本文選題：腹股溝疝 + 無(wú)張力疝修補(bǔ)術(shù)　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景腹股溝疝屬于腹外疝中的一種,發(fā)生位置在腹股溝區(qū),主要包括斜疝、直疝、股疝�；颊叩陌Y狀主要為腹股溝區(qū)的包塊,為可復(fù)性或不可復(fù)性,同時(shí)伴隨局部區(qū)域的腫脹不適,對(duì)于患者的日常活動(dòng)及生活質(zhì)量都存在影響。腹股溝疝是一種外科常見(jiàn)病。一旦成年人出現(xiàn)腹股溝疝,就必須通過(guò)外科手術(shù)的方法才能得有效的治愈。隨著修補(bǔ)理念和醫(yī)療材料器械的不斷進(jìn)步,腹股溝疝的外科修補(bǔ)方式主要經(jīng)歷了開(kāi)放式有張力、開(kāi)放式無(wú)張力和腹腔鏡下無(wú)張力幾個(gè)重要的階段。目前疝外科手術(shù)現(xiàn)狀是種類(lèi)眾多,且在臨床上應(yīng)用均比較廣泛,各自都占有重要的位置。術(shù)式的不同選擇都會(huì)產(chǎn)生不盡相同的療效,那么如何才能更好的治療腹股溝疝那?目前對(duì)于不同術(shù)式的優(yōu)劣比較的研究很多,但針對(duì)不同的疝類(lèi)型或不同患者人群,選擇具體術(shù)式的臨床效果分析和研究較為少見(jiàn)。本文旨在總結(jié)我院針對(duì)Ⅰ、Ⅱ型(中華醫(yī)學(xué)會(huì)2004年分型標(biāo)準(zhǔn))腹股溝疝患者,應(yīng)用Lichtenstein術(shù)式的效果及心得體會(huì)。目的1.觀察Lichtenstein無(wú)張力疝修補(bǔ)術(shù)治療Ⅰ、Ⅱ型(中華醫(yī)學(xué)會(huì)2004年分型標(biāo)準(zhǔn))腹股溝疝的臨床應(yīng)用效果。2.探討Lichtenstein無(wú)張力疝修補(bǔ)術(shù)的臨床價(jià)值,為該術(shù)式的臨床應(yīng)用和個(gè)體化治療提供理論依據(jù)。方法本文收集2014年1月-2016年7月,大連醫(yī)科大學(xué)附屬第一醫(yī)院應(yīng)用lichtenstein術(shù)式治療分型為Ⅰ、Ⅱ型腹股溝疝的患者的臨床病例資料。共69例,其中Ⅰ型27例,Ⅱ型42例;斜疝31例,直疝34例,其中合并斜疝和直疝4例;單側(cè)疝63例,雙側(cè)疝6例;男性61例,女性8例;年齡范圍為30-75歲,平均年齡:45.8±14.3歲。本組患者均營(yíng)養(yǎng)良好,無(wú)惡病質(zhì),無(wú)嚴(yán)重凝血功能障礙,無(wú)心、腦、肺、腎等器官的重大疾病,無(wú)免疫系統(tǒng)及血液系統(tǒng)等合并癥,排除Ⅲ、Ⅳ型腹股溝疝,排除股疝、嚴(yán)重嵌頓致使需要切除部分腸段的疝。對(duì)這組患者的術(shù)后短期復(fù)發(fā)率、術(shù)后并發(fā)癥發(fā)生率、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后住院時(shí)間、術(shù)后疼痛、術(shù)后異物感等方面的臨床指標(biāo)情況進(jìn)行分析和研究。之后再將這組病例資料按照Ⅰ和Ⅱ型,斜疝和直疝分成兩個(gè)亞組,并對(duì)上述指標(biāo)進(jìn)行分析及差異比較。采用電話隨訪方式。結(jié)果本組69例患者均成功接受完成了 Lichtenstein無(wú)張力疝修補(bǔ)術(shù)。平均手術(shù)時(shí)間為42.1±8.6 min。平均術(shù)后住院時(shí)間為4.1±1.2d。平均出血量為5.8±1.8 ml。隨訪中未發(fā)現(xiàn)復(fù)發(fā)患者。術(shù)后并發(fā)癥:出現(xiàn)切口感染2例,尿潴留1例。術(shù)后24小時(shí)、3個(gè)月、6個(gè)月V.A.S疼痛評(píng)分的平均數(shù)分別為:2.0±1.2分、0.4±0.2分、0.1 ±0.4分。術(shù)后異物感百分率為:無(wú)異物感:92.0%,輕度:6.4%,中度:1.6%。Ⅰ型組和Ⅱ型組,斜疝組和直疝組在各臨床指標(biāo)上均無(wú)明顯差異,無(wú)統(tǒng)計(jì)學(xué)意義(P值均0.05)。結(jié)論(1)Lichtenstein術(shù)式對(duì)于Ⅰ、Ⅱ型腹股溝疝的臨床治療效果良好,具有操作簡(jiǎn)單、安全有效、術(shù)后恢復(fù)快、并發(fā)癥發(fā)生率低的優(yōu)勢(shì),且符合個(gè)體化治療原則。(2)自固定補(bǔ)片應(yīng)用于Lichtenstein術(shù)可以簡(jiǎn)化手術(shù)步驟,節(jié)省手術(shù)時(shí)間,且理論上避免了形成慢性疼痛的可能原因,但缺乏具體的論據(jù)支持,需要進(jìn)一步的研究論證。
[Abstract]:Background inguinal hernia is one of the abdominal hernia, which occurs in the inguinal area, mainly including oblique hernia, direct hernia, and inguinal hernia. The symptoms of the inguinal area are mainly the masses of the inguinal area, which are complex or unrefolding, accompanied by swelling discomfort in the local area, and have an impact on the daily activities and quality of life of the patients. Inguinal hernia is a kind of hernia. The surgical repair of inguinal hernia is mainly through open tension, open tension-free and tension-free laparoscopic stages. The present situation of hernia surgery is a large number of types and is widely used in clinical practice. Each of them occupies an important position. The different options of the operation will produce different effects. Then how can the inguinal hernia be better treated? At present, there are many studies on the advantages and disadvantages of different surgical methods, but for different types of hernia. The purpose of this paper is to summarize the effect and experience of Lichtenstein operation for inguinal hernia patients with type I and II (Chinese Medical Association in 2004). Objective 1. to observe Lichtenstein tension-free herniorrhaphy for the treatment of type I, type II (China, China) The clinical application of inguinal hernia by the Medical Association in 2004) the clinical application of inguinal hernia.2. to explore the clinical value of Lichtenstein tension-free herniorrhaphy, to provide theoretical basis for the clinical application and individualized treatment of this type of operation. Methods this article collected the first hospital of Dalian Medical University in July, January 2014, with the application of Lichtenstein type treatment classification. The clinical data of patients with type I and type II inguinal hernia were reported in 69 cases, including 27 cases of type I, 42 cases of type II, 31 cases of oblique hernia and 4 direct hernia, 63 cases of unilateral hernia and 4 cases of bilateral hernia, 63 cases of unilateral hernia, 6 cases of bilateral hernia, 61 men in male, 8 cases, age 30-75 years, average age of 45.8 + 14.3 years. All patients of this group were well nourished, no cachexia and no Severe coagulation dysfunction, unintentional, brain, lung, kidney and other major diseases, no immune system and blood system complications, excluding type III, type IV inguinal hernia, removing inguinal hernia, and serious incarcerated hernia that require partial resection of the intestine. The postoperative short-term recurrence rate, postoperative complication rate, operation time, intraoperative bleeding volume and operation for this group of patients The post hospitalization time, postoperative pain, and postoperative foreign body sensation were analyzed and studied. Then the case data were divided into two subgroups according to type I and type II, oblique hernia and direct hernia, and the above indexes were analyzed and compared. The results of 69 patients in this group were successfully accepted L. Ichtenstein tension-free herniorrhaphy. The average operation time was 42.1 + 8.6 min. and the average postoperative hospital time was 4.1 + 1.2d.. The average bleeding amount was 5.8 + 1.8 ml.. The postoperative complications were 2 cases of incision infection, 1 cases of urinary retention. The average number of V.A.S pain scores in 24 hours, 3 months and 6 months after operation was 2 + 1.2, respectively. 0.4 + 0.2, 0.1 + 0.4. The percentage of foreign body sensation after operation was: no foreign body sensation: 92%, mild: 6.4%, moderate: 1.6%. type I group and type II group. There was no significant difference in clinical indexes between the oblique hernia group and the direct hernia group. There was no statistical significance (P value 0.05). Conclusion (1) Lichtenstein operation has good clinical treatment effect on type I and type II inguinal hernia. It has the advantages of simple operation, safe and effective, quick recovery and low complication rate, and accords with the principle of individualized treatment. (2) the application of self fixed patch to Lichtenstein can simplify the procedure of operation, save the time of operation, and theoretically avoid the possible causes for the formation of chronic pain, but lack of specific support of the argument, need further Research argumentation.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R656.21

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 陳寧波;曾杰;;局麻下應(yīng)用UHS與Lichtenstein兩種術(shù)式治療腹股溝疝的療效對(duì)比分析[J];臨床外科雜志;2016年02期

2 李繼東;耿天祥;;ProGrip自固定補(bǔ)片在腹股溝疝無(wú)張力修補(bǔ)術(shù)中的應(yīng)用體會(huì)[J];中華疝和腹壁外科雜志(電子版);2015年04期

3 余建偉;滕安寶;孫春磊;李煜;胡曄;;局部麻醉下免縫合自固定疝補(bǔ)片的臨床應(yīng)用體會(huì)[J];中國(guó)臨床保健雜志;2015年03期

4 周峰;于鵬;李永密;于躍洋;王會(huì)敏;;腹股溝疝個(gè)體化治療在臨床中的應(yīng)用[J];外科理論與實(shí)踐;2014年06期

5 朱海峰;王福榮;董文亮;劉亮;冷晗;李醫(yī)明;陳安杰;汪穎厚;王斌;;自固定補(bǔ)片與普通平片在無(wú)張力疝修補(bǔ)術(shù)中的臨床研究[J];中華疝和腹壁外科雜志(電子版);2014年04期

6 ;成人腹股溝疝診療指南(2014年版)[J];中國(guó)實(shí)用外科雜志;2014年06期

7 閻立昆;姚建鋒;王小強(qiáng);劉瑞廷;王國(guó)榮;邱健;李小軍;;自固定補(bǔ)片與普通聚丙烯補(bǔ)片臨床應(yīng)用對(duì)比分析[J];中華疝和腹壁外科雜志(電子版);2014年01期

8 張建新;張智勇;葉家欣;金煒東;蔡遜;;腹股溝疝D(zhuǎn)esarda法修補(bǔ)術(shù)80例[J];中華普通外科雜志;2013年01期

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