目的评价应用疝环充填式无张力疝修补术治疗腹股沟嵌顿疝并发小肠坏死的手术效果。方法对于我院2001年5月至2009年5月期间收治的21例腹股沟嵌顿疝并发小肠坏死患者应用疝环充填式无张力疝修补术给予一期修补，先行坏死肠管切除，后置入网塞。结果无手术死亡病例，1例患者发生切口感染，经换药后治愈。平均住院时间65 d。全部患者随访6个月至8年，平均51个月，未见复发。结论 疝环充填式无张力疝修补具有创伤小、安全及患者恢复快的优点，对于腹股沟嵌顿疝并发小肠坏死可以行一期修补，临床效果满意。
【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 investigate the most suitable anaesthesia method for the tension-free herniorrhaphy.Methods A total of 422 unilateral inguinal hernia cases from 2002 to 2005 were collected and randomly divided into the local anaesthesia group and epidural anaesthesia group. Observation indices and some relative data, such as operative duration, date of ambulation, date of foodintake, length of hospital stay, operation-correlated complications, anaesthesia complications, usage rate of ancillary drug, satisfactory rate for anesthesia, cost of hospitalization, were included and recorded in the questionnaire, and all the patients who took the tension-free herniorrhaphy were asked to answer it as the follow-up research. Results It was found that the occurrence of postoperative anaesthetic complications, the cost of hospitalization, length of stay of local anaesthesia group were significantly less than those of epidural anaesthesia group, and the date of moving and the date of foodintake were also significantly earlier than those of the other group (P＜0.05). However, there was no significant difference of operative duration, postoperative recovery situation and the satisfactory rate between two groups (P＞0.05).Conclusion The local anaesthesia is suitable for most of the tension-free herniorrhaphy, and it may be used as the conventional anaesthetic method.
目的 探讨带记忆弹簧圈（MK）补片在无张力修补中、小切口疝中的应用。方法 回顾性分析2005年1月至2007年1月期间我院实施MK补片下置术修补腹壁中、小切口疝25例患者的临床资料，其中初发21例，复发4例。结果 22例一期愈合，3例发生切口皮下积液，经穿刺抽吸处理后治愈。住院7～15 d，均痊愈出院。随访10个月至2年，无复发病例。结论 用MK补片下置术修补腹壁中、小切口疝经济、安全、有效、感染风险降低。
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.
Objective To evaluate the clinical effect of Easy Prosthesis D-10 on open preperitoneal groin tension-free hernioplasty. Methods The operative time, operation-correlated complications, hospital stay and recent follow-up findings of 63 patients underwent preperitoneal groin tension-free hernioplasty were analyzed from October 2006 to April 2008. Results No case died in perioperative period. The average operative time was (47.6±10.5) minutes. None of incision infection and scrotal hydrocele occurred. The average hospital stay was (7.7±2.1) days. During follow-up period of 6 to 24 months, no recurrence, chronic pain and foreign body sensation were found. Conclusion The open preperioneal groin tension-free hernioplasty by Easy Prosthesis D-10 is safe and reliable, especially for the inguinal hernia with large hernia ring or defect of transversalis fascia and recurrent hernia.
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。