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12.
13.
Herniography has been used for 25 years in the diagnosis of occult herniation but has not gained widespread acceptance in
the UK, despite studies confirming its high sensitivity and specificity for occult hernias and an excellent record of safety
and patient acceptability. The traditional approach in the UK to suspected occult groin herniation has been surgical exploration.
This study examined the use of herniography in a single district general hospital to assess its impact in limiting unnecessary
groin explorations and allowing discharge of patients without hernias. The case notes of 90 successive patients referred for
herniography by the department of general surgery in a single UK district general hospital over an 18-month period were reviewed.
Eighty-seven completed examinations were analysed in which 23 hernias were diagnosed in 20 patients. Thirteen patients have
undergone hernia repair with resolution of symptoms. There were no false positive examinations, although two inguinal hernias
were incorrectly diagnosed radiologically as femoral hernias; there were two false negative examinations where additional
hernias were found at laparoscopic repair. There were no reported complications. Twenty-four patients were discharged directly
from the surgical clinic after a negative herniogram. Thirty patients were referred to other specialities. No patient had
undergone groin exploration after a negative herniogram. Herniography is a useful tool in assessing obscure groin pain and
potential occult herniation. It can reliably rule out the presence of a hernia and avoid the need for surgical exploration.
Many patients with a negative herniogram can be reassured and discharged, whilst others may be referred on to other specialities
safe in the knowledge that an occult hernia has been excluded. 相似文献
14.
腹腔镜下切口疝补片修补术的临床应用 总被引:13,自引:4,他引:9
目的 探讨腹腔镜下腹壁切口疝修补术的手术方法、安全性等问题。方法对2004年3月至2006年5月79例行腹腔镜下补片修补术治疗腹壁切口疝病人的临床资料进行分析。结果 78例(98.7%)手术成功,1例因腹腔内广泛粘连而中转开放修补。平均手术时间为88min,平均术后住院4.6d,18例(22.8%)病人术中发现有1个以上的隐匿性缺损。术后并发症:术后短期内修补区腹壁明显疼痛58例(73.4%)。腹壁缝合点较长时间疼痛6例(7.6%),浆液肿14例(17.7%),无手术死亡,1例术后出现肠瘘,经保守治疗好转,1例腰部切口疝的病人术后复发。结论 多数病人腹壁切口疝可以经腹腔镜行粘连松解及补片修补术,并可在术中发现其他隐性缺损,手术安全性较高。对腹腔内广泛粘连而影响操作器械进入及粘连分离者,应及时中转开腹手术。 相似文献
15.
Nawf Sharief Judith E. Kingston Vanessa M. Wright Kate Costeloe 《Pediatric hematology and oncology》1991,8(4):323-327
We describe a familial case of Marfan's syndrome with associated intrathoracic stomach detected during the neonatal period. The patient developed a primitive leukemia at 3 months of age. Acute leukemia in a patient with Marfan's syndrome has not previously been reported. 相似文献
16.
Day surgery for laparoscopic repair of abdominal wall hernias 总被引:1,自引:0,他引:1
Laparoscopic repair of abdominal wall hernias is still a controversial and nongeneralized therapeutic option. The aim of
this paper is to evaluate the results of laparoscopic surgery on abdominal wall hernias at a day-surgery unit and to describe
our procedure protocol. Prospective analysis of 300 patients undergoing laparoscopic surgery for abdominal wall hernias was
conducted: 260 preperitoneal and 40 intraperitoneal. The patients' clinical features, hernia type, intraoperative and postoperative
complications, and follow-up are studied for both types of surgery. All the patients receiving surgery with extraperitoneal
laparoscopy were completed as a day-surgical procedure with a rate of conversion to open surgery of 2.3%. Twelve (30%) of
the 40 patients operated on for ventral hernias using intraperitoneal laparoscopy required hospitalization: five for perioperative
complications and seven for pain (16%). There was no case of infection or mesh rejection. The recurrence rates were 0.78%
(two cases) for the inguinal hernias and 2.5% (one case) for the ventral hernias. In conclusion, laparoscopic repair of abdominal
wall hernias in a day-surgery setting is an efficient alternative to open surgery.
Electronic Publication 相似文献
17.
Comparison of local and general anesthesia in tension-free (Lichtenstein) hernioplasty: a prospective randomized trial 总被引:3,自引:0,他引:3
To compare pulmonary effects, postoperative pain and fatigue, morbidity, patient satisfaction, and cost of different anesthetic
techniques for inguinal hernia repair, 50 patients were randomized to local and general anesthesia groups (LA and GA). All
patients received the same premedications and the same postoperative analgesic regimen. The standardized postoperative analgesic,
intramuscular pyroxicam 20 mg, was given to all patients in the recovery room and an additional 20 mg on the same day was
given as requested by each patient. Pulmonary function studies and arterial blood gas analysis were performed 1 h prior to
the operation and at the postoperative 8th and 24th hours. All patients underwent Lichtenstein's tension-free hernioplasty.
Postoperative pain and fatigue were registered 8 h and 24 h after the operation. A questionnaire was filled out by the patients,
and they were asked to give grades for the general comfort of the anesthesia and the surgical procedure (1=worst, 10=best).
Postoperative pulmonary function tests were significantly poorer in the GA group both on 8th- and 24th-hour measurements (P<0.05). Patients who underwent LA had significantly lower PCO2 and higher PO2 at the postoperative 8th hour (P<0.05). Mean postoperative pain and fatigue scores revealed a significant difference in favor of local anesthesia at only
the 8th hour (P<0.05). There were two complications, one in each group (a hematoma in LA and a urinary retention in GA). Patient satisfaction
grades were not different in the two groups. We conclude that LA in inguinal hernia repair does not adversely affect pulmonary
functions, patients feel less pain, and patient satisfaction is comparable to that with GA.
Electronic Publication 相似文献
18.
F. Berndsen D. Arvidsson L.-K. Enander C.-E. Leijonmarck U. Wingren C. Rudberg S. Smedberg G. Wickbom A. Montgomery 《Hernia》2002,6(2):56-61
Interest in inguinal hernia surgery has increased significantly with the introduction of new operating techniques during
the past decade. This multicenter study compared short-term results in patients treated by the laparoscopic transabdominal
preperitoneal patch technique (TAPP; n=518) and the Shouldice technique (n=524). We evaluated demographics, operative data, complications, hospital stay, postoperative pain, use of analgesics, functional
status, sick leave, and complaints up to 3 months postoperatively. The median operating time was shorter in the Shouldice
group (55 vs. 65 min), but there were no significant differences in complication rates, and major complications were rare.
The hospital stay was 1 day or less in over 98% of cases in both groups, but more operations were performed on outpatient
basis in the Shouldice group. In the TAPP group postoperative pain and analgesic consumption were less, postoperative functional
status was better, and sick leave was shorter (10 vs. 14 days). These results show that the two methods are equally safe and
have few major complications. The TAPP operation is associated with less postoperative pain, better postoperative functional
status, and shorter sick leave, but at the price of a longer operating time.
Electronic Publication 相似文献
19.
经皮穿刺髓核成形术治疗腰椎间盘突出症初步临床报道 总被引:36,自引:2,他引:34
目的 寻求一种简单、安全、有效、微创的椎间盘突出症治疗方法。方法 对 1 6例腰椎间盘突出症采用经皮穿刺髓核成形术 (Nucleoplasty)治疗 ,并对其疗效进行观察分析。 结果 全部患者经二周至一个月短期随访 ,症状均有不同程度改善 ,疗效优良率为 93 8% ,有效率为 1 0 0 %。未发现明显并发症。结论 髓核成形术是一种先进、安全、有效的椎间盘突出微创手术 ,具有操作简单、安全、微创、疗效佳、恢复快、无需住院等优点。 相似文献
20.
目的:探讨腹腔镜在腹股沟疝修补手术中的优缺点,方法:31例腹股沟疝行腹腔镜疝修补术,其中斜疝25例,直疝6例,复发疝4例,均行腹腔内术式(TAPP)。结果:手术全部完成,平均手术时间61min(40-95min),无中转手术,4例同时行胆囊切除术,平均住院7.5d,术后近期随访无复发,结论:腹腔镜疝修补术是一种安全的手术,术后恢复时间短,复发率低。 相似文献