 had bowel resection). One baby who had intestinal resection died from overwhelming infection. The median hospital stay in babies with uncomplicated hernia was one day and 4 days in those with complicated hernia. The morbidity of incarcerated and strangulated inguinal hernia in newborns is high, with attendant risk of bowel gangrene and testicular infarction. The principle of early referral and repair of inguinal hernias should be encouraged to avoid such morbidity and possible mortality.     

Acute appendicitis in inguinal hernia: report of two cases

We report two cases of acute appendicitis in right incarcerated inguinal hernia (Amyand's hernia). One patient had gangrenous appendicitis that affected the adjoining caecum. A limited right hemicolectomy was done by extending the groin incision laterally and proximally. The second patient had simple appendicectomy. Posterior wall was repaired using nylon darn in both cases. Acute appendicitis should be considered in the differential diagnosis of obstructed right inguinal hernia.     

腹腔镜手术在11例小儿特殊类型腹股沟嵌顿疝治疗中的应用

目的 探索经脐双孔法腹腔镜手术治疗小儿特殊类型腹股沟嵌顿疝的临床价值.方法 回顾性分析2012年12月至2015年11月华中科技大学同济医学院附属武汉儿童医院收治的11例行腹腔镜手术的特殊类型腹股沟嵌顿疝患儿的临床资料,对患儿的一般资料、手术方法、住院时间、术后并发症等进行分析.结果 4例Amyand疝均行腹腔镜手术;3例合并美克尔憩室,其中2例同时行全腹腔镜下美克尔憩室切除,1例为Littre疝,经脐小切口行美克尔憩室切除肠吻合术;1例腹股沟直疝伴大网膜嵌顿行腹腔镜手术;3例合并嵌顿肠管浆肌层撕裂行腹腔镜下肠修补术.所有患儿术后均无切口感染、阴囊血肿发生,平均住院时间(5.9±2.4)d.术后随访10个月至3年,无睾丸萎缩、复发等.结论 经脐双孔法腹腔镜手术治疗小儿特殊类型腹股沟嵌顿疝安全、微创、恢复快,值得推广应用.     

小儿腹股沟疝的治疗进展

手术是治疗小儿腹股沟疝的基本方法,20世纪初以来,主要是传统的经典手术和腹横纹小切口手术。近10年来,随着腹腔镜技术的发展,腹腔镜治疗小儿腹股沟疝的技术亦日趋成熟,产生了各种手术方法,可同时探测对侧腹股沟区,及时发现未闭的鞘状突,并进行治疗。腹腔镜治疗嵌顿或绞窄疝亦是可行的,但有效性尚待进一步研究。腹腔镜手术有其本身的并发症,但多是可以预防的。     

高频超声对腹股沟肿块的诊断价值

目的探讨高频超声对腹股沟肿块的诊断价值。方法对96例经高频超声及彩色多谱勒检查诊断并有手术或病理结果的腹股沟肿块病例进行回顾性分析。结果诊断腹股沟疝40例(其中可复性疝35例,嵌顿疝5例;符合病理共36例,符合率90.00%),鞘膜积液28例(其中精索鞘膜积液9例,睾丸精索鞘膜积液12例,交通性鞘膜积液7例;符合病理26例,符合率92.86%),隐睾(腹股沟型)16例(其中单侧隐睾14例,双侧隐睾2例,符合病理15例,符合率93.75%),腹股沟淋巴结肿大12例(其中良性6例,恶性淋巴瘤2例,淋巴结转移癌4例,符合病理共9例,符合率75.00%)。结论高频超声对腹股沟肿块中的腹股沟疝、鞘膜积液、隐睾(腹股沟型)诊断准确率高,对淋巴结的良恶性诊断准确率较高。     

腹股沟疝一侧术后对侧发病的时间间隔分析

目的探讨腹股沟疝一侧术后对侧发生腹股沟疝的时间间隔,并对其进行分析。方法回顾医院2012年5月—2019年9月收治的腹股沟疝患者37例,所有患者对侧均有腹股沟疝手术史,将2次发病的时间间隔分为3组,T≤2年为短期组,2相似文献   

嵌顿性腹股沟疝无张力修补的临床治疗观察

目的探讨无张力修补术嵌顿性腹股沟疝的临床治疗效果及注意事项。方法将我院2006年1月～2011年12月收治的64例嵌顿性腹股沟疝患者随机分为观察组和对照组,观察组32例行无张力修补术治疗,对照组32例行传统Bassini修补术。分析比较两组患者手术治疗效果、术后并发症。结果观察组平均手术时间、术后腹股沟疝复发率、并发症发生率明显低于对照组,差异存在统计学意义（P〈0．05）。结论嵌顿性腹股沟疝患者行无张力修补手术便捷,临床治疗效果确切,术后并发症低,值得临床推广。     

腹股沟疝患儿腹腔镜经皮腹膜外闭合术后疝复发及对侧腹股沟疝发生的危险因素分析

目的 探讨腹股沟疝患儿腹腔镜经皮腹膜外闭合术后疝复发及对侧腹股沟疝发生的危险因素.方法 选取2011年7月—2017年12月湖南省人民医院胃肠小儿外科诊治的腹股沟斜疝患儿225例,入选206例.其中,男性120例,女性86例;平均随访(48.12±1.23)个月;手术时平均年龄(3.88±1.01)岁.手术期间常规观察...     

内环处腹横筋膜切开治疗小儿嵌顿性腹股沟斜疝的临床研究

目的介绍内环处腹横筋膜切开治疗小儿嵌顿性腹股沟斜疝的新术式,观察其术后复发情况。方法采用新术式治疗小儿嵌顿性腹股沟斜疝74例(实验组),并与采用传统术式85例(对照组)进行对比研究。结果实验组术后疝复发率低于对照组(χ2=4.89,P<0.05)。结论新术式治疗小儿嵌顿性腹股沟斜疝的效果优于传统术式,值得临床推广应用。     

卵巢嵌顿疝致卵巢坏死的危险因素分析

  目的  分析女性婴幼儿卵巢嵌顿性腹股沟斜疝导致卵巢坏死的危险因素。  方法  回顾性研究昆明市儿童医院2018年6月1日至2021年6月1日间,57例女性婴幼儿卵巢嵌顿性腹股沟斜疝（以下简称为卵巢嵌顿疝）并行手术的患儿,分析患儿的年龄、临床资料、实验室检查、术中有无卵巢扭转,并进行单因素及多因素Logistic回归分析。  结果  共纳入57例女性婴幼儿,中位年龄46 d,最小年龄19 d,最大年龄2岁5月。57例患儿均行手术治疗,术中均证实为卵巢嵌顿。单因素分析结果显示白细胞、CRP、卵巢扭转与卵巢坏死有关（P < 0.05）,多因素分析提示卵巢扭转是术中卵巢坏死的独立危险因素（OR = 1.390,95% CI:1.056-1.829,P = 0.019）。  结论  卵巢扭转是婴幼儿卵巢嵌顿性腹股沟疝发生卵巢坏死的独立危险因素。     

Outcomes After Laparoscopic Transabdominal Pre-Peritoneal Repair (TAPP) For Groin Hernia In A Single Consultant Series

Aim:TAPP repair is an established minimally invasive approach for groin hernia repair. The objective of this study was to report post-operative outcomes after TAPP repair in a single surgeon series and benchmark these against reported outcomes in the literature.Methods:All patients who had an elective or emergency TAPP repair of a groin hernia from September 2016 to March 2020 in a district general hospital were retrospectively analysed from the electronic care record (ECR) for post-operative morbidity, re-admission, recurrence and length of hospital stay. The primary outcome of interest, chronic post-operative pain, was assessed via telephone interviews using the European Registry for Abdominal Wall Hernias Quality of Life (EuraHS-QoL) questionnaire.Results:164 patients, incorporating 190 hernia repairs were included. 155 (94.5%) were men and 9 (5.5%) were women. The median age was 51 (range: 20-81). 160 (97.6%) patients had an elective repair and 4 (2.4%) had an emergency repair. 157 (95.7%) patients underwent a primary inguinal hernia repair, of which 26 (15.8%) had a bilateral inguinal hernia repair. 7 (4.3%) patients had a femoral hernia repair. All procedures were performed by a single consultant surgeon. One emergency patient required conversion to open to allow for resection of ischaemic small bowel, however, the hernia itself was repaired laparoscopically. 94 (57.3%) patients were successfully contacted to provide EuraHS-QoL scores. 13/94 patients (13.8%) complained of chronic pain at rest on an average follow-up of 32.7 months (range: 16-43m). 2/94 (2.1%) patients had mild pain, 9/94 (9.6%) had moderate pain and 2/94 (2.1%) patients had severe pain at rest. 131 (79.9%) TAPP repairs were performed as day case procedures. Median length of stay in those patients who were not day cases was 1 day (range=1-11 days). Post-op morbidity rate was 7.9% (n=13), however, these were minor complications (Clavien-Dindo I/II). Incidence of seroma and haematoma was 1.8% (n=3) each. Re-admission rate was 3% (n=5). Mean follow-up of patients was 21 months (SD 12.6m, range=1-43m). Two patients (1.2%) had a recurrent groin hernia during this time period and one patient (0.6%) had a port site hernia.Conclusion:The outcomes of chronic post-operative pain and rate of recurrence were comparable to those reported in the literature. Re-admission rate was low and there were no major complications. The majority of patients were performed as a day case.     

TAPP联合腹壁小切口技术在难复位腹股沟嵌顿疝急诊手术患者中的应用

目的 分析腹腔镜经腹腹膜前疝修补术(Transabdominal preperitoneal,TAPP)联合腹壁小切口的杂交技术治疗急性难复位腹股沟嵌顿疝的临床疗效。方法 回顾性分析福建中医药大学附属人民医院2017年8月～2019年8月应用TAPP联合腹壁小切口的杂交技术治疗的12例难复位腹股沟嵌顿疝急诊患者,均为单侧斜疝嵌顿,疝内容物在腔镜下用器械辅助无法完全返纳,遂取内环处腹股沟区小切口,返纳疝内容物,再完成TAPP术。观察患者术中出血量、手术时间、住院天数及术后并发症情况。结果 嵌顿疝内容物10例为小肠,2例为大网膜。其中1例完成TAPP术后,发现小肠坏死,另取脐部小切口完成坏死小肠切除吻合。12例患者均顺利完成手术,术中出血量10～30 m L,平均(20.1±3.2) mL;手术时间80～125 min,平均(95.2±20.6) min。术后腹股沟区血清肿1例,阴囊积液2例,无腹股沟区顽固性疼痛、缺血性睾丸炎、腹腔感染、肠梗阻及切口感染病例。经过对症处理后,1周内阴囊积液及血清肿症状趋于消失。住院时间平均(4.0±1.2)d,随访3～24个月未见疝复发、腹股沟区慢性疼痛及补片感染病例。结论 TAPP联合腹壁小切口的杂交技术治疗难复位腹股沟嵌顿疝具有康复快、创伤小等优点,如果严格掌握适应证,可在临床广泛应用。     

27例股疝的临床诊疗体会

目的 总结股疝的临床特点、股疝诊断及手术方式选择。方法 回顾性分析合肥市第三人民医院2007年5月至2016年2月收治的27例股疝患者的临床资料。结果 27例患者以40岁以上女性多见，难复性股疝11例，嵌顿性股疝11例（5例为绞窄），易复性股疝5例；2例患者拒绝手术治疗，25例手术治疗。手术患者中，行常规McVay疝修补手术8例，行嵌顿松解+单纯高位结扎5例（小肠切除术3例），行无张力修补术12例（嵌顿松解+无张力修补术2例），手术患者均采用开放式腹股沟韧带上入路手术。痊愈患者25例，1例患者拒绝手术，保守治疗后出院，1例患者签字放弃治疗，出院后死亡。随访手术患者均无复发。结论 股疝症状不典型，极易嵌顿，病情进展快，尤其高龄患者，早期诊断，及时手术是股疝治疗的关键，手术风险可控，效果明显。     

Ultrasonographic evaluation of contralateral exploration of patent processus vaginalis in unilateral inguinal hernia

To see accuracy of ultrasound scan to detect patent processus vaginalis in padiatric patient. We investigated the presence of contralateral patent processus vaginalis (CPPV) by Ultrasound scan (US) in children with clinically diagnosed unilateral inguinal hernia. Thirty patents (17 boys and 13 Girls) with unilateral inguinal hernia underwent US examination using a 7.5 MHZ transducer. If a CPPV was visible as a hydrocele (inflow of peritoneal fluid) in to a processus vaginalis on straining, then US scanning was performed while the patient was at rest and while inducing straining by standing, coughing and or crying. A groin with hydrocele in the inguinal canal on straining was diagnosed as a CPPV and was explored bilaterally through surgery. The US findings were compared with surgical results. In 30 patients, 12 cases were diagnosed by US as patients with a CPPV, these patients underwent bilateral surgery. Eleven of 12 Cases were confirmed surgically as CPPV. From the findings of the present study it could be concluded that a PPV could be correctly detected by US in pediatric patients with the accuracy of 91.67%. US is a non invasive and accurate method for evaluating the presence of a PPV. Preoperative diagnosis of CPPV is important to remove the need for a second operation with patients presenting with unilateral inguinal hernia.     

新生儿腹股沟嵌疝的护理

目的 总结新生儿腹股沟嵌疝围手术期的护理要点,提高新生儿腹股沟嵌疝手术治愈率,降低术后并发症的发生.方法 分析我院1999～2006年收治的34例新生儿腹股沟嵌疝患儿的护理记录及临床资料,总结新生儿腹股沟嵌疝围手术期护理要点.结果 34例新生儿腹股沟嵌疝患儿,2例肌注镇静剂后体检时自行复位,Ⅱ期手术治愈.急诊手术32例,8例发生肠管坏死而行了肠切除肠吻合术.术前合并新生儿肺炎7例,新生儿硬肿症1例.经积极抗感染、营养支持、保暖等治疗,30例均在术后7～8d康复出院,2例因术后合并并发症放弃治疗后死亡.结论 新生儿腹股沟嵌疝是小儿外科的常见急症,早诊断、早治疗及正确的围手术期护理,是新生儿腹股沟嵌疝治疗的关键.     

腹腔镜与传统手术治疗小儿嵌顿性腹股沟斜疝疗效对比分析

目的 对比分析腹腔镜手术与传统经腹横纹切口手术治疗小儿嵌顿性腹股沟斜疝的临床疗效。方法 回顾分析2013年9月至2014年9月156例嵌顿性腹股沟斜疝患儿临床资料,其中80例行腹腔镜手术,76例行经腹横纹切口手术,对两组患儿的手术时间、肠鸣音恢复时间、住院时间、术后复发率、术后感染等进行对比分析。结果 腹腔镜组患者平均手术时间、肠鸣音恢复时间、住院时间均显著优于传统手术组,差异有统计学意义(P<0.05);两组患者术后复发率、感染率比较,差异无统计学意义(P>0.05)。结论 腹腔镜手术治疗小儿嵌顿性腹股沟斜疝较经腹横纹切口手术具有创伤小、恢复快等优点。     

乙状结肠癌疝入右侧腹股沟致难复性斜疝1例

报道乙状结肠癌疝入右侧腹股沟致难复性斜疝1例。患者因发现右侧腹股沟肿物60余年、进行性增大3年、疼痛半个月入院。入院查腹部CT:右侧腹股沟区可见直肠、乙状结肠疝入,乙状结肠壁增厚。查电子结肠镜及病理诊断提示:乙状结癌。初步诊断:右侧腹股沟乙状结肠癌难复性斜疝。行腹腔镜探查中转开腹根治性乙状结肠切除,降结肠、直肠端端吻合+右侧腹股沟疝修补术。患者术后顺利出院。     

腹腔镜下单通道腹膜外高位结扎术治疗小儿腹股沟疝

目的 探讨腹腔镜下单通道腹膜外高位结扎术治疗小儿腹股沟疝的手术效果。方法 回顾分析我科2015年6月至2016年5月采用腹腔镜下单通道腹膜外高位结扎术治疗的350例腹股沟疝患儿的临床资料。对手术方法、手术时间、术后并发症等进行分析。结果 350例患儿腹腔镜下单通道腹膜外高位结扎手术均顺利完成，单侧平均手术时间为（4.5±1.2）min，双侧为（8.0±1.2）min。所有患儿均于术后第1天出院，平均住院时间为（2.6±0.8）d。术后均无腹股沟区疼痛不适、阴囊血肿等。随访半年至1年，未见疝复发、线结排斥反应、睾丸萎缩等并发症发生。结论 腹腔镜下单通道腹膜外高位结扎术治疗小儿腹股沟疝经腹壁一次穿刺可保持穿刺针在同一穿刺隧道，避免结扎过多组织引起术后疼痛不适，并减少线结排斥反应，简便易行，值得临床推广应用。     

经腹改良手术治疗小儿腹股沟嵌顿疝17例报告

目的:探讨改良的经腹小儿腹股沟嵌顿疝手术的疗效。方法:自2012年7月至2013年1月,选取17例小儿腹股沟嵌顿疝患者,受腹腔镜下疝囊高位结扎手术术式的启发,采用改良的经腹手术方式(即经腹小横切口疝还纳及内环口腹膜外全荷包缝合结扎术)完成手术。结果:平均手术时间31 min。术后阴囊和腹股沟区肿胀不明显。随访3个月,无1例复发。结论:改良术式是一种比较好的手术方法,具有术野暴露清楚,操作方便,手术时间短,术后阴囊水肿发生率低等优点。