疝环充填式无张力疝修补术116例并发症分析

目的总结腹股沟疝行疝环充填式无张力疝修补术的并发症。方法回顾分析我院2005年5月至2007年12月应用美国Bard公司产品修补腹股沟疝116例，观察其并发症，分析其原因。结果全组无死亡，随访时间6个月-1年，8例患者发生并发症，其中术后切口感染1例（0．9％），切口血肿1例（0．9％），顽固性疼痛1例（0．9％），局部硬块和异物感2例（1．7％），阴囊水肿、积液2例（1．7％），精索炎、睾丸炎1例（0．9％）。结论疝环充填式无张力疝修补术较传统疝修补术具有明显的优势，但该方法仍有一定比率的并发症发生，这与手术操作和术后处理有关。     

Obstructed small bowel ruptured toward the inguinal canal resulting from metastatic colon carcinoma in an irreducible,recurrent inguinal hernia with mesh-plug repair: Report of a case

Four years after treatment of colon cancer an 82-year-old man presented with an irreducible, recurrent inguinal hernia with mesh-plug repair. Delayed surgical exploration revealed metastatic cancer with small bowel adhesion to the mesh-plug and perforation. The mesh-plug with adherent tissue was removed through the inguinal incision, and the ruptured small bowel was resected. Histopathology revealed moderately differentiated mucinous adenocarcinoma of the tissue adhering to the prosthetic material corresponding to the original colon cancer.     

疝环填充式无张力疝修补术治疗56例腹股沟疝临床分析

目的 探讨成人腹股沟疝应用疝环填充式无张力疝修补术的治疗效果.方法 回顾性分析56例应用填充式无张力疝修补法治疗成人腹 股沟疝临床病例资料.结果 56例患者均手术顺利,痊愈出院,均获得随访,无复发,虽有1例切口感染,经处理后痊愈.结论 疝环填充式无张力疝修补 术安全、简单、疼痛轻、恢复快、复发率低,值得推广应用.尤其适用于后壁薄弱、缺损大、有全身合并症的老年患者.     

疝环充填式无张力疝修补术120例临床效果观察

目的观察疝环充填式无张力疝修补术治疗腹股沟疝的临床疗效。方法选取该院2006年1月-2010年12月收治的腹股沟疝患者120例作为观察组,给予疝环充填式无张力疝修补术治疗;另选取该院2001年1月-2005年12月收治的腹股沟疝患者105例作为对照组,给予传统疝修补术治疗。观察并比较2组手术时间、下床活动时间、住院时间、术后并发症发生率、复发率和手术费用。结果观察组术后下床活动时间、住院时间均短于对照组,术后并发症发生率及复发率均低于对照组,差异均有统计学意义(P<0.05)。结论疝环充填式无张力疝修补术治疗腹股沟疝,具有手术创伤小、术后恢复快、复发率低等优点,值得临床推广应用。     

局麻下网塞腹膜前修补术在腹股沟疝中的应用

目的探讨在局麻下网塞腹膜前修补术治疗腹股沟疝的临床价值。方法局麻下将网塞外层完全展开作腹膜前修补术治疗腹股沟疝203例,分析术后疼痛情况、近期并发症及远期慢性疼痛、复发、睾丸萎缩的发生情况,评价其效果。结果 203例全部在局麻下完成手术,手术时间15～65 min,平均31.4 min。术中出血0～20 mL,平均3.5mL。术后疼痛情况：注射镇痛药1例,口服芬必得13例,未用任何镇痛药189例。术后恢复日常活动和工作时间3～18d,平均8.7 d。术后近期并发症仅有血肿2例。186例中随访率91.6%,术后随访8～25个月,平均13.1个月,无复发、腹股沟感觉异常、慢性疼痛、睾丸萎缩等并发症。结论局麻下网塞腹膜前修补术治疗腹股沟疝能进一步降低术后复发率,减少术后腹股沟区慢性疼痛和异物不适感,创伤小,恢复快,适应证广。     

疝环充填式无张力疝修补术在老年腹股沟疝中的应用

目的 探讨疝环充填式无张力疝修补术在老年度股沟疝中的应用价值。方法 选择年龄在60岁以上的老年腹股沟疝,共有28例,其中合并其他慢性疾病20例,占71.5％,复发性疝3例,均使用本方法做疝修补术。结果 本组近期随访,效果良好。无复发及严重的术后并发症。结论 疝环充填式疝修补术操作简单,术后复发率低,并发症少,能早期活动,尤其适合于有多种慢性疾病并存的老年腹股沟疝。     

腹腔镜经腹腔腹膜前疝修补术与疝环充填式修补术治疗成人腹股沟疝的对比研究

目的 与疝环充填式无张力修补术对比,回顾性分析腹腔镜经腹腔腹膜前疝修补术(TAPP)治疗腹股沟疝的效果.方法 选取2014年1月至2016年12月本院开展的62例腹腔镜经腹腔腹膜前疝修补术患者为TAPP组,同期行疝环充填式无张力疝修补术88例患者为对照组.对比两组患者的住院时间、住院费用、疼痛评分、术后并发症(切口感染、血清肿、缺血性睾丸炎、复发)等.结果 与对照组相比,TAPP组平均住院时间[(3.4±1.53)d比(6.5±2.71)d,P=0.003]、疼痛评分[(2.15±1.13)比(5.78±2.27),P=0.013]、总并发症发生率(3.22％比12.5％,P=0.047)均更少;住院费用增多[(13 246.7±1 238.5)元比(7 852.5±533.8)元,P=0.0016],差异有统计学意义.结论 腹腔镜经腹腔腹膜前疝修补术是安全有效的,具有微创、疼痛轻、恢复快等优点.     

Comparison of Bassini repair and mesh-plug repair for primary inguinal hernia: a retrospective study

The purpose of this study was to compare the mesh-plug repair with the Bassini repair for the treatment of primary unilateral inguinal hernias. Patients with primary unilateral inguinal hernias who underwent a Bassini repair (n = 118) between January 1992 and May 1996 and a mesh-plug repair (n = 113) between July 1996 and April 1998 were retrospectively reviewed. We recorded information regarding the types of hernia according to Nyhus classification, operation time, complications, postoperative recovery, and recurrence after surgery. The two groups were comparable regarding age, sex, side of hernia, types of hernia, and the follow-up interval. The operation time was 55 +/- 20min for Bassini repair and 54 +/- 18min for mesh-plug repair. There was no incidence of mesh infection in the mesh-plug repair cases. The amount of diclofenac sodium (suppository) was 307 +/- 222mg in the Bassini repair group and 132 +/- 182mg in the mesh-plug repair group (P < 0.0001). The length of hospital stay was 8.2 +/- 2.0 days in the Bassini repair group and 4.3 +/- 2.7 days in the mesh-plug repair group (P < 0.01). Nine patients (7.6%) in the Bassini repair group had recurrence, compared with one patient (0.9%) in the mesh-plug repair group. The recurrence-free survival in the mesh-plug repair group was significantly longer than that in the Bassini repair group (P = 0.03). In conclusion, patients with primary unilateral inguinal hernias who undergo a mesh-plug repair recover more rapidly and have less recurrence in comparison with those who undergo a Bassini repair.     

A randomized trial of antibiotic prophylaxis for the prevention of surgical site infection after open mesh-plug hernia repair

Background

The efficacy of antibiotic prophylaxis for the prevention of surgical-site infection (SSI) after open tension-free inguinal hernia repair remains controversial.

Methods

A double-blind, randomized, placebo-controlled trial was conducted. Patients who underwent elective open mesh-plug hernia repair were eligible for randomization. In the antibiotic prophylaxis group, 1.0 g cefazolin was intravenously administrated 30 minutes before the incision. In the placebo group, an equal volume of sterile saline was administered. The primary end point was the incidence of SSI.

Results

A total of 200 patients were enrolled. SSI developed in 2 of 100 patients (2%) in the antibiotic prophylaxis group and 13 of 100 patients (13%) in the placebo group, indicating a significant difference between the 2 groups (relative risk ratio, 0.25; 95% confidence interval, 0.070 to 0.92; P = .003). Other complications occurred in 23 patients: 7 (7%) in the antibiotic prophylaxis group and 16 (16%) in the placebo group (P = .046).

Conclusions

This study indicates that antibiotic prophylaxis is effective for the prevention of SSI after open mesh-plug hernia repair.     

自制网塞在充填式无张力疝修补术中的应用(附60例报告)

目的探讨自制网塞在充填式无张力疝修补术中的应用。方法对我院2003年8月至2006年8月用自制网塞行充填式无张力疝修补术治疗腹股沟疝病人60例的临床资料进行回顾性分析。结果本组手术全部成功,平均手术时间45min,术后阴囊小血肿2例,自行吸收而愈。未见有排斥反应。随访3个月～3年共50例,术后复发2例,为开展手术早期病例。结论自制网塞充填式无张力疝修补术是治疗腹股沟疝的较理想术式,具有费用低,大小适合等优点。