MESH HERNIOPLASTY USING A STAPLER

Background: The recent development of laparoscopic hernioplasty has evoked extensive re-examination of the safety and effectiveness of using synthetic mesh materials in hernia surgery. We have investigated the efficacy of anterior stapling mesh repair in the treatment of inguinal hernia. Methods: From July 1993 to June 1994. a modified open mesh hernioplasty using staples for anchorage has been performed in 127 patients. Results: The mean age of patients was 61.4 13.0 years. Over 90% of them were operated on under local anaesthesia. The operation time ranged from 30 to 95 min with a median of 39 min. Only sixteen patients (12.6%) required postoperative parenteral analgesics and the median time for resuming daily activities was 7 days. Apart from two patients with reactionary haemorrhage, there was no other significant complication observed. Only one recurrence was encountered over the 26-month median follow-up period. Conclusions: We conclude that the modified mesh hernia repair with a stapling device is a feasible, inexpensive and safe procedure that is well tolerated under local anaesthesia by most patients.     

疝环充填式无张力疝修补术

目的 评价美国巴德分司生产的聚丙烯丙塞在治疗腹股沟疝和股疝中的临床疗效。方法 采用疝环充填式无张力疝补术治疗４９例腹股沟疝和股疝。总结这些临床资料,并评定疗效。结果 该项技术比传统手术操作简单,疼痛轻,恢复快,经随访１年无复发。结论 疝环充填式无张力疝修补术适用于各种类型的腹股钩疝和股疝,尤其适用于年老体弱者、巨大的腹股沟疝或复发疝;嵌顿疝如无肠坏或局部感染,也可考虑使用。此外,不同类型的腹股沟疝     

LAPAROSCOPIC MESH REPAIR OF RECURRENT INGUINAL HERNIA

Background: Pre-peritoneal mesh repair has been a long-standing technique for recurrent hernias. Laparoscopic technique has been applied to this operation with the aim of assessing its results at early follow up of 1 year. Methods: The outcome in 56 patients was reviewed and all patients contacted 12 months after surgery. Results: There was one immediate failure at 1 week, needing a further operation. There were no other recurrences at 1 year. Ten patients had minor postoperative complications. Conclusions: At early follow up, this is a satisfactory technique for recurrent hernias.     

腹膜前Marlex网片植入法修补腹股沟复发疝

采用腹膜前Marlex网片植入法对21例腹股沟复发疝进行了修补。手术应用原切口入路的简化腹膜前修补法,显露腹股沟管壁结构,游离腹膜前间隙,植入Marlex网片。既能做到无张力修利,又能加强管壁结构。本组21例除1例术后皮下血肿,2例发生局部感觉异常外无其它并发症。随访2～5年无1例复发。作者认为,复发疝解剖层次改变、组织缺损重、瘢痕组织无弹性,采用传统方法修补易致复发;而采用人工假体植入则能有效防止复发。     

OPEN MANAGEMENT OF SEPTIC ABDOMEN BY MARLEX MESH ZIPPER

Marlex mesh with zipper was used for abdominal closure in 5 of 147 patients with generalized peritonitis seen during a period of 2 years. Residual/recurrent intra-abdominal sepsis necessitating repeated explorations prompted use of this technique followed by frequent peritoneal lavages. Abdominal sepsis was successfully controlled in 4 of 5 patients, although we lost 3 of 5 patients due to multiple factors.     

疝环充填式无张力疝修补术临床应用（附50例报告）

目的 应用疝环填充式无张力疝修补术修补腹股沟疝.方法 采用疝环填充式无张力疝修补术修补腹股沟疝50例,不切开疝囊,用锥形疝环填充物将疝囊推入腹腔,然后用补片平放于精索后方.结果 该技术较传统方法创伤小、无张力、疼痛轻、恢复快和并发症少.经术后随访和影像学观察,效果满意.结论 该方法可广泛应用于各种腹股沟疝的病人,尤其适用于老年和复发疝的病人.     

善释腹膜前专用网塞在腹股沟疝无张力修补术中应用的临床体会

目的总结善释腹膜前专用网塞在腹股沟疝无张力修补术中的临床应用。方法回顾性分析我院2007年3月到2009年7月156例使用善释腹膜前专用网塞行腹股沟疝无张力修补术的临床资料。结果本组随访2月到2年,全部治愈,无复发。术后无切121感染及疼痛,异物感1例,发生率0．6％（1／156）。结论善释腹膜前专用网塞行腹股沟疝无张力修补术具有手术简便,复发率低,术后并发症少等优点,是疗效确切的无张力疝修补方法。     

游离前臂皮瓣与钛网联合修复上颌骨缺损

目的观察游离前臂皮瓣与钛网联合修复上颌骨缺损的临床效果.方法 2002年1月～2002年11月,对3例上颌牙龈癌、1例腭部黏液表皮样癌和1例上颌窦癌分别行上颌骨次全切除或全切除术,术后遗留上颌骨缺损用 4 cm×5 cm～6 cm×7 cm大小的游离前臂皮瓣与钛网联合修复.术后通过临床检查、CT和鼻内窥镜检查评价其效果. 结果 5例患者均获5～15个月随访,无肿瘤复发,移植皮瓣全部成活,面部外形及牙槽突和腭部形态恢复良好,鼻腔面钛网被软组织覆盖,语言和吞咽功能恢复良好.其中2例已行可摘局部义齿修复. 结论游离前臂皮瓣和钛网联合应用是上颌骨缺损较理想的修复方法.     

善释腹膜前修补装置在腹股沟疝修补术中的应用

目的探讨腹膜前疝修补装置在腹股沟疝修补术中的应用及技术要点。方法使用善释腹膜前修补装置修补耻骨肌孔缺损,观察和随访术后情况。结果本组23例患者,手术时间30～50min,平均38min;切口均甲级愈合,患者术后12h下地活动,切口疼痛轻微,无皮下血肿、阴囊积液、切口感染等并发症;住院时间4～6d。术后随访6个月无腹股沟疝复发。结论根据腹股沟区的腹膜前解剖学特点,在耻骨肌孔后方使用足够大的补片进行覆盖修补,更加符合力学原理,手术操作简单安全,效果肯定。     

REPAIR OF GIANT INCISIONAL HERNIAS WITH POLYPROPYLENE MESH: A RETROSPECTIVE STUDY

The aim of the present study was to evaluate the long term results of repair of ventral incisional hernias or of defects in the abdominal wall using polypropylene mesh. Eighty-eight patients were operated on from 1979-1996, inclusive. Abdominal protrusion was found in 78 patients. Fifty-one of these patients had previously had an incisional hernia repaired and the remaining 10 patients had an abdominal wall defect as a result of excision of a malignant tumour. The polypropylene mesh was placed extraperitoneally and sutured with two rows of interrupted stitches, using non-absorbable sutures. Recurrence of the hernia was found in 10 of the 67 patients with incisional hernia. Eight patients had a relaxation of the muscles of the abdominal wall. Perioperative complications consisted of infection ( n &#114 = &#114 4), embolism ( n &#114 = &#114 1), haematoma ( n &#114 = &#114 1), and pneumonia ( n &#114 = &#114 3, one fatal), and one fatal bowel perforation. Median follow up time was 5.7 years (range 0-17). It is therefore possible to obtain acceptable results after repair of larger incisional hernias even if they had been repaired before.     

REPAIR OF GIANT INGUINOSCROTAL INGUINAL HERNIA USING MARLEX MESH AND SCROTAL SKIN FLAPS

A new technique for the repair of giant inguinoscrotal hernia is described. It consists of: reduction of the hernia; repair of the hernial orifices with marlex mesh; creation of a midline anterior wall defect to increase intra-abdominal capacity; covering this defect with marlex mesh; then covering the midline marlex mesh with a rotation flap of inguinoscrotal skin. This technique increases intra-abdominal capacity and allows reduction of the hernia without compromising respiratory function, in patients with chronic airflow limitation, by using skin that would otherwise be discarded.     

局麻下善愈补片在腹股沟疝腹膜前修补术中应用的体会

目的探讨局麻下国产善愈补片腹膜前修补腹股沟疝的临床经验和疗效。方法回顾性分析68例患者经腹股沟切口腹膜前间隙置入国产善愈补片进行腹股沟疝修补术的病例,观察麻醉效果、手术时间、住院时间、住院费用及随访观察术后并发症及复发情况。结果全部采用局麻,单侧手术时间30～45min,平均35min,术后切口疼痛较明显的3人,均为年轻患者。住院时间2—3d。术后平均随访10个月无复发,无明显异物感,阴囊积液2人。结论应用国产善愈补片腹膜前间隙修补腹股沟疝手术针对耻骨肌孔进行修补,具有手术修补范围大、术后恢复快、并发症少、住院时间短、术后复发率低等优点,与传统手术相比是一种更为理想的手术方式。     

善释D10补片与善释网塞修补腹股沟疝的临床分析

目的探讨应用善释D10补片及善释网塞修补腹股沟疝的临床疗效。方法回顾性分析2006年4月至2010年1月127例应用善释补片修补腹股沟疝患者的情况。57例腹股沟疝患者应用善释D10补片行开放式腹膜前置入无张力疝修补术;70例腹股沟疝患者应用善释网塞行疝环充填式无张力修补术。结果善释D10补片疝修补术组在手术时间、手术操作、创伤程度、术后疼痛、阴囊积液、局部异物感、伤口麻木感等方面优于善释网塞修补术组。结论善释补片修补腹股沟疝的临床疗效是安全可靠的,善释D10补片腹膜前修补术更具有创伤小、操作简单、手术时间短、术后不适少的优点。     

钛网联合Cage配合自锁钛板治疗多节段颈椎间盘突出症

目的总结钛网联合Cage配合自锁钛板在多节段颈椎间盘突出症前路椎间盘切除后椎体间融合的效果。方法回顾性分析2004年9月-2007年6月采用钛网联合Cage配合自锁钛板治疗18例多节段颈椎间盘突出症的临床效果。男11例，女7例；年龄32～75岁，平均54岁。病程6个月～15年，平均5．8年。肢体感觉障碍16例；四肢肌力2级3例，3级12例，4级1例，5级2例；锥体束征阳性16例；大小便障碍13例：性功能障碍8例；伴神经根型症状7例。其中连续的多节段12例，不连续的多节段6例。术前JOA评分为（8．30±1．21）分。X线片及MRI示不同程度椎间盘退变、突出、颈髓受压。术前X线片测得病变椎间隙高度为（6．40±0．87）mm。结果术后切口均I期愈合。患者均获随访，随访时间6～36个月，平均18个月。术后早期四肢运动功能恢复较好，感觉障碍恢复较慢；术前肌张力高者术后肌张力下降；患者肢体灵活性改善。手术椎间隙于术后3～6个月获骨性融合，未见塌陷。术后6个月，JOA评分为（12．60±0．78）分，改善率51．8％，与术前比较差异有统计学意义（P〈0．05）：病变椎间隙高度为（8．20±0．46）mm，与术前比较差异有统计学意义（P〈0．05）。按照Odom临床效果分级进行评价，优17例，良1例。无死亡，无脊髓、神经、气管及食道损伤等并发症发生，无Cage移位及松动发生。结论对于多节段颈椎间盘突出症，钛网联合Cage配合自锁钛板固定更具优势。     

腹壁巨大缺损的修复重建

目的探讨带蒂大网膜加聚丙烯网片修复手术切除致腹壁巨大缺损的临床效果。方法1994年～2004年,采用带蒂大网膜加聚丙烯网片修复12例因腹壁肿瘤切除致腹壁巨大缺损的患者,缺损范围10cm×7cm～25cm×17cm。结果12例患者术后伤口均I期愈合。获随访1～5年,无肿瘤复发,无腹壁切口疝、肠粘连、肠梗阻和肠瘘等并发症发生。结论带蒂大网膜代替腹膜加聚丙烯网片修复腹壁缺损的方法疗效可靠,副作用少。     

立体网孔表面生物型人工膝关节假体的研制和兔生物力学研究

目的 研制一种兔用立体网孔表面生物型人工膝关节假体,观察并探讨其置换入兔膝关节内的功能情况及其生物力学性能. 方法 30只成年新西兰大白兔随机分成实验组及对照组,行左侧人工膝关节置换术,髌骨不置换.自行设计兔立体网孔表面生物型人工膝关节假体,股骨及胫骨假体髓内茎近端关节面4/5表层由不锈钢网围绕实心圆柱体制成,股骨髁和胫骨平台内表面用2层不锈钢网焊接而成,用于实验组行生物学假体固定;同时制作相同形状、大小假体,其髓内茎以及股骨髁和胫骨平台内表面光滑,用于对照组行骨水泥固定.术后观察动物一般情况,术后1、3、6个月处死动物取材行大体观察和x线片观察假体固定及愈合情况,测量膝关节活动度,并进行生物力学测试,计算假体骨界面最大剪切强度. 结果 实验组与对照组各死亡1只动物,均在二次实验时补充,其余动物均存活至实验完成,术后7 d恢复正常爬行.术后1、3、6个月膝关节功能恢复优良率实验组分别是60%、80%、80%,对照组分别是60%、80%、60%,差异均无统计学意义(P>0.05).实验组术后标本大体观察见大量骨重建,X线片示假体位置良好,固定牢靠,无脱位及松动发生;对照组大体观察未见骨重建,x线片示假体位置良好,固定牢靠,无脱位及松动发生,仅术后6个月股骨假体周围出现透亮带,产生应力遮挡.术后1个月实验组假体骨最大剪切强度低于对照组,术后3个月和6个月实验组高于对照组,差异均有统计学意义(P<0.01). 结论 兔立体网孔表面生物型人工膝关节假体植入动物体内的固定强度在术后3个月和6个月优于骨水泥假体.     

颈椎前路钛网钢板内固定及自体髂骨植骨在不同颈椎节段中的生物力学研究

目的 采用颈椎前路钛网钢板及自体髂骨植骨对不同颈椎节段进行内固定，分析其生物力学改变。方法 取自愿捐赠的6具新鲜尸体C3～7标本，C5、C5.6及C4～6椎体次全切除后，分别行髂骨植骨和钛网前路钢板内固定术，测量各节段的前屈、后伸、左、右侧弯及左、右旋转运动变化，以完整标本作为对照组。结果 自体髂骨的植入使失稳颈椎的稳定性提高，其侧弯、屈伸运动度减少，与对照组比较，差异有统计学意义（P〈0．05），但抗旋转运动减少不明显（P〉0．05）。不同颈椎节段开槽减压椎间撑开钛网前路钢板内固定状态下，手术节段的即刻稳定性比对照组及撑开植骨状态增加（P〈0．05）。结论 颈椎前路椎体次全切除之后，植骨仅能部分改善其稳定性，但应用颈椎前路钛网钢板内固定可明显增强颈椎的稳定性，也较完整颈椎运动功能单位稳定。