腹腔镜下切口疝补片修补术的临床应用

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。     

Spigelian hernias: a prospective analysis of baseline parameters and surgical outcome of 34 consecutive patients

Most of the papers published on spigelian hernia are either case reports or small retrospective series. In this prospective multicenter study, we aimed to outline the specific features of spigelian hernias and patients’ characteristics more clearly. Surgeons enrolled patients to be entered into the database as they diagnosed and treated the hernias at will. The baseline and surgical outcome parameters were noted in each patient. A painful mass was the main presenting complaint in half of 34 patients. Accurate preoperative diagnosis was possible in 31 patients. Open intraperitoneal mesh repair was the preferred technique. The mean hospital stay and time until return to normal daily activities were 4.1 and 15.6 days. Although a rare condition, diagnosis of a spigelian hernia is not difficult once remembered. Its surgical repair seems to cause few complications and is very well tolerated by the patient.     

Mesh fixation with human fibrin glue (Tissucol) in open tension-free inguinal hernia repair: a preliminary report

Background: The Lichtenstein technique for inguinal hernia repair is easy to learn and associated with few complications. However, recent studies have suggested that this technique is inferior to some ‘sutureless’ repair systems in terms of perceived difficulty, operating time, surgeon satisfaction, etc. Methods: We employed a sutureless Lichtenstein technique in 80 consecutive patients with primary unilateral inguinal hernia, to assess patient and trainee surgeon outcomes. Human fibrin glue was used in place of conventional sutures. Results: The mean operating time was 36 min and all patients were discharged 5–6 h after the operation. On a 100-point visual analogue scale, the surgeons rated the difficulty of the operation as low (mean score, 31), and perceived satisfaction as high (mean score, 84). No complications were observed at 12-month follow-up. Conclusion: This study confirms the efficacy of mesh fixation with human fibrin glue, and supports the viability of a sutureless Lichtenstein procedure.     

Hernia repair in elderly patients under unmonitored local anaesthesia is feasible

Background: There is a growing interest in the use of local anaesthesia for inguinal hernia repair. It certainly seems to be an acceptable alternative for the elderly. Supporting intravenous sedation, however, still requires monitoring, anaesthetic personnel and some preparations for the patient. Therefore we set up a feasibility study of hernia repair under local anaesthesia without intravenous sedation or monitoring in elderly patients. Method: A total of 62 patients (aged 65 years or more) with unilateral inguinal hernia received a Mesh Plug Repair. Prospectively collected data included procedure-related complications and information on pain and quality of life as measured by Short Form 36. Results: No procedure-related complications were noted. Comparing the preoperative scores, the SF-36 on day 14 (n=61) did not differ significantly. After a median follow-up of ten months (n=54), significantly higher scores were found for scales of physical and emotional role and pain (all p<0.05). Twenty-two patients reported some form of pain (40.7%). 94.4% of the patients would recommend the procedure when asked. Conclusion: The results of this study indicated that Mesh Plug Repair performed under unmonitored local anaesthesia with no intravenous sedation is a feasible alternative for elderly patients. It has advantages for the medical organization without disadvantages for the patient.     

Repair of large midline incisional hernias with polypropylene mesh: Comparison of three operative techniques

Polypropylene mesh is widely used for the reconstruction of incisional hernias that cannot be closed primarily. Several techniques have been advocated to implant the mesh. The objective of this study was to evaluate, retrospectively, early and late results of three different techniques, onlay, inlay, and underlay. The records of 53 consecutive patients with a large midline incisional hernia — 25 women and 28 men, mean age 60.4 (range 28–94) — were reviewed. Polypropylene mesh was implanted using the onlay technique in 13 patients, inlay in 23 patients, and underlay in 17 patients. Either the greater omentum or a polyglactin mesh was interponated between the mesh and the viscera. The records of these 53 patients were reviewed with respect to: size and cause of the hernia, pre- and postoperative mortality and morbidity, with special attention to wound complications. Patients were invited to attend the outpatient clinic at least 12 months after implantation of the mesh for physical examination of the abdominal wall. Postoperative complications occurred in 14 (26.4%) patients. The onlay technique had significantly more complications, as compared to both other techniques. Reherniation occurred in 15 (28.3%) patients. The reherniation rate of the inlay technique was significantly higher than after the underlay technique (44% vs 12%, P=0.03) and tended to be higher than the onlay technique (44% vs 23%, P=0.22). Repair of large midline incisional hernias with the use of a polypropylene mesh carries a high risk of complications and has a high reherniation rate. The underlay technique seems to be the better technique.     

犯罪青少年个性与父母养育方式的相关研究

目的 分析和探讨犯罪青少年个性和父母养育方式的特点及父母养育方式对犯罪青少年个性特质的影响。方法 以河南省某少年管教所少年犯240人为研究组，以240名在校中学生240名为对照组，采用艾森克个性问卷(EPQ)和父母养育方式问卷(EMBU)对两组被试进行集体施测。结果 犯罪青少年个性具有N(情绪性)分和P(精神质)分高、E(内外向)分低的特点；其父母养育方式表现出低情感温暖、理解，高惩罚严厉、高拒绝否认和过分偏爱的特点。犯罪青少年个性4个维度与其父母养育方式的绝大多数因子存在显相关关系。结论 犯罪青少年人格具有偏离正常的倾向，其父母养育方式失当可能是造成犯罪青少年人格偏差的重要因素。     

腹腔镜下造口旁疝补片修补术可行性、安全性探讨

目的：就所开展的腹腔镜下造口旁疝补片修补术的临床资料，进行该手术可行性和安全性的探讨。方法：自2004年9月至2006年4月，我院为10例造口旁疝病人进行了腹腔镜下补片修补术。结果：10例造口旁疝病人中9例修补成功，1例因腹腔内广泛致密粘连而中转为开腹缝合修补；手术时间平均113（45～180）min：疝环大小平均5．6（4～6）cm；术后2例出现暂时性腹胀；7例修补区域腹壁疼痛，持续2周后均明显缓解：1例出现呼吸功能减退，经使用无创呼吸机辅助治疗后缓解；5例出现浆液肿，经2～4次穿刺抽液并加压包扎后治愈，无血肿发生．也未发生与手术相关的感染。术后住院时间平均5．7（3-9）d；术后随访平均9．1（2～19）个月，未见早期复发。结论：腹腔镜造口旁疝补片修补术从技术上讲是安全、可行的，从早期的临床结果来看．效果较理想。     

“Suture hernia”: identification of a new type of hernia presenting as a recurrence after laparoscopic ventral hernia repair

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.     

Long-term follow-up after umbilical hernia repair: are there risk factors for recurrence after simple and mesh repair

Adult umbilical hernia is a common surgical condition mainly encountered in the fifth and sixth decade of life. Despite the high frequency of the umbilical hernia repair procedure, disappointingly high recurrence rates, up to 54% for simple suture repair, are reported. Since both mesh and suture techniques are used in our clinic we set out to investigate the respective recurrence rates and associated complications, retrospectively. Patients who were treated between January 1998 and December 2002 were identified from our hospital database and invited to attend the outpatient department for an extra follow-up, history taking and physical examination. The use of prosthetic material, occurrence of surgical site infection, body mass and height as well as recurrence were recorded at the time of this survey. In total, 131 consecutive patients underwent operative repair of an umbilical hernia. Twenty-eight percent of the patients were female (n=37). In 12 patients (11%) umbilical hernia repair was achieved with mesh implantation. Fourteen umbilical hernia recurrences were noted (13%); none had been repaired using mesh. No relationship was found between wound infection or obesity and umbilical hernia recurrence. In the light of these results it is necessary to re-evaluate our clinical “guidelines” on mesh placement in umbilical hernia repair: apparently not every umbilical fascial defect needs mesh repair. Research should focus on establishing risk factors for hernia recurrence.