Objective To retrospectively compare short-term outcomes and health economics of PHS versus UHS for inguinal hernia repair. Methods We included 105 patients suffering from reducible inguinal hernia hospitalized in the First Affiliated Hospital of Lanzhou University from September, 2007 and September, 2012. The referred hernia types involved direct and indirect hernia (unilateral and bilateral). Based on different repair materials, the patients were divided into two groups, PHS group (n=53) and UHS group (n=52). Outcome parameters for comparison included incidences of seroma and scrotum edema, hospital duration, costs, etc. Results There were no differences in age, sex, hernia type, incidences of seroma and scrotum edema after surgery, hospital duration and costs between the two groups. However, the patients in the PHS group spent less money than those in the UHS group regarding the costs of materials and hospitalization, with significant differences. Conclusion For inguinal hernia repair, PHS and UHS are alike in reducing short-term complications, but PHS can significantly reduce patients’ economic burden due to less costs.
目的:观察经喉罩全凭七氟醚吸入麻醉在小儿腹股沟疝手术中的临床应用效果。方法：60例ASAⅠⅡ级择期行腹股沟疝囊高位结扎术的患儿随机分成喉罩七氟醚组（实验组）和氯胺酮组（对照组）。实验组以七氟醚诱导后置入喉罩，经喉罩全凭七氟醚吸入维持麻醉，对照组以氯胺酮和异丙酚诱导和维持麻醉。比较两组血流动力学、呼气末CO2分压（PETCO2）、手术时间、苏醒时间、出室时间（在恢复室内停留时间）。记录术中和术后不良反应如体动反应、嗜睡、恶心呕吐等发生情况。结果：对照组在T3、T4、T5时点HR、BP均明显高于实验组相应时点（Plt;0.05）。实验组患儿苏醒时间和出室时间均明显低于对照组（Plt;0.05）。对照组体动反应和嗜睡发生率明显高于实验组（Plt;0.05）。实验组术后恶心发生率明显高于对照组（Plt;0.05）。结论：经喉罩全凭七氟醚吸入麻醉用于小儿腹股沟疝手术，术中经过更平稳，麻醉恢复更快，术中及术后不良反应少。
Objective To discuss the surgical treatment and experience of mesh infection after prosthetic patch repair of inguinal hernia. Methods The clinical data of 67 cases of mesh infection after prosthetic patch repair who were treated in Chao-Yang Hospital from Jan. 2011 to Jun. 2012 were retrospectively analyzed. Results All patients were treated with surgical operation successfully， including removing the infected mesh and surrounding tissues， primary suture， and a placement of wound drainage， without replacement of a new patch substitute. The hospital stay of the patients was 10-25days with an average of 16days. Of the 67 patients， 51 patients got primary healed and the other 16 patients healed delayed after local dressing change due to the superficial infection following stitch removal. Sixty-six patients were followed-up for 6-24 months （average of 20 months） after operation without recurrence and complication， including seroma， wound infection， intestinal fistula， and postoperative pain. Conclusions The treatment of mesh infection after inguinal hernia repair is very complicated， but the primary suture repair and a placement of wound drainage after removing infected mesh with complete debridement is a effective therapy for it.
Objective To explore the surgical techniques and the clinical effect of laparoscopic transabdominal preperitoneal （TAPP） hernia repair for recurrent inguinal hernia. Methods Clinical data of 130 cases of recurrent inguinal hernia who underwent TAPP hernia repair from Mar. 2009 to Dec. 2012 in Beijing Chao-Yang Hospital of Capital Medical University were retrospectively analyzed. Results Operations were completed successfully in 129 cases and 1 case was converted to open surgery. The operation time was （54.5±16.1） min （30-100min） and the hospital stay was （4.5±2.1） d （2-11d）. The rates of postoperative pain， hydrocele， and urinary retention were 3.8% （5/130），11.5% （15/130）， and1.5% （2/130） respectively. There were no complications such as foreign body sensation，wound infection，and intestinal obstruction after operation. All cases were followed-up for 7-50 months 〔（24.3±11.3） months）〕 with no recurrence was observed. Conclusions Laparoscopic TAPP hernia repair for recurrent inguinal hernia has advantages of minimal invasion and few complications，who is safe and effective.
目的 介绍1例因外伤后耻骨缺损造成反复复发腹股沟疝的治疗经验。方法 回顾性分析该患者的诊治经过，总结治疗经验。结果 该患者在外院接受左侧腹股沟疝修补术（Lichtenstein法），术后1年左侧腹股沟疝复发，再于笔者所在医院先后接受两次手术治疗。第1次行开放的双侧腹膜前间隙无张力疝修补术，术后1年再次复发，复发原因可能是补片下界固定不可靠。第2次的术式与第1次相同，术后患者恢复良好，随访16个月无复发。结论 外伤后耻骨缺损是疝修补术后复发的主要原因，坚固有效的补片支撑点是防止再次复发的关键。
目的 观察运用两种不同缝线固定修补材料对疝修补术后的复发、切口感染、慢性疼痛等并发症发生情况。方法 对2008年4月至2010年4月期间笔者所在科室收治的250例腹股沟疝患者行无张力疝修补手术时，采用多股丝线或可吸收合成缝线固定修补材料进行前瞻性对比研究。结果 2组患者术后疝复发、切口感染和切口疼痛（包括慢性疼痛）发生率间的差异均无统计学意义（P＞0.05）。结论 腹股沟疝无张力修补术后的复发、切口感染、慢性疼痛等并发症的发生与缝线选择无关。术者的操作技巧、严格的无菌操作原则、彻底止血以及组织损伤小才是防止术后感染、慢性疼痛等并发症发生的重要因素。
Objective To assess the significance of multi-detector row CT in differential diagnosis of the inguinal hernia and femoral hernia. Methods CT images which were reconstructed by multi-planer reconstruction （MPR） of 260 patients with inguinal hernia and femoral hernia who treated in our hospital form Oct. 1， 2012 to Oct. 31， 2013 were analyzed retrospectively， for exploring the relationship between sac and anatomic structure in the groin area. Results There were 146 patients with indirect hernia （75 in right， 60 in left， and 11 in bilateralism）， 82 patients with direct hernia（39 in right， 34 in left， and 9 in bilateralism）， and 32 patients with femoral hernia （17 in right and 15 in left）. The 157sacs of patients with indirect hernia originated lateral to the inferior epigastric artery， entered the inguinal canal and through the deep ring， which mainly located anterior （103/157， 65.6%） or anteromedial （36/157， 22.9%） to the spermatic cord or round ligament. The 91 sacs of patients with direct hernia originated medial to the inferior epigastric artery， and mainly located medial to the spermatic cord （70/91， 76.9%）. Sacs of both indirect hernia and direct hernia located anterosuperior to the inguinal ligament. The 32 sacs of patients with femoral hernia located posterior to the inguinal ligament and inside the “radiological femoral triangle” of coronal views. Conclusions The MPR images available from multi-detector row CT permit the accurate diagnosis of groin hernias. By using simple anatomical criteria， direct hernia， indirect hernia， and femoral hernia can be reliably distinguished．
Objective To compare the feasibility， safety， and efficiency of laparoscopic total extraperitoneal （TEP）hernia repair surgery and laparoscopic transabdominal preperitoneal （TAPP） hernia repair surgery. Methods The clinical data of 95 patients with inguinal hernia who underwent laparoscopic TEP hernia repair surgery （TEP group） and TAPP hernia repair surgery （TAPP group） from Mar. 2010 to Oct. 2013 in our hospital were retrospectively analyzed， and clinical parameters including operation time， intraoperative blood loss， postoperative hospital stay， postoperative comp-lication， and operation cost of 2 groups were compared. Results All the procedures were successful， none of them was converted to open surgery. There was no significant difference between TEP group and TAPP group when considering operation time 〔（65±16） min vs.（68±17） min〕， intraoperative blood loss 〔（7.0±1.2） mL vs. （8.0±1.4） mL〕， visual pain analogue scale 〔（2.0±1.1） score vs. （1.8±1.1） score〕， postoperative hospital stay 〔（3.1±1.4） d vs. （3.3±1.2） d〕，and time to release to regular activities 〔（4.2±1.0） d vs. （4.5±1.2） d〕， P＞0.05. But the operation cost of TEP group was significantly lower than that of TAPP group 〔（8 033±536） yuan vs. （9 632±643） yuan， P=0.007〕. There were 6 atients （6.3%， 6/95） suffered complications， 3 cases in TEP group and 3 cases in TAPP group， including 3 cases of seroma or hematoma in scrotum， 1 case of transient neurapraxia， and 3 cases of urinary retention. There was no signi-ficant difference in incidence rate of postoperative complication between the 2 groups （P=1.000）. All patients were followed-up for 1-35 months 〔（20.0±10.2） months〕 without recurrence and chronic pain. Conclusions TEP and TAPP hernia repair surgery are feasible， safe， effective， and minimally invasive technique for inguinal hernioplasty. There are advantages and disadvantages of both TAPP and TEP hernia repair surgery， but there is no statistically significant difference regarding intraoperative and postoperative complications.
目的探讨提高腹股沟疝的治疗效果。方法回顾性总结我院1990~2001年采用低张力疝修补术治疗126例腹股沟疝的经验。 结果126例患者手术过程顺利，手术时间平均45 min, 平均住院8 d，无伤口感染。术后并发尿潴留5例，阴囊积液4例，经对症治疗后痊愈出院。本组病例术后随访2年无一复发，87例随访2~7年，仅1例复发。结论该术式符合解剖生理特征，掌握其手术适应证，可以避免术后复发。
目的探讨无张力疝修补术在双侧腹股沟疝中的临床应用价值。 方法1999年5月至2002年4月采用无张力疝修补术治疗双侧腹股沟疝25例，其中采用充填法18例, 双层补片5例, 一侧充填一侧双层补片2例。结果全组病例切口均一期愈合, 术后5~7 d出院，随访至今无复发。结论无张力疝修补术具有手术创伤小、痛苦少、术后恢复快等优点, 是治疗双侧腹股沟疝的最佳术式。