ObjectiveTo evaluate the lesion detection rate and completeness rate of the preoperative ultrasonic diagnosis in patients with external abdominal hernia， and to analyze the quality of preoperative ultrasonic reports， thereby exploring potential improvement measures.MethodsWe conducted a retrospective analysis of clinical data， ultrasonic examination results， and surgical records from patients with external abdominal hernias who underwent surgery at Peking Union Medical College Hospital from January to December 2023.With intraoperative diagnosis as the gold standard， the lesion detection rate were evaluated， and the quality of the reports was evaluated based on whether they indicated the type of inguinal hernia， the width of the neck of the hernia sac and its mobility.ResultsA total of 112 patients with surgically treated external abdominal hernias were included in the study， comprising 98 cases of inguinal hernia and 14 cases of abdominal wall hernia.The preoperative ultrasonic lesion detection rate of inguinal hernia was 95.9%， and the completeness rate of the ultrasound report of inguinal hernia was 14.3%.The preoperative ultrasonic lesion detection rate of ventral hernia was 100.0%， and the completeness rate of the ultrasound report of ventral hernia was 50.0%.ConclusionUltrasound demonstrates a high detection rate for external abdominal hernias， effectively providing information regarding location， size， neck width of the hernia sac， mobility characteristics and relationships with surrounding tissues.Consequently， it is recommended that more comprehensive information be included in ultrasound reports to assist clinicians in making decisions and treatment.
Objective:To investigate the application value of color Doppler ultrasound in the differential diagnosis of inguinal hernia and femoral hernia.Methods:The data of 107 patients with inguinal hernia and femoral hernia who were admitted to Lujiang County People's Hospital, Anhui Province from October 2021 to September 2022 were analyzed retrospectively. All patients underwent color Doppler ultrasonography before surgery, and the examination results were analyzed. The value of color Doppler ultrasound in the differential diagnosis of inguinal hernia and femoral hernia was discussed.Results:All 107 patients were confirmed by surgery including 75 cases of indirect hernia, 20 cases of direct hernia and 12 cases of femoral hernia. Color Doppler ultrasound found 73 cases of indirect hernia, 19 cases of direct hernia and 12 cases of femoral hernia, and 3 cases were misdiagnosed as lipoma. The sensitivity and specificity of color Doppler ultrasound were 96.00% and 96.87% for diagnosing indirect hernia, 95.00% and 96.55% for diagnosing direct hernia, 100.00% and 100.00% for diagnosing femoral hernia .Conclusion:Color Doppler ultrasound has high sensitivity and specificity for diagnosing inguinal hernia and femoral hernia. It can provide reference for the development of surgical plan and adjustment of details.
Objective:To explore the effect of health management combined with psychological intervention in children after laparoscopic inguinal hernia surgery.Methods:In this prospective study, 193 children with inguinal hernia who underwent laparoscopic ligation of hernia sac surgery at Nanning Maternity and Child Health Hospital from July 2020 to June 2022 were selected as the research subjects and were divided into observation group (97 cases) and control group (96 cases) by simple random number table method. The children in the control group received routine nursing and psychological intervention, and the children in the observation group received health management combined with psychological intervention on this basis. The postoperative recovery, postoperative complications, psychological status before and after intervention and parents' satisfaction with nursing were compared between the two groups.Results:The ambulation time, exhaust time, defecation time and hospital stay of the observation group were shorter than those of the control group, and the FLACC score at 24 h after operation was lower than that of the control group (All P<0.05). Before intervention, there was no differences in the scores of CSDC dimensions and total scores between the two groups (P>0.05). After intervention, the scores of CSDC dimensions and total scores in the two groups were lower than those before intervention, and those in the observation group were lower than those in the control group (P<0.05). The difference of each CSDC dimension and total score before and after intervention in the observation group was greater than in the control group (P<0.05). The total incidence of postoperative complications in the observation group was lower than that in the control group (P<0.05). The total nursing satisfaction of parents in the observation group was better than that in the control group (P<0.05).Conclusion:Health management combined with psychological intervention can promote the recovery of children after laparoscopic inguinal hernia surgery, improve the psychological state of children, reduce the incidence of postoperative complications, and improve the nursing satisfaction of parents.
Objective:To explore the application effect of operating room nursing process based on continuous quality improvement in open inguinal hernia repair.Methods:A total of 110 patients with inguinal hernia undergoing open herniorrhaphy with seven-step method in Beijing Tiantan Hospital Affiliated to Capital Medical University were enrolled between January 2020 and December 2022. According to the implementation of operating room nursing program based on continuous quality improvement, they were divided into control group (55 cases, before implementation, between January 2020 and June 2021) and observation group (55 cases, after implementation, between July 2021 and December 2022). The operation time, incidence of postoperative incision infection, surgical cooperation of nursing staffs, surgical cooperation of nursing staffs, standardization of operation by nursing staffs (aseptic operation, surgical procedure and hand hygiene operation), overall nursing quality of operating room, and patients satisfaction were compared between the two groups.Results:Compared with the control group, the operation time was shorter [(80.84±3.58) min vs (82.59±4.21) min], surgical cooperation was better [(9.12±0.14) scores vs (8.25±0.68) scores], and overall satisfaction was higher (90.91% vs 76.36%) in the observation group, with statistical significance (P<0.05). The incidence of incision infection in the observation group was lower than that in the control group, but the difference was not statistically significant (P>0.05). The standardization scores of aseptic operation, surgical procedure and hand hygiene operation by nursing staffs, and scores of overall nursing quality in operating room (environmental management, items placement, disinfection and isolation, registration of nursing documents) in the observation group were improved compared with those in the control group (P<0.05).Conclusion:The operating room nursing process based on continuous quality improvement can effectively improve intraoperative doctor-nurse cooperation, shorten the operation time, improve overall nursing quality of operating room and patients satisfaction, which may reduce the incidence of incision infection. However, it needs to be further observed in a large sample study.
Objective:To analyze the feasibility and safety of laparoscopic totally extraperitoneal hernia repair in the treatment of the right inguinal hernia with history of appendectomy.Methods:From September 2020 to September 2022, the clinical data of 73 patients with right or bilateral inguinal hernia who underwent laparoscopic totally extraperitoneal hernia repair (TEP) at the General Surgery Department of the 991st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army was retrospectively analyzed. According to whether they had a history of appendectomy, they were divided into a study group (after appendectomy group) and a control group (without surgery history group). The operation-related indicators,, postoperative pain degree, postoperative recovery, total hospitalization cost, and incidence of complications were compared between the two groups.Results:All the patients in the two groups successfully underwent TEP with no perioperative death; the operative time, intraoperative blood loss, hernia sac diameter, incidence of intraoperative peritoneal injury, number of intraoperative peritoneal injuries, amount of plastic clamp used and incidence of medical glue used in the two groups were not statistically significant (P>0.05). No case in the study group was converted to the transabdominal preperitoneal hernia repair (TAPP) or open surgery, and 2 cases in the control group were converted to TAPP, but there was no significant difference in the convert rate between the two groups (P=0.504). There was no significant difference in the time to get out of bed, postoperative hospital stay, or total hospitalization cost between the two groups. There was no significant difference in the VAS score of the postoperative day, the VAS score of the next day, or the postoperative pain duration between the two groups. There were 2 cases of seroma and 1 case of bladder injury in the study group, and 5 cases of seroma and no bladder damage in the control group. In all cases, the follow-up time was 2 to 24 months, and the middle follow-up time was six months. There was no chronic pain in either group. There was no recurrence in the study group, but one recurrence in the control group. There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05).Conclusion:TEP is safe and feasible in the treatment of the right inguinal hernia with a history of appendectomy.
Objective:To explore the application effect of cluster nursing based on the concept of enhanced recovery after surgery (ERAS) in patients with inguinal hernia repair.Methods:A total of 94 patients who underwent inguinal hernia repair in Yichang First People's Hospital from January 2020 to December 2021 were selected and divided into the control group of 47 cases and the observation group of 47 cases by the random number table method. The control group was given the ERAS care model, and the observation group was given bundled care based on the ERAS concept. The postoperative recovery, postoperative pain at different time points, anxiety and depression before and after nursing, the occurrence of adverse reactions and nursing satisfaction were compared between the two groups.Results:The, postoperative eating time, anal exhaust time, ambulation time, and hospital stay in the observation group were significantly shorter than those in the control group (P<0.05). 2, 4, 8, 12, 24 h after operation, the visual analogue scale (VAS) score of the observation group was significantly lower than that of the control group (P<0.05). The scores of the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) in the two groups after nursing were lower than those before nursing (P<0.05), and the observation group was significantly lower than the control group (P<0.05). The incidence of adverse reactions in the observation group (4.26%) was significantly lower than that in the control group(17.02%) (P<0.05). The nursing satisfaction of the observation group (97.87% vs 87.23%) was significantly higher than that of the control group (P<0.05).Conclusion:The bundled nursing based on the ERAS concept applied to patients undergoing inguinal hernia repair can speed up postoperative recovery, relieve postoperative pain, relieve anxiety and depression, reduce adverse reactions, and improve nursing satisfaction.
Abdominal wall hernia is a common surgical disease. Complex abdominal wall hernia generally refers to cases with difficult treatment and high risk of postoperative complications. How to diagnose complex abdominal wall hernia; what related treatment techniques are available; how to prevent complications such as postoperative infection or abdominal compartment syndrome (ACS); how to manage the patients during perioperative period to enhance the surgical treatment effect; this paper intends to discuss the above issues.
日间手术（day surgery或ambulatory surgery）这一概念最早由英国儿科医生James H. Nicoll在20世纪初提出，是指"患者在一个工作日内完成入院、手术和出院的一种手术模式，不包括在诊所或医院开展的门诊手术"。也就是将传统需要住院多日完成的手术在24 h之内完成。目前在国际上被广泛认可的定义是由1995年成立的国际日间手术协会（International Association for Ambulatory Surgery，IAAS）提出的："患者在同一个工作日完成手术或操作并出院的，不包括那些在诊所或门诊进行的手术或操作"。需要过夜观察的患者，称之为"日间手术-延期恢复患者"。2013年中国日间手术合作联盟（China Ambulatory Surgery Alliance，CASA）正式加入IAAS，标志着中国日间手术进入了一个新的发展时期，日间手术的概念和内涵更加清晰。2015年CASA推出中国日间手术定义："日间手术指患者在1 d（24 h）内入、出院完成的手术或操作"。有两点补充说明：一是日间手术是对患者有计划进行的手术和操作，不含门诊手术；二是关于日间手术住院延期患者，指特殊病例由于病情需要延期住院的患者，住院最长时间不超过48 h[1]。2022年国家卫生健康委印发《医疗机构日间医疗质量管理暂行规定》，提出：本规定所称日间医疗，是指医疗机构在保障医疗质量安全前提下，为患者提供24 h内完成住院全流程诊疗服务的医疗服务模式。对日间医疗质量管理的组织建设、制度规范、流程管理等各个方面提出基本要求，并明确卫生健康行政部门的监督管理职责。近年来，我国日间手术进一步和国际接轨，"日归手术（same-day surgery）"的概念也被广泛接纳：日归手术通过优化与再造日间手术服务流程，改变我国日间手术传统的过夜模式，融入个体化的加速康复外科（enhanced recovery after surgery，ERAS）理念，将过去需要住院1 d的日间手术缩短为当天住院，当天手术，当天出院。
Objective:To observe the effects of inguinal nerve block combined with sufentanil anesthesia in Lichtenstein repair of elderly inguinal hernia.Methods:Retrospective analysis of the clinical data of 88 elderly patients with inguinal hernia treated with Lichtenstein repair at Mengcheng County Traditional Chinese Medicine Hospital from January 2021 to December 2022. They were divided into an observation group (from January 2022 to December 2022) and a control group (from January 2021 to December 2021) based on the time of admission. All patients were treated with Lichtenstein repair, and the control group was given lumbar anesthesia combined with epidural anesthesia during surgery, the observation group was given inguinal nerve block combined with sufentanil anesthesia during surgery. The basic conditions of operation (onset time of anesthesia, maintenance time of anesthesia, degree of postoperative pain) were compared between the two groups. The blood circulation status [blood oxygen saturation (SpO2), heart rate (HR), mean arterial pressure (MAP)] were observed before anesthesia induction, before skin incision, at 15 min after skin incision and at the end of surgery. The early cognitive function [Montreal Cognitive Assessment (MoCA)] was compared between the two groups at 6 h, 12 h, 1 d and 3 d after surgery, and the adverse reactions in the two groups within 3 d after surgery were analyzed.Results:The maintenance time of anesthesia was longer in the observation group than that in the control group (P<0.05), the onset time of anesthesia were shorter and degree of postoperative pain were lower than those in the control group (P<0.05). Before skin incision, at 15 min after skin incision and at the end of surgery, the SpO2 level in observation group was lower than that in the control group (P<0.05), and there was no significant statistical differences in HR and MAP between the two groups (P>0.05). At 6 and 12 h after surgery, the score of MoCA scale was lower in observation group than that in control group (P<0.05). There was no significant statistical difference in MoCA scale score between the two groups at 1 and 3 d after surgery (P>0.05). The total incidence rate of adverse reactions in observation group within 3 d after surgery was lower than that in control group (P<0.05).Conclusion:Inguinal nerve block combined with sufentanil anesthesia in elderly patients undergoing Lichtenstein repair has good anesthetic effect, stable blood circulation, and high drug safety, but is not conducive to improving early postoperative cognitive function.
Objective:To explore the effects of ultrasound-guided ilioinguinal and inferior iliac nerve block (IINB) combined with transversus abdominis plane block (TAPB) on heart rate, blood pressure, postoperative analgesia and stress response in elderly patients undergoing inguinal hernia repair..Methods:A prospective study method was used to select 86 elderly patients who received inguinal hernia Lichtenstein treatment in Xiantao First People's Hospital Affiliated to Yangtze University from April 2020 to February 2022, and were divided into control group and observation group according to random number table method, with 43 cases in each group. The control group received ultrasound guided IINB, and the observation group received ultrasound guided IINB combined with TAPB. The heart rate, systolic blood pressure, diastolic blood pressure, analgesic effect at different time points, postoperative stress index (TNF-α), C-reactive protein (CRP), cortisol and postoperative adverse reactions were compared between the two groups when entering the operating room (T0), skin resection (T1) and skin suture (T2).Results:At T0, there was no statistical significance in heart rate, systolic blood pressureor diastolic blood pressure between the two groups (P>0.05). The heart rate and systolic blood pressure in the observation group at T1 were significantly lower than those in the control group, and the systolic blood pressure in the observation group at T2 was significantly lower than that in the control group, with statistical significance (P<0.05). The VAS scores of the observation group at 2, 4, 8, 12 and 24 hours after operation were lower than those of the control group, and the difference was statistically significant (P<0.05). Before surgery, CRP, TNF-α and cortisol were not significantly different between the two groups (P>0.05). 1 and 3 days after surgery, CRP, TNF-α and cortisol in the observation group were significantly lower than those in the control group, with statistical significance (P<0.05). The incidence of anesthesia complications in 86 patients was 5.81%(5/86), and there was no significant difference between the two groups (P>0.05).Conclusion:Ultrasound-guided IINB combined with TAPB has a better effect on stabilizing heart rate, systolic blood pressure and diastolic blood pressure in elderly patients undergoing inguinal hernia repair, and can improve analgesic effect and stress response, with guaranteed safety.
Objective:To investigate the incidence and risk factors of incisional hernias after stoma closure.Methods:A retrospective analysis was performed on patients undergoing ostomy reduction from July 2015 to December 2019 in the Department of General Surgery of Nanjing Drum Tower Hospital. Gender, age, body mass index (BMI), hypertension, diabetes, benign or malignant disease, ileostomy or colostomy, emergency or elective surgery, stoma (end type or loop type), ostomy was endoscopic or not, operation time, blood loss, postoperative hospital stay, postoperative incision infection, follow-up time, and whether incisional hernia occurred again at the original stoma were recorded. The risk factors for incisional hernia that occurred after stoma reduction were evaluated by univariate analysis and multivariate logistic regression analysis.Results:A total of 89 patients were analyzed. The incidence of ostomy site incisional hernias after stoma closure was 23.6% (21 cases), of which 9 underwent surgical treatment and the others received conservative treatment. Univariate analysis and multivariate logistic regression analysis suggested that the independent risk factors for incisional hernia included: colostomy (OR 7.161, 95% CI 1.479-34.667, P=0.014), age ≥68 years (OR 1.093, 95% CI 1.029-1.161, P=0.004), emergency surgery (OR 6.343, 95% CI 1.663-24.190, P=0.007). The BMI of patients with incisional hernia after stoma closure was higher than that of patients without incisional hernia [(25.2±3.5) kg/m2vs (23.2±2.8) kg/m2], and the difference was statistically significant (P=0.009).Conclusion:Ostomy site incisional hernias after stoma closure often occurs, which often requires secondary surgical treatment, which seriously affects the quality of life of patients and increases the economic burden. Colostomy, age ≥68 years and emergency surgery are independent risk factors for incisional hernia. For these patients and patients with BMI≥25 kg/m2, stoma closure combined with preventive mesh implantation can be used as clinical treatment.
Objective:To study the application value of Robocare nursing mode combined with high frequency chest wall oscillation in laparoscopic abdominal wall incisional hernia repair.Methods:A total of 114 patients who underwent laparoscopic abdominal wall incisional hernia in Hanchuan People's Hospital from January 2019 to January 2022 were selected as the study subjects, and were divided into an observation group and a control group by the random number table method, with 57 patients in each group. The control group adopted conventional nursing mode, and the observation group adopted Robocare nursing mode on the basis of the control group. Both groups were treated with high-frequency chest wall oscillation after the operation. Perioperative indexes were compared between the two groups, including time to get out of bed, exhaust time, abdominal drainage tube removal time, length of hospital stay, and Karnofsky score 1 week after surgery. Short form 36 (SF-36) score, the Self-rated Anxiety Scale (SAS) and the Self-rated Depression Scale (SDS) were compared between the two groups 1 day before nursing and 3 months after discharge. The postoperative complications of the two groups were recorded. The satisfaction of nursing was compared between the two groups.Results:Compared with the control group, the abdominal drainage tube removal time and hospital stay were shorter in the observation group, and the Karnofsky score was higher 1 week after surgery (P<0.05). There was no significant difference between the two groups in getting out of bed time and exhaust time (P>0.05). Before nursing, there was no significant difference in the scores of the SF-36 scale between the two groups (P>0.05); After nursing, the scores of SF-36 scale in both groups were improved (P<0.05); The scores of SF-36 scale and the difference before and after nursing in the observation group were higher than those in the control group (P<0.05); Before nursing, there was no significant difference in SAS and SDS scores between the two groups (P>0.05). After nursing, the SAS and SDS scores of the two groups decreased (P<0.05); The difference of SAS and SDS scores before and after nursing in the observation group was higher than that in control group (P<0.05); Compared with the control group, the incidence of postoperative complications in the observation group was lower (P<0.05); Compared with the control group, the observation group had higher satisfaction with this nursing (P<0.05).Conclusion:Robocare nursing mode combined with high-frequency chest wall oscillations for laparoscopic abdominal incisional hernia repair can promote the physical recovery of patients, reduce the incidence of complications such as incisional hernia recurrence, shorten the length of hospital stay, significantly reduce anxiety and depression, improve the quality of life of patients, and improve the satisfaction of patients with nursing services.
Objective:To investigate the feasibility, safety and operative effect of abdominal wall reconstruction for abdominal wall defect after surgical resection of adult abdominal desmoid tumor.Methods:The clinical data of 34 patients with abdominal desmoid tumor who received operative treatment in Department of Hernia and Abdominal Wall Surgery, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology from September 2013 to September 2019 were retrospectively analyzed. There were 3 males and 31 females, the average age was (42.6±10.3) years, ranging from 21 to 78 years. All patients received surgical resection of abdominal desmoid tumor and abdominal wall defect reconstruction.Results:All patients received operations successfully. The pathological diagnosis was desmoid tumor for 34 patients. The diameter of abdominal wall defect after surgical resection was (6.8±2.3) cm, ranging from 4 to 16 cm. There was no damage with bowel and other organs during operation. Four patients need analgesics for 3 days for postoperative pain treatment. Postoperative hospital stay ranged from 3 to 9 (4.8±1.2) days. After operation, there was no postoperative infection and blood loss during the first three days. All patients were followed up for 2 to 24 months. No abdominal hernia, tumor recurrence, chronic pain or mesh infection. There was one death within 2 years, and the cause of death was not related to abdominal desmoid tumor.Conclusion:Adequately resection, careful dissection and separation technique, combined with the application of polypropylene mesh for patients with adult abdominal desmoid tumor is safe and effective.
Objective:To explore the application effect of ultrasound-guided transverse abdominal muscle plane block in laparoscopic inguinal hernia surgery.Methods:Retrospective analysis of clinical data of 86 patients with inguinal hernia at Haian Traditional Chinese Medicine Hospital, from April 2019 to April 2022, all of whom underwent laparoscopic hernia repair surgery. They were divided into observation group and control group according to different anesthesia methods, with 43 patients in each group. The control group received routine anesthesia, and the observation group received ultrasound-guided transverse abdominal muscle plane block. The perioperative indexes [operation time, extubation time, recovery time of spontaneous breathing, recovery time, recoveryquality (Steward recovery score), postoperative hospitalization time and postoperative fentanyl dosage] were compared between the two groups. The heart rate, mean pulsatile pressure (MAP) and pulse oxygen saturation (SpO2) before anesthesia induction (T0), 3 min after anesthesia induction (T1), and at the end of surgery (T2) were compared between the two groups. The visual analogue scale (VAS) score and Ramsay sedation score were compared between the two groups at 1, 6 and 12h after operation, and the adverse reactions of the two groups were compared.Results:There was no significant difference in operation time between the two groups (P>0.05); The extubation time, recovery time of spontaneous breathing, recovery time, hospitalization time and postoperative fentanyl dosage in the observation group were all lower than those in the control group, and the Steward score was higher than that in the control group, with statistical significance (P<0.05). There was no significant difference between the two groups in heart rate, MAP and SpO2 levels at T0 (P>0.05); The levels of heart rate and MAP at T1 and T2 in the two groups were lower than those at T0 in the same group, with statistical significance (P<0.05); The heart rate level at T2 in both groups was lower than that at T1 in the same group, and the MAP level was higher than that at T1 in the same group, with statistical significance (P<0.05); The heart rate level of the observation group at T1 and T2 was lower than that of the control group at T1 and T2, and the MAP level was higher than that of the control group at T1 and T2, with statistical significance (P<0.05). The VAS score and Ramsay sedation score of the two groups at 6 and 12 h after operation were lower than those of the same group at 1 h after operation, and the difference was statistically significant (P<0.05); The VAS score and Ramsay sedation score of the two groups at 12 h after operation were lower than those of the same group at 6 h after operation (P<0.05). The VAS scores of the observation group at 1, 6 and 12 h after operation were lower than those of the control group, while the Ramsay sedation score were higher than those of the control group, with statistically significant difference (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion:Ultrasound-guided transverse abdominal muscl plane block is used in laparoscopic inguinal hernia repair, which has good recovery quality, postoperative analgesia and sedation effect, and high safety for patients.
Objective:Explore the nursing application effect of proactive personalized psychological intervention in adult inguinal hernia patients during the perioperative period.Methods:A simple random sampling method was used to select 300 patients with inguinal hernia admitted to Nanjing Gaochuan People's Hospital from January 2020 to January 2022 as the research objects for a prospective study. All of the patients were divided into a control group (150 cases) and an observation group (150 cases) by the random number method. Routine care was given to the control group. On the basis of the above, the observation group was combined with proactive and personalized psychological intervention. The patients in both groups were intervened until they were discharged. Compare the surgical coordination, heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels between the two groups of patients before and 5 minutes before anesthesia, postoperative recovery, psychological status, and quality of life of patients before and after intervention.Results:The total operative coordination rate in the observation group was higher than that in the control group. Compared with those before intervention, the levels of HR, SBP, and DBP in the control group increased and were higher than those in the observation group 5 min before anesthesia began. The time of first flatus, first getting out of bed and moving, postoperative hospitalization and postoperative recovery of food intake in the observation group were shorter than those in the control group. After intervention, the anxiety, stress and depression scores of the two groups decreased, which were lower in the observation group than in the control group. However, various scores of the quality of life increased, which was relatively higher in the observation group than in the control group, the differences were statistically significant (all P<0.05).Conclusion:Active and personalized psychological intervention can effectively shorten the postoperative recovery time of adult inguinal hernia patients undergoing surgical treatment, improve their psychological state, have little impact on the intraoperative physiological changes of patients, and can also improve their intraoperative cooperation and postoperative quality of life.
Objective:To investigate the clinical effect of high ligation of single hole and double needle hernia sacs in the treatment of giant inguinal hernia in children.Methods:From January 2003 to January 2023, 36 children with giant oblique inguinal hernias were treated with high ligation of single hole and double needle hernia sacs. The clinical data of these patients were retrospectively analyzed. The operative time, intraoperative blood loss, wound pain, complication rate and recurrence rate were observed.Results:High ligation of the hernia sac with a single hole and double needle was performed successfully in all 36 cases. The average operation time of unilateral hernia was 10 min, and that for bilateral hernia was 12 min. The average intraoperative bleeding was 1 ml, and postoperative incision pain was slight. No scrotal emphysema or seroma occurred in the male child. All the children were included in the management of the day operation procedure, and no recurrence was reported after 6-60 months of follow-up. Regular B-ultrasound examinations showed no scrotal effusion, normal testicular blood flow, no atrophy, and no recurrent cases.Conclusion:High ligation of single hole and double needle hernia sacs is safe and reliable in the treatment of giant inguinal hernia in children, with a low complication rate and recurrence rate.
Objective:To explore the ultrasonic signs of inguinal hernia and femoral hernia, and their differential diagnosis value.Methods:A retrospective analysis was performed on 60 patients with suspected inguinal hernia or femoral hernia admitted to Tianchang City Hospital of Traditional Chinese Medicine between October 2020 and December 2021. All underwent ultrasonography and surgical exploration. The ultrasonic signs and characteristics of inguinal hernia and femoral hernia were analyzed. Taking results of surgical exploration as the golden standard, the Kappa consistency of diagnosis results between ultrasound and surgical exploration was analyzed.Results:Surgical exploration showed that there were 55 patients with inguinal hernia or femoral hernia, including 45 cases with indirect hernia, 6 cases with direct hernia and 4 cases with femoral hernia. There are 5 patients without inguinal hernia or femoral hernia, including 2 cases with abdominal wall lipoma, 2 cases with hydrocele and 1 case with cryptorchidism. Taking the results of surgical exploration as the golden standard, the sensitivity and specificity of ultrasound in the diagnosis of inguinal hernia and femoral hernia were 92.73% and 80.00%, respectively (Kappa=0.571). The accuracy of ultrasound in the differential diagnosis of indirect hernia, direct hernia and femoral hernia was 90.91% (Kappa=0.768). The accuracy of ultrasound in the differential diagnosis of hydrocele, abdominal wall lipoma and cryptorchidism was 80.00% (Kappa=0.706), respectively.Conclusion:Ultrasound is of great value in the diagnosis and classifications of inguinal hernia and femoral hernia, which is the first choice for the differential diagnosis of inguinal hernia and femoral hernia.
Objective:To investigate the effect ultrasound-guided ilioinguino-iliohypogastric nerve block (IINB) combined with local anesthesia in tension-free inguinal hernia repair in elderly patients.Methods:A prospective study was conducted on 104 elderly patients who underwent tension-free inguinal hernia repair in Hanchuan People's Hospital of Hubei Province from February 2019 to February 2021. Patients were divided into experimental group and control group using a random number table method, with 52 patients in each group. The control group was given subarachnoid nerve block anesthesia, and the experimental group was given IINB combined with local anesthesia under ultrasound guidance. The visual analogue scale (VAS) of pain at 24, 48, and 72 hours after operation was compared between the two groups, and the stress response indexes [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and cortisol] before and 24, 48 hours after surgery, and hemodynamic [heart rate, mean arterial pressure (MAP), and oxygen saturation (SpO2) levels] at T0 (before anesthesia), T1 (after anesthesia for 10 minutes), T2 (during skin incision), T3 (when pulling hernia sac) and T4 (during skin suture) were compared.Results:At rest, the VAS scores of the experimental group were lower than those of the control group at 24, 48, and 72 h postoperatively and the difference was statistically significant (P<0.05). During activity, the difference in VAS scores between the two groups was not statistically significant at 24 h after surgery (P>0.05), and the differences in VAS scores at 48 and 72 h after surgery were statistically significant (P<0.05). The heart rate of the experimental group was higher than that of the control group at the moments of T1, T2, T3, T4, and the MAP values of the experimental group were higher than those of the control group at the moments of T1 and T4; the SpO2 values of the experimental group were higher than those of the control group at the moments of T2 and T3 (P<0.05); serum IL-6, TNF-α, CRP and cortisol levels in the experimental group were lower than those in the control group at 24 and 48 h after surgery (P<0.05). The incidence rate of total adverse reactions in the experimental group was lower than that in the control group (9.62% vs 23.08%), but the difference was not statistically significant (χ2=1.847, P=0.065).Conclusion:Under ultrasound guidance, IINB has good anesthesia effect and high safety in tension-free inguinal hernia repair in elderly patients, which can effectively reduce stress and inflammatory response during perioperative period and maintain hemodynamic stability of the body.
Objective:To explore the application effect of comfortable operating room nursing in laparoscopic inguinal hernia repair.Methods:According to the random number table method, 80 patients undergoing laparoscopic inguinal hernia repair in the First People's Hospital of Huoqiu County were divided into an observation group and a control group between January 2020 and June 2022, with 40 cases in each group. The control group was given routine operating room nursing, while the observation group was additionally given comfortable operating room nursing. The scores of the Hamilton Anxiety Scale (HAMA) and Kolcaba General Comfort Questionnaire (GCQ) were compared between the two groups at the visit (before nursing) and after the operation (after nursing). The heart rate (HR), blood pressure entered the pre-operation waiting room (T0), before anesthesia (T1), and 5 min after the operation (T2) were observed. The preoperative waiting time and stay time in the anesthesia recovery room in both groups were recorded. The satisfaction with the operating room nursing service was evaluated.Results:Before nursing, there was no significant difference in HAMA score or GCQ score (P>0.05). After nursing, the HAMA score of patients in the observation group was lower than that in the control group, while the GCQ score was higher than that in the control group (P<0.05). At T0, there was no significant difference in HR, systolic blood pressure (SBP), or diastolic blood pressure (DBP) between the two groups (P>0.05). At T1 and T2, HR, SBP, and DBP in the observation group were lower than those in the control group (P<0.05). The stay time in anesthesia recovery room in the observation group was significantly shorter than that in the control group [(36.01±6.60) min vs (41.88±5.47) min, P<0.05], and scores of satisfaction with operating room nursing (service attitude, behaviors, health education, information checking, humanistic care) were higher than those in the control group (P<0.05).Conclusion:Comfortable operating room nursing can relieve anxiety, improve comfort, reduce stress response, shorten stay time in anesthesia recovery room and improve patients satisfaction after laparoscopic inguinal hernia repair.
Objective:To explore the clinical effect of laparoscopic transabdominal preperitoneal repair (TAPP) in the treatment of inguinal hernia after radical prostatectomy, and to provide theoretical basis for optimizing the surgical treatment of inguinal hernia after radical prostatectomy.Methods:A retrospective study was conducted on 68 patients with inguinal hernia and 215 patients with primary inguinal hernia after radical prostatectomy treated by TAPP in the Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University from January 2016 to December 2020. According to the causes of inguinal hernia, the patients with inguinal hernia after radical prostatectomy were the experimental group, and the patients with primary inguinal hernia were the control group. The operation time, intraoperative blood loss, intraoperative complication rate, postoperative hospital stay, postoperative pain score, postoperative complication rate and postoperative recurrence of the two groups were analyzed and compared.Results:The surgical time of the experimental group was longer than that of the control group (P<0.05). There was no statistically significant difference (P>0.05) between the two groups of patients in terms of intraoperative bleeding volume, incidence of intraoperative complications, postoperative hospitalization days, postoperative pain score, incidence of postoperative complications, and postoperative recurrence.Conclusion:TAPP is safe and effective in the treatment of inguinal hernia after radical prostatectomy. The efficacy of laparoscopic repair for inguinal hernia after radical prostatectomy is similar to that of patients with primary inguinal hernia.
