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Objective:To investigate the influencing factors for postoperative deep vein thrombosis in elderly patients with inguinal hernia.Methods:The retrospective case-control study was conducted. The clinical data of 352 elderly patients with inguinal hernia who were admitted to the Affiliated Hospital of Jining Medical College from March 2018 to March 2021 were collected. There were 325 males and 27 females, aged (72±3)years. Observation indicators: (1) treatment and follow-up; (2) analysis of influencing factors for postoperative deep vein thrombosis. Follow-up was conducted using outpatient examination and telephone interview to detect occurrence of deep vein thrombosis in patients up to September 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test. The univariate analysis was conducted using the corresponding statistical methods based on data type. The Logistic regression model was used for multivariate analysis. Results:(1) Treatment and follow-up. Of the 352 inguinal hernia patients, there were 18 cases with irreducible hernia and 334 cases with reducible hernia. All the 352 patients underwent laparoscopic hernio-rrhaphy successfully, including 95 cases with totally extraperitoneal prosthetic, 257 cases with transabdominal preperitoneal prosthesis. The operation time and volume of intraoperative blood loss of the 352 patients were (70±7)minutes and (8.0±1.5)mL, respectively. There were 39 cases with intraoperative blood transfusion and 313 cases without intraoperative blood transfusion, 167 cases with common patch, 185 cases with light patch. The compression time of operative area, time to first out-of-bed activities, duration of postoperative hospital stay of the 352 patients were (19.7±2.9)hours, (5.6±1.8)hours, (3.0±1.9)days, respectively. All the 352 patients were followed up for 6 months after operation. During the follow-up, there were 7 patients with deep vein thrombosis. (2) Analysis of influencing factors for postoperative deep vein thrombosis. Results of univariate analysis showed that age, body mass index, smoking history, alcoholism history, hypertension, chronic obstructive pulmonary disease, coronary heart disease, cerebrovascular disease, varicose veins, intraoperative blood transfusion, time to postoperative first out-of-bed activities, duration of postoperative hospital stay were related factors for postoperative deep vein thrombosis in elderly patients with inguinal hernia ( t=2.19, 2.06, χ2=9.86, 9.02, 7.90, 14.36, 17.12, 36.25, 28.27, 7.32, t=3.30, 3.04, P<0.05). Results of multivariate analysis showed that age, hypertension, chronic obstruc-tive pulmonary disease, coronary heart disease, cerebrovascular disease, varicose veins, intraopera-tive blood transfusion, time to postoperative first out-of-bed activities, duration of postoperative hospital stay were independent influencing factors for postoperative deep vein thrombosis in elderly patients with inguinal hernia ( odds ratio=4.32, 5.95, 6.44, 15.85, 9.63, 7.61, 9.88, 7.27, 7.96, 95% confidence intervals as 0.92?8.72, 4.45?12.74, 1.74?19.46, 3.97?36.84, 4.95?16.26, 2.65?18.03, 3.50?21.47, 1.48?16.37, 2.08?14.73, P<0.05). Conclusion:Age, hypertension, chronic obstructive pulmonary disease, coronary heart disease, cerebrovascular disease, varicose veins, intraoperative blood transfusion, time to postoperative first out-of-bed activities, duration of postoperative hospital stay are independent influencing factors for postoperative deep vein thrombosis in elderly patients with inguinal hernia.
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Some aspects of hernia and abdominal wall surgery in China have come up to an international advanced level,such as number and quality of operation.The latest issue of The Lancet gave a high score of 99 points on diagnosis and treatment of inguinal hernia in China,which has far outstripped the other developed countries of the world,with China in fourth place globally.The journal commented that,considering the treatment of inguinal hernia rely mainly on surgery,the reason Chinese surgeon performed well recalled for the great number of patients,surgery of huge quantity and the strong operation ability of the doctors in China.But there is still a wide gap on comprehensive strength between Chinese and international levels,and quality control standard is one of major aspects.If hernia and abdominal wall surgery wants to develop further,perfect quality control system is a crucial step.
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Objective To analyze the clinical curative effect of retroperitoneoscopy combined with inguen small incision surgery in treatment of urothelium carcinoma.Methods Ninety-eight urothelium carcinoma patients were divided into observation group (56 cases) and control group (42 cases) according to the surgery method.The patients in observation group were treated with retroperitoneoscopy combined with inguen small incision surgery,and the patients in control group were treated with open surgery.The operation time,intraoperative bleeding volume,postoperative drainage volume,postoperative gastrointestinal function recovery time,postoperative ambulation time,drainage tube removal time,hospitalization time,incision fat liquefaction,incision hernia,incision prolapse,incision pain and discomfort,postoperative analgesia,postoperative 3 months incision satisfaction and postoperative 36 months tumor recurrence were observed.Results The operation time,intraoperative bleeding volume,postoperative gastrointestinal function recovery time,postoperative ambulation time and hospitalization time in observation group were significantly lower than those in control group:(135.23 ±32.18) min vs.(177.58 ±57.29) min,(119.33 ±35.02) ml vs.(161.29 ± 72.06) ml,(2.03 ± 0.73) d vs.(2.79 ± 0.79) d,(20.68 ± 9.75) h vs.(32.41 ± 11.12) h,(8.51 ± 0.93) d vs.(9.81 ± 2.21) d,and there were statistical differences (P ＜ 0.05 or ＜ 0.01).There were no statistical differences in postoperative drainage volume and drainage tube removal time between 2 groups (P ＞ 0.05).The rates of incision fat liquefaction,incision hernia,incision prolapse,incision pain and discomfort and postoperative analgesia in observation group were significantly lower than those in control group:1.79％ (1/56) vs.26.19％ (11/42),0 vs.11.90％ (5/42),0 vs.7.14％ (3/42),1.79％ (1/56) vs.11.90％ (5/42),1.79％ (1/56)vs.11.90％ (5/42),the rate of postoperative 3 months incision satisfaction in observation group (92.86％,52/56) was significantly higher than that in control group (78.57％,33/42),and there were statistical differences (P ＜ 0.01 or ＜ 0.05).The rate of tumor recurrence in observation group (14.29％,8/56) was significantly lower than that in control group (47.62％,20/42),and there was statistical difference (P ＜ 0.01).Conclusions Retroperitoneoscopy combined with inguen small incision surgery in treatment of urothelium carcinoma can significantly reduce the patients' treatment and recovery time,improve the beauty of incision and patients' satisfaction degree,and reduce the postoperative tumor recurrence rate.
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Objective To compare the effect and safety of totally transumbilical single -port laparoscopic herniorrhaphy and traditional surgery in treatment with pediatric indirect inguinal hernia.Methods 100 children with indirect inguinal hernia were divided into control group(n =50)and observation group(n =50).The control group was given to traditional surgery.The observation group was given to totally transumbilical single -port laparoscopic herniorrhaphy.The operation related index,postoperative complications and hernia recurrence rate were compared between the two groups.Results The intraoperatve bleeding,incision length,operation time and hospital stays of the observation group respectively were (18.1 ±5.9)mL,(1.3 ±0.3)cm,(27.4 ±7.9)min and (4.5 ±1.2)d,those of the control group respectively were (38.7 ±8.1)mL,(2.2 ±0.4)cm,(46.7 ±9.2)min and (7.4 ±1.3)d,the difference was statistically significant (t =3.439,3.811,2.872,2.878,P =0.026,0.019,0.045,0.049).The postoperative complications rate of observation the group and the control group were respectively 8.0%(4 /50)and 24.0%(12 /50),the difference was statistically significant(χ2 =4.762,P =0.029).Postoperative follow -up of 1 year,the hernia recurrence rate of the observation group and the control group respectively was 0(0 /50)and 12%(6 /50),the difference was statistically significant (χ2 =6.383,P =0.012).Conclusion Using totally transumbili-cal single -port laparoscopic herniorrhaphy treat with pediatric indirect inguinal hernia is safe and effective.It is ben-eficial to prevent recurrence,and is worth clinical promotion.
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Objective To evaluate the results of operative treatment of comp ou nd acetabular fractures through single ilioinguinal approach. Methods 46 cases o f compound acetabular fractures were treated through single ilioinguinal approac h from June 1994 to October 2003 in our department. Their functional recovery an d complications were followed up. Results On the average, 40 cases were followed up for 40.4 months. All the fractures healed and no infection was found. Clinic al results were excellent and good in 33 patients, and only one patient showed s light ectopic ossification after the operation. Conclusions Acetabular fractures associated with anterior and posterior hemi-transverse fractures, most both co lumn fractures and some T shape fractures can be treated through the single ilio inguinal approach which can result in good reduction, satisfactory functional re covery, less invasive incision, and low rate of postoperative complications.