利用腹外斜肌腱膜重建腹股沟管的疝修补

我们在对腹股沟区及骨盆解剖标本的立体测量基础上,利用腹外斜肌腱膜来重建腹股沟管行疝修补,现报告如下.     

腱膜性腹股沟疝修补术治疗腹股沟疝54例分析

目的探讨腱膜性腹股沟疝修补术治疗腹股沟疝的疗效。方法回顾性分析我院1996年9月~2004年9月采用腱膜性腹股沟疝修补术治疗54例腹股沟疝患者的临床资料。结果手术后所有病人切口疼痛轻微,无切口感染,1例并发阴囊血肿,经穿刺抽液治愈。手术后6~7 d拆线岀院。平均随访42(12~72)个月,无睾丸坏死或萎缩,无复发。结论应用腱膜性腹股沟疝修补术治疗腹股沟疝具有操作简单、效果良好、术后疼痛轻微、无严重并发症等优点,是治疗腹股沟疝较理想的手术方式。     

腹外斜肌腱膜支撑缝合修补移植肾破裂

我院从 1985年 7月～ 1999年 11月 ,共行同种异体肾移植术 40 2例 ,其中尸肾移植术 397例 ,亲属活体供肾移植 5例 ,发生移植肾破裂 14例 ,均为尸肾移植术 ,发生率为 3 .48%。采用腹外斜肌腱膜支撑缝合修补法挽救破裂供肾5例 ,均获成功 ,报告如下。材料与方法一、临床资料5例供者均为青年男性脑死亡者 ,左侧供肾 2例 ,右侧供肾 3例。 5例受者均为男性 ,年龄 33～ 5 9岁 ,平均 46 .4岁。合并有急性排斥反应 5例 ,肾功能延迟恢复 4例。肾破裂发生时间距术后4～ 11ｄ ,平均为 6ｄ。破裂修补距临床确诊时间平均为 1.5ｈ。临床表现主要为移植肾区…     

腹外斜肌筋膜原位修补腹股沟疝22例分析

本研究旨在观察腹外斜肌筋膜原位修补腹股沟疝的效果,现将结果报道如下。 一、临床资料 1.一般资料:本组22例中,男18例,女4例。年龄19～65岁。平均年龄32.5岁。其中腹股沟斜疝18例,直疝4例。均为择期手术。 2.手术方法:于腹股沟管中点内侧2cm处作一与其平行切口,下至耻骨处。逐层切开止血,充分显露腹外斜肌筋膜。于其中点内外各1 cm处沿其纤维方向剪开,并与其下组织充分游离。同时游离两侧腹外斜肌筋膜,外至腹股沟韧带,内至腹直肌鞘外缘。再将覆盖在精索上的提睾肌从腹股沟管底面和耻骨面钝性     

55例成人腹股沟疝传统修补术后复发原因分析

目的 分析成人传统腹股沟疝修补手术后复发的原因.方法 对513例成人传统腹股沟疝修补手术后复发的55例行再次修补手术,采用疝环充填式无张力疝修补术35例,Marlex补片修补11例,9例行Shouldice修补术.结果 随访6个月~5 a,无1例再复发.结论 腹股沟疝术后复发的原因很多,疝环充填式无张力疝修补术可有效降...     

无张力疝修补术治疗腹股沟疝的体会(附126例报道)

目的 总结腹股沟疝无张力疝修补术的手术经验.方法 回顾性分析我院2002年2月至2009年1月期间126例腹股沟疝患者行无张力疝修补术的临床资料及手术方法.结果 本组126例患者无围手术期死亡者,并发症主要有局部肿胀、异物感、疼痛等,随访6个月～6年(平均38个月)有6例(4.8%)复发.结论 无张力疝修补术是治疗腹股沟疝较为理想的术式.     

无张力疝修补术治疗复发性腹股沟疝(附16例临床分析)

目的探讨无张力疝修补术在复发性腹股沟疝中的临床应用价值。方法自2002年1月至2005年1月,我院应用无张力疝修补术治疗复发性腹股沟疝16例进行回顾性分析。结果平均手术时间55min,术后1例出现阴囊积液,2例切口脂肪液化,无切口感染病例,平均住院5天,随访12～36个月均无复发。结论无张力疝修补术是治疗复发性腹股沟疝的较理想术式,具有安全、创伤小、术后恢复快、疗效满意,尤其是复发率低等优点。     

应用无张力疝修补术修补腹股沟疝100例分析

<正>2009-03—2012-12,我科在腰硬联合麻醉下应用无张力疝修补术治疗腹股沟疝100例,效果良好,现报告如下。1资料与方法1.1一般资料本组患者100例均为男性,年龄40～95岁,平均60岁。腹股沟斜疝88例,腹股沟直疝12例。腹股沟原发疝98例,复发疝2例。1.2方法 (1)材料:贝朗公司生产的10 cm×7 cm聚丙烯平片。使用前先将其折叠,修剪成刀型,并在中间剪一开口,以便     

疝环充填式无张力疝修补术治疗成人腹股沟疝

目的:探讨疝环充填式无张力疝修补术在腹股沟疝修补术中的价值。方法:回顾性总结我院应用疝环充填式无张力疝修补术治疗腹股沟疝患者36例次。其中合并高血压、冠心病、心肺功能不全、糖尿病者占41.7％(15／36)。结果:切口均为一期愈合。术后5~8天出院,随访6~20个月,平均12个月,随访率为88.9％(32／36),无1例复发。结论:疝环充填式无张力疝修补术具有更符合人体解剖结构、无张力、创伤小、痛苦小、恢复快、复发率低等优点。适合基层医院推广使用。     

腹股沟疝网塞无张力疝修补术的临床疗效观察（附312例报告）

目的探讨疝环充填式无张力疝修补术治疗腹股沟疝的临床治疗方法和疗效。方法回顾性分析312例腹股沟疝病人采用的聚丙烯网塞及成型补片行疝环充填式无张力疝修补术。结果手术时间30分钟-90分钟,术后24—36h下床活动。6例术后伤口持续疼痛,26例切口轻度异物感,8例切口下血肿;11例阴囊积液。无切口感染及引起其他并发症,2例术后6个月复发。结论疝环充填式无张力疝修补术具有符合人体生理解剖结构、术后疼痛轻、恢复快、并发症少和复发率低的优点。     

免气囊分离器完全腹膜外补片腹腔镜腹股沟疝修补术

目的探讨免气囊分离器完全腹膜外腹腔镜腹股沟疝修补术的优点、难点、术中常见的失误及解决办法. 方法 2003年11月～2004年7月,完成11例免气囊分离器完全腹膜外补片腹腔镜腹股沟疝修补术.腹股沟斜疝8例,7例为右侧,1例为左侧;直疝3例,左侧2例(其中1例为复发性直疝),右侧1例. 结果平均手术时间74.1 min,平均出血量13.6 ml,平均术后住院天数为2.2 d.术后平均5.3 d恢复日常活动.术中发生腹壁下动脉游离、误入解剖层次和腹膜撕裂各1例.随访1～7月,未见1例复发及神经性疼痛等并发症. 结论免气囊分离器完全腹膜外腹腔镜腹股沟疝修补术与常规气囊分离器完全腹膜外腹腔镜腹股沟疝修补术一样安全、可行,了解该术式的要点,有助于顺利完成手术.     

Incidental Non-Inguinals Hernias in Totally Extra-Peritoneal Hernia Repair

Introduction

Totally extra-peritoneal (TEP) inguinal hernia repair allows identification and repair of incidental non-inguinal groin hernias. We assessed the prevalence of incidental hernias during TEP inguinal hernia repair and identified the risk factors for incidental hernias.

Materials and Methods

Consecutive patients undergoing TEP repair from May 2005 to November 2012 were the study cohort. Inspection for ipsilateral femoral, obturator and rarer varieties of hernia was undertaken during TEP repair. Patient characteristics and operative findings were recorded on a prospectively collected database.

Results

A total of 1,532 TEP repairs were undertaken in 1,196 patients. Ninety-three patients were excluded due to incomplete data, leaving 1,103 patients and 1,404 hernias for analyses (1,380 male; 802 unilateral and 301 bilateral repairs; median age, 59 years). Among the 37 incidental hernias identified (2.6% of cases), the most common type of incidental hernia was femoral (n=32, 2.3%) followed by obturator (n=2, 0.1%). Increasing age was associated with an increased risk of incidental hernia, with a significant linear trend (p<0.01). The risk for patients >60 years of age was 4.0% vs 1.4% for those aged <60 years (p<0.01). Incidental hernias were found in 29.2% of females vs 2.2% of males, (p<0.0001). Risk of incidental hernia in those with a recurrent inguinal hernia was 3.0% vs 2.6% for primary repair (p=0.79).

Conclusions

Incidental hernias during TEP inguinal hernia repair were found in 2.6% of cases and, though infrequent, could cause complications if left untreated. The risk of incidental hernia increased with age and was significantly higher in patients aged >60 years and in females.     

Review Article: Appendicitis In Groin Hernias

To review the clinical presentation, outcome and causes of acute appendicitis presenting within a groin hernia. A comprehensive review of the past 70 years of English language surgical literature was conducted pertaining to acute appendicitis presenting within an inguinal or femoral hernia. Thirty-four reports describing 45 patients were reviewed to determine age, position, gender, pathologic stage at presentation, causal suppositions, and clinical outcomes. Hernial appendicitis presented as an inguinal abscess or a tender inguinal mass, often in the femoral position, and most commonly at the extremes of age. It was almost never recognized preoperatively, and, because of the sequestered nature of the inflammatory process, presented with few classic systemic signs or symptoms suggestive of acute appendicitis. Advanced pathologic stage and death correlated with the patient's age, delay in presentation, and delay in recognition. Evaluation of an inguinal abscess or a nonreducible tender groin hernia presenting in a patient at the extremes of age, should include computed tomography to rule out an occult acute appendicitis within the hernia, as systemic signs and symptoms of appendicitis are rarely evident. The condition appears to be caused by inflammatory adhesions caused by appendicitis occurring within an enlarged hernial orifice rather than appendicitis caused by external compression of the appendix base. Early recognition of this unique presentation of appendicitis allows trans-hernial appendectomy and immediate herniorraphy. Delayed diagnosis requires drainage of abscess with appendectomy and interval hernia repair.     

腹股沟疝无张力修补术后复发的外科治疗

目的探讨无张力疝修补术后复发性腹股沟疝的外科手术治疗方法。方法67例复发性腹股沟疝中,使用人工材料行无张力疝修补手术后复发者有13例(19.4%),均再次手术治疗,采用Kugel补片1例、PHS补片修补3例和疝环充填式无张力修补9例。结果术后发生伤口积液1例,阴囊水肿1例,无切口感染,术后随防3～63个月,未见复发。结论无张力疝修补术后亦难免复发,再手术时宜根据术中所见选用不同的疝修补方式,但网塞疝环充填法仍然是一种简单、有效的治疗方法。     

疝环充填式无张力疝修补术治疗腹股沟嵌顿疝

目的探讨疝环充填式无张力疝修补术治疗腹股沟嵌顿疝的临床效果. 方法采用美国巴德公司的聚丙烯锥形充填物及成型补片对45例腹股沟斜疝嵌顿施行疝环充填式无张力疝修补术. 结果手术时间48～98 min,平均75 min.术后12～24 h均下床活动.切口疼痛2～4 d.术后切口脂肪液化2例,排尿困难2例.术后住院3～10 d,平均5 d.39例随访5～18个月,平均12.5月,无复发. 结论疝环充填式无张力疝修补术具有安全、创伤小、恢复快、术后复发率低的优点,对嵌顿疝可Ⅰ期成功修补,临床效果满意.     

Groin hernias: features of recurrences

Summary In 2390 groin hernias operated on by the same surgeon there were 2327 inguinal hernias (97.4%) and 63 femoral (2.6%); 261 (11.2%) were recurrent hernias. The aim of this study was to define the different features of recurrences in a series of 206 recurrences operated on by an inguinal approach. The median time of recurrence was 3 years (< 1–58). It was < 1 year in 67 cases (40%) and 50% of all recurrences had occurred in 2.4 years. The time of recurrence after operation performed in childhood was 31 years (15–58). All recurrences were located in the area of the myo-pectineal and femoral orifices. There was only one site of recurrence in 125 cases (61%); the recurrence was direct in 73 cases (58%), indirect in 44 cases (35%) and femoral in 8 cases (7%). There were 2 sites of recurrence in 81 cases (39%), 76 mixed (94%) and 6 inguinal associated with a femoral hernia (6%). Altogether there were 288 sites of recurrence. There were 44 direct diverticular recurrences and 26 of these were located near the pubic tubercle. The rate of recurrence in current practice is much higher than that in specialized centers. The long delay of recurrence after simple resection of the sac in childhood constitutes an indirect argument for the Marcy procedure in adolescents and young men with type I or II hernias. The preeminence of direct recurrences and the existence of direct diverticular suprapubic recurrences are arguments for mesh procedures. The fact that all recurrences are located in the area of myo-pectineal and femoral orifices must be considered for the choice of a mesh procedure.     

开放与腹腔镜无张力疝修补术治疗老年腹股沟疝的对比研究

目的比较开放和腹腔镜完全腹膜外无张力疝修补治疗老年腹股沟疝的疗效。方法 2006年1月～2010年1月136例老年腹股沟疝行开腹无张力填充式腹股沟疝修补术（开放组,n=72）或腹腔镜完全腹膜外腹股沟疝修补术（totally extraperitoneal hernioplasty,TEP）（TEP组,n=64）,比较2种术式疗效。结果开放组手术时间（65.3±18.1）min,明显短于TEP组（78.1±12.6）min（t=4.742,P=0.000）。开放组住院费用（4960.2±1033.3）元,明显低于TEP组（6998.0±1632.2）元（t=8.796,P=0.000）。开放组术后24 h和1周疼痛评分明显高于TEP组（Z=-7.144,P=0.000;Z=-6.408,P=0.000）;术后住院时间（4.9±2.4）d明显长于TEP组（3.6±1.5）d（t=-3.733,P=0.000）。136例无严重并发症。开放组72例随访8～46个月,平均15个月,其中〉24个月11例;TEP组64例随访4～35个月,平均14个月,其中〉24个月9例,2组均无术后复发。结论 2种术式治疗老年腹股沟疝是安全有效的。TEP疼痛轻,恢复快,应首选,尤其适用于双侧腹股沟疝修补;开放无张力疝修补术费用低,易开展,非常适用于合并有心肺疾病无法耐受全麻或CO2气腹的老年患者。     

Groin pain in the absence of hernia: a new syndrome

Abstract Abstract. Groin pain may be produced by a true hernia, trauma to the groin structures or peripheral nerve, or root compression at various levels. Approximately 4,000 patients underwent inguinal herniorrhaphy (group A). An additional 134 patients complaining of groin pain and exhibiting no evidence of primary or recurrent hernia fell into two categories: 30 patients who had a previous herniorrhaphy (group B) and 104 patients without previous surgery (group C). Group B patients underwent a diagnostic nerve block which, when positive, suggested ilioinguinal nerve compromise at the wound. Those who failed conservative measures underwent nerve division. Group C patients were advised to decrease recreational and occupational activities; if that failed, they underwent lumbosacral spine imaging. There were no neuralgias in group A. Eight group B patients responded to conservative measures; the 22 others required ilioinguinal nerve division which relieved their pain. In group C, 42 patients responded to physical activity restriction plus NSAIDs; the remaining 62 underwent imaging which revealed lumbosacral bone pathology producing root compression and were referred to orthopedists. Lumbosacral spine pathology should be suspected in patients who complain of groin pain in the absence of hernia or previous herniorrhaphy. Recognition of this syndrome may avoid negative exploratory herniorrhaphies. Electronic Publication     

平片无张力修补术与腹腔镜经腹腔腹膜前补片植入术治疗成人原发性腹股沟疝的比较

目的比较平片无张力修补术(Lichtenstein)与腹腔镜经腹腔腹膜前补片植入术(transabdominal preperitonealpatch repair,TAPP)治疗成人原发性腹股沟疝的效果。方法回顾分析我院2002年1月~2006年1月行Lichtenstein术223例及行TAPP术121例的临床资料,比较其手术效果及并发症。结果TAPP组术中发生胸腹腔内器官损伤率高于Lichtenstein组[5.8%(7/121)vs 0.4%(1/223),χ2=7.626,P=0.006],而腹壁器官损伤2组并发症发生率分别为0.8%(1/121)和3.1%(7/223),差异无显著性(χ2=0.969,P=0.325)。术后并发症发生率TAPP组低于Lichtenstein组[14.0%(17/121)vs 36.3%(81/223),χ2=18.881,P=0.000]。TAPP组随访(14±7)月,1例(0.8%)复发,Lichtenstein组随访(16±8)月,2例(0.9%)复发,差异无显著性(χ2=0.000,P=1.000)。结论Lichtenstein与TAPP各有优缺点。在进行疝修补时外科医师应选用个体化的方案,严格掌握各种方法的适应证。     

Results of Performing Mesh Plug Repair for Groin Hernias

The simplicity and good postoperative results of mesh plug repair for groin hernias have been reported in numerous articles. We have been performing this procedure in our department for more than 5 years, and the present study was conducted to reexamine its clinical outcome from our viewpoint. A total of 224 patients with a collective 244 groin hernias underwent mesh plug repair between March 1993 and August 1998. There were 155 (63.5%) indirect hernias, 79 (32.4%) direct hernias, 2 (0.8%) femoral hernias, and 8 (3.3%) compound hernias; 27 (11.1%) were recurrent hernias. Two plugs were inserted in all the compound hernias and in two of the direct hernias with a diffuse weak inguinal floor. The mean operating time was 32.2 min. The complications that developed during this study were continuous pain in four patients, seroma in two, and hematoma in one. The rates of recurrence were 0% for indirect hernias and 12.7% for direct hernias. The patients in whom recurrence developed underwent mesh plug repair again and have had no further recurrence. Our experience showed mesh plug repair to be an excellent technique for indirect hernias or recurrent hernias after mesh repair, but it might be unsuitable for direct hernias with a diffuse bulging weakness in the floor of the inguinal canal. Received: November 25, 1999 / Accepted: September 26, 2000