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Experience of Tension-Free Hernioplasty for Inguinal Hernia (Report of 126 Cases)

目的 總結腹股溝疝無張力疝修補術的手術經驗。方法 回顧性分析我院2002年2月至2009年1月期間126例腹股溝疝患者行無張力疝修補術的臨床資料及手術方法。結果 本組126例患者無圍手術期死亡者,并發癥主要有局部腫脹、異物感、疼痛等,隨訪6個月～6年(平均38個月)有6例(4.8%)復發。結論 無張力疝修補術是治療腹股溝疝較為理想的術式。

Clinical Comparative Study of Tension-Free Herniorrhaphy with Different Suture

目的　觀察運用兩種不同縫線固定修補材料對疝修補術后的復發、切口感染、慢性疼痛等并發癥發生情況。方法　對2008年4月至2010年4月期間筆者所在科室收治的250例腹股溝疝患者行無張力疝修補手術時，采用多股絲線或可吸收合成縫線固定修補材料進行前瞻性對比研究。結果　2組患者術后疝復發、切口感染和切口疼痛（包括慢性疼痛）發生率間的差異均無統計學意義（P＞0.05）。結論　腹股溝疝無張力修補術后的復發、切口感染、慢性疼痛等并發癥的發生與縫線選擇無關。術者的操作技巧、嚴格的無菌操作原則、徹底止血以及組織損傷小才是防止術后感染、慢性疼痛等并發癥發生的重要因素。

ADVANCES IN CLINICAL APPLICATION OF HERNIOPLASTY BY HIGH MOLECULAR MATERIAL

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.

大型肩峰下三角肌下滑囊炎伴米粒體形成的手術治療

THE PROPHYLAXES, DIAGNOSIS AND TREATMENT OF PELVI-PERITONEAL HERNIA AFTER MILES OPERATION FOR RECTAL CARCINOMA

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.

Plug Mesh TensionFree Hernioplasty Under Local Anesthesia (Report of 70 Cases)

目的報告在局麻下行疝環充填式無張力疝修補術治療腹股溝疝的體會。方法對該院70例腹股溝疝患者行疝環充填式無張力修補術后的早期自主活動、進食、排尿以及住院日期等情況進行觀察。結果在局麻下行疝環充填式無張力疝修補術較之硬膜外麻醉或全麻有更寬的手術指征，且術后進食早，下床早,排尿困難明顯降低,住院時間縮短，費用也較低。結論在局麻下行疝環充填式無張力疝修補術，是一種對人體生理功能干擾小、術后恢復快、并發癥少、簡單易掌握的理想方法之一。

Diagnosis of Inguinal Region Hernia in Multi-detector Row CT

【摘要】 目的 評價多排螺旋CT（MDCT）在腹股溝區疝診斷中的價值。 方法 回顧性分析2009年6-12月96例經臨床證實為腹股溝區疝患者的CT圖像資料。通過多平面重建技術獲得冠狀位及矢狀位圖像，評價不同平面圖像在腹股溝區疝診斷及分類中的應用價值。 結果 63例斜疝患者（66疝）疝囊于腹壁下動脈外側經腹股溝深環進入腹股溝管，疝囊位于精索或圓韌帶前側（43/66，65.2%）或前內側（15/66，22.7%）；30例直疝患者（37疝）疝囊位于腹壁下動脈內側，位于精索內側（27/37，73.0%）；斜疝及直疝疝囊均走行于腹股溝韌帶前上方；3例股疝患者（3疝）疝囊位于腹股溝韌帶后下方，冠狀位“影像學股三角”內。 結論 MDCT對腹股溝區疝的診斷與鑒別診斷具有重要價值，可為手術前評估及手術中操作提供重要參考信息。【Abstract】 Objective To assess the value of multi-detector row CT (MDCT) in diagnosis of the inguinal region hernia. Methods The CT images of 96 patients with inguinal region hernia from June to December 2009 were retrospectively analyzed. The diagnosis and application of coronal and sagittal views in inguinal region hernia were assessed by multi-planer reconstruction. Results Hernia sac in 63 indirect hernia patients (66 hernias) originated lateral to the inferior epigastric artery enter the inguinal canal through the deep ring, anterior (43/63,68.3%) or anteromedial (15/63,23.8%) to the spermatic cord or round ligament;sac in 30 direct hernia patients (37 hernias) originated medial to the inferior epigastric artery, medial to the spermatic cord;both indirect and direct hernia sac located anterosuperior to the inguinal ligament;sac in three femoral hernia patients (three hernias) located posterior to the inguinal ligament and inside the “radiological femoral triangle” of coronal views. Conclusion MDCT plays on important role in diagnosing the inguinal region hernia, and provides critical information for preoperative and intraoperative.

Surgery Diagnosis and Treatment of Traumatic Diaphragmatic Hernia

目的 分析創傷性膈疝的診斷、外科治療和預后。 方法 對1999年1月-2010年1月收治的16例創傷性膈疝的臨床資料進行回顧性分析。 結果 16例均行手術治療，胸腹腔臟器損傷處理后行膈肌修補，2例手術后死亡，14例痊愈出院。 結論 創傷性膈疝常合并多發傷，胸腹部X線平片、鋇餐檢查及胸部、上腹部ＣＴ掃描不僅能對膈疝做出正確的診斷，對臨床手術指導具有重要的意義。診斷一旦明確，須及時手術治療，方能降低病死率。

The Clinical Application of TensionFree Repair to Treatment of Hernia

目的探討無張力疝修補術在雙側腹股溝疝中的臨床應用價值。 方法1999年5月至2002年4月采用無張力疝修補術治療雙側腹股溝疝25例，其中采用充填法18例, 雙層補片5例, 一側充填一側雙層補片2例。結果全組病例切口均一期愈合, 術后5~7 d出院，隨訪至今無復發。結論無張力疝修補術具有手術創傷小、痛苦少、術后恢復快等優點, 是治療雙側腹股溝疝的最佳術式。

充填式無張力疝修補術后網塞感染的探討及處理