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排序方式: 共有7713条查询结果,搜索用时 31 毫秒
61.
目的 分析总结腰椎间盘突出症手术后复发的原因及治疗方法。方法 腰椎间盘突出症手术后复发的范围限定于临床症状、体征及影像学证实为受累神经根与第一次手术的节段相同。回顾1990年~2001年收治的资料完整的病例38例。总结造成复发的原因,分析造成这些原因的因素以及防范措施,并提出治疗方案。结果 复发的原因为髓核再突出20例(占52.7%)、疤痕压迫5例(占13.1%)、硬脊膜及神经根四周粘连5例(占13.1%)、腰椎失稳4例(占l0.5%)、神经根管、侧隐窝狭窄4例(占l0.5%),其中经保守治疗和手术治疗分别为2l例(占55.3%)和17例(占47.7%),治疗优良率92%。结论 腰椎间盘突出症术后复发的主要原因为髓核再突出。复发后经中西医结合治疗能取得满意疗效,治疗上首先应采用保守治疗。 相似文献
62.
Combined open and laparoscopic approach to chronic pain following open inguinal hernia repair 总被引:1,自引:0,他引:1
Introduction: Chronic groin pain is the most common long-term complication after open inguinal hernia repair. Traditional surgical management
of the associated neuralgia consists of injection therapy followed by groin exploration, mesh removal, and nerve transection.
The resultant hernia defect may be difficult to repair from an anterior approach. We evaluate the outcomes of a combined laparoscopic
and open approach for the treatment of chronic groin pain following open inguinal herniorrhaphy. Methods: All patients who underwent groin exploration for chronic neuralgia after a prior open inguinal hernia repair were prospectively
analyzed. Patient demographics, type of prior hernia repair, and prior nonoperative therapies were recorded. The operation
consisted of a standard three trocar laparoscopic transabdominal preperitoneal hernia repair, followed by groin exploration,
mesh removal, and nerve transection. Outcome measures included recurrent groin pain, numbness, hernia recurrence, and complications.
Results: Twelve patients (11 male and 1 female) with a mean age of 41 years (range 29–51) underwent combined laparoscopic and open
treatment for chronic groin pain. Ten patients complained of unilateral neuralgia, one patient had bilateral complaints, and
one patient complained of orchalgia. All patients failed at least two attempted percutaneous nerve blocks. Prior repairs included
Lichtenstein (n=9), McVay (n=1), plug and patch (n=1), and Shouldice (n=1). There were no intraoperative complications or wound infections. With a minimum of 6 weeks follow up, all patients were
significantly improved. One patient complained of intermittent minor discomfort that required no further therapy. Two patients
had persistent numbness in the ilioinguinal nerve distribution but remained satisfied with the procedure. Conclusions: A combined laparoscopic and open approach for postherniorrhaphy groin pain results in good to excellent patient satisfaction
with no perioperative morbidity. It may be the preferred technique for the definitive management of chronic neuralgia after
prior open hernia repair. 相似文献
63.
Book reviews in this article: Fifty athletes with chronic undiagnosed groin pain underwent surgical exploration and inguinal hernia repair. Six months later, all athletes were sent questionnaires to assess their return to sport, level of pain (using analogue pain scores) and the overall result of their surgery. Operative findings revealed a significant bulge in the posterior inguinal wall in 40 athletes. Forty-four athletes (88%) replied to the questionnaire. Forty-one athletes (93% of respondents) had returned to normal activities. Pain scores indicated a marked improvement in their level of pain (P < 0.001). Thirty-three athletes (75%) rated the result as good and 10 (23%) as improved. It is concluded that athletes with chronic groin pain who are unable to compete in active sport should be considered for routine inguinal hernia repair if no other pathology is evident after clinical examination and investigation. 相似文献
64.
Laparoscopic flip-flap technique versus conventional inguinal hernia repair in children. 总被引:1,自引:0,他引:1
Mohamed E Hassan A R Mustafawi 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2007,11(1):90-93
BACKGROUND AND OBJECTIVES: Inguinal hernia repair is one of the most frequently performed pediatric surgical operations. Several pediatric laparoscopic inguinal hernia repair techniques have been introduced. But debate is unresolved regarding the feasibility of laparoscopy for treating pediatric inguinal hernias. METHODS: A retrospective cohort study enrolled 33 patients who underwent congenital inguinal hernia repair by either the new laparoscopic flip-flap technique or conventional open repair. Patients were divided into 2 groups according to the type of surgery: Group A included those who underwent the new laparoscopic technique, and Group B included those who underwent conventional open repair. RESULTS: Group A comprised 15 patients (mean age, 39 months), and group B comprised 18 (mean age, 44 months). Mean operative time was 47.5 minutes for Group A versus 27.5 minutes for Group B. Intraoperative complications for Group A included 1 case (7%) of vas deferens injury, and 3 cases (20%) in which the flaps were torn during suturing. In Group B, no intraoperative complications were encountered. In both groups, the mean postoperative hospital stay was 5.5 hours. Postoperative follow-up of 3 months revealed recurrence in 4 patients in Group A (27%), while there were no recurrences in Group B. CONCLUSION: Our preliminary experience shows unsatisfactory outcomes with laparoscopic flip-flap hernia repair in children. In spite of advancement in the application of laparoscopy in pediatric surgery, conventional open hernia repair is still the gold standard for children, in our experience. Future studies with more numbers and longterm follow-up should be conducted. 相似文献
65.
“Suture hernia”: identification of a new type of hernia presenting as a recurrence after laparoscopic ventral hernia repair 总被引:2,自引:0,他引:2
After laparoscopic repair of ventral or incisional hernias, the recurrence rates reported are around 4%. Different mechanisms
for the recurrences have been identified. We report two cases in which the patients were operated on laparoscopically for
recurrence after laparoscopic ventral hernia repair. In both cases, the site of the recurrent hernia was situated at the transfascial
fixation sutures. Patients were treated by laparoscopy with a larger intraperitoneal mesh covering the new hernia and the
old mesh. 相似文献
66.
目的 探讨急性创伤性膈疝的发病机理 ,临床特征和处理方式。方法 回顾性分析2 6例急性创伤性膈疝的临床资料。结果 患者均为多发伤 ,有不同程度的呼吸困难 ,均行手术探查 ,膈肌修补。 2例术中死亡。 14例术后出现多器官功能障碍 ,其中 3例术后死于多器官衰竭。本组 2 1例存活。结论 外伤性膈疝早期诊断 ,及时手术 ,防治并发症可提高抢救成功率。 相似文献
67.
A male patient of 60 years presented with a swelling in the left groin of 10 months duration. Past records showed bilateral
lumbar sympathectomy and omentopexy done 20 and 6 years back, respectively, for Buerger’s disease. Abdominal examination revealed
a huge hernial swelling in the left groin extending from the symphysis pubis to anterior superior iliac spine measuring 25 × 18 cm.
On exploration, the contents were intestines and omentum, which were coming out through a defect of 5 × 3 cm in the lower
fibers of the conjoint muscle 4 cm cephalad to the deep ring, a finding which made the final diagnosis as an incisional hernia.
We present this interesting case as a very rare complication of omentopexy, probably not reported previously, and an unusual
case of an incisional hernia presenting as an inguinal hernia which is very difficult to diagnose unless encountered before.
Its rarity and clinical challenge is highlighted. 相似文献
68.
Foramen of Winslow hernia is a rare surgical condition that is notoriously difficult to diagnose and most patients are diagnosed only at the time of surgery. As such, a high index of suspicion is necessary to avoid potentially life‐threatening complications. The present paper describes two such cases. In the first case, a freely suspending gall bladder herniated into the lesser sac via the foramen of Winslow. This was diagnosed during a scheduled laparoscopic cholecystectomy. In the second case, the caecum herniated into the foramen of Winslow causing small bowel obstruction and ischaemic hepatitis. Diagnostic dilemma and treatment of the condition is also described. 相似文献
69.
Abstract A young male motorcyclist presented to the Pelvic Unit with an open-book fracture of his pelvis and an acute obstructed direct
inguinal hernia. He was managed operatively and made an excellent recovery. Traumatic abdominal wall hernias are rare. This
is a unique combination of injuries that the trauma surgeon should be aware of. 相似文献
70.