无张力修补术治疗复发性股疝的体会

目的 股疝是普外科的常见疾病之一,股疝容易嵌顿,多为急诊手术,修补后复发并不少见.笔者应用疝补片无张力修补术治疗复发性股疝,效果良好.方法 回顾性分析无张力疝修补术在治疗5例复发性股疝中的应用.结果 5例患者手术顺利,平均手术时间1h,平均住院时间10d.5例患者均随诊1～5a未再复发.结论 无张力修补术应作为治疗复发性股疝的首选术式.     

疝环填充式无张力疝修补术38例报告

我院自2005年3月至2008年1月共完成疝环填充式无张力疝修补术（mesh blug hernia repair，简称Meshblug修补术）38例。现报道如下。     

无张力修补腹壁疝158例

无张力疝修补术是运用人工复合材料进行疝修补的新方法,笔者自1998年3月以来,应用美国Bard公司生产的锥形疝环充填物和网状补片进行无张力疝修补术158例,取得良好疗效,现报告如下:     

门诊局麻疝环充填式无张力疝修补术42例报告

目的：探讨门诊局麻疝环充填式无张力疝修补术可行性和安全性。方法2010年03月~2013年01月,在门诊局麻下采用疝环充填式无张力疝修补术,完成单侧腹股沟疝修补术42例。其中斜疝41例(复发斜疝l例),直疝1例。结果42例均顺利完成手术,麻醉效果满意。手术时间20~65 min,平均32 min。在院时间3~20 h,平均4.8 h。42例随访2~24个月,平均9.5月,无复发和睾丸萎缩。结论门诊局麻下疝环充填式无张力疝修补术安全可靠,经济方便,适合Ⅱ~Ⅲ型单侧腹股沟疝患者。     

无张力疝修补术在腹股沟嵌顿疝中的应用（附21例报告）

目的探讨疝环充填式无张力疝修补术在腹股沟嵌顿疝中的临床应用价值。方法对我院2003年1月至2007年6月行疝环充填式无张力疝修补术治疗21例腹股沟嵌顿疝病人的临床资料进行回顾性分析。结果无术后死亡,术后疼痛2例,1例发生阴囊积液,手术全部成功完成,平均手术时间65min,病人术后2d可正常活动。随访6-18个月,未见复发病例。结论疝环充填式无张力疝修补术治疗腹股沟嵌顿疝具有安全、创伤小、恢复快的优点,临床效果满意。     

现代无张力疝修补手术方法 概论

合理的腹股沟疝修补手术应该是高位游离结扎疝囊，按解剖层次进行修补，纠正病理解剖变化，争取恢复腹股沟区的正常生理解剖机能。内环是出口，腹横筋膜是第一道防线，腹横筋膜和内环的修复对防止疝的复发有着重要作用。     

疝环充填式无张力疝修补术98例治疗体会

传统的疝修补术采用的是非生理解剖性的高张力性修补，其有缝合张力过高，术后手术部位有牵扯感、疼痛、修补的组织愈合差、复发率高等缺点。而无张力疝修补术优点在于术后疼痛轻，没有牵扯感，康复所需时间短，复发率低，不改变腹股沟的解剖关系，补片的组织相容性好，不易感染。我科自2004年6月-2007年12月共做腹股沟疝无张力修补术98例，现报告如下。     

平片式无张力疝修补术68例临床分析

目的 总结平片式无张力疝修补术的临床经验。方法 回顾性分析我院1999年8月至2002年10月平片式疝修补术68例的临床资料。结果 与传统疝修补术相比较，手术适应证扩大，并发症少，复发率低，与疝环充填式无张力疝修补术相比，费用低，手术时间短，易掌握。结论 平片式疝修补术是一种手术适应证宽，并发症少，复发率低，费用低，手术时间短的安全可靠的手术方法。     

无张力疝修补术与传统疝修补术治疗腹股沟疝气的临床疗效对比

目的：观察对比无张力疝修补术与传统疝修补术治疗腹股沟疝气的各自临床效果。方法将269例腹股沟疝气患者随机分为治疗组145例和对照组124例。对照组给予传统疝修补术治疗,治疗组给予无张力疝修补术治疗,观察两组临床疗效。结果治疗组手术时间、术中出血量、下床活动时间及住院时间均明显少于对照组,差异有统计学意义(P<0.05)。结论无张力疝修补术较传统疝修补术治疗腹股沟疝气有明显的优势,无张力疝修补术为对人体结构造成破坏,具有术后恢复快、并发症少、复发率低等优点,值得临床推广应用。     

人工材料与开放式无张力疝修补

腹股沟疝是临床常见病，传统的张力修补术后复发率较高，人工生物材料的出现使得外科医生能够利用无张力修补的方法来完成疝修补，并因此改善了治疗结果，本文比较了常见的几种人工修补材料的性质和优缺点，并且简要介绍了使用这些材料完成的开放式无张力疝修补术。     

改良Lichtenstein疝修补术与Lichtenstein疝修补术的对比研究

目的比较改良Lichtenstein疝修补术与Lichtenstein疝修补术手术方法,探讨更加合理的手术方式。方法回顾分析我科316例成年腹股沟疝患者,其中162例实施改良Lichtenstein疝修补术,另154例实施Lichtenstein疝修补术。结果改良Lichtenstein组与Lichtenstein组平均手术时间30 min,改良Lichtenstein组无复发病例,Lichtenstein组复发5例,两组住院时间无差别,均未见睾丸萎缩。结论改良Lichtenstein修补腹股沟疝是目前较理想的术式之一,复发性腹股沟疝和老年高危患者应首选改良Lichtenstein术式。     

腹膜前无张力修补腹股沟疝74例

目的探讨腹膜前腹股沟疝无张力修补手术的疗效,以及以疝囊为中心进行腹膜前游离并接受腹膜前无张力疝修补术的手术方法。方法应用美国巴德公司提供的定型产品内存弹力记忆环及定位袋的双层聚丙烯Kugel补片,以及北京天助畅运公司生产的善释腹膜前补片装置,对74例腹股沟疝患者进行以疝囊为中心腹膜前游离并行腹膜前无张力疝修补术。结果 74例均顺利完成手术,每例侧手术时间平均32 m in,术后6 h下床活动。患者术后无伤口感染、阴囊血肿,1例发生右侧阴囊积液,1例股疝大腿根部积液。术后平均住院时间4 d。术后随访1~48个月,未复发。结论该手术是一种安全有效的手术方式,手术操作简单,实用性强。     

无张力腹股沟疝修补术后复发的临床分析及处理

目的探讨无张力腹股沟疝修补术后复发的原因、预防和再手术治疗的方法。方法回顾性分析60例无张力腹股沟疝修补术后复发的临床资料,找出复发的原因,提出再次手术的方法;60例患者手术的方式仍为开放式无张力腹股沟疝修补术,其中疝环充填式无张力疝修补术后复发疝18例,平片修补术后复发疝9例,改良Kugel腹股沟疝修补术后复发疝3例。结果随访6～24个月,平均15个月,仅有2例患者复发。结论无张力腹股沟疝修补术后复发与腹内压持续增加、术中解剖不清、术中操作失误、年龄有关。     

低张力疝修补术36例临床分析

目的：探讨低张力疝修补术的优点和近期疗效。方法：采用美国Bard公司生产的聚丙烯疝修补网片（Bard Perfix Mesh)、美国强生公司生产的Prolene疝修补网片补片及美国戈尔公司的聚四乙烯疝补片对36例41侧腹外疝在疝囊高位结扎后行低张力修补术。结果;本组腹股沟疝的手术时间30－80min,平均55min,术后1例双侧斜疝者使用度冷丁1次,其余病人均疼痛轻微,未使用止痛药;术后进食时间6－24h,平均12h,下地活动时间3－48h,平均24h;出院时间为术后3－7d,平均5d,无切口感染,硬结,血肿,异物反应,尿潴留等并发症;阴囊血肿1例,积液3例4侧,复发1例。结论：低张力疝修补术是一种简单,安全,痛苦小,恢复快,效果好,经济的疝修补方法,实用于疝环相对较小,腹壁缺损不严重的各种腹外疝及复发疝。     

Variations in the inferior pelvic pathway of the lateral femoral cutaneous nerve: Implications for laparoscopic hernia repair

Laparoscopic repair of inguinal hernias is gaining acceptance in the repertoire of the general surgeon. However, nerve entrapment sequelae have been reported and appear to be higher with the laparoscopic approach. Contributing factors include pelvic variations in nerve pathways and the use of staples. We examined the pelvic relations of the lateral femoral cutaneous nerve (LFCN) to the anterior superior iliac spine (ASIS) and the iliopubic tract (IPT) because of the high morbidity of entrapment of this nerve, despite its low incidence. The LFCN, ASIS, and IPT were identified and their relationships measured in 48 male and 24 female cadavers ranging in age from 61 to 96 yr. The LFCN was located 1.7 (±1.2) cm medial to the ASIS along the IPT and 1.4 (±0.7) cm posterior (deep) to the IPT at this point, with no significant sex differences. The intrapelvic pathway of the LFCN, including its branches, varied widely so that in 18% of these specimens the LFCN was in either the vertical plane of the ASIS (13%) or in the plane of the IPT (5%). In 11% this nerve was within 1 cm of the ASIS. These data indicate that exclusive use of the ASIS as a guide for staple placement may result in entrapment of this nerve or its branches. © 1996 Wiley-Liss, Inc.     

Examination of the variations of lateral femoral cutaneous nerves: report of two cases

The origins, courses and relations of lateral femoral cutaneous nerves (LFCNs) were examined bilaterally in 28 cadavers, and the variations were observed in two. On the right side of one cadaver, the ventral rami of the first and second lumbar spinal nerves were united and then this nerve was divided into four branches. From medial to lateral, these branches were the obturator nerve, the femoral nerve, the medially located LFCN and the laterally located LFCN. On the left side of another cadaver, there were three LFCNs. All of these nerves pierced the psoas major muscle anterolaterally. Two of these nerves, which pierced the psoas major muscle more proximally than the third, united with each other by a communicating branch anterior to the iliacus muscle. These types of variations are very important, especially in the presence of paresthesias or pain in the anterior thigh, lateral thigh and gluteal region. In these cases, surgeons must always remember the possible variations of the LFCN during surgical procedures in order to prevent injury and the occurrence of meralgia paresthetica.     

Strangulated intestinal obstruction secondary to a typical obturator hernia: a case report with literature review

Obturator hernia is a rare pelvic hernia with incidence of 1%. It's a significant cause of intestinal obstruction in emaciated elderly women. Delayed diagnosis and surgical intervention contributed to its relatively high morbidity and mortality. We present a typical case of obturator hernia with positive Howship-Romberg sign and Hannington-Kiff sign. The diagnosis was confirmed by spiral CT preoperatively. During the emergency laparotomy, the incarcerated intestine was reduced and removed. Obturator foramen was repaired by simple suture. The patient recovered uneventfully and no recurrence occurred during the follow-up. The obturator hernia should be included in the differential diagnosis if clinically suspected. Early diagnosis and prompt surgical treatment are essential to reduce the morbidity and mortality associated with obturator hernia.     

股骨近端抗旋髓内钉治疗老年股骨转子间骨折39例临床分析

目的评价应用股骨近端抗旋髓内钉(PFNA)治疗老年股骨转子间骨折的方法及疗效。方法回顾分析PFNA治疗老年股骨转子间骨折39例。结果本组手术过程顺利,无神经、血管损伤,住院期间无感染等并发症。39例患者中36例获门诊随访,随访时间6~14个月,平均10个月,获得随访的患者未发生螺钉切割或髋内翻等并发症,骨折术后均I期愈合,平均愈合时间15周。根据Harris功能评分,优良率达91.7%。结论 PFNA治疗老年股骨粗隆间骨折创伤小,并发症少,是一种安全、有效的治疗方法,值得在老年股骨转子间骨折的治疗中推广应用。     

Deep femoral artery with four variations: a case report

During our routine dissection course for students we found a complex variation of the femoral artery on the left side of a 72-year-old male cadaver. The deep femoral artery was originating from the anterior aspect of the femoral artery; the inferior epigastric and the external pudendal arteries were arising from the deep femoral artery. Besides, the lateral circumflex femoral artery was arising from the lateral aspect of the femoral artery and distal to the origin of the deep femoral artery.     

闭孔疝的术前诊断和手术治疗14例临床分析

目的探讨闭孔疝术前诊断和手术方法,为临床诊断和治疗闭孔疝提供参考依旧。方法对我院1985-2005年收治闭孔疝14例闭孔疝的病史,临床表现,影像学检查及手术情况进行回顾性分析。结果早期病例9例均是以发生绞榨性肠梗阻剖腹探查明确诊断,手术采取直接拉拢修补。近期病例5例术前诊断闭孔疝,手术采用B rad补片修补。结论闭孔疝手术中注意闭孔神经压迫症状,特别是Howsh ip-Romberg征对本病有重要意义,腹部CT扫描为标准方法,手术采用补片修补操作简便,安全,可靠。