Objective To study the advances in clinical application of hernioplasty by high molecular material. Methods The literature in the recent years on the advances of hernioplasty by high molecular material was reviewed. Results At present time many operative techniques of hernioplasty by high molecular material have been developed. The representative techniques were ①Rives-Stoppa′s mesh inlay hernioplasty; ②Lichtenstein′s tesion-free herniorrhaphy; ③mesh plug hernioplasty; ④Gilbert′s sutureless hernioplasty; ⑤laparoscopic inguinal hernioplasty. The reparing high molecular material was divided into absorbable and unabsorbable material, the former included polyglycolic-acid and polyglaction, the later consists of polypropylene polyester and expanded polytetrafluoroethylene.Conclusion The clinical application of henioplasty by high molecular material is increasing. According to the hernia type and patient condition, excellent outcome will be achieved by the application of proper repairing method and repair material.
目的 分析改良区域阻滞麻醉法在腹股沟疝手术中的临床应用价值。方法 对2003年12月至2008年12月期间我院收治的168例腹股沟疝患者应用区域阻滞麻醉，对术中疼痛、肌松程度、手术时间、术后并发症、住院时间和住院费用方面进行临床观察。结果 所有患者麻醉效果满意,肌肉松弛,解剖层次清楚,除5例在牵扯精索时有轻微酸痛外,余无任何不适,术后无特殊并发症。平均手术时间40 min(包括麻醉),平均住院9 d,普通疝修补术平均费用1 480元,无张力疝修补术平均费用3 265元。结论 改良区域阻滞麻醉下行腹股沟疝手术麻醉效果满意、安全性高、简单易行、经济实惠,可作为各种腹股沟疝手术的麻醉方法,更适合在基层医院应用。
The soft-tissue-cutaneous flap adjacent to the abdominal incisional hernia was ultilized to repair huge hernia in 6 cases with success. Patients were followed up for 2y7 years without recurrence. The operative planning, the technique and the matters needing attention were introduced in details. The soft tissues and skin adjacent to hernia used for repair was easy to obtain and a simple technique. The adoption of this operation in hospitals at the grassroots level was feasible.
Objective To investigate the application of transverse fascia in inguinal hernia repair. Methods In this study, 617 patients underwent inguinal hernia repair between January 1990 and December 2005 in our hospital were included, which were divided into two groups according to different operative ways: transverse fascia method group (n=337) and Bassini method group (n=280). Then intraoperative results, postoperative complications, and rehabilitated results of patients in two groups were compared. Results Compared with Bassini method group, the patients in transverse fascia method group did not show significant difference in operative time and blood loss during operation (Pgt;0.05). The differences of severe postoperative pain, testicular swelling, the time of the body’s restore for normal activities, and recurrence rate of patients between two groups were significant (Plt;0.05), while the difference of hematoma of scrotum and infection of incisional wound (Pgt;0.05). Conclusion The strengthening of posterior wall by transverse fascia and reconstruction of inner ring is a simple and effective method for inguinal hernia repair.
腹股沟疝和痔一样是人类独有的疾病，这是因为人是直立的缘故，当然，猩猩是否也有此问题尚未见报道。在胚胎发育和解剖上，腹股沟有薄弱之处是重要因素，老年人腹股沟部筋膜、肌肉弱化也是重要因素，许多论著和医生经验均有论述。
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.
Objective To investigate the prophylaxes, diagnosis and treatment of pelvi-peritoneal hernia (PPH) after Miles operation for rectal carcinoma. Methods Three hundred and nine patients who underwent Miles operation from January 1986 to June 1999 were collected and analysed retrospectively, 11 of them were complicated with PPH. Results The morbidity of PPH after Miles operation was 3.6% (11/309). The main manifestations included abdominal distention to some extent (11 cases), pain (3 cases), vomiting (2 cases), gastric liquid more than 500 ml a day by gastric tube (3 cases), and non-exsufflation of the stoma of colostomy (11 cases). Two cases had pea green small intestinal liquid by perineal tube. The signs were slight abdominal tender (5 cases), active or excessive intestinal gurgling sound (7 cases), and diminished intestinal gurgling sound (4 cases). Abdominal plane films, showing the distant small intestinal obstruction, were taken in all 11 cases. Only 2 patients were correctly diagnosed before reoperation, and other patients were regarded as adhesive intestinal obstruction. The average observational time following appearance of the clinical manifestations after Miles operation was 7.4 days. All patients were diagnosed by laparotomy, 3 of them underwent adhesion lysis and reposition, and 8 patients partial ileum resection and anastomosis. The content of the hernias was ileum. The morbidity after reoperation was 27.3% (3 cases), and the complication was wound infection. All 11 patients were cured and left hospital. Conclusion The PPH after Miles operation is often lack of typical clinical manifestations. The early diagnosis and laparotomy in time is key to management. It is important to prevent the complication.
目的 探讨应用改良Kugel补片后入路腹膜前修补腹股沟斜疝的优点、手术效果及其体会。方法 回顾性分析2006年12月至2007年6月期间我院采用改良Kugel补片施行腹股沟斜疝无张力修补术15例患者的临床资料。观察手术时间、伤口疼痛、术后恢复情况、并发症和复发率。结果 手术时间35～90 min，平均（50±10） min； 术后1 d能下床活动，术后均未使用止痛剂，术后住院时间3～5 d。全组切口一期愈合，无感染发生，1例切口周围有青紫，微波治疗1周后青紫消失。随访半年无不适和复发。结论 改良Kugel补片后入路腹膜前疝修补术具有微创、无张力、免缝合、疼痛轻、恢复快、并发症少等特点
ObjectiveTo compare the clinical efficacy of abdominal preperitoneal laparoscopic hernia repair with 3DMax patch and plain film for treatment of inguinal hernia. MethodsThe clinical and follow-up survey data of 120 patients with inguinal hernia in The Second Affiliated Hospital of Harbin Medical University, between January 2009 and May 2014, which were treated by laparoscopic transabdominal preperitoneal repair (TAPP) were retrospectively analyzed. One hundred and twenty cases were divided into two groups:plain film group (45 cases) and 3DMax group (75 cases) according to the intraoperative use of different patchs. The patches of 3DMax group were not fixed, the patches of plain film group were fixed with metal nails. The postoperative clinical effect of two groups were analyzed. ResultsThe operative time, intraoperative blood loss, and postoperative hospitalization days of two groups were no statistical significance (P > 0.05). The postoperative off bed activity time of patients in 3DMax group and plain film group was (20.2±8.1) h and (26.3±9.2) h, respectively, the average off bed activity time in 3DMax group was significantly earlier than that in plain film group (P=0.041). The material expenses and hospitalization expenses of the 3DMax group were significantly lower than those of the plain film group (P=0.001, P=0.038). The incidence of foreign body sensation of inguinal region in 1, 3, and 9 months after operation of 3DMax group were lower than those of plain film group (P=0.045). The VAS score in 1 and 3 months after operation of 3DMax group were lower than those of plain film group (P < 0.05), but there was no statistically significant in 6 months after operation of 2 groups (P > 0.05). There was no recurrence case in two groups. ConclusionsThe use of 3DMax patch in laparoscopic TAPP operation have more simple operation, hospitalization expenses decreased, recovery faster, postoperative inguinal nerve pain and foreign body sensation more lighter, and complications more less. It is worthy of clinical popularization and Application.