良性前列腺增生症合并腹股沟疝的同期手术治疗

目的探讨良性前列腺增生症（BPH）合并腹股沟疝同期行经尿道前列腺等离子双极电切术（PKRP）和疝环充填式无张力疝修补术的手术治疗安全性和效果。方法对36例良性前列腺增生症合并腹股沟疝同期行PKRP、疝环充填式无张力疝修补术和25例同期行传统的耻骨上经膀胱前列腺摘除术、疝修补术的两组临床资料进行对比分析。结果两组病例均顺利完成手术康复出院,但PKRP和疝环充填式无张力疝修补术在手术时间、术中出血量、术中输血率、术后留置尿管时间、术后住院天数、疝复发率等指标明显优于传统的耻骨上经膀胱前列腺摘除术和疝修补术（P〈0．05）。结论BPH合并腹股沟疝同期行PKRP和疝环充填式无张力疝修补术是安全有效的,且术中出血少、创伤小、手术时间短、术后恢复快、疝复发率低等,术前应充分评估并严格手术指征。     

无张力疝修补术在治疗老年腹股沟疝中的临床应用效果分析

目的探讨无张力疝修补术在治疗老年腹股沟疝中的临床应用效果。方法将我院2009～2011年间收治的92例老年腹股沟疝患者随机分为无张力疝修补术治疗组(观察组)和传统疝修补术治疗组(对照组),每组各46例,观察两组患者的治疗效果。结果观察组患者手术时间、术中出血量、下床时间以及住院时间均少于对照组,组间差异有统计学意义(P<0.05)。观察组患者并发症发生率为4.3%,对照组患者并发症发生率为8.7%,组间差异无统计学意义(P>0.05)。结论无张力疝修补术治疗老年腹股沟疝临床疗效确切,患者痛苦小,术后并发症发生率低,且操作简便,是一种安全有效的治疗方法 ,值得临床进一步推广使用。     

无张力疝修补术治疗腹股沟疝91例临床分析

目的探讨无张力疝修补术治疗腹股沟疝的临床疗效。方法选取2007年1月～2009年3月于本院进行治疗的182例腹股沟疝患者为研究对象,将其随机分为对照组（传统疝修补法组）91例和观察组（无张力疝修补术组）91例,后将两组患者术后VAS评分、手术时间、下地时间、住院时间、并发症发生率、患者满意率及术后24个月的复发率进行比较。结果观察组的术后VAS评分低于对照组,手术时间、下地时间、住院时间短于对照组,并发症发生率及术后24个月的复发率低于对照组,患者满意率高于对照组,均差异有统计学意义（P〈0.05）。结论无张力疝修补术治疗腹股沟疝的临床疗效明显优于传统的疝修补术,可显著改善多个评估项目,综合优势明显。     

Case report of tension-free vaginal tape-associated bowel obstruction and relationship to body habitus

Tension-free vaginal tape (TVT) is increasingly being used as the gold standard to treat stress urinary incontinence. Previously reported complications include peritoneal perforation with acute bowel injury. A thin, petite 51-year-old woman with stress urinary incontinence underwent uneventful TVT placement. Three years later, she presented to hospital with de novo small-bowel obstruction. Laparotomy revealed TVT tape violating the peritoneum and causing the distal ileum to adhere to the pelvic sidewall. The compromised bowel was resected and primary anastomosis performed. Delayed, adhesion-related small-bowel obstruction can be a complication of TVT.     

改良充填式无张力股疝修补术20例报告

目的探讨改良充填式无张力股疝修补的效果。方法回顾性分析我院2002年1月至2008年6月使用网塞及平片行改良充填式无张力股疝修补术20例,均经腹股沟切口,高位游离疝囊,网塞充填于股环上方薄弱的腹膜前间隙内,常规使用平片并与陷窝韧带、耻骨梳韧带固定。结果20例手术顺利,恢复良好,随访6~36月均无复发。结论经改进的充填式无张力股疝修补术可有效避免压迫股静脉,防止股疝复发,预防直疝和斜疝新发,为股疝治疗合理手术方式之一。     

A cost-effectiveness analysis of tension-free versus shouldice inguinal hernia repair: a randomized double-blind clinical trial

Background  The use of open tension-free techniques in hernia surgery seems to be superior to those techniques that apply tension to the suture line. However, the cost-effectiveness of tension vs. tension-free repairs has not been investigated before. Methods  This study is a cost-effectiveness analysis within a randomized controlled clinical trial that compared open-tension (OT) versus mesh-plug tension-free (MPTF) hernia repair, with a 2-year follow-up for each patient. Between July 2002 and June 2003, 106 patients with inguinal hernia were randomized to either procedure. Main outcome measures included average surgical time, time to full recovery, pain visual analog scale, amount of analgesics required, off-work time, hospital stay, and heath-care costs. Results  The average cost was $885.15 (95% CI $843.56–$926.74) and $837.66 (95% CI $796.42–878.89) USD for the OT and the MPTF herniorrhaphy, respectively (P < 0.05). Average yearly savings with the MPTF repair were calculated as $7,598.84 USD. Surgery time, time to full recovery, pain visual-analog scale, use of analgesics, off-work time, and hospital stay were significantly lower for the MPTF repair. Disability-adjusted life-years were reduced 56% with the MPTF repair, which represented a total savings of $12,656.60 USD with this procedure. Conclusion  This controlled clinical trial demonstrates that the MPTF technique significantly decreases care costs in patients operated on for inguinal hernias.     

腹腔镜经腹膜前、完全腹膜外和无张力疝修补术的前瞻性对照研究

目的通过对比研究腹腔镜经腹腹膜前补片植入术（TAPP）、完全腹膜外腹腔镜疝修补术（TEP）和开放无张力疝修补术,总结3种手术方法的优缺点。方法将124例腹股沟疝患者随机分为TAPP组44例、TEP组R40例及开放无张力修补组40例。分别行TAPP、TEP和无张力疝修补术（Lichtenstein修补）,术后对患者进行随访,比较3组患者的手术相关参数。结果TAPP组与TEP组在手术时间、住院天数、住院费用、恢复工作时间、术后疼痛程度方面比较差异无统计学意义。两组与开放无张力修补组比较差异有高度统计学意义（P〈0．01）。3组在并发症方面的差异无统计学意义。TAPP组与TEP组术后各有1例因补片曲卷移位而复发。结论与开放无张力疝修补手术相比,TAPP及TEP较安全可行,且患者疼痛轻、恢复快。TAPP对于复发性疝、双侧疝及隐形疝的优势更加明显,随着修补材料的不断改进及手术熟练程度的提高,TAPP会有更广阔的前景。     

善愈聚丙烯补片在小切口疝的临床应用

目的探讨总结善愈聚丙烯补片在腹部小切口疝的临床应用经验。方法对我院2007年1月至2009年2月收治的26例腹壁小切口疝临床资料进行回顾性分析。结果本组患者均治愈,手术时间30—70min,患者术后疼痛轻,未使用止痛药,无切口感染,无术后慢性疼痛,平均手术费用4100元,随访3～25个月,无并发症,异物感不明显。结论善愈补片修补腹壁小切口疝是一种安全、可靠的手术方式。     

胸腰椎旁神经阻滞应用于腹股沟疝修补术临床研究

目的：比较胸-腰椎旁神经阻滞和硬膜外麻醉下行腹股沟疝修补术的麻醉效果。方法：选取60例ASAⅠ-Ⅱ,年龄18—60岁拟行腹股沟疝修补术的择期手术病人,随机分胸-腰椎旁阻滞组（A组）和硬膜外麻醉组（B组）。观察两组的麻醉起效时间,评估麻醉效果,并对两组的术后尿潴留（是否需导尿）、术后伤口疼痛（手术结束至伤口开始疼痛的时间）进行比较。结果：胸-腰椎旁阻滞组麻醉起效时间、术后伤口疼痛时间长于硬膜外麻醉组（P〈0．05）,术后尿潴留例次明显少于硬膜外麻醉组（P〈0．05）。麻醉效果优良率两组差异无显著性惨0．05）。结论：胸-腰椎旁神经阻滞下行腹股沟疝修补术麻醉效果好,术后并发症少,对全身器官功能影响小,尤其适合于不能行硬膜外麻醉的病人。     

疝环充填式无张力疝修补术治疗腹股沟疝81例分析

目的总结应用疝环充填式无张力疝修补术治疗腹股疝81例临床经验。方法采用Bardmesh,Perfixplug材料进行疝环充填,补片平铺式无张力腹股沟疝修补术。结果81例治愈出院,术后平均住院5.5天,最短3天。随访3月至3年,再发1例,复发率为1.23%。结论无张力疝修补术具有方法简便,损伤小,恢复快,复发率低等优点,是一种更符合人体解剖结构和疝的病理生理的手术方法。