【Abstract】Objective To investigate the effects of tension-free herniorrhaphy on endocrine functions of patients with inguinal hernia. MethodsOne hundred and twenty-seven patients were randomly divided into tension-free group(n=65) and conventional group (n=62). The mean ages of tension-free group and conventional group were(51.8±14) year and(48.4±12) year respectively. There were 52 indirect hernias and 13 direct hernias in tension-free group. There were 51 indirect hernias and 11 direct hernias in conventional group. Bassini repair was used in conventional group. Peripheral blood samples were obtained preoperatively and 3 h, 24 h after operation for measuring the levels of cortisol, T3, TSH, insuline, Cpeptide and and glucose. The data were analysed through t test. ResultsThe levels of cortisol, C-peptide and glucose in conventional group were remarkably higher (P6”0.05) while the levels of T3,TSH were notably lower (P＜0.05) than those in tension-free group at 3 h, 24 h postoperatively, the level of insulin in conventional group was significantly higher than that in tension-free group at 24 h postoperatively. ConclusionThe results of this study indicate that tension-free repair imposes less influence on the endocrine functions of patients with inguinal hernia postoperatively than conventional repair does. This might explain pathophysiologically the quick recovery of the patients receiving tension-free herniorrhaphy.
目的:探讨腹股沟马鞍疝无张力疝修补手术方式的选择。方法:回顾性调查206例腹股沟马鞍疝患者,其中行巴德网塞充填式修补术57例,普里灵疝装置腹膜前间隙修补术149例,观察两种修补方式的手术时间、手术方式及要点、术后并发症、恢复情况、平均住院日及复发率。结果:两种方式修补的患者围手术期均无死亡。手术时间、恢复情况、术后平均住院天数和并发症两种方式差异均无统计学意义(Pgt;0.05)。患者术后平均随访分别为(2.3±0.5)和(2.2±0.7)年,随访时间无统计学差异(Pgt;0.05)。普里灵疝装置修补组的费用较巴德网塞组低。57例巴德网塞修补术后有2例复发,149例普里灵疝装置腹膜前间隙修补术后无复发。结论:腹膜前间隙无张力疝修补术是腹股沟马鞍疝的首选手术方式。
Objective To summary the experience of transabdominal preperitoneal space tension-free repair for inguinal saddle hernia. Methods 〗The clinical data of 151 cases of inguinal saddle hernias underwent transabdominal preperitoneal space tension-free repair with Prolene hernia system (PHS) were retrospectively analyzed. The operative time, postoperative pain, hospital stay, recurrence and postoperative complications were observed. Results The average operative time in unilateral hernias was (29.8±9.6) min. Postoperative complications included one case of pain in groin and 4 cases of scrotum edema. No incision infection and mortality occurred. Postoperative duration of hospital stay was 3 to 5 days. All cases were followed up for 1-5 years and no recurrence happened. Conclusion 〗Transabdominal preperitoneal space tension-free repair for inguinal saddle hernia by PHS is safe and reliable.
Objective To evaluate the clinical effectiveness of laparoscopic and open tension-free hernia repairs in adults. Methods A fully recursive literature search was conducted in PubMed (2002 to September, 2009), EMBASE (2002 to September, 2009), Cochrane Central Register of Controlled Trials (Issue 3, 2009), CBM (2002 to September, 2009) , CNKI and VIP Chinese Scientific Journals Full-text Database (2002 to September, 2009) in any language. Randomized or quasi-randomized controlled trials of inguinal hernia treated by laparoscopic and open methods in adults were considered for inclusion. The four analyzed outcome variables were chronic pain, long term recurrence, intraoperative complications and postoperative complication. Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out using RevMan 5.0 software. Results Eighteen published reports of eligible studies involving 5816 participants met the inclusion criteria. Compared with open methods, laparoscopic inguinal hernia had no significant differences in long-term recurrence rate [OR 1.53, 95%CI (1.00 to 2.34), P=0.05] and postoperative complication rate [OR 0.74, 95%CI (0.52 to 1.05), P=0.09], and had lower tendency chronic pain [OR 0.45, 95%CI (0.34 to 0.59) , Plt;0.000 01] with statistical significance. There were significant differences in intraoperative complications between the two groups [OR 2.15, 95%CI (1.32 to 3.53), P=0.002]. Conclusion Current evidence suggests that laparoscopic hernia repair is superior to open methods in chronic pain .There is no significant difference in long-term recurrence rate and postoperative complications between the two methods. More studies are needed for intraoperative complications and other long-term postoperative complications.
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。
Objective To explore the cause and treatment of chronic pain after tension-free repair of inguinal hernia. Methods 〗The clinical data of 426 cases with inguinal hernia underwent the tension-free hernioplasty during February 2002 to September 2007 were retrospectively analyzed. Results 〗Tension-free hernioplasty was performed to all patients. According to operative methods, they were divided into two groups: polypropylene filling group (n=210) and expanded polytetrafluoroethylene (e-PTFE) mycromesh group (n=216). The chronic pain rate after operation, polypropylene filling group (9.0%, 19/210) was significantly higher than e-PTFE mycromesh group (4.2%, 9/216)， P＜0.05. Conclusion 〗The tension-free repair by e-PTFE mycromesh has less pain in the inguinal hernia due to the material is more suitable to human physiology, more soft and light, with less complications.
目的报告在局麻下行疝环充填式无张力疝修补术治疗腹股沟疝的体会。方法对该院70例腹股沟疝患者行疝环充填式无张力修补术后的早期自主活动、进食、排尿以及住院日期等情况进行观察。结果在局麻下行疝环充填式无张力疝修补术较之硬膜外麻醉或全麻有更宽的手术指征，且术后进食早，下床早,排尿困难明显降低,住院时间缩短，费用也较低。结论在局麻下行疝环充填式无张力疝修补术，是一种对人体生理功能干扰小、术后恢复快、并发症少、简单易掌握的理想方法之一。
目的总结Millikan无张力疝修补术治疗腹股沟疝的经验。方法对笔者2008年1月至2010年1月期间完成的Millikan无张力疝修补术患者的临床资料进行总结、分析。结果本组 32例共35侧疝，按国内疝学组分型(2003年)，Ⅰ型2侧，Ⅱ型9侧，Ⅲ型21侧，Ⅳ型3侧。直疝6侧，斜疝29侧。其中行急诊疝修补术2例。术后发生尿潴留2例(6.25%),无切口感染、血肿、睾丸炎等并发症发生； 住院时间3~5 d，平均3.5 d。随访2~24个月，平均18个月，无复发及慢性疼痛者。结论Millikan手术是一种操作简便、安全、符合无张力疝修补原理的术式，适用于Ⅱ~Ⅳ型腹股沟疝的修补。
ObjectiveTo investigate the application of tension-free herniarepair under local anesthesia in senile inguinal hernia. MethodsClinical data of 163 cases of senile inguinal hernias with herniorrhaphy under local anesthesia in our department from October 2011 to October 2014 were analyzed retrospectively, including epidural anesthesia 90 patients and local anesthesia 73 patients. ResultsAll patients were successfully completed surgery. Hospital charges in local anesthesia were much cheaper than that in epidural anesthesia group (P=0.002). Hospital days in local anesthesia were much shorter than that in epidural anesthesia group (P=0.035). Lung complication in local anesthesia were much less than that in epidural anesthesia group (P=0.015). Other indicators were no significant difference between the two groups (P > 0.05). ConclusionTension-free herniorrhaphy under local anesthesia in elderly patients is safe, reliable, less invasive method with low costs, slight postoperative pain, and worthy of promotion.