目的探讨普理灵疝装置（PHS）在腹股沟疝修补术中应用的技术要点和目前存在的问题。方法对218例使用普理灵疝装置行无张力修补术的腹股沟疝患者资料进行分析。结果218例患者手术顺利，平均手术时间54 min，术后平均住院时间2.5 d，并发症发生率5.5%（12/218），无复发病例。结论普理灵疝装置是无张力疝修补技术的重要内容，尤其适用于老年Ⅲ型疝和Ⅳ型疝。
目的 观察运用两种不同缝线固定修补材料对疝修补术后的复发、切口感染、慢性疼痛等并发症发生情况。方法 对2008年4月至2010年4月期间笔者所在科室收治的250例腹股沟疝患者行无张力疝修补手术时，采用多股丝线或可吸收合成缝线固定修补材料进行前瞻性对比研究。结果 2组患者术后疝复发、切口感染和切口疼痛（包括慢性疼痛）发生率间的差异均无统计学意义（P＞0.05）。结论 腹股沟疝无张力修补术后的复发、切口感染、慢性疼痛等并发症的发生与缝线选择无关。术者的操作技巧、严格的无菌操作原则、彻底止血以及组织损伤小才是防止术后感染、慢性疼痛等并发症发生的重要因素。
目的 评价3DMax补片在腹腔镜下全腹膜外修补术(totally extraperitoneal,TEP)中修补腹股沟疝的价值。方法 回顾性分析我院2009年2～6月期间腹腔镜下应用3DMax补片对18例腹股沟疝患者行TEP的临床资料，分析其手术时间、住院时间、复发和并发症发生情况。结果 18 例患者中Ⅰ型疝3例，Ⅱ型疝4例，Ⅲ型疝9例，Ⅳ型疝2例； 斜疝11例，直疝6例，股疝1例。成功完成腹腔镜下TEP 17例。1例因疝内容物为末端回肠，与疝囊粘连并局部狭窄梗阻，中转开放手术切除部分回肠。手术时间40～95 min，平均65.4 min。术后均未使用镇痛剂，术后住院时间2～7 d，平均住院5.5 d。术后发生阴囊血清肿1例，经穿刺排液后愈合良好。随访1～6个月，无复发病例。结论 腹腔镜下TEP具有创伤小、恢复快、复发率低等优点，采用预先成型的3DMax 补片使手术操作更加简便。
目的探讨应用超普疝修补装置（UHS）行无张力疝修补的效果和手术体会。 方法回顾性分析2012年6月至2013年11月期间笔者所在医院采用UHS施行腹股沟疝无张力修补术41例患者的临床资料，观察手术时间、伤口疼痛、住院时间、住院费用、并发症发生率以及复发率。 结果手术时间25～100 min，平均48 min；患者术后1 d下床活动；术后有10例患者使用止痛药物；全组切口均一期愈合，无切口感染发生，有2例出现阴囊水肿；术后住院时间4～10 d，平均6 d；住院费用9 249.33～18 976.49元，平均11 428.47元。术后随访1～6个月，平均3个月，无一例复发。 结论UHS技术是目前较为理想的治疗腹股沟疝的手术方式。
ObjectiveTo investigate the relation between preoperative peripheral blood neutrophil/albumin (NEU/ALB) or hypersensitive C-reactive protein (hs-CRP)/ALB ratio and seroma after laparoscopic transabdominal preperitoneal (LTAPP) hernia repair. MethodsThe patients diagnosed with inguinal hernia and underwent LTAPP hernia repair admitted to the Heji Hospital Affiliated to Changzhi Medical College from June 2020 to June 2023 were retrospectively collected. The multivariate logistic regression analysis was conducted to identify the risk factors affecting the occurrence of seroma after LTAPP hernia repair. The area under receiver operating characteristic curve (AUC) and 95% confidence interval (95%CI) were used to evaluate the discriminatory value of preoperative peripheral blood NEU/ALB ratio and hs-CRP/ALB ratio for seroma after LTAPP hernia repair. Delong test was used to compare the discriminatory value of these indicators. The test level was α=0.05. ResultsA total of 357 patients who met the inclusion criteria were included in this study, and the seroma occurred in 42 cases (11.8%). The results of multivariate logistic regression analysis showed that the larger the diameter of the hernia sac [OR (95%CI)=4.654 (2.829, 7.657), P<0.001], the more intraoperative bleeding [OR (95%CI)=3.021 (1.498, 6.094), P=0.002], and the higher NEU/ALB ratio [OR (95%CI)=2.585 (1.618, 4.130), P<0.001] or hs-CRP/ALB ratio [OR (95%CI)=1.874 (1.239, 2.834), P=0.003], the higher the probability of seroma after LTAPP hernia repair. The AUC (95%CI) of NEU/ALB or hs-CRP/ALB indicator for predicting seroma after LTAPP hernia repair was 0.750 (0.702, 0.794) and 0.762 (0.715, 0.806), respectively. The optimal cutoff values were 2.970 and 4.001, with sensitivity of 78.6% and 73.8%, and specificity of 60.3% and 65.7%, respectively. The AUC (95%CI) of the NEU/ALB in combination with hs-CRP/ALB in predicting seroma after LTAPP hernia repair was 0.851 (0.810, 0.886), with sensitivity and specificity of 71.4% and 87.0%, respectively. The AUC of the NEU/ALB in combination with hs-CRP/ALB in predicting seroma after LTAPP hernia repair was higher than that of NEU/ALB (Z=2.864, P=0.004) or hs-CRP/ALB alone (Z=2.956, P=0.003). ConclusionFrom the data analysis results of this study, the occurrence rate of seroma after LTAPP hernia repair is not low, and the occurrence of seroma should be paid close attention to patients with larger hernia sac diameter, more intraoperative bleeding, and higher NEU/ALB or hs-CRP/ALB ratio.
Objective To evaluate the clinical experience and skills of laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection in order to spread and popularize this kind of operation. Methods Under general anesthesia, 32 patients (42 sides) with inguinal hernias were repaired by laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a dissection balloon from August 2005 to December 2007. Results All of operations were successfully performed. The operative time was 60-120 minutes, the blood loss was 20-60 ml, and the length of postoperative hospitalization was 3 days. All cases were followed up for 8 to 18 months and found no recurrence. Conclusion Laparoscopic totally extraperitoneal hernia repair with non-stapling of mesh and without using a balloon dissection is feasible, reliable and effective, offering a low recurrence rate, while its price is higher than tension-free herniorrhaphy by traditional method.
【摘要】 目的 探讨自制双孔导线针在腹腔镜小儿腹股沟疝手术中的应用价值。 方法 回顾性分析2006年4月-2010年6月行腹腔镜小儿腹股沟疝手术655例患儿的临床资料。单孔针手术组452例，双孔针手术组203例，将两组患儿术中、术后资料进行对比分析。 结果 单孔针组手术时间(17. 7±3. 5) min；术中出血(5. 4±1. 3) mL，住院时间(2. 5±1. 0) d发生腹壁下小血肿15例，术后复发3例；双孔针组手术时间(8. 2±2. 3) min，术中出血(1. 4±0. 3) mL，住院时间(2. 1±0. 8) d，发生腹壁下小血肿2例，术后复发1例。双孔针组的手术时间、术中出血、并发症发生率等均明显优于双孔针组(Plt;0. 05)，两组住院天数、复发率差异均无统计学意义(Pgt;0. 05)。 结论 自制双孔导线缝扎针在腹腔镜小儿腹股沟疝手术中应用能够缩短手术时间，操作安全快捷，创伤更小等优点，值得推广应用。【Abstract】 Objective To explore the clinical value of self-made diplopore suture needle in laparoscopic herniorrhaphy in children. Methods The clinical data of 655 patients who underwent laparoscopic herniorrhaphy between April 2006 and June 2010 were retrospectively analyzed. The patients were divided into the single-hole needle group (452 patients) and the diplopore needle group (203 patients), and the operative and post-operative data of the two groups were analyzed and compared. Results The operation time in the single-hole needle group was (17.7±3.5) minutes and the bleeding volume during the operation was (5.4±1.3) mL; while 15 patients suffered from small hematoma under the abdominal wall and three recurred. The operation time in the diplopore needle group was (8.2±2.3) minutes with (1.4±0.3) mL blood loss; while two patients suffered from small hematoma under the abdominal wall and one recurred. The patients in the single-hole needle group stayed in the hospital for (2.5±1.0) days, while the patients in diplopore needle group stayed for (1.4±0.3) days. The operation time, bleeding volume, rate of complications in diplopore needle group were significantly less than those in the single-hole needle group (Plt;0.05). The hospital staying days, and the recurrence rate in the two groups didn’t differ much (Pgt;0.05). Conclusion The advantages of self-made diplopore needle in laparoscopic herniorrhaphy in children include short operation time, less trauma, and simple operation; it is worth generalizing and applying.
ObjectiveTo compare the efficiency of total extraperitoneal inguinal herniorrhaphy with laparoscopic technique using an innovative self-gripping mesh and polypropylene mesh. MethodsThe clinical data of 142 cases of unilateral inguinal hernia who underwent total extraperitoneal prosthesis (TEP) in our hospital form June 2012 to March 2015 were retrospectively analyzed. the operation type was total extraperitoneal inguinal herniorrhaphy with laparoscopic technique. Depending on the kind of mesh, all patients were divided into two groups from the self-gripping mesh group (n=60) and the polypropylene mesh group (n=82). ResultsThere was no significant difference in the operation time, intraoperative blood loss, hospital stay, and The Visual Analogue Score of post-operative (at 12, 24, 48, and 72 hours after operation) between the 2 groups (P>0.05). On the post-operative complications, there was no significant difference in incidences of total complication, scrotal edema, seroma, bladder injury, vascular injury of abdominal, and urinary reten-tion too (P>0.05). All the patients were followed up for 3-36 months (the median time was 19-month), and no recurrence occurred during the follow-up period. ConclusionInnovative self-gripping mesh is safe and effective, and maybe a good direction of mesh for material development.