腹股沟疝的诊断及治疗进展.ppt

* Confidential, for internal purposes only. Not for external distribution. * MUST SUTURE IN! Place onlay on top of transversalis fascia Use onlay to prevent recurrence. Onlay reinforces the other space that may be subject to herniation in the future (e.g. for an indirect hernia repaired with a plug, the onlay provides protection to the direct space). Suture plug to margins of ring to recreate a tighter ring 早期的 “无张力” 疝修补术 优点 (和“组织对组织”修补方式比较): 更少的张力 更少的疼痛 可使用局麻 复发率降低 缺点 (和其他补片修补方式比较): 更长的手术时间 更长的恢复时间 (4-6 weeks) 切口 5-7 cm 太长 较多的缝合，增加了张力，引起更多的疼痛 网塞修补方式 开放, 前入路 网塞修补方式 优点: 解剖，分离面小，游离少 疼痛少 可使用局麻 降低了神经损伤的几率 更少的缝合 手术时间短 更少的并发症 病人恢复快 网塞的发展---巴德网塞 Drs. Ira Rutkow Alan Robbins 首先发展并使用 真正的无张力疝修补 简单，易学 前入路，腹膜前间隙修补 巴德网塞 在美国，大约37%的腹股沟疝采用此补片修补 已经经过大量的临床验证 1993 年开始被使用 在美国已经超过200万病人使用 世界范围内，已经超过300万病人使用 大量的临床验证数据 真正的无张力疝修补术 简单，易学 病人疼痛少，恢复快 预成型的外掰 解剖，分离少 20-30 分钟的手术时间 复发率 1% 单丝聚丙烯材质 可以局麻下手术 特点 关于局麻 网塞的放置和缝合 将网塞完全放入腹膜前间隙 最少 1-2 针缝合在内环口周围. Rutkow 术式 Rutkow 术式v. Millikan术式 放置区别 Classic Modified 完全腹膜前间隙修补—PHS或改良Kugel技术 * * * * Confidential, for internal purposes only. Not for external distribution. * * * Someone once said that “in order to fully understand where you are, you must first appreciate where you’ve been”. Now we could trace hernia surgery back to the guy on the previous slide, but I think it would be more appropriate to focus on the major players, not to simply bore you with a history lesson, but to begin to weave the story of the advancing understanding of the art and science of herniology. Notice: unilateral hernia repair…loose one testicle, bilateral…both * * He described the three-layer hernioplasty: transversalis fascia, transversus abdominus, internal oblique muscle. Essential to open the external ring and resect the cremasteric fascia. * Arthur’s insights into the anatomy and physiology of groin hernias led to his collaboration with Ethicon to develop the PHS. * * Confidential, for internal purposes only. Not for external distribution. * High re