腹腔内放置复合补片原位修补巨大造口旁疝八例

目的总结应用复合补片腹腔内修补巨大造口旁疝的经验。方法回顾性分析复合补片经腹腔内修补巨大造口旁疝8例的临床资料,其中男性6例,女性2例,年龄46～63岁,平均54.7岁。患者均因直肠癌行Miles手术后发生造口旁疝,疝病史3～8年,其中复发性造口旁疝2例。疝环最大径11～15 cm,平均12.6 cm。根据疝环大小选择合适补片,补片边缘均超出疝环缘3 cm以上。在补片中心剪-3 cm直径的孔,并在孔的一侧剪开补片,将补片中心孔套入造口肠管,补片其他部分覆盖住腹壁缺损,补片聚四氟乙烯面朝向腹腔,聚丙烯面朝向腹壁。用2-0的Prolene线连续缝合补片被剪开的一侧裂口,并将补片中心孔的聚四氟乙烯材料缘与造口肠管用3-0的可吸收线间断缝合固定4～5针。然后用1-0的Prolene线经全腹壁穿刺缝合方式,将补片铺平并固定于腹壁,间隔距离5 mm。多余皮肤行适当整形。结果手术时间97～146min,平均109 min。伤口均一期愈合,1例发生浆液肿,2例发生术后近期修补区刺痛。随访3～27个月,平均20个月,无复发。结论复合补片经腹腔内修补巨大造口旁疝是一种安全有效的方法。     

The prevalence of penoscrotal abnormalities and inguinal hernia in elementary-school boys in the west of Iran

AIM: We designed a cross-sectional study in order to determine the prevalence of inguinal hernia and penoscrotal abnormalities in the Lorestan province, situated in the west of Iran. METHODS: We studied 3205 elementary-school boys, aged 6-12 years, who underwent clinical examinations of the groin and genitalia in 2002. RESULTS: Abnormalities were detected in 213 children (6.64%). The most frequent anomaly was indirect inguinal hernia, seen in 78 children (2.4%). The other abnormalities were retractile testes in 39 boys (1.22%), undescended testes in 36 boys (1.12%), hydrocele in 28 boys (0.87%) and hypospadiasis in 25 boys (0.78%). Also, three children had micropenises, two had epispadiasis and another two boys had varicoceles. Ambiguous genitalia and apenia were not seen in the present series. Most of the parents were not aware of their children's anomalies (60.1%). CONCLUSIONS: Education of the public and medical staff about these abnormalities and screening system are needed to improve the outcome.     

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。     

Laparoscopic cure of small ventral hernias with composite mesh

BACKGROUND: The use of mesh is recommended to reduce the rate of recurrence after the curing of ventral hernias. METHODS: A multicentre prospective trial was conducted to assess the laparoscopic cure of small ventral hernias with a composite mesh. RESULTS: Around 222 patients entered the trial and received laparoscopic repair for ventral hernias of less than 5 cm. There was one conversion. The mean length of post-operative hospitalisation was 2.5 days. At 1 year, the recurrence rate was 2%. Two meshes were removed due to infection, 3% of the patients were using analgesics and 86.1% of the patients described no pain on EVA scoring. CONCLUSION: The laparoscopic cure of small ventral hernias with composite mesh is efficient. Further technical progress is warranted to reduce the rate of seroma formation.     

Diaphragmatic Hernia Induced in Rat Fetuses by Administration of Bisdiamine

Administration of N, N'-bis (dichloroacetyl)-l,8-octamethylenediamine, bisdiamine, to pregnant Donryu rats on a single day of gestation induced unilateral and bilateral diaphragmatic hernias in fetuses with high incidence. The protruded liver was not covered with a serous membrane or a muscular layer. Incidence of unilateral diaphragmatic hernia on the left side was high when bisdiamine was administered on day 9 or 13 of gestation, and that on the right side was high when administered on day 12 of gestation. Incidence of bilateral diaphragmatic hernia was high when bisdiamine was administered on day 12 of gestation. Differences in sensitivity to hernia formation according to day of bisdiamine administration between right and left sides may reflect differences in developmental chronology between the two sides. Two distinct times for induction of left diaphragmatic hernia might be attributed to at least two different mechanisms. The present model is expected to help analyzing not only anatomical characteristics of congenital diaphragmatic hernia but also possible mechanisms responsible for their development.     

腹壁切口疝网片无张力修补术

目的 评估腹壁切口疝无张力修补术。方法 回顾分析15例腹壁切口疝用聚丙烯网片修补。网片用单丝不吸收缝线连续缝合固定在缺损边缘，网片必须超过缺损边缘2cm。常规术前预防性用单剂抗生素。结果 随访15－38个月无一例复发。结论 腹壁切口疝用聚丙烯网片无张力修补是一安全简单方法且术后疼痛轻微。     

大骨瓣开颅术在大面积脑梗死所致脑疝中的应用

目的 探讨大面积脑梗死所致脑疝的手术方法。方法 对大面积脑梗死所致早、中期小脑幕切迹疝采用标准外伤大骨瓣开颅术及非功能区脑组织切除术。结果 12例中10例存活,2例死亡;10例幸存者随访3～6个月,智能均接近正常,其中6例能独立生活。结论 标准外伤大骨瓣开颅术是治疗脑梗死所致脑疝的有效方法。     

成人腹股沟疝患病情况的多中心研究

目的：了解上海地区的腹股沟疝的患病及相关情况。方法：对上海市的三家医院20734例体检者进行了专项的腹股沟疝情况的调查。结果：腹股沟疝的患病率约为3．6‰，其中男性为4．8‰，女性为1．3‰。60岁以下的患病率约为1.7‰，60岁以上的患病率约为11．5‰，腹股沟疝的发病似与职业，肥胖，吸烟等因素无关，但有较明显的家族性倾向。结论：腹股沟疝的发病男性多于女性；60岁以上者明显多于60岁以下者；有家族倾向，发病与职业，肥胖，吸烟等因素的关系不明确。     

Bard Composix补片修补巨大切口疝临床应用

目的 总结应用Bard Composix补片修补4例巨大切口疝的临床经验。方法 使用美国巴德公司的Composix补片对4例巨大腹壁切口疝进行修补术治疗。结果 4例病人均无并发症,随访1～11个月无复发。结论 Composix补片修补巨大切口疝具有安全、创伤小、恢复快的优点,是治疗切口疝的理想术式。