腹腔镜完全腹膜外疝修补术预防性放置负压引流管的疗效

目的探讨腹腔镜完全腹膜外疝修补术（TEP）术中预防性放置负压引流管的治疗效果。 方法选取2016年5月至2019年11月，苏州市第九人民医院成人腹股沟疝患者72例，随机分为2组，每组36例。对照组接受TEP术中未预防性放置负压引流管，研究组接受TEP术中预防性放置负压引流管。观察对比2组患者的治疗效果。 结果2组患者的术中出血量没有差异（P>0.05），研究组患者的手术时间、住院天数以及术后下床活动时间都多于对照组（P<0.05）；研究组患者术后并发症发生率要低于对照组（P<0.05）。 结论考虑到大多数血清肿不需要临床干预以及腹膜自身强大的吸收能力，预防性放置负压引流管不需要做常规推荐。     

Posterior cord syndrome associated with postoperative seroma: The case to perform a complete neurologic exam

Context: Posterior cord syndrome (PCS) is the least common incomplete spinal cord injury. Findings of posterior cord syndrome include loss of proprioception and vibration, which are not routinely tested with the American Spinal Cord Injury Association’s International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) exam and can easily be missed. Seromas may develop after spinal instrumentation and can cause cord compression.Findings: This case describes a unique presentation of posterior cord syndrome following a large seroma formation after laminectomy. A patient developed ataxia with functional decline following posterior laminectomy. Examination revealed loss of vibration and proprioception in the extremities with preservation of strength. Imaging of the cervical spine demonstrated a large fluid collection at the laminectomy site causing cord compression. The fluid collection was thought to represent a seroma based on clinical presentation, imaging, and laboratory testing. The patient was admitted to inpatient rehabilitation with improvement in function allowing discharge to home.Conclusion/clinical relevance: Seromas are a complication following cervical instrumentation that can cause compression of the adjacent spinal cord resulting in functional decline. The seroma, in this case, led to the loss of vibration and proprioception with resultant ataxia, signs that are not routinely identified on ISNCSCI exam; therefore, this highlights the need to broaden the neurological examination when evaluating a patient with spinal cord injury who has experienced a neurological setback.     

腹腔镜腹股沟疝修补术后血清肿的成因分析及防治体会

目的分析腹腔镜腹股沟疝修补术后血清肿的成因和防治措施。方法将2017年1月～2018年1月期间我院收治的160例进行腹腔镜单侧腹股沟疝修补术治疗患者作为研究对象,观察患者血清肿发生率,分析其原因并制定相关对策。结果 160例患者中发生血清肿患者共计50例,多数患者无需进行特殊治疗,仅4例患者需要抽液并进行加压治疗,患者均未出现其他并发症。血清肿的发生可能与患者年龄、手术方式及患者其他疾病有关(P0.05)。结论患者年龄、手术方式及其他疾病可能与血清肿的发生具有一定的关联,临床可通过提高手术操作技巧等方式减少血清肿的发生。     

Fine-needle aspiration for periprosthetic fluid removal after implantation of a remote internal-port tissue expander

BackgroundUse of internal filling ports in tissue expander–based reconstructions are advantageous because of easier self-care, lower infection rates, and fewer instances of capsule formation. The appearance of periprosthetic fluid accumulation after internal-port tissue expander implantation is a common complication that warrants treatment. In this study, we introduced a noninvasive method using fine-needle aspiration (FNA) to remove fluids accumulated after implantation of a remote internal-port tissue expander.MethodsIn this study, 245 patients who underwent implantation of remote internal-port tissue expanders in our hospital from July 1, 2012, to July 1, 2019, were included and divided into two groups. In the control group, patients underwent tissue expander implantation before July 1, 2016, and large quantities of fluids were removed with surgical aspiration procedures in most cases. In the FNA group, the patients underwent implantation after July 1, 2016, and large quantities of fluids were removed first with the FNA procedure. Patients’ demographic data, indications for FNA application, and related complications were collected and analyzed.ResultsOverall, 395 expanders were placed in 245 patients. Postoperative management was similar in both groups. Fluids were managed with 23 expanders in the control group and with 31 expanders in the FNA group. There was no difference in the fluid aspiration rate between the two groups. The surgical aspiration rate was 11.1% (23/208) in the control group. The success rate of FNA was 90.3% (28/31). In the FNA group, the surgical aspiration rate was 1.6% (3/187), which was significantly lower than that in the control group. There were no significant differences in complications between the two groups.ConclusionFNA can be used for periprosthetic fluid removal after the implantation of a remote internal-port tissue expander in most cases. This method is more convenient and safer than surgical aspiration for the postoperative management of internal-port tissue expander implantation.     

腹腔镜腹股沟疝修补术后血清肿诊疗策略

目的探讨腹腔镜经腹腹膜前腹股沟疝修补术后血清肿的分型及预防、治疗措施。方法回顾性分析中国人民解放军武汉总医院2010年1月至2015年5月采用腹腔镜经腹腹膜前腹股沟疝修补术治疗的340例病人临床资料,观察术后血清肿发生情况及临床表现,以及临床治疗效果。结果术后血清肿共46例,占13.5%。Ⅰ型7例,Ⅱ型30例,Ⅲ型6例,Ⅳ型3例,轻微病人多数给予理疗及中药外敷缓解;较重病人给予穿刺抽液多可缓解;2例病人血清肿持续逾5月余,给予反复穿刺抽液后缓解;1例病人术后1个月复查发现血清肿,但无明显疼痛不适,1年后复查疝复发,予以开放无张力疝修补术痊愈。结论统一的血清肿分型可以让我们更准确地了解腹腔镜经腹腹膜前腹股沟疝修补术术后血清肿的发生率和严重程度,便于提供更有效的治疗对策。血清肿重点在于预防。术中精细解剖,对于易感人群给予个体化处理,以期降低血清肿发生率,减少由此引起的医疗风险。     

Laparoscopic repair of direct inguinal hernia: a new technique that reduces the development of postoperative seroma

Background Seroma are common early postoperative complications encountered in laparoscopic inguinal hernia repair. Previous anecdotal evidence from our surgical practice suggested a lower incidence of postoperative seroma formation with direct hernia repairs when the lax transversalis fascia (TF) is inverted by tacking to the pubic ramus. We undertook a study to investigate whether TF inversion in this way reduces the incidence of postoperative seroma. Method A total of 216 patients undergoing transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repairs from August 2003 to December 2005 were included in this prospective non-randomised controlled study. Surgeon 1 would routinely invert the TF whereas surgeon 2 would not. At follow-up the presence of postoperative seroma and pain was recorded. Results Mann–Whitney U test demonstrated no significant difference in terms of age, sex and time to follow-up between the surgeons’ patient groups (P > 0.05), and Chi-square test demonstrated significantly that inversion of the TF is associated with a lower incidence of postoperative seroma (P < 0.05). There was no significant difference in terms of postoperative pain at follow-up. Conclusion Inversion of the TF is associated with a statistically lower incidence of postoperative seroma, without increasing postoperative pain despite the use of one or two additional tacks.     

Total extraperitoneal (TEP) mesh repair of inguinal hernia in the developing world: comparison of low-cost indigenous balloon dissection versus direct telescopic dissection: a prospective randomized controlled study

Background  Creation of extraperitoneal space during TEP repair requires an expensive commercially available balloon. Patients and methods  Fifty-six patients suffering from uncomplicated primary unilateral or bilateral groin hernia were randomized into two groups; group 1 – indigenous balloon dissection and group 2 – direct telescopic dissection. Results  There were 55 males and 1 female, with an average age of 49 years; 50% of the inguinal hernias were bilateral. Creation of extraperitoneal space was considered as satisfactory in majority of patients (94.6%) with satisfactory anatomical delineation. Peritoneal breach was noticed during dissection in 36 (64.3%) patients. There was one (3.8%) conversion of TEP to TAPP in group 2. Distance between pubic symphysis to umbilicus was an important factor, which affected the easiness of dissection. In patients with this distance ≤14 cm lateral placement of ports was considered for easy use of graspers. The incidence of scrotal edema was significantly higher in group 2 as compared with group 1 (p < 0.01). Patients with indirect inguinal hernias in group 2 presented with a greater number of scrotal edema. Pain score on VAS at 6 h after surgery was significantly higher in group 2 (p < 0.021). Patients with age <65 years, bilateral hernias, and indirect hernias had a correlation with higher pain score at 6 h. Of the patients, 17.9% developed seroma in group 1 versus 64.3% in group 2 (p < 0.001). Conclusion  Anatomical delineation of inguinal area and dissection in the extraperitoneal space in TEP repair was equally satisfactory with both low-cost indigenous balloon (group 1) and telescopic dissection (group 2). Balloon dissection was associated with significantly reduced postoperative pain at 6 h, scrotal edema, and seroma formation. However at 3 months follow-up balloon dissection did not offer significant advantage over direct telescopic dissection in the overall long-term outcome of TEP repairs. If balloon dissection is considered useful for the beginner, low-cost indigenous balloon may be used to avoid higher cost of commercially available balloon dissector with added early advantages.     

Postoperative seroma formation after abdominoplasty with placement of continuous infusion local anesthetic pain pump

The most common complication after abdominoplasty is seroma formation. The incidence of seroma formation in abdominal procedures as a whole, including abdominoplasty, panniculectomy and transverse rectus abdominis myocutaneous flap abdominal donor sites, ranges from 1% to 38%. A recent concern among surgeons is the possibility of a causal relationship between the use of continuous infusion devices such as local anesthetic pain pumps and the development of seromas. A case of postoperative, persistent, recurrent seroma formation after abdominoplasty with the use of continuous infusion local anesthetic pain pump is presented. After several attempts at aspiration and drain catheter placement, only open surgical excision of the seroma cavity was found to be definitively effective in treating the development of seroma.     

胸乳径路内镜甲状腺术后并发血清肿的危险因素分析

目的:探讨经胸乳径路内镜甲状腺切除术术后并发胸前壁血清肿的危险因素,为临床预防提供依据。方法:回顾性分析344例内镜甲状腺手术患者的临床资料,对可能影响血清肿形成的危险因素进行Logistic回归分析。结果:344例中10例发生血清肿,发生率2.9%。单因素Logistic回归分析提示年龄、体重、体重指数、高血压、胸前壁分离范围、拔管方法与血清肿形成有关,而多因素Logistic回归分析表明年龄、高血压、胸前壁分离范围、拔管方法是血清肿形成的独立危险因素。结论:年龄、高血压、胸前壁分离范围、拔管方法等因素是内镜甲状腺术后血清肿形成的危险因素,术前应选择合适的患者。