疝环充填式无张力疝修补术治疗复发性腹股沟疝21例报告

目的总结疝环充填式无张力疝修补术治疗复发性腹股沟疝的近期效果. 方法采用Mesh-plug定型产品行疝环充填式无张力疝修补,治疗老年复发性腹股沟疝21例. 结果平均手术时间40(25～70)min,术后并发尿潴留3例,阴囊积液1例,切口下血肿1例,伤口持续疼痛1例,局部轻度隆起伴异物感1例.随访12～24个月,无再次复发病例. 结论疝环充填式无张力疝修补术符合解剖生理,手术方法操作简单,手术时间短,游离少,创伤小,无张力,近期疗效满意,对老年复发性腹股沟疝患者尤为适用.     

局麻下Lichtenstein无张力平片疝修补术治疗腹股沟疝797例分析

目的评估Lichtenstein无张力疝修补术治疗腹股沟疝的结果并总结临床经验。方法回顾分析797例腹股沟疝患者Lichtenstein无张力疝修补术的临床资料。结果平均住院时间65min,术后并发症发生率为24.1%(194例次),复发率0.1%(1例)。结论成人腹股沟疝采用在局麻下Lichtenstein手术恢复快,复发率低并且适合在日间门诊开展。     

膨体聚四氟乙烯补片Lichtenstein修补术治疗腹股沟疝

目的 回顾性分析膨体聚四氟乙烯平片Lichtenstein法修补腹股沟疝的治疗方法.方法 2000年8月至2006年4月期间512例腹股沟疝患者采用美国Gore-Tex公司的Mycromesh平片行无张力疝修补术.男:489例,女:23例.年龄最大96岁,最小16岁,平均59.7岁.左侧:173例,右侧:305例,双侧:34例.Ⅰ型疝100例(19.5%),Ⅱ型疝352例(68.8%), Ⅲ型疝32例(6.3%),Ⅳ型28例(5.5%)(中华疝学组2001年10月的腹股沟疝分级标准).连续硬膜外麻醉,手术方法按照标准前入路Lichtenstein法操作.结果 全部病例手术成功.平均手术时间94.9 min,术后平均住院时间4.4 d,术后并发症45例(8.8%),术后因深静脉栓塞(DVT)致肺动脉栓塞死亡1例(0.2%),术后平均随访31.2个月.随访期内无复发病例.结论 本术式外科医生容易掌握,手术简单,效果肯定,基本可以满足临床各种情况下的腹股沟疝无张力修补需要.     

三位一体补片无张力疝修补术56例临床分析

目的总结三位一体补片无张力疝修补手术治疗腹股沟疝的临床应用。方法分析2003年8月至2007年8月行无张力疝修补手术治疗的56例腹股沟疝。观察手术效果，手术时间、术后并发症、住院天数及复发率。结果本组56例腹股沟疝全部治愈。手术平均时间45min。全部采用持续性硬脊膜外麻醉，12例采用术后镇痛泵，术后伴轻微切口疼痛9例，伴切口内异物感2例，术后发生阴囊积液2例，2例术后切口稍微红肿，住院平均时间7d，术后随访6个月至2年，未见疝复发及切口感染。结论利用三位一体疝修补片进行无张力疝修补术是一种对人体生理功能影响小、术后恢复块、并发症少、治疗效果好的珲想术式。     

Lichtenstein无张力疝修补术治疗腹股沟疝1712例分析

目的 评估Lichtenstein无张力疝修补术治疗腹股沟疝的结果并总结临床经验.方法 回顾性分析1712 例腹股沟疝患者的1847例次(其中双侧疝135例)Lichtenstein无张力疝修补术的临床资料.结果 平均住院3.5 d,术后并发症发生率为2.54%(47例次),复发率0.16%(3例).结论 成人腹股沟疝采用在局麻下Lichtenstein 手术术后恢复快、复发率和并发症发生率低并且适合在日间病房开展.     

腹股沟疝充填式无张力疝修补术的探讨

目的:探讨腹股沟疝充填式无张力疝修补术的临床疗效。方法:总结2002年1月～2003年3月我院收治34例腹股沟疝,经手术施行充填式无张力疝修补术的临床资料进行分析探讨。结果:平均手术时间40min(30～100min,包括双侧疝手术用时),术后6h下床活动,术后3天恢复活动,术后2例轻度切口异物感持续1个月,其余无术后并发症,无复发,34例术后7天切口均甲级愈合,治愈出院。结论:疝充填式无张力疝修补术是一种较传统疝修补术,更符合人体解剖结构和疝的病理生理的手术方法,手术操作简便,损伤轻,术后恢复快。     

无张力疝修补术治疗腹股沟疝965例分析

目的观察无张力疝修补术治疗成人腹股沟疝的疗效。方法采用网塞填充法疝修补术和Lichtenstein疝修补术治疗965例次腹股沟疝,总结临床资料,评定疗效。结果965例手术时间30～60min,平均39min,术后住院3—8d,平均5d。术后随访6～24个月,复发4例,补片感染2例,无顽固性疼痛。结论无张力疝修补术复发率低、住院时间短、并发症少,是治疗腹股沟疝安全、有效的手术方法。     

腹壁、腹膜、肠系膜、腹膜后

三种人工材料在开放式无张力疝修补术中的应用对比；腹腔镜疝修补术治疗小儿腹股沟疝；无张力腹股沟疝修补术后疝复发的临床分析；巨大腹壁切口疝24例围手术期处理分析；应用人工材料行腹肌后筋膜前修补治疗切口疝80例；普理灵疝装置在腹股沟疝修补术中的应用；无张力疝修补术后复发11例再修补处理及分析；自主成形填塞式疝补片在修补老年腹股沟疝中的应用；原发性盆部腹膜外肿瘤84例的外科治疗；腹膜后巨大肿瘤的手术切除。     

网塞充填式无张力腹股沟疝修补术212例

目的观察网塞充填式无张力腹股沟疝修补术的临床效果。方法回顾性分析2009年5月至2014年5月,山西省泽州县人民医院收治的行网塞充填式无张力疝修补术治疗的腹股沟疝患者212例的临床资料,观察手术后局部疼痛、切口感染以及手术复发等情况,总结手术经验。结果 212例患者均顺利完成手术,手术时间35~70 min,平均(55±4)min;住院时间3~6 d,平均(5±1)d,术后早期阴囊肿胀13例(6.1%),治疗后好转。术后随诊2个月至5年,无复发,无顽固性疼痛,无腹股沟不适及异物感。结论网塞充填式无张力疝修补术安全可靠、创伤小、易掌握。     

540例老年腹股沟疝无张力疝修补术的围手术期处理

目的：总结无张力疝修补术治疗老年腹股沟疝的围手术期处理经验。方法：回顾性分析1999年1月～2004年10月应用无张力疝修补术治疗老年腹股沟疝540例的临床资料，其中Bard Mesh PerFix plug462例，Prolene Hernia System(PHS)78例。结果：全部病人治愈出院。手术时间30～140min，平均45min。平均住院5d，术后伤口均一期愈合．无一例切口感染。术后疼痛轻微，仅7例应用止痛药。术后并发尿潴留11例，皮下血肿5例，阴囊血肿3例。术后随访3～70个月，疝复发2例。结论：无张力疝修补术创伤小、恢复快、并发症少、复发率低。加强围手术期处理能增加手术的安全性．降低并发症。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.