Lichtenstein (美国)疝中心资料

About The Lichtenstein Hernia Institute Lichtenstein Lichtenstein (美国)疝中心资料( Amid 博士为该中心主任,该资料来源于 Lichtenstein 疝中心网站,代表 Amid 博士观点)The Lichte

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About The Lichtenstein Hernia Institute Lichtenstein Lichtenstein (美国)疝中心资料

Amid 博士为该中心主任,该资料来源于 Lichtenstein 疝中心网站,代表 Amid 博士观点)

The Lichtenstein Hernia Institute is the only facility in the United States devoted exclusively to research, teaching and surgery of abdominal wall hernias (inguinal hernia, femoral hernia, umbilical hernia, ventral hernia or incisional hernia). In 1984, for the first time, internationally recognized hernia experts at the Lichtenstein Hernia Institute originated and popularized their revolutionary "tension-free" mesh technique, which is now accepted worldwide and considered the gold standard of hernia repair by the American College of Surgeons. In fact, according to the American College of Surgeons' comparative trials (government grant) published in the New England Journal of Medicine, May 2004, the Lichtenstein tension-free repair is "superior to the laparoscopic technique for mesh repair of primary hernias.”

Lichtenstein 疝中心是美国唯一一个集研究、教学和手术为一体的腹外疝机构(腹股沟疝,股疝,脐疝,腹疝和切口疝)。 1984 年, Lichtenstein 疝中心的世界级疝专家首次在该中心发明和推广革命性的疝补片无张力修补手术。今天, Lichtenstein 无张力疝修补术不仅被全世界的医生广泛接受,而且被美国医师协会尊称为疝修补手术的金标准。在美国政府资助下,美国医师协会作过比较性实验,结果发表在 2004 年 5 月份的“新英格兰医学杂志“上。该实验结果中称“ Lichtenstein 无张力疝修补术就修补原发性疝来说优于腹腔镜手术”。

Doctor Amid, a Fellow of the American College of Surgeons and Royal College of Surgeons of England, is a co-founder and Director of the Lichtenstein Hernia Institute. He is an international author and lecturer, and has published more than 150 scientific articles and book chapters on the subject of abdominal wall hernias. His writings have been translated into all major languages. Institute surgeons have trained experts from all over the world and are frequently invited to lecture and demonstrate their techniques across the United States and throughout Europe, Canada, the Far East, South America, and Australia."

Amid 医生是美国医师协会会员和英国皇家医师协会会员,而且是 Lichtenstein 疝中心主任和创始人之一。作为世界级作者和演讲者, Amid 在腹外疝领域发表过 150 多篇文章和书籍章节。他的文章已被翻译成世界上各种主要语言。该中心培训了一大批来自于世界各地的医生。该中心的医生被邀请到世界各地讲课并做手术演示。他们的足迹遍布美国,欧洲,加拿大,远东,南美和澳洲。

What is a Hernia? 什么是疝?

Hernia is a tear, or hole, in the musculature of the abdominal wall (Figure 1). 疝是腹壁肌肉组织的薄弱或缺损。(图 1 所示)

Figure 1 图 1

The black spot represents the hernia opening in the muscular wall of the abdomen. The parallel lines represents normal muscle fibers 中间黑色点代表腹壁肌肉组织上的疝缺损。水平线代表正常的肌肉纤维。

Through this hole, the patient's intestines push out, producing a lump underneath the skin. 病人的小肠通过这个缺损向外突出,形成皮下的包块。

Hernia will not go away on its own. The objective of hernia surgery is to restore the patient to the normal existence he can no longer enjoy while suffering from the condition. For anyone who needs surgery, development of the "tension-free" mesh technique has reduced postoperative pain and recovery time, and virtually eliminated the chances of recurrence.

疝不会自动消失。疝手术的目的是恢复病人被疝夺走的正常生活。对于任何一个需要手术的疝患者,无张力补片修补手术都大大减少了病人术后的疼痛,缩短了术后恢复的时间,事实上根除了疝复发的机会。

What are the methods of repair? 疝修补手术有哪些方式?

Conventional Method: 传统方法

The conventional method of repair (also called the Bassini or Shouldice method) consists of stitching together the edge of the tear (Figure 2). However, stitching creates distortion of muscle fibers and undue tension and pulling along the stitch line (Figure 2), causing additional pain and making for a longer recovery period. It can also lead to recurrence of the hernia.

传统疝修补方法 (Bassini 或者 Shouldice 方法 ) 包括把缺损的边缘缝合在一起。(图 2 )。然而,缝合改变了组织的正常解剖结构,在缝合部位上制造了张力(图 2 ),引起额外的疼痛,延长了恢复时间,而且会导致复发。

Figure 2 图 2

Stitching the edges of the opening together causes suture line tension, represented by the distortion of the parallel muscle fibers. 如图中扭曲的平行线所示,将疝缺损的边缘缝合制造了张力。

Tension-Free Mesh Method: 补片无张力修补术

The "tension-free" mesh technique was pioneered by the Lichtenstein Hernia Institute in 1984, and is currently considered the gold standard of hernia repair by the American College of Surgeons. In this procedure, repair is achieved by covering the opening of the hernia with a patch of mesh, instead of sewing the edge of the hole together (Figure 3)

1984 年, Lichtenstein 疝中心率先开展用补片进行无张力疝修补术。今天,该方法被美国医师协会认为是疝修补手术的金标准。这一手术方法不是简单地把疝缺损的边缘强行缝合在一起,而是用一张补片覆盖缺损的部位。(图 3 )

Figure 3

A polypropylene patch or screen covers the hernia completely and is "tension-free"".

图 3 用一张聚丙烯网片覆盖在缺损部位之上 ,完全没有张力。

The surgery is performed under local anesthesia and on an outpatient basis. Within only two to three weeks, the patients own tissue grows into the mesh, making it a part of the patient's body (Figure 4)

该手术在局麻下进行,为日间手术,不用住院。 2-3 个星期内,病人自身组织生长入补片的网孔中,使网片成为自身组织的一部分。

Figure 4

The entire area of the groin susceptible to hernia formation is permanently protected by the mesh.

图 4 整个容易发生疝的区域永久性地被补片覆盖而保护起来。

Laparoscopic Method: 腹腔镜疝修补手术

The laparoscopic (video surgery) method is a variation of the "tension-free" procedure and is performed by insertion of different surgical instruments and video camera into the abdominal cavity or the preperitoneal space for mesh implantation. The surgeon operates by looking at the projected images on a video monitor.

腹腔镜手术方法是无张力疝修补的变化方式。医生用不同的手术器械插入病人的腹腔,借助摄象机把一张补片放入病人腹腔或者腹膜前间隙。医生通过一个电视屏幕上的成像进行手术。

“Mesh Plug” Method: 网塞方法

The idea of using a plug made of mesh for hernia repair was conceived at the Lichtenstein Hernia Institute more than twenty years ago for the purpose of repairing femoral hernias. Femoral hernia is an uncommon type of groin hernia, in which the patient's intestine pushes out through what is called the femoral tunnel. The repair consists of a procedure in which the tunnel is closed off by the insertion of a "plug," in the same way that a bottle is securely sealed when a cork is pressed down into the neck, hugging the sides of the bottle.

Lichtenstein 疝中心 20 多年以前就已经构思出用网片做成塞子的形状修补股疝的方法。股疝是一种比较特殊的疝。病人的小肠通过股管而突出。修补的方法是用个塞子把股管塞住。道理跟用瓶塞塞住瓶子一样。

Recently, the mesh plug repair method has been much commercialized, and widely advertised as an appropriate alternative for the repair of inguinal hernias. However, although theoretically sound for femoral hernias, it is not suitable for inguinal hernias, for the following reasons:

1. Contrary to femoral hernias, which occur through a tunnel slightly more than an inch long, the inguinal hernias occur through a hole in a flat surface. The analogy of the corked bottle is not applicable, and more importantly, the actual repair is not as effective, since the contact area with the plug is only the edge of the hole.

2. Several months after insertion, plugs lose up to 75% of their size due to shrinkage. As a result, similar to a shrinking cork in a bottle, the procedure is prone to failure: the plugs become loose. More importantly, the shrunken plug becomes a rock-hard foreign object, which, according to reports from the U.S. and Europe, can lead to a hard and painful lump in the groin (requiring removal of the plug in 6% of cases). In addition, the plug can migrate into the scrotum and poke a hole into the bladder or intestines and lead to serious complications.

近来,网塞修补术被大力商业化,并被宣传为修补腹股沟疝的方法。虽然网塞对于股疝修补从理论上讲是合理的,但是网塞不适用于腹股沟疝修补。原因如下:

股疝发生在略大于一英寸的隧道上,而腹股沟疝却是发生在一个平面上的破损。所以,瓶塞的比喻就不恰当了。更重要的是:网塞的实际修补效果并不好,因为组织与网塞的接触面仅仅在网塞的边缘。

网塞植入几个月后收缩到原体积的 75% 。类似于瓶塞的道理,如果一个瓶塞的体积缩小到原体积的 75% ,还能塞得住吗?所以,当网塞收缩后,疝的修补就失败了。更重要的是:网塞收缩后变硬,在病人体内形成坚硬的异物团。美国和欧洲都报道了网塞变硬后形成硬团而在腹股沟区引起疼痛( 6% 的网塞修补后由于此类原因而取出网塞)另外,网塞会移入阴囊,戳破膀胱或者小肠,从而引起严重后果。

How long is the recovery period after each method? 术后需要多长时间恢复?

Conventional Method: 传统方法 (张力)

The conventional (Bassini or Shouldice) method is associated with weeks of postoperative pain. It takes as long as four to six weeks for the stitched tissue to heal together. Premature physical activities and straining before the healing process is complete can lead to disruption of the stitches and recurrence of the hernia.

传统方法 (Bassini or Shouldice) 修补后疼痛持续几个星期。缝合的组织需要 4 到 6 个星期方可愈合。组织完全愈合前体力活动和牵拉会拉裂缝合部位而引起疝复发。

Tension-Free and Laparoscopic Methods: 无张力修补和腹腔镜修补

In the "tension-free" and laparoscopic methods, there is no recovery period relevant to healing of approximated tissue, since the techniques do not involve pulling together and stitching of the sides of the hole. Rather, the healing process is solely dependent on the factor of postoperative discomfort, which is minimal, and necessitates a mild painkiller for a few days. However, relevant to complications and risk of recurrence, there is a significant difference between the two methods (see text below).

无张力修补和腹腔镜修补术不把组织与组织缝合在一起,所以不需要组织愈合时间。愈合过程仅仅取决于术后的不适,而这些不适是很微小,仅仅需要几天服用适量的镇痛药即可。尽管如此,这两种方法在并发症和复发率方面仍然存在很大差别。(见附表)

Based on statistics from 25,000 documented operations, and according to internationally published material (U.S., England, Italy, Spain, Austria, and France), patients undergoing "tension-free" mesh hernia repair are regularly discharged from the hospital within hours of their surgery. They can return to unrestricted work in two to ten days, based on the nature of their job and the degree of their motivation.

25000 个有记录的病历和世界范围(美国,英国,意大利,西班牙,澳大利亚,法国)的临床报告证明:病人在接受补片无张力疝修补后几个小时内就可以回家。根据他们的工作性质和愿望的程度,病人术后 2 到 10 天内就可以正常上班。

What is the chance of recurrence after each method? 各种修补方法的复发率怎么样

Conventional Method: 传统方法

Following the conventional repair method, the chance of recurrence is 10-15%. This is due to pulling and tension on the tissues, which leads to a breakdown of the stitch line.

把组织缝合在一起产生张力,张力沿缝合的边缘撕裂组织而导致疝复发。所以,传统手术的复发率在 10-15% 。

Laparoscopic Method: 腹腔镜方法

Depending on the experience and expertise of the operating surgeon, the reported recurrence rate after laparoscopic inguinal hernia repair is 0.5% to 11%.

根据医生的经验和技术水平,腹腔镜修补后的疝复发率在 0.5% 到 11% 之间。

Tension-Free Method: 无张力方法

Based on reports from international sources, the possibility of recurrence after "tension-free" repair, which has been performed by an expert, is in the neighborhood of 1 in 1,000 patients. In general, depending on the experience and expertise of the operating surgeon, the reported recurrence rate of the operation is 0.1% to 4%.

根据世界各地的报道,疝专家所做的无张力修补手术复发率在 0.1% 左右。总体来看,无张力疝修补的复发率在 0.1% 到 4% 之间。

Are there problems after surgery? 疝修补后有什么问题吗?

(Comparison of Different Methods) 几种方法的对比

Tension Free and Conventional Methods: 无张力和传统手术

Complications from conventional and tension-free hernia repair are few and not life threatening.

无张力手术和传统手术后的并发症并不多,而且不危及生命。

Laparoscopic Method: 腹腔镜方法

On the other hand, laparoscopic repair can be associated with life?threatening, and in some instances, fatal complications. The operation requires general anesthesia, insertion of tubes through the abdominal wall, pumping of carbon dioxide gas into the abdomen, placement of the mesh in the preperitoneal space (in front of the bladder and prostate), as well as fixation of the mesh by firing a staple gun into the muscles. Because of the same, complications such as entrapment of nerves by staples or tacks, injury to the intestines, bladder and major blood vessels can arise. In addition, similar to the other methods of preperitoneal hernia repair, in case of a future need for prostate or bladder operation, laparoscopic hernia repair can make these procedures extremely difficult, if not impossible, and risky.

与传统方法和无张力方法不同,腹腔镜方法却可能伴随着严重,甚至致命的并发症。腹腔镜手术需要全身麻醉,通过腹部的小孔把手术器械插入腹腔,向腹腔内注入二氧化碳,把补片放入腹膜前间隙(膀胱和前列腺前),以及用打钉枪发射金属钉来固定补片。打钉枪发射的金属钉有可能损伤小肠,膀胱,和主要血管。另外,与其它腹膜前间隙修补方法相同,腹腔镜修补使以后如果膀胱和前列腺出现问题需要进行的手术变得极其困难,而且风险增高。

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