CN100425207C - Connected two-in-one patch for strainless hernia repair - Google Patents

Connected two-in-one patch for strainless hernia repair Download PDF

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CN100425207C
CN100425207C CN 200610070710 CN200610070710A CN100425207C CN 100425207 C CN100425207 C CN 100425207C CN 200610070710 CN200610070710 CN 200610070710 CN 200610070710 A CN200610070710 A CN 200610070710A CN 100425207 C CN100425207 C CN 100425207C
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patch
sheet
nourishing
small
hernia
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CN 200610070710
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CN1985767A (en
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刘亚奇
刘克忠
刘玉荣
张志敏
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刘克忠
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Abstract

本发明公开了一种用于无张力疝修补术的二合一连体补片,材料选用聚丙烯,包括大补片(1)、小补片(2),大补片(1)上设有小补片(2),大补片(1)的形状为刀把形,小补片(2)的形状为鸭嘴形状,大补片(1)或小补片(2)的厚度为0.4-0.6mm,大补片(1)和小补片(2)上设有圆形精索孔(3),圆心至大补片(1)的左边断开。 The present invention discloses a method for combo piece patch hernia repair surgery, a polypropylene material selection, nourishing sheet comprising (1) a small patch (2), provided on the nourishing sheet (1) a small patch (2), nourishing sheet (1) is shaped as a knife-shaped, the shape of a small patch (2) is a duckbill shape, thickness, nourishing sheet (1) or a small patch (2) 0.4 -0.6mm, nourishing sheet (1) and a circular patch small holes spermatic cord (3) (2), the center to the left nourishing sheet (1) is disconnected. 本发明补片综合了Stoppa、Lichtenstien、Plug三种基本手术特点,不易卷缩移位、厚度可调整、成型补片面积大、放置位置深、补片价格不贵,精索走行不会受到补片的影响而扭曲受压,便于对睾提肌的保留、利用及腹外斜肌腱膜下神经纤维的防护,患者术后舒适度相比其它术式明显改善且复发率低。 The patch of the present invention combines Stoppa, Lichtenstien, Plug three basic surgical characteristics, easy crimping displacement, adjustable thickness, forming large area patch, deep placement of the patch inexpensive, spermatic cord will not be traveling up Effect of distorted sheet pressed, testis levator facilitate retention, protection, and the use of the external oblique fascia nerve fibers, comfort postoperative surgical significant improvement over other low recurrence rate.

Description

一种用于无张力疝修补术的二合一连体补片 One kind of combo piece patch hernia repair surgery for

一、 技术领域- First, the technical field -

本发明属于一种临床外科手术植入人体材料,具体涉及一种用于无张力疝修补术的二合一连体补片。 The present invention pertains to a surgical implantation of human clinical material, particularly relates to a method for combo piece patch hernia repair surgery.

二、 背景技术 Second, the technical background

疝是普通外科的常见病和多发病,临床实践已证实手术是根治疝的唯一方法。 Hernia is a common disease in general surgery, clinical practice has proven method hernia surgery is the only cure. 而疝手术术式较多,归类不外有两种:有张力疝修补术和无张力疝修补术。 The hernia surgical procedures are more classified there are only two ways: tension and tension-free hernia repair hernia repair.

自Bassini首创有张力疝修补术以来,至今已有100余年历史,尽管其总体疗效尚称满意,但有关各术式的立论依据及其适应证一直有着争论,疝修补的术后复发和并发症仍存在问题。 Since the first Bassini tension hernia repair, has been 100 years of history, although it said the overall effect is still satisfactory, but about the various procedures for the argument has always been a debate based on their indications, hernia repair the recurrence and complications there are still problems. 据报道,初发腹股沟疝的术后复发率约为10%,而复发性疝可高达20%,总的并发症发生率也在7%—12%之间。 According to reports, the initial issuance of inguinal hernia recurrence rate of about 10%, while recurrent hernia up to 20%, overall complication rates are between 7% -12%. 作为有张力疝修补术,其不足之处主要体现在以下几个方面:1、都是用病人已有缺陷的邻近组织进行修复。 As tension hernia repair its deficiencies mainly in the following areas: 1, are used to repair defects in patients with existing adjacent tissues. 2 、将不在正常解剖部位的组织作强行拉拢、 缝合,张力很大,不符合外科手术的原则。 2, will not be the normal anatomy force to draw tissue, suture, great tension, does not comply with the principles of surgery. 3、"联合肌腱与腹股沟韧带的缝合"是两种不同组织间的缝合,不易产生真正的愈合。 3, "the joint tendon and the inguinal ligament suture" is a suture between two different tissues and difficult to produce true healing. 4、修复术留有的大量线结增加了术后发生并发症的机会。 4, repair left a large number of knots increases the chances of postoperative complications.

国内外无张力疝修补定型术式有单纯筋膜缝合修复术、Lichtenstein (单层平片修补手术)、Rutkow手术(妬环充填式无张力修补术)、Gilbert 手术(三合一片无张力修补术)、腹腔镜腹股沟疝修补术(LiHR)等。 Domestic and hernia repair has a simple shape fascia surgical suture repair, Lichtenstein (single flat sheet repair surgery), Rutkow surgery (tension ring filling Jealous repair), Gilbert surgery (three-piece tension-free repair ), laparoscopic inguinal hernia repair (LiHR) and so on. 目前无张力疝修补术以其复发率低、恢复快,使疝手术技术有了很大飞跃,已作为根治疝的主要手术,逐步取代了传统有张力疝修补术。 Currently tension-free hernia repair its recurrence rate, fast recovery, the technology has a great leap hernia surgery, has been used as the main cure hernia surgery, and gradually replaced the traditional tension hernia repair. 然而近年无张力疝修补术在我国推广,同时也出现了术后并发症和手术缺陷。 However, in recent years, tension-free hernia repair in the promotion of our country, but there have been complications and surgical defects. 我国无张力疝修补术后复发率为1一5%,较传统手术有所降低,但与国外相比仍有差距。 Our tension-free hernia repair the recurrence rate of 1 to 5%, somewhat lower than traditional surgery, but still a gap compared with foreign countries. 术后复发的原因,除了因补片深部感染要取出补片外,主要是手术解剖不清, 补片巻縮移位、补片面积小、放置位置不当、网塞或补片固定不佳。 Causes of recurrence, in addition to a patch because of deep infection To remove the patch, the main surgical anatomy unclear, Volume shrinkage patch displacement, a small area of ​​the patch, improper placement, plug or patch fixed network poor. 再从各型手术总体看,无论国外或国内手术,对于睾提肌的保留、利用及腹外斜肌腱膜下神经纤维的防护注意不够;补片进入人体可产生异物感, 一定程度上 Overall then from various types of surgery, whether foreign or domestic surgery for levator testis reserves the use of the external oblique fascia and under the protection of nerve fibers insufficient attention; patch into the human body can produce foreign body sensation, to a certain extent

影响了患者术后的舒适度。 Affect patient comfort after surgery. 鉴于国内上述现状,用已成型的进口修复材料治 In view of the current situation of the above, the repair material has been formed with the rule of imports

疗各年龄段的各类疝已显得很不合理,有的牵强附会,增加病人痛苦;有的小疝大做,浪费材料;有的手术操作不到位,造成病人复发。 All ages all types of hernia treatment has become very unreasonable, some far-fetched, increase patient pain; some large and small hernia, waste material; some surgical procedures are not in place, resulting in patient relapse.

三、发明内容 III. SUMMARY OF THE INVENTION

本发明就是针对上述补片存在的问题,提供一种用于无张力疝修补术的二合一连体补片,解决现有补片设计功能单一,易巻縮移位、厚度不可调整、 成型补片覆盖面积小、放置位置过浅、网塞补片固定不佳、补片价格贵;精索走行受补片影响扭曲受压;对于睾提肌的保留、利用及腹外斜肌腱膜下神经纤维的防护不够,患者术后舒适度差和复发率高的技术问题。 The present invention is a patch for the presence of the problem, there is provided a two-in piece patch hernia repair surgery for solving the conventional function of a single patch design, easy to shift Volume shrinkage, the thickness can not be adjusted, molding patch small footprint, placement too shallow, poorly mesh plug fixing patch, patch expensive; spermatic patch traveling by distorting effect compression; levator reserved for testosterone, and the use of the external oblique fascia inadequate protection of nerve fibers, technical problems and poor patient comfort after surgery recurrence rate.

本发明的技术方案: 一种用于无张力疝修补术的二合一连体补片,包括大补片l、小补片2,大补片1上设有小补片2,大补片l的形状为刀把形, 上边为一大矩形,右下边为一小矩形,大矩形尺寸为15cm—10cmX8cm—6 cm,倒角的半径为1—2 cm,小矩形尺寸为8 cm—5. 5cmXl cm—O. 5 cm, 倒角的半径为2 cm;小补片2的形状为鸭嘴形状,长X宽的尺寸为10 cm— 6cmX5cm—3cm,右边是一个半圆,左边是长方形,半圆的半径R为2—1.5 cm,大补片l、小补片2的厚度为0.4—0.6mm,小补片2上的弧形顶端距大补片1的右边距离a为2cm—l. 5 cm ,小补片2的上边距大补片1的上边距离b为3cm ;大补片1和小补片2上设有精索孔3,精索孔3的形状为圆形, 直径为0. 5 cm—O. 8cm,精索孔3的圆心至大补片1的左边断开,精索孔3 的圆心距小补片2的弧形顶端距离为c, c等于6. 5 cm—4cm,精索孔3的圆心距小补片2的 Aspect of the present invention: one piece Combo patch hernia repair surgery, comprising nourishing sheet L, small patch 2, nourishing sheet 2 is provided on the small patch 1, nourishing sheet l is a knife-shaped shape, the upper side of a large rectangular, a small rectangle to the lower right, is a large-size rectangle 15cm-10cmX8cm-6 cm, the radius of chamfering is 1-2 cm, a small rectangular size of 8 cm-5. . 5cmXl cm-O 5 cm, radius of the chamfer is 2 cm & lt; 2 shape of the small patch of a duckbill shape, length X width dimension 10 cm- 6cmX5cm-3cm, the right is a semi-circle on the left is rectangular, semicircular R is the radius of 2-1.5 cm, the thickness of the sheet nourishing l, 2 small patch of 0.4-0.6mm, arcuate top 2 on the right side from a small patch sheet 1 nourishing distance a 2cm-l. 5 cm & lt, small patches on the upper margin of sheet 2 of nourishing 1 is a distance b 3cm; spermatic cord holes 3 provided on the two sheets 1 and nourishing the small patch, the shape of the spermatic cord 3 has a circular hole diameter 0 . 5 cm-O. 8cm, hole center to the left spermatic cord nourishing sheet 1 off 3, spermatic cord hole center distance from the top of a small patch 3 is arcuate 2 c, c is equal to 6. 5 cm- 4cm, spermatic cord from the hole center of a small patch 3 2 边距离为d, d等于3cm—1.5cm, 一种用于无张力疝修补术的二合一连体补片的材料为聚丙烯。 To-edge distance d, d is equal to 3cm-1.5cm, material tension-free hernia repair patch for combo piece is polypropylene.

本发明与现有技术相比具有以下有益效果: 一种用于无张力疝修补术的二合一连体补片,综合了多种补片设计理念,大小片剪裁根据解剖的腹横筋膜前、后间隙而定;其中面积大的补片围绕精索平展于腹膜前间隙,覆盖了内环口、赫氏三角、股管内口及同侧腹直肌后腹,不遗漏疝孔;同时补片重叠区作为精索出口,较精确地控制索孔扩张度(正常0.5—0.8cm,扩縮值为士0.2cm),防止疝脱出.,面积小的补片固定于赫氏三角、腹横筋膜。 The prior art and the present invention has the following advantages compared: one kind of piece Combo patch hernia repair surgery for a variety of integrated patch design, the size of the front cut sheet according to anatomical transverse fascia after a given gap; wherein the large area flat patch around the spermatic cord in the preperitoneal space, covering the inner opening, Hexcel triangle, the inner nozzle and the ipsilateral femoral posterior rectus abdominal, hernia without missing hole; simultaneously complement sheet overlap region as the spermatic cord outlet, more precisely control the pore dilation cable (normally 0.5 - 0.8 cm, the value of scaling persons 0.2cm), preventing hernia prolapse., a small area of ​​the patch is fixed to the triangle Hexcel, transverse abdominal muscle membrane. 这样, 对腹股沟疝的3个薄弱环节(疝环、腹横筋膜缺损或耻骨肌孔、腹股沟管后壁)分别进行了修补和加强,而且有效预防了直疝或斜疝甚至股疝的发生, 因全部采用平补片,大大降低了复发率和患者的住院费用。 Thus, three of the inguinal hernia weakness (hernia cycloalkyl, transversalis fascia or pubic muscle defect aperture, the rear wall of the inguinal canal) were carried out repair and strengthening, but also effectively prevent the direct hernia inguinal hernia or femoral hernia occurs even, because in all flat patch, greatly reducing the relapse rate of patients and hospital costs. 同时小片被精索及缝合后的睾提肌覆盖,距体表厚度增加,而且据腹壁状况可调整补片厚度, 腹壁皮下脂肪少、腹壁平坦者选择较薄补片:腹壁皮下脂肪多、腹壁膨隆者选择较厚补片;奠定了减轻术后不适的解剖基础。 While the die was put spermatic cord and the suture cremaster cover, increasing the thickness from the surface, and adjusted according to conditions of the abdominal wall patch thickness, less abdominal subcutaneous fat, abdominal selects thin flat patch: multiple abdominal subcutaneous fat, abdominal bulging chooses thick patches; laid the foundation anatomy reduce postoperative discomfort.

总之,在无张力疝修补手术中通过使用本发明的补片,综合了Stoppa、 Lichtenstien、 Plug三种基本手术特点,并可以控制补片精索孔扩张度,通过面积小的补片环周固定防止补片旋转移位,保留睾提肌、精索原位放置, 加大腹膜前间隙补片面积,不覆盖神经,对构成内环的腹横筋膜的缺损进行代替和加强,不留空隙,使无张力疝修补术复发率低于国内外标准,术后舒适度相比其它术式明显改善,达到良好的临床效果,取得更好的社会效益和经济效益。 In short, in hernia repair surgery by the use of the patch of the present invention, a combination of Stoppa, Lichtenstien, Plug three basic surgical characteristics, and may control the spermatic cord hole patch dilation, a small area is fixed by circumferential patch patch to prevent rotational displacement, to retain levator testis, spermatic cord placed in situ, to increase the area of ​​the patch preperitoneal space, does not cover the nerve, for constituting the inner transverse fascia defects for strengthening and replaced, without leaving any gaps, the hernia repair the recurrence rate is lower than the tension-free domestic and international standards, postoperative comfort compared to other surgical procedures significantly improved to achieve good clinical results, achieve better social and economic benefits.

以下通过具体的对比分析和临床试验进一步说明本发明的有益效果.- The following advantageous effects of the present invention is further illustrated by the comparative analysis and specific clinical trials .-

1 、 二合一连体补片手术与国内外目前常用补片的手术比较 1, Combo Siamese patch surgery at home and abroad at present more commonly used surgical patch

<table>table see original document page 5</column></row> <table>2、临床初期前瞻性研究 <Table> table see original document page 5 </ column> </ row> <table> 2, the initial clinical prospective study

为了探讨二合一连体补片在腹股沟疝手术中的临床应用效果。 To investigate the clinical effect of combo Siamese patch in inguinal hernia surgery.

项目组于2001年底策划,从2002年1月至2003年12月,将收治ii-iv型腹股沟疝病人240例,以应用不同补片及手术方式随机分成三组进行对比。 Project planning group at the end of 2001, from January 2002 to December 2003, will be admitted ii-iv type of inguinal hernia patients 240 cases, to apply different patches and surgical procedures were randomly divided into three groups were compared. 分别为二合一连体补片组(A组)120例、网塞充填补片组(B组)60例、 三合一疝装置组(C组)60例,男232例、女8例;最小年龄22岁,最大年龄93岁。 Respectively combo piece patch group (A) 120 cases, 60 cases of mesh plug filling padding sheet group (group B), 60 cases of triple hernia system (group C), 232 cases of male, 8 female ; the youngest 22 years old and the oldest 93 years old. 3组一般资料差异无显著性(p〉0.05)具有可比性。 3 group general information was no significant difference (p> 0.05) were comparable. 以3月,6 月,l年,2年,复诊或通信为随访方式,时间为2—3年,具体见表l。 At 3 months, 6 months, l year, 2 years, or referral to follow the communication mode, the time which is 2 - 3 years, particularly in Table l.

表1: 240例ii-iv型腹股沟疝病人随机分组情况 Table 1: 240 cases of type ii-iv inguinal hernia patients randomized case

<table>table see original document page 6</column></row> <table> <Table> table see original document page 6 </ column> </ row> <table>

材料来源二合一连体补片组采用巴德、贝朗15cmX15cm平面补片制做;疝环充填组利用巴德Bard Perfix Plug产品,每套分为两部分,即成型补片和疝环填充物,前者为8cmX4cm长方形网眼补片,后者为圆锥形梅花瓣样网片材料,高3cm,直径3cm三合一疝装置组为美国强生普理灵疝装置(phs),型号为ras卜1,包括一块表层片, 一块底层片以及中间相连的圆柱形网片,材料均为单丝聚丙烯。 Source material patch piece combo group was Bard, Braun 15cmX15cm making planar patch; plug & mesh group using Bard Bard Perfix Plug products, each divided into two parts, i.e. ring shaped hernia patch and filling was 8cmX4cm former is a rectangular mesh patch, which has a conical shape plum petal-like web material, high 3cm, diameter 3cm triple hernia system group Johnson U.S. Prolene hernia system (PHS), a model ras Bu comprising a top sheet, a bottom sheet and a middle web connected to a cylindrical, monofilament materials are polypropylene.

结果分析三组术后切口感染、远期不适(疼痛、异物感)、术后复发、 补片费用情况对比分析如下(表2) Results Analysis of three sets of postoperative infection, long-term discomfort (pain, foreign body sensation), recurrence, where the cost of the patch following comparative analysis (Table 2)

<table>table see original document page 6</column></row> <table> <Table> table see original document page 6 </ column> </ row> <table>

*远期不适指发生在术后3月至2年内的局部慢性疼痛、麻木或异物感等症状。 * Refers to long-term discomfort of chronic pain occurs in the local March 2 years after surgery, numbness or other symptoms foreign body sensation.

*统计学方法采用t检验,数据以平均值士标准差(X士S)表示。 * T-test statistical methods, data expressed as mean ± standard deviation (X disabilities S).

统计结果显示,住院时间、切口感染两项A组与B、 C两组没有显著差异(P〉0.05),无统计学意义。 Statistics show that hospital stay, wound infection and two Group A B, C groups no significant differences (P> 0.05), was not statistically significant. B组与C组分别有两例和一例在术后半年内复发,与A组间没有显著差异(P〉0.05),无统计学意义。 Groups B and C are two cases and recurrences within six months after surgery, no significant difference (P> 0.05) between A and the group was not statistically significant. 疼痛、异物感及补片费用三项,A组低于B、 C两组,与两组间有显著差异(P<0.05),存在统计学意义。 Pain, foreign body sensation and cost three patches, A group is less than B, C groups, with significant differences between the two groups (P <0.05), statistically significant. 对比结果,显示出二合一补片的综合特点优于其它补片术式。 Comparison results showing the characteristics of the integrated combo patch over other surgical patch.

3、临床远期效果对比 3, long-term clinical effects of contrast

总结我中心4年来无张力疝修补术病例1288例,将其中4种补片手术的临床复发率、舒适度和卫生经济学效益作一评价 I summarize Center four years of tension-free hernia repair cases of 1288 cases, the rate of clinical relapses four of which patch surgery, comfort and health benefits of economic evaluation as a

表一四种补片手术方法复发率比较 Table recurrence rate of fourteen kinds of surgical patch Comparative

<table>table see original document page 7</column></row> <table> <Table> table see original document page 7 </ column> </ row> <table>

经四组率比较的直接概率计算,P二O.OOl,按a二0.05水准,拒绝H。 By direct comparison of the four groups of the probability calculation, P two O.OOl, according to a level of 0.05 was refused H. ,接受H,,可以认为四组复发率间总的来讲有差别;按多重比较原理,二合一连体补片法与三合一法,P=0. 119,两组间复发率尚不能认为有差别;合并后再与平面补片法比较,P二0.026,可认为二合一连体补片法、三合一法复发率与平面补片法、网塞填充法(P=0.003)复发率差别有统计学意义。 , May be considered to accept H ,, recurrence rate differences between the four groups in general; Press multiple comparison principle, method and patch piece combo triple law, P =, recurrence rates between the two groups is still 0119 can not be considered a difference; combined then compared with the plane of the patch test, P 0.026 two, the recurrence rate can be considered combo piece patch method, the three-plane method patch method, a method of filling the mesh plug (P = 0.003 ) recurrence rate difference was statistically significant. 表二四种补片手术方法疼痛发生情况比较(术后3个月之内)<table>table see original document page 8</column></row> <table> 经四组率比较的直接概率计算,P=0.001,按a二0.05水准,拒绝H。 Table twenty-four kinds patch Comparative postoperative pain occurs (within 3 months after surgery) <table> table see original document page 8 </ column> </ row> <table> by direct comparison of the four probability calculation , P = 0.001, according to a level of 0.05 was refused H. ,接受H,,可以认为四组疼痛发生率间总的来讲有差别;按多重比较原理,二合一连体补片法与三合一法、平面补片法、网塞填充法比较,差别均有统计学意义。 , H ,, may be considered acceptable differences between the incidence of pain in general four groups; multiple comparison according to the principle, method and combo piece triple patch method, planar patch method, comparative mesh plug filling process, the differences were statistically significant.

表三四种补片手术方法局部硬块感情况比较 Table thirty-four kinds of surgical patch sense the comparative local lumps

<table>table see original document page 8</column></row> <table> <Table> table see original document page 8 </ column> </ row> <table>

经四组率比较的直接概率计算,P二O.OOl,按a =0.05水准,拒绝HO, 接受H1,可以认为四组局部硬块感间总的来讲有差别;按多重比较原理, 二合一连体补片法与三合一法、平面补片法(P=o.008)、网塞填充法比较, By direct comparison of the four groups of the probability calculation, P two O.OOl, according to a = 0.05 level, the HO reject, accept the H1, that there may be differences between the four groups in general partial sensing lumps; multiple comparison according to the principle of two-in a three-piece method and patch method, method patch plane (P = o.008), comparing the mesh plug filling,

差别均有统计学意义。 The differences were statistically significant.

表四四种补片手术方法卫生经济学效益比较 The table below compares health economics benefits of surgical forty-four kinds of patches

<table>table see original document page 8</column></row> <table>经四种手术住院费用比较,其中实验室检査费用、抗生素费用、床位、 护理、诊疗费用等个体间无差异,二合一连体补片手术的住院费用明显低于其它三种。 <Table> table see original document page 8 </ column> </ row> <table> Surgical Instrumentation hospital costs by comparison, where the laboratory costs, the cost of antibiotics, bed, nursing, medical expenses and other no difference between individuals, combo Siamese patch surgery hospitalization costs were significantly lower than the other three.

临床应用 Clinical application

从2002年2月到2006年10月,共做本发明所述的补片手术813例, 男786例、女27例;最小年龄17岁,最大年龄101岁。 From February 2002 to October 2006, a total of 813 cases of surgical patch according to the present invention, male 786 cases, 27 females; the youngest 17 years old, the maximum age of 101 years old.

本术式适应除I型疝外,18周岁以上各型腹股沟斜疝、直疝,其中I 型疝0例、II型疝228例、m型疝447例、IV型疝138例,术后随访3个月 This operation adapted to other type I hernia, inguinal hernia 18 years or more various types, direct hernia, hernia 0 cases where the type I, type II hernia 228 cases, m type hernia 447 cases, IV type hernia 138 cases were followed up 3 months

—4年。 -4 years.

本组疝合并其它病,术前须经保守疗法治疗,病情稳定后手术。 This group of diseases associated with other hernias, subject to the conservative therapy before surgery, in stable condition after surgery. 手术效果本组观察813病例,均于术后12—24小时进食并下地活动,术后3天体温、白细胞总数和分类变化均在正常范围。 Surgical results observed in this group 813 cases were in the 12-24 hours after eating and ambulation, three days after the body temperature, leukocyte count and classification changes were within the normal range. 抗生素使用3—5天,切口无红肿和渗液,术后3个月一4年内疼痛0. 86%(7例/813例),局部硬块感1. 1% (9例/813例),无感染,随访3个月一4年,尚未见复发。 Antibiotics 3-5 days, 3 months, 4 years, a cut-pain and no swelling exudate, after 0.86% (7 cases / 813 cases), the local sense lumps 1.1% (9 cases / 813 cases), no infection, followed up for 3 months to 4 years, has not been recurrence.

四、 附图说明: 图l为本发明的结构示意图。 IV BRIEF DESCRIPTION OF: structural diagram of the present invention. FIG l.

五、 具体实施方式: 实施例1 V. DETAILED DESCRIPTION: Example 1

一种用于无张力疝修补术的二合一连体补片,包括大补片l、小补片2, 小补片2的左边至延长的精索孔3的圆心线部分重叠粘合有大补片1,大补片1的形状为刀把形,上边为一大矩形,右下边为一小矩形,大矩形尺寸为15 cmX8 cm,倒角的半径为2 cm,小矩形尺寸为8 cmXl cm,倒角的半径为2 cm;小补片2的形状为鸭嘴形状,长X宽的尺寸为10 cmX5 cm,右边是一个半圆,左边是长方形,半圆的半径R为2cm,大补片l、小补片2的厚度均为0. 6mm,小补片2上的弧形顶端距大补片1的右边距离a为2cm , 小补片2的上边距大补片1的上边距离b为3cm •,大补片1和小补片2上设有精索孔3,精索孔3的形状为圆形,直径为0.8cm,精索孔3的圆心至大补片1的左边断开,精索孔3的圆心距小补片2的弧形顶端距离为C, C等 An apparatus for tension-piece combo hernia repair patch comprising nourishing sheet L, small patch 2, the center line portion of the left panel 2 patch to extend the hole 3 of the spermatic cord overlap adhesive has nourishing sheet 1, sheet 1 is shaped nourishing knife-shaped, the upper side of a large rectangular, a small rectangle to the lower right, the large size of the rectangle is 15 cmX8 cm, the radius of the chamfer is 2 cm, the size of the small rectangle 8 cmXl cm & lt, chamfering radius of 2 cm & lt; 2 shape of the small patch of a duckbill shape, length X width dimension 10 cmX5 cm, on the right is a semi-circle on the left is rectangular, semicircular radius R of 2cm, nourishing sheet L, the thickness of the small patch 2 are 0. 6mm, the top of the arc on the right panel pieces 2 from nourishing patch 1 is a 2cm distance, small patches on the upper margin of sheet 2 of a nourishing distance b is 3cm •, nourishing sheet 1 is provided with a small patch 2 and spermatic cord hole 3, the hole shape of the spermatic cord 3 is circular, having a diameter of 0.8cm, the center hole 3 to the left spermatic cord sheet 1 off nourishing open, spermatic cord 3 from the hole center distance smaller arcuate top patch 2 is C, C, etc.

于6. 5 cm,精索孔3的圆心距小补片2的长边距离为d, d等于3cm。 To 6. 5 cm, of the spermatic cord 3 from the hole center small patch 2 is the longitudinal distance d, d is equal to 3cm. 一种用于无张力疝修补术的二合一连体补片的材料选用巴德公司生产的15cmX 15cm聚丙烯平面补片。 A material piece combo patch hernia repair surgery for selection Bard produced 15cmX 15cm polypropylene flat patch. 手术方法 Surgical methods

斜疝术式:取疝常规切口4cm,分层切开腹外斜肌腱膜,显露出腱膜下腹内斜肌、腹横肌、睾提肌及神经走行。 Surgical inguinal hernia: taking a conventional hernia incision 4cm, layered cut external oblique fascia, revealing the oblique abdominal aponeurosis, transverse abdominal muscle, testis levator muscle and nerve traveling.

第一步建立腹横筋膜前间隙(第一间隙):沿睾提肌及精索内精膜切开 The first step in establishing transverse fascia front gap (first gap): mentioned in the testis and spermatic cord muscle fine cut film

2—3cm,上、下牵开睾提肌瓣,剥出精索,高位闭合疝囊,即可暴露出腹股沟管后壁腹横筋膜,以放置小补片。 2-3cm, upper and lower flap retractor levator testis, stripping out the spermatic cord, high hernia sac is closed, the rear wall of the inguinal canal to expose the fascia transversalis, to place a small patch.

第二步建立腹膜前间隙(第二间隙):以疝囊残端为中心,环周切开腹横筋膜,向内(延伸达右腹直肌后腹)、上(联合腱后)、外(弓状缘肌腹后) 钝性分离腹膜前间隙4一6cm,同时,将股管内口贴附的腹膜或隐性股疝囊完全剥离出来,间隙面积约15X9cm,以放置大补片。 Step establish preperitoneal space (second gap): sac stump to the center, circumferential cut transverse fascia, inwardly (extending up to the right rear abdominal rectus), the (combined after tendon), the outer (after arcuate edge muscle belly) blunt dissection preperitoneal space 4 a 6cm, while the spout is attached inside flank intraperitoneal or femoral hernia recessive completely stripped out, a gap area of ​​about 15X9cm, nourishing to place the sheet.

第三步将一种用于无张力疝修补术的二合一连体补片置入第一、二间隙:将一种用于无张力疝修补术的二合一连体补片套入精索,缝合索孔,直径控制在0. 6—0. 8cm。 Combo piece patch third step for hernia repair surgery into the first and second gaps of: a non-tension hernia repair patch piece combo set into a fine cable, rope suture hole diameter control at 0. 6-0. 8cm. 将面积大的补片平展于扩开的腹膜外间隙,调整网片证实超过疝环周缘4一6cm,耻骨肌孔完全覆盖;再将面积小的补片平展于腹横筋膜前,依次与腹股沟韧带内1/2、腹直肌鞘外缘、联合腱、弓状缘lcm 肌腹后环周固定缝合10—12针,探察无漏隙,原位缝合睾提肌及精索内精膜、腹外斜肌腱膜、皮肤。 Extraperitoneal space large area patch flat to spread apart, adjusting web confirmed ring 4 a 6cm beyond the circumferential edge hernia, pubic muscle hole is completely covered; small then the area of ​​the patch flat to the front transverse fascia, sequentially groin 1/2 ligament, the outer edge of the rectus sheath, tendon joint, circumferential fixing suture needles after 10-12 lcm arcuate edge muscle belly, leak detectors gap, sutured the muscle testis and spermatic cord mentioned fine film, external oblique fascia, skin. 实施例2 Example 2

一种用于无张力疝修补术的二合一连体补片,包括大补片l、小补片2, 小补片2的左边至延长的精索孔3的圆心线部分重叠粘合有大补片1,大补片1的形状为刀把形,工边为一大矩形,右下边为一小矩形,大矩形尺寸为10cmX6 cm,倒角的半径为1 cm,小矩形尺寸为5.5 cmXO. 5 cm,倒角的半径为2cm;小补片2的形状为鸭嘴形状,长X宽的尺寸为6cmX3 cm,右边是一个半圆,左边是长方形,半圆的半径R为2cm,大补片l、小补片2 的厚度均为0. 4mm,小补片2上的弧形顶端距大补片1的右边距离a为1. 5cm ,小补片2的上边距大补片1的上边距离b为3cm ;大补片1和小补片2上设有精索孔3,精索孔3的形状为圆形,直径为0. 5cm,精索孔3的圆心至大补片1的左边断开,精索孔3的圆心距小补片2的弧形顶端距离为c, c等于4 cm,精索孔3的圆心距小补片2的长边距离为d, d等于1. 5cm。 An apparatus for tension-piece combo hernia repair patch comprising nourishing sheet L, small patch 2, the center line portion of the left panel 2 patch to extend the hole 3 of the spermatic cord overlap adhesive has nourishing sheet 1, sheet 1 is shaped nourishing knife-shaped working edge of a large rectangular, a small rectangle to the lower right, is a large-size rectangular 10cmX6 cm, 1 cm & lt radius of chamfering, a size of the small rectangle 5.5 cmXO . 5 cm, 2cm chamfer radius; shape of the small patch 2 is a duckbill shape, length X width dimension 6cmX3 cm, on the right is a semi-circle on the left is rectangular, semicircular radius R of 2cm, nourishing sheet the thickness of l, 2 small patches are 0. 4mm, the arcuate top 2 from the right side of the small patch 1 nourishing distance a sheet 1. 5cm, small patches on the upper margin of sheet 2 of the nourishing is the distance b 3cm; spermatic cord holes 3 provided on the two sheets 1 and nourishing the small patch, the shape of the spermatic cord 3 has a circular hole, a diameter of 0. 5cm, spermatic cord to the center hole 3 of the sheet 1 nourishing left off the center hole 3 of the spermatic cord from a small patch of an arcuate tip distance 2 c, c is equal to 4 cm, the spermatic cord 3 from the hole center small patch 2 is the longitudinal distance d, d is equal to 1. 5cm. 一种用于无张力疝修补术的二合一连体补片的材料选用贝朗公司生产的15cmX 15cm聚丙烯平面补片。 A material piece combo patch hernia repair surgery for the selection of B. Braun produced 15cmX 15cm polypropylene flat patch. 手术方法 Surgical methods

直疝术式:同实施例1中的手术方法分层切开,分离出精索与直疝囊, 处理疝囊后,沿联合腱弓状下缘切开腹横筋膜,依次分离出腹直肌鞘后、联合腱弓状下缘后扇形股膜前间隙4一5cm,至此腹横筋膜前、后间隙连通,裁剪一种用于无张力疝修补术的二合一连体补片,套入精索,面积大的补片平展于腹膜外间隙,并与腹直肌鞘后、联合腱弓状下缘后1. 5cm缝合固定8针; 用面积小的补片替代^横筋膜,与切开之弓状下缘缝合4一6针,放回精索, 缝合睾提肌、腹外斜肌)健膜、皮肤。 Direct hernia formula: with embodiments of surgical incision layered Example 1, isolate the spermatic cord and a straight sac, the sac treatment, cut along the transverse fascia tendon joint arcuate edge, sequentially separated abdominal linear after the muscle sheath, the tendon joint arcuate edge of the front lower gap film 4 a sector shares 5cm, transversalis fascia to this, the space in communication, one kind of combo cut piece patch hernia repair surgery for jacket the spermatic cord, large area flat patch in extraperitoneal space, and with the posterior rectus sheath, the joint 1 after tendon arcuate lower edge 8 5cm suture needle; replaced with a small area patch ^ transversalis fascia, and the lower edge of arcuate suture cut a 4-pin 6, back spermatic cord, testis suture levator obliques) fasciae, skin.

Claims (1)

1、一种用于无张力疝修补术的二合一连体补片,包括大补片(1)、小补片(2),其特征是:大补片(1)上设有小补片(2),大补片(1)的形状为刀把形,上边为一大矩形,右下边为一小矩形,大矩形尺寸为15cm-10cm×8cm-6cm,倒角的半径为1-2cm,小矩形尺寸为8cm-5.5cm×1cm-0.5cm,倒角的半径为2cm;小补片(2)的形状为鸭嘴形状,长×宽的尺寸为10cm-6cm×5cm-3cm,右边是一个半圆,左边是长方形,半圆的半径R为2-1.5cm,大补片(1)、小补片(2)的厚度为0.4-0.6mm,小补片(2)上的弧形顶端距大补片(1)的右边距离a为2cm-1.5cm,小补片(2)的上边距大补片(1)的上边距离b为3cm;大补片(1)和小补片(2)上设有精索孔(3),精索孔(3)的形状为圆形,直径为0.5cm-0.8cm,精索孔(3)的圆心至大补片(1)的左边断开,精索孔(3)的圆心距小补片(2)的弧形顶端距离为c,c等于6.5cm-4cm,精索孔(3)的圆心距小补片(2)的长边 A combo piece patch hernia repair surgery, comprising nourishing sheet (1), a small patch (2), characterized in that: with a small fill nourishing sheet (1) shaped plate (2), nourishing sheet (1) is knife-shaped, the upper side of a large rectangular, a small rectangle to the lower right, is a large-size rectangle 15cm-10cm × 8cm-6cm, the radius of chamfering is 1-2cm small rectangular size of 8cm-5.5cm × 1cm-0.5cm, 2cm radius of chamfering; shape of the small patch (2) is a duckbill shape, a size of length × width 10cm-6cm × 5cm-3cm, the right is a semi-circle on the left is rectangular, semicircular radius R 2-1.5cm, nourishing sheet (1), the thickness of the small patch (2) is 0.4-0.6 mm, on a small patch (2) of the arcuate top from nourishing sheet (1) to the right side from a 2cm-1.5cm, small patches (2) on the margin nourishing sheet (1) from the upper side of b 3cm; nourishing sheet (1) and a small patch ( spermatic cord provided with holes (3), spermatic cord hole (3) 2) is circular in shape, the diameter of 0.5cm-0.8cm, spermatic hole (3) to the center of nourishing sheet (1) off to the left open, spermatic center hole (3) a small distance from the top of arcuate patch (2) of c, c is equal to 6.5cm-4cm, spermatic center hole (3) from a small patch (2) in the longitudinal 离为d,d等于3cm-1.5cm,一种用于无张力疝修补术的二合一连体补片的材料为聚丙烯。 From as d, d is equal to 3cm-1.5cm, material tension-free hernia repair patch for combo piece is polypropylene.
CN 200610070710 2006-12-06 2006-12-06 Connected two-in-one patch for strainless hernia repair CN100425207C (en)

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