聚丙烯补片材料在腹股沟疝修补中的临床应用研究

目的:采用生物材料补片进行修补,加强腹壁薄弱区域实现功能重建,分析该方法治疗腹股沟疝的临床疗效。方法:选择我院收治的无嵌顿性择期腹股沟疝手术患者30例,随机分为传统修补组与生物补片修补组。比较患者的围手术期指标(手术时间、出血量、住院时间、术后下地活动时间、镇痛药物应用例数)、临床疗效,通过随访比较术后1个月、3个月、6个月患者的VAS评分及主观满意度,记录切口感染及其他并发症的发生情况。结果:所有患者均顺利完成手术,并完成半年以上随访。研究组的手术时间、术中失血量、住院时间、术后下地活动时间、镇痛药物应用均明显短于或低于对照组(P0.05)。两组患者术后1个月、3个月、6个月的VAS评分、主观满意度均较术前显著降低(P0.05),但两组之间相比差异无统计学意义(P0.05)。结论:采用生物补片材料修补腹股沟疝的手术创伤较小且患者恢复期短,近期疗效及安全性与传统手术相当。     

腹腔镜下腹壁疝修补术的治疗现状与进展

腹壁疝是普外科最常见的疾病之一,主要包括腹股沟疝、切口疝、造口旁疝等,手术是其唯一的治愈方法。腹腔镜腹壁疝修 补术是在无张力疝修补术的基础上发展起来的一种微创技术,主要包括腹腔镜下腹壁疝修补术(LIHR),如经腹腔镜腹膜前补片修 补术(TAPP)和完全腹膜外补片修补术(TEP),腹腔镜下切口疝修补术及腹腔镜下造口旁疝修补术。其术后常见并发症与传统疝修 补术相同,但发生率显著低于传统的开腹疝修补术。与传统疝修补术相比,腹腔镜腹壁疝修补术具有术后疼痛轻、并发症少、疤痕 小、复发率低等优势,因此临床应用前景广阔。本文主要就腹腔镜下腹壁疝修补术的治疗现状与进展进行了综述。     

开放式腹膜前间隙修补术与Lichtenstein修补术治疗腹股沟疝的比较

目的：比较腹股沟疝采用Lichtenstein 修补术和开放式腹膜前间隙修补术的临床效果和安全性。方法：将我院普外科收治的 132例腹股沟疝患者随机分为两组,每组66 例。一组患者采用Lichtenstein 修补术进行治疗,另外一组患者采用开放式腹膜前间 隙修补术进行治疗,对比两组平均手术时间、平均术中出血量、平均术后下床时间、平均术后住院时间、平均术后恢复时间;对比 两组患者术后各种并发症的发生情况和1 年内复发情况。结果：腹膜前间隙组平均手术时间、平均术后下床时间、平均术后住院 时间、平均术后恢复时间略短于Lichtenstein 组,平均术中出血量略少于Lichtenstein 组,但差异无统计学意义(P＞0.05);腹膜前间 隙组患者各种并发症发生率及术后1 年内复发率明显低于Lichtenstein 组,差异具有统计学意义(P＜0.05)。结论：腹股沟疝采用开 放式腹膜前间隙修补术和Lichtenstein 修补术治疗的临床效果均较好,但开放式腹膜前间隙修补术的并发症发生率和1 年内复发 率更低,临床优势更明显。     

腹股沟疝腹腔镜下修补术与无张力修补术应用于老年患者的综合疗效研究

目的:腹股沟疝是外科中最常见的疾病之一,手术治疗是腹股沟疝的惟一可靠方法。腹腔镜下腹股沟疝修补术,尤其是完全腹膜外腹腔镜(Totally Extra-preperioneal Prosthetic,TEP)疝修补术,已经成为腹股沟疝治疗的"金标准"。然而,针对65岁以上老年人群,心血管基础疾病较多,全麻风险大,TEP术式疗效是否优于无张力疝修补术还未有报道,本研究拟探讨针对老年人腹股沟疝修补的最佳手术方式。方法:排除两种修补术明确的禁忌症患者,对研究入组的92例≥65岁腹股沟疝老年患者,根据手术方式(TEP术或无张力疝修补术)进行分组,术后分别统计:(1)围手术期评价指标(手术时间、术中出血量、手术并发症、疼痛等级、离床活动时间、住院时间及住院总费用);(2)远期随访指标(术后2年内的慢性疼痛和复发情况)。综合评估腹腔镜下修补术与无张力修补术应用于老年腹股沟疝气治疗的综合疗效。结果:TEP术相比于无张力疝术只显示出在平均减少20 m L出血量及缓解术后24小时1个AVS疼痛数量级的优势(P0.01);在术后下床活动时间、手术时间、术后96小时疼痛指数、围手术期并发症、住院天数、慢性疼痛指数及远期疗效等主要评价指标中均与无张力修补术相当(P0.05);但却大大增加了手术费用(P0.01)。结论:针对≥65岁腹股沟疝老年患者,尤其是基础疾病多,对医疗费用敏感的人群,开展无张力修补术仍不失为目前最佳选择。     

充填式无张力疝修补术及并发症防治

目的:探讨无张力疝修补术的应用价值及及并发症防治的意义。方法:回顾性分析填充式无张力疝修补术治疗腹股沟疝52例的临床资料。结果:全组手术时间(46±22)min,切口均一期愈合,术后3～7d出院,并发症发生率仅1.9%,随访无复发。结论:无张力疝修补术创伤小、疼痛轻、恢复快,是治疗腹股沟疝的最佳术式,熟练的技术和规范化操作是预防并发症发生的关键。     

局麻下无张力修补腹股沟疝56例分析

目的总结无张力疝修补治疗腹股沟疝56例的效果。方法局麻下、使用聚丙烯编织而成的平片对56例各类腹股沟疝患者进行无张力修补治疗。结果与在硬麻或全麻下与传统的修补方法相比,具有手术适应证广、方法简单、创伤小,恢复快,并发症少和复发低率。结论应用国产的平片修补腹股沟疝效果良好,价格便宜,局麻下施行无张力疝修补术适合在基层医院推广。     

腹腔镜下经腹腹膜前疝修补术与李金斯坦疝无张力修补术治疗老年腹股沟疝患者的疗效对比分析

摘要 目的：对比腹腔镜下经腹腹膜前疝修补术（TAPP）和李金斯坦（Lichtenstein）疝无张力修补术两种手术方式治疗老年腹股沟疝患者的疗效。方法：收集2018年8月-2020年7月于上海中医药大学附属岳阳中西医结合医院甲疝外科治疗的118例老年(≥60岁)腹股沟疝患者的临床资料进行回顾性分析,根据不同的手术方法分组,68例患者行TAPP作为TAPP组,50例患者行Lichtenstein疝无张力修补术作为Lichtenstein组。比较两组患者手术时间、术中出血量、术后切口视觉模拟量表（VAS）评分、排气时间、住院时间及术后近远期并发症发生率。结果：两组患者手术时间比较无显著差异（P＞0.05）;TAPP组患者术中出血量、排气时间和住院时间均显著低于Lichtenstein组（P＜0.05）;TAPP组患者术后不同时点切口VAS评分均显著低于Lichtenstein组（P＜0.05）;TAPP组患者近期并发症发生率显著低于Lichtenstein组（P＜0.05）;两组患者远期并发症发生率比较无显著差异（P＞0.05）。结论：与Lichtenstein疝无张力修补术比较,TAPP是治疗老年腹股沟疝患者安全有效的手术方法,可减轻患者术后疼痛感,患者恢复更快,并发症发生率更低,值得推广及应用。     

充填式无张力疝修补术及并发症防治

目的：探讨无张力疝修补术的应用价值及及并发症防治的意义。方法：回顾性分析填充式无张力疝修补术治疗腹股沟疝52例的临床资料。结果：全组手术时间（46±22）min,切口均一期愈合,术后3～7d出院,并发症发生率仅1．9％,随访无复发。结论：无张力疝修补术创伤小、疼痛轻、恢复快,是治疗腹股沟疝的最佳术式,熟练的技术和规范化操作是预防并发症发生的关键。     

双源CT测量前交叉韧带单束重建术后隧道位置的临床研究

目的:应用双源CT(Dual-source computer tomography,DSCT)测量前交叉韧带(Anterior cruciate ligament,ACL)单束重建术后胫骨、股骨隧道位置,并对隧道位置进行评价。方法:对2013年1月至2014年6月我科收治的92例(男64例,女28例,平均年龄31.2岁)ACL单束重建患者术后膝关节进行双源CT三维重建,应用Adobe Photoshop CS6软件圈画隧道中心并采用Lorenz法测量胫骨隧道中心点相对位置百分比(Tx,Ty),采用Bernard四格表法测量股骨隧道中心点相对位置百分比(Fx,Fy)。结果:Tx平均为(54.54±3.42)%,Ty平均为(39.58±6.72)%,Fx平均为(28.98±6.51)%,Fy平均为(28.04±8.70)%。男、女性及左、右膝之间Tx、Ty、Fx、Fy的差异均无统计学意义(P0.05)。结论:双源CT能够清晰,三维显示ACL术后隧道,可以用来评估隧道位置,为改进前交叉韧带损伤后的手术方式及个体化解剖重建提供帮助。     

普理灵疝装置治疗110例老年腹股沟疝的临床观察

目的:探讨普理灵疝装置(prolene hernia system,PHS)治疗老年腹股沟疝的临床疗效.方法:回顾性分析新疆维吾尔自治区人民医院2008年12月～2012年12月应用普理灵疝装置治疗的110例老年腹股沟疝患者的临床资料,对手术方法、术后能力恢复、并发症和复发率等项目进行分析.结果:110例老年腹股沟疝患者的手术时间平均50min,其中42例局麻患者术后即能下床活动,68例硬膜外麻醉患者术后第2天能离床活动.本组患者无死亡,无切口感染、缺血性睾丸炎、尿潴留等.术后有排尿困难4例,在12h后症状缓解;部分术后伤口稍微疼痛,于术后1～2天缓解;伤口异物感3例,全部切口Ⅰ期愈合,平均住院时间4d.术后110例随访2～18个月,无明显异物感,无慢性疼痛,无复发病例.结论:PHS可有效降低老年腹股沟疝术后的复发率、手术创伤小,患者恢复快,适合于老年人腹股沟疝的外科治疗.     

腹腔镜TAPP与李金斯坦（Lichtenstein）疝修补术治疗腹股沟疝对血清睾酮浓度、MMP-2的影响

摘要 目的：探讨腹腔镜腹膜前疝修补术（TAPP）与李金斯坦（Lichtenstein）疝修补术治疗腹股沟疝对血清睾酮浓度、基质金属蛋白酶-2（MMP-2）的影响。方法：选取2017年1月~2021年1月80例腹股沟疝患者,采用随机数字表法将其分为TAPP组（n=44）与Lichtenstein组（n=36）,记录两组手术指标、术后并发症及复发率,于术前和术后1个月血清检测睾酮和MMP-2水平。结果：TAPP组术中出血量、术后肛门排气时间显著少于Lichtenstein组（P＜0.05）,两组手术时间比较无差异（P＞0.05）;TAPP组术后住院时间少于Lichtenstein组,住院费用高于Lichtenstein组（P＜0.05）,两组术后复发率对比无差异（P＞0.05）;TAPP组阴囊水肿发生率显著低于Lichtenstein组（P＜0.05）,其它并发症组间比较无差异（P＞0.05）;两组术前术后血清睾酮均无变化（P＞0.05）。术后两组MMP-2水平均显著降低（P＜0.05）,但组间比较无差异（P＞0.05）。结论：两种术式对股沟疝患者睾丸功能均无损伤,且均可有效降低血清MMP-2水平,防止股沟疝复发,安全有效;相比之下,腹腔镜ATPP创伤更小,术后恢复更快,但手术难度较大,费用较高,两种术式各有优缺点,需结合患者的实际情况选择术式。     

腹腔镜腹股沟疝修补术患者术后出血及二次手术相关因素分析

目的:探讨影响腹腔镜腹股沟疝修补术患者术后出血及二次手术相关因素。方法:回顾性分析行腹腔镜腹股沟疝修补术的6632例患者的临床资料,将凝血病、抗凝治疗或抗血小板治疗的829例患者归入风险组(n=829),其他患者归为对照组(n=5803),收集并比较二组患者的手术方式、年龄、性别、美国麻醉师协会(ASA)分级、疝缺损面积(I-III级)、一期手术与二次手术等患者资料,进行一年随访;采用多变量分析影响患者继发性出血及并发症所致二次手术的相关因素。结果:风险组的术后出血发生率显著高于对照组(4.22%vs 1.26%,P0.001),所有患者术后出血发生率为1.63%。影响术后继发性出血的其它负面因素有:开放式腹股沟疝术式、年龄增加、较高ASA分级、二次手术、男性和较大的疝缺损。风险组与并发症相关的二次手术发生率显著高于对照组(2.65%vs 1.14%,P0.001),所有患者与并发症相关的二次手术发生率为1.32%。影响患者并发症所致二次手术负面因素有:双侧手术、较高ASA分级、凝血病与抗凝治疗和抗血小板治疗、高龄,保护因素包括:较小的疝缺损面积与腹腔镜手术式。结论:行腹腔镜腹股沟疝手术患者术后出血性及并发症相关的二次手术的风险小于行开放术式患者。     

Bilateral Hernias in the Female

An experience with 216 bilateral hernias in female patients is reviewed. The condition is rare, occurring only once in every 250 patients admitted for a hernia repair. Bilateral primary indirect inguinal hernias were the most frequent type. Bilateral primary femoral hernias were quite rare while bilateral primary direct inguinal hernias were even more uncommon. Other rare bilateral combinations are briefly described. The incidence in children is given.Etiological factors are discussed, emphasizing the strong posterior wall of the inguinal canal in females.Two per cent of patients developed a recurrent hernia; one per cent of hernias recurred. No recurrence following a bilateral primary indirect inguinal hernia repair and no “femoral” recurrence following inguinal repair were recorded.     

Lipid peroxidation and inguinal hernia repair. Tension-free vs. Andrews technique

AIM OF THE STUDY: To evaluate the early effect of inguinal hernia repair by the tension-free method compared to the conventional Andrew's technique on lipid peroxidation. PATIENTS-METHODS: Thirty-four patients subjected to elective hernia repair were enrolled in the study divided in two groups. Group A (n=18) underwent hernia repair by the tension-free method using a polypropylene mesh. Group B (n=16) underwent hernia repair by the Andrew's technique (i.e. a modification of the Bassini's technique). Venous blood samples were drawn preoperatively and at 12, 24 and 48 h postoperatively. Malondialdehyde (MDA) was estimated by the thiobarbiturate assay. RESULTS: Neutrophil counts were significantly higher in patients of group B compared to group A at 12 and 48 h postoperatively. Concentrations of fibrinogen were similar between the two groups. MDA was significantly higher in patients of group B hours compared to group A at 12, 24 and 48 h postoperatively. Positive correlation was found between neutrophil counts and MDA at 12 h (r: +0.43, P: 0.015) and 48 h (r: +0.496, P: 0.005) but not at 24 h. No correlation was found between serum fibrinogen and MDA. CONCLUSION: Hernia repair by the Andrews's technique elicits a sustained triggering of lipid peroxidation, compared to the tension-free method.     

The long-term effect of mesh bioprosthesis in inguinal hernia repair on testicular nitric oxide metabolism and apoptosis in rat testis

Polypropylene mesh is the most widely used material in inguinal hernia repair. Although polypropylene mesh is known as an inert material, it is experimentally proven that mesh generates a chronic inflammatory tissue reaction. The aim of the present study was to investigate the long-term effects of polypropylene mesh material used in inguinal hernia operations on testicular function, testicular nitric oxide (NO) metabolism and germ cell-specific apoptosis in rats. The study comprised 40 male rats that were randomly allocated into two groups. In group 1, the left spermatic cord was elevated and a 0.5 x 1 cm polypropylene mesh was placed behind the left inguinal spermatic cord and group 2 consisted of the sham-operated controls. Blood samples were taken at 6 months preoperatively and postoperatively after to assess luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels for hormonal evaluation. Testicular NO was evaluated by the Griess method, apoptosis by a TUNEL method and inducible nitric oxide synthase (iNOS) and endothelial NOS (eNOS) expressions by immunohistochemical staining. Mild (+) eNOS expression was observed in all specimens. Mild (+) iNOS expression was only detected in ipsilateral testis of the mesh-implanted study group. Apoptotic cells were not detected in any samples. We are of the opinion that long-term polypropylene mesh implantation has no effect on testicular hormonal function and only a limited effect on nitric oxide levels and this effect is not sufficient to cause apoptosis in testis that could lead to infertility. It seems that mesh implantation is a reliable method in inguinal hernia repair; however, further work is required by more sensitive methods to fully elucidate the potential testicular damage.     

Femoral Hernia in the Female

A study of 384 consecutive femoral herniorrhaphies performed upon female patients admitted to Shouldice Hospital, Toronto, during a 19-year period was carried out. Its main purpose was to describe the techniques used and to evaluate the results obtained. A careful 10-year follow-up plan for all cases existed.Two hundred and ninety-three operations were performed for the repair of simple femoral hernia; 91 were performed for the repair of femoral hernia which had developed following an initial ipsilateral inguinal or femoral repair performed previously, either in this hospital or elsewhere.The basic repair was subinguinal. Four modifications are described, one entirely subinguinal and three combined with exploration of the inguinal canal.The recurrence rate for simple femoral hernia in the female was 1.3% and for “recurrent” femoral hernia in the female, 5.5%.