目的 运用腹腔镜下内外环联合修补术治疗小儿复发性腹股沟疝，以降低再次复发率。方法 以脐单孔加内环体表微切口为手术切口路径，经腹腔镜内环高位结扎辅以外环口修补治疗小儿复发性腹股沟疝。结果 163例复发性腹股沟疝患儿应用该手术方法治疗，手术顺利，手术时间为（8.5±0.4） min， 7.9～9.8min，无中转开放手术；术后1～3d出院。163例术后均获随访，随访时间为10～36个月，平均20个月。1例（0.61%）先天性腹壁肌肉发育不良者于术后1年复发，再次行开放式疝囊高位结扎加腹股沟管前壁修补术。结论 采用腹腔镜下内环高位结扎联合微切口外环修补手术治疗小儿复发性腹股沟疝，其创伤小、恢复快、复发率低，值得推广。
众所周知，传统上对腹股沟疝修补术后再发生的疝，都认为是腹股沟复发疝（以下简称复发疝），这种认识一直沿用至今，不仅给临床工作带来困扰，有的还当成“医疗事故”，并对临床疗效的判断、分析以及科研资料的统计带来不利影响。以往对腹股沟复发疝的认识是一个笼统的概念，对复发疝发生的时间、病因、解剖部位及疝的类型等未作认真、细致的分析和考虑，如疝发生的时间是在术后短期还是术后数月、数年甚至数十年，其原因是不同的。又如第一次手术时是腹股沟斜疝，而术后再发生的疝可能是斜疝，亦可能是直疝、股疝或其它疝，其解剖部位或疝的类型有可能与原发疝相同或不同。
腹股沟疝是普外科领域里最常见的疾病之一。根据北美和欧洲国家的有关流行病学资料统计，腹股沟疝的发病率约为1‰～5‰。尽管目前国内尚无全面、系统的流行病学资料，但2001年上海地区腹股沟疝患病情况的初步流行病学调查结果显示，腹股沟疝的发病率大约在3.6‰，60岁以上老年人的发病率则高达11.8‰［1］。按此估算，我国的腹股沟疝发病人数将超过几百万人，而目前较为保守地估算，我国每年的腹股沟疝和切口疝手术会在5～10万例。
Objective To summarize the experiences and methods on reoperation of recurrent incisional hernia after mesh repair with prosthetic patch. Methods Sixteen patients who got reoperation from January 2007 to December 2010 because of recurrent incisional hernia after mesh repair were analyzed retrospectively. Results All patients received prosthetic patch repair for reoperation. Thirteen patients received new mesh repair accompanied with old mesh removal, repair conducted by suturing new mesh with old mesh together in two patients, and repair performed by new mesh overlapping the old mesh in one patient. All patients recovered with primary wound healing. Fluid upon the mesh occurred in 3 patients and cured by percutaneous puncture and pressure dressing. Postoperative hospital stay was 7 to 16 days and the average 9 days. The drainage was removed 2 to 7 days after operation and the average was 4 days. All the 16 patients were followed up. And during a follow-up range of 5 to 36 months and the average 20 months, there was slight foreign body sensation in one patient, no chronic pain in wound area occurred. And no abdominal wall hernia recurrence occurred. Conclusions Reoperation of recurrent incisional hernia after mesh repair need to consider the recurrent position, material of the previous mesh, and the previous surgical methods, and should select appropriate prosthetic patch and surgical procedure, then could gain satisfied results.
Objective To investigate the optimal surgical approach for bilateral inguinal hernias and complex (recurrent and compound) inguinal hernia. Methods Data of eighty patients with bilateral inguinal hernias and (or) complex inguinal hernias treated by tension less hernia repair between Feb. 2007 and Jun. 2010 in Sichuan Provincial People’s Hospital were analyzed. Preperitoneal approach through inferior abdominal median incision was applied in the repair with local, lumbar or epidural anesthesia. Results Operation time was （30±10.2） min in unilateral hernia, （50±17.5） min in bilateral hernia. There was no ischemic orchitis or pain case after operation. Within 3 months following up, no recurrence occurred. Conclusion The preperitoneal approach through inferior abdominal median incision for inguinal hernia repair is proved to be effective, safe, and convenient, and especially fit for bilateral hernias and complex hernia.
ObjectiveTo evaluate the curative effect of individualized tension-free hernia repair surgery in the treatment of recurrent inguinal hernia. MethodsWe retrospectively analyzed the clinical data of 31 patients with recurrent inguinal hernia treated by tension-free hernia repair surgery between August 2008 and August 2013. Among them, four underwent hernia ring pure mesh plug filling repair, 19 underwent modified Lichtenstein operation, and 8 underwent routine peritoneal clearance. ResultsPostoperative complications included one case of incision infection, 3 of incision seroma, 2 of incision scrotal hematoma, and one of urinary retention. The patients recovered well postoperatively, and the length of hospital stay ranged from 5 to 7 days. Follow-up was done for 25 patients with a time period of 4 to 38 months, averaging (10±13) months. No chronic pain or recurrence occurred during the follow-up. ConclusionIndividualized optimal treatment options of operation time and method according to patients' conditions, and simple, effective and accurate operation can get out of the dilemma of repeated recurrences.