目的 了解局部麻醉下腹股沟疝无张力修补术后患者排便变化的相关影响因素。 方法 采用自行设计的问卷调查表，对2010年5月－6月行无张力修补术的腹股沟疝患者术后排便情况及变化进行调查，并就相关影响因素采用logistic回归方法进行统计分析。 结果 腹股沟疝无张力修补术后患者进食量减少、活动量减少、饮食成分变化、担心排便引起复发是术后排便变化的影响因素。 结论 加强该病症术后健康宣传，指导患者正常进食、多活动，消除患者对腹股沟疝复发的焦虑，可促进其早期排便。Objective To research on the risk factors for change of defecation after inguinal hernia mesh-repairs under local anesthesia. Methods Self-made questionnaires were used to investigate the defecation change among patients having undergone inguinal hernia mesh-repairs from May to June 2010, and the correlated factors for change of defecation were analyzed by logistic regression analysis. Results Reduction of activity and food, changes of food ingredients, and worries about recurrence were risk factors for change of defecation. Conclusion In order to facilitate the recovery of the patients, nurses should promote patients’ knowledge on the surgery, guide them to eat as usual and do more exercises, and eliminate their anxiety on recurrence of the disease.
目的评价疝环充填式无张力疝修补术治疗腹股沟嵌顿疝的临床效果。方法采用Bard Mesh perfix plug定型产品对12例腹股沟嵌顿疝患者施行疝环充填式无张力疝修补术，观察其疗效。结果2例肠坏死行小肠切除吻合术； 无术后死亡，12例均于术后1天下床活动。发生尿潴留2例。住院时间4～6 d。全部随访1～23个月，无复发。结论疝环充填式无张力疝修补术可应用于腹股沟嵌顿疝的治疗，且安全有效。
Objective To explore the effectiveness of tension-free herniorrhaphy with Ultrapro Plug (UPP) mesh through a femoris approach for femoral hernia repair. Methods Between March 2009 and January 2013, 123 patients (126 sides) underwent tension-free herniorrhaphy with UPP mesh through a femoris approach. There were 17 males and 106 females, aged 32-95 years (mean, 63.3 years). The locations were the left side in 48 cases, the right side in 72 cases, and both sides in 3 cases. The disease duration was 1 month to 26 years (median, 25 months). Of 123 cases, 35 cases (36 sides) were reducible and 88 cases (90 sides) were irreducible. According to American Society of Anesthesiologists (ASA) classification, 20 cases were rated as grade I, 42 cases as grade II, 56 cases as grade III, and 5 cases as grade IV. The operation time, postoperative hospitalization time, complication, recurrence, and chronic pain were recorded. Results The operation time was 7-28 minutes (mean, 14.5 minutes); postoperative hospitalization time was 2-96 hours (mean, 19.4 hours) (112 patients discharged from hospital within 24 hours). Wound dehiscence occurred in 1 case and fat liquefaction in 2 cases. A total of 119 patients (122 sides) were followed up 4-50 months (median, 18 months); no recurrence was noted. Two cases (2 sides) suffered from chronic pain after operation, whose visual analogue scale (VAS) was 20 mm and 30 mm, respectively. Conclusion Tension-free herniorrhaphy with UPP mesh through a femoris approach should be recommended because it has the advantages of simple operation, short operation time, less complication, and lower incidence of chronic pain.
目的:总结疝环充填式无张力疝修补术治疗腹股沟疝的临床疗效。方法:对我院1999年4月至2008年8月采用疝环充填式无张力疝修补术治疗569例腹股沟疝患者的临床资料进行回顾性分析,对手术时间、伤口疼痛、术后自主能力的恢复、住院时间、并发症及复发率等进行观察。结果:与传统疝修补手术相比,具有方法简便,术后疼痛轻,恢复快, 住院时间短,并发症少,复发率低和更宽的手术指征等优点。结论:疝环充填式无张力疝修补术是一种治疗腹股沟疝的理想手术方法。
目的 探讨局部麻醉（以下简称局麻）腹股沟疝无张力修补术在基层医院的应用价值。方法 分析内蒙古医学院附属人民医院2010年10月至2011年12月期间242例行局麻腹股沟疝修补手术患者的临床资料。结果 除1例因过度紧张而停止手术外，其余手术顺利。平均手术时间50min，所有患者术后0.5～4h （平均2h） 均能下床活动，切口疼痛时间0.5～1d。无一例发生尿潴留；12例患者术后阴囊轻-中度水肿，切口感染1例。全部病例术后观察1～2d出院。门诊随访2～15个月（平均8个月），复发2例。结论 局麻下腹股沟疝无张力修补术安全、疼痛轻微、禁忌证少、复发率及费用低，值得在基层医院推广。
ObjectiveTo explore the surgical effect and cost-effectiveness of day surgery versus inpatient surgery for tension-free herniorrhaphy. MethodsA total of 100 cases of unilateral inguinal hernia who treated in West China Hospital of Sichuan University from Jan. 2010 to Sep. 2010 were collected prospectively, and were randomly divided into 2 groups: day surgery group (50 cases) and inpatient surgery group (50 cases). Comparison of the surgical effect and cost-effectiveness of day surgery versus inpatient surgery was performed. ResultsThere was no significant difference in the operation time, blood loss during the operation, incidence of urinary retention, scrotal edema fluid, incision foreign body sensation, and total complications, the time of get out of bed after surgery, and the time of returning to work after surgery (P > 0.05), but the hospital stay of day surgery group was shorter than that of inpatient surgery group (P < 0.05). The total cost of day surgery group was lower than that of inpatient surgery group (P < 0.05). There was no significant difference in the preoperation cost and introperative cost (P > 0.05), but the postoperative cost of day surgery group was lower than that of inpatient surgery group (P < 0.05). In the preoperation cost, there was no significant difference in the intraoperative monitoring fee, anesthesia and surgery materials fee, and drug charges (P > 0.05), but in the postoperative cost, the drug charges, nursing care fee, bed fee, and escort fee of day surgery group were all lower than that of inpatient surgery group (P < 0.05). ConclusionsThe effect of day surgery for tension-free herniorrhaphy is similar with inpatient surgery. But compared with inpatient surgery, the total cost of day surgery is lower, turn-over rate is higher, so it improves utilization of medical resources, reduces economic burden, and also reduces the medical burden of the country.
Objective To explore the effectiveness of preperitoneal herniorrhaphy with Ultrapro Plug (UPP) mesh for umbilical hernia repair in adults. Methods Between September 2011 and June 2015, 71 patients with umbilical hernia underwent preperitoneal herniorrhaphy with UPP mesh. There were 26 males and 45 females, aged 19-92 years (mean, 54.3 years). The disease duration was 45 days to 30 years (median, 18 months). Umbilical hernia was diagnosed through physical examination, ultrasound, and other relevant auxiliary examination. According to American Society of Anesthesiologists (ASA) classification, 12 cases were rated as grade Ⅰ, 34 cases as grade Ⅱ, 21 cases as grade Ⅲ, and 4 cases as grade Ⅳ. The operation time, postoperative hospitalization time, complication, and recurrence were recorded. Results The diameter of hernia ring ranged 0.5-3.0 cm (mean, 1.8 cm). There was no vessel or intestine injury. The operation time was 12-35 minutes (mean, 22.4 minutes); postoperative hospitalization time was 12-48 hours (mean, 16.3 hours). Fat liquefaction of incision occurred in 2 cases, and primary healing of incision was obtained in the other cases. Sixty-nine patients were followed up 8-51 months (median, 28 months). Hernia recurrence and patch infection occurred in 1 case respectively during follow-up. No postoperative foreign body sensation and chronic pain occurred. Conclusion Repairing umbilical hernia in adults with UPP mesh should be safe and reliable, because it has the advantages of short operation time, short hospital stay, less complication, and lower incidence of recurrence.
Objective To summarize the experience of surgical treatment of late-onset mesh infection after open inguinal hernia tension-free repair. Methods The retrospective descriptive study was conducted. The clinical data of 128 mesh infection patients after open inguinal tension-free hernia who were admitted to the Department of General Surgery of Shaanxi Provincial People’s Hospital form December 2016 to December 2021 were collected. All patients underwent debridement under general anesthesia through a treatment process of laparoscopic exploration, methylene blue staining, removal of mesh, wound irrigation, and negative pressure closed drainage. Patients were observed for completion of surgery, postoperative recovery, and follow-up results. Results One hundred and twenty-eight patients underwent open debridement successfully. In 98 patients, no abnormality was found on laparoscopic exploration and the infected meshs were removed by direct debridement surgery. In 28 patients, laparoscopic exploration revealed that the meshs had broken through the peritoneum and were tightly adherent to the mesentery and intestinal canal. In 2 patients, revealed abdominal abscesses at the paracolic sulcus of the ascending colon and at the ileocecal tract. The infected meshs were removed relatively intact in 112 patients, and the residual meshs were not removed intact in 16 patients. The operative time of 128 patients were 75–345 minutes with an average of 154 minutes, the bleeding volume was 10–200 mL with an average of 37.4 mL, the time to remove the negative pressure drainage tube after surgery were 5–14 days with an average of 8.4 days, the postoperative hospital stay were 6–18 days with an average of 11.6 days. There were 114 cases of class A healing, 12 cases of class B healing, and 2 cases of class C healing. One hundred and twenty-eight patients underwent postoperative follow-up for 6 to 60 months, with a media follow-up time of 30 months. During the follow-up period, 4 patients developed ipsilateral inguinal hernia recurrence, 4 patients developed reinfection, and 3 patients developed varying degrees of pain in the inguinal region. Conclusions Late-onset mesh infection after open inguinal tension-free hernia repair requires removal mesh by surgical treatment. Laparoscopic exploration, methylene blue-assisted debridement, complete removal of the mesh, strict wound irrigation and negative pressure closure drainage are safe and reliable treatment.