【Abstract】Objective To investigate the effects and advantages of laparoscopic hernioplasty for hernia. Methods From June 1995 to June 2005, 222 patients with hernia were treated with laparoscopy. Transabdominal preperitoneal hernia repair (TAPP) were performed in 166 patients. Totally extraperitoneal hernia repair(TEP) were performed in 25 patients. Closure of the internal orifice of hernia was performed in 21 patients. Furthermore, incisional hernia in 2 patients, diaphragmatic hernia in 1 patient and mesenteric hernia in 1 patient were performed by laparoscopic hernioplasty and 6 patients with hernia of oesophagus finestra performed hernioplasty combined collapse gastric fundus with laparoscopy. In this series 45 patients associated with other abdominal disease were simultaneously treated with laparoscopy. Results All cases were operated successfully. The span of operation reduration was 42.5 min 〔(10～180 min)〕. The average length of postoperative hospital stay were 4.6 days. There was one early failure owing to the use of too small a piece of mesh.Conclusion The results indicate that mesh repair of hernias is a satisfactory technique with a low recurrence rate and a low major complication rate.
腹股溝疝和痔一樣是人類獨有的疾病，這是因為人是直立的緣故，當然，猩猩是否也有此問題尚未見報道。在胚胎發育和解剖上，腹股溝有薄弱之處是重要因素，老年人腹股溝部筋膜、肌肉弱化也是重要因素，許多論著和醫生經驗均有論述。
目的 探討應用改良Kugel補片后入路腹膜前修補腹股溝斜疝的優點、手術效果及其體會。方法 回顧性分析2006年12月至2007年6月期間我院采用改良Kugel補片施行腹股溝斜疝無張力修補術15例患者的臨床資料。觀察手術時間、傷口疼痛、術后恢復情況、并發癥和復發率。結果 手術時間35～90 min，平均（50±10） min； 術后1 d能下床活動，術后均未使用止痛劑，術后住院時間3～5 d。全組切口一期愈合，無感染發生，1例切口周圍有青紫，微波治療1周后青紫消失。隨訪半年無不適和復發。結論 改良Kugel補片后入路腹膜前疝修補術具有微創、無張力、免縫合、疼痛輕、恢復快、并發癥少等特點
目的 探討局部麻醉下行自體疝囊植入法修補腹股溝疝的方法和治療體會。方法 對36例腹股溝疝患者的臨床資料進行回顧性分析，單一采用利多卡因作腹股溝區域阻滯麻醉，并改進利用自體疝囊植入充填封閉內環部及腹股溝管后壁的缺損與裂隙，然后進行常規方法修補縫合。結果 本組36例患者麻醉與手術效果皆滿意，平均麻醉時間5min，平均手術時間40min，術中均未再注射止痛藥物。患者術后早期切口有飽滿、夯實感，疼痛癥狀較傳統手術輕。無傷口瘀血、感染、陰囊血腫或尿潴留等并發癥發生。術后6h即可進食，2～5d可下床活動，平均住院時間7d，住院費用較硬膜外麻醉減少20%～30%。經隨訪1～5年，平均隨訪3年，無再復發。結論 局部區域阻滯麻醉安全性高，并完全能滿足手術需要；而自體疝囊組織為“天然補片”，植入后可充分加強內環部及腹股溝管后壁的強度，愈合后形成較為堅固的纖維組織壁，最大程度地防止疝的形成與復發。麻醉與手術操作相對簡單，費用低廉，便于基層醫院開展。
Objective To study the superiority and efficiency of total peritoneum intraperitoneal onlay mesh (TPIPOM) in laparoscopic inguinal hernioplasty. Methods One hundred and five cases of laparoscopic inguinal hernioplasty with TPIPOM and 34 cases of inguinal hernioplasty with trans-abdominal preperitoneal laparoscopic mesh repair (TAPP) were performed from January 2002 to August 2005. Perioperative data and follow-up results were collected and compared in two groups. Results The laparoscopic hernioplasty was successfully performed in all patients. The total operation time, hospital stay, average off-bed time, duration of pain in TPIPOM group were significant shorter than those in TAPP group 〔(30.8±10.3) min vs (68.4±22.4) min, (3.8±1.3) d vs (4.3±1.5) d, (1.2±0.5) d vs (1.8±0.7) d, (1.0±0.5) d vs (1.6±0.9) d, respectively〕, P＜0.01, the total hospital cost was RMB 5 000.8±800.5 in TPIPOM group and that was RMB 8 000.5±950.6 in TAPP group (P＜0.01). No significant scrotal edema was observed postoperatively and no recurrence reported during (18.6±8.9) months follow-up in both groups. Conclusion Laparoscopic inguinal hernioplasty with TPIPOM is safe and efficacy with advantages of mini-invasion, simple procedures, shorter operation time, no complications and better recovery.
The management of neonates with high risk congenital diaphragmatic hernia (CDH) which gives rise to respiratory distress syndrome in 6 hours after born is so troublesome that the mortality is very high. The past advocation that CDH should accept emergency operation has been called in question. Another therapeutic procedure is recommended that CDH repair operation should be performed after the respiration and circulation has been stabilized. This procedure has presented better effect than before. The present advances in the management including general measures, mechanical ventilation, extracorporal membranous oxygenator (ECMO), nitric oxide (NO) inhalation, glucocorticoid, pulmonary surfactant, CDH repair and so on were reviewed.