From jan.1984 through dec.1991,65 cases of hand skin defects were primarily repaired by podicled groin flap. Four of the 65 cases had skin defects on both sides of the palms and dorsal aspot of the hands which were treated by the Y-shaped hypogastric groin flap .Five easec had thumb loss in which the lxdicled groin tubed flap was used to reconstruct the thumb.The time of division of the pedicles ranged from 14 to 28 days(averaged 16 days).All flape survived after division of the podicl...
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 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。
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。
目的 探讨局部麻醉下行自体疝囊植入法修补腹股沟疝的方法和治疗体会。方法 对36例腹股沟疝患者的临床资料进行回顾性分析，单一采用利多卡因作腹股沟区域阻滞麻醉，并改进利用自体疝囊植入充填封闭内环部及腹股沟管后壁的缺损与裂隙，然后进行常规方法修补缝合。结果 本组36例患者麻醉与手术效果皆满意，平均麻醉时间5min，平均手术时间40min，术中均未再注射止痛药物。患者术后早期切口有饱满、夯实感，疼痛症状较传统手术轻。无伤口瘀血、感染、阴囊血肿或尿潴留等并发症发生。术后6h即可进食，2～5d可下床活动，平均住院时间7d，住院费用较硬膜外麻醉减少20%～30%。经随访1～5年，平均随访3年，无再复发。结论 局部区域阻滞麻醉安全性高，并完全能满足手术需要；而自体疝囊组织为“天然补片”，植入后可充分加强内环部及腹股沟管后壁的强度，愈合后形成较为坚固的纤维组织壁，最大程度地防止疝的形成与复发。麻醉与手术操作相对简单，费用低廉，便于基层医院开展。
摘要:目的:总结应用自体真皮片移植疝修补术治疗腹股沟疝20例的近期治疗效果。方法:使用自体真皮片移植,对20例各类腹股沟疝患者进行无张力修补治疗;观察手术方法及时间、手术指征、术后患者自主能力的恢复、术后伤口疼痛、并发症和复发率。结果:与传统疝修补手术相比,自体真皮移植疝修补术具有方法简便、手术指征广、术后疼痛轻、恢复快、并发症少和复发率低的优点。结论:自体真皮移植疝修补术是一项更符合人体解剖结构和疝的病理生理的手术方法,具有传统方法无法比拟的优势。尤其适于在基层医院推广。Abstract: Objective: To summarize the recently therapeutic effect of autodermis transplantation repair of inguinal hernia. Methods: Twenty patients were treated by tension free hernia repair with autodermis transplantation. The operative procedure, surgical indication,ability recovery,postoperative pain,complications and recurrence rate were studied. Results: Autodermis transplantation hernia repair was superior to the traditional because of easier performance,wider indications,blander postoperative pain,faster recovery,fewer complications and lower recurrence. Conclusion: Autodermis transplantation hernia repair is more consistent with human anatomic structure and hernial pathophysiology than the conventional method, especially suiltable for primary hospital.
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。
ObjectiveTo discuss the main auxiliary inspection methods and their guiding significance for inguinal hernia.MethodsBy searching literatures and international guidelines, to review the main auxiliary examination methods, such as ultrasound, CT, and MRI.ResultsClinical physical examination combined with ultrasound could increase diagnostic sensitivity. CT could provide surgeons with a better sense of wholeness and structural details, and could be used as a guide for specific types of inguinal hernia. The soft tissue recognition of MRI was good, and it had a good effect on the identification of hidden hernia, mesh conditions, and tissue inflammation.ConclusionEach examination has its own advantages, and should be selected based on clinical practice and medical center conditions.