疝修补材料的进展

1986年Lichtenstein等在国际外科杂志刊登了用Marlex补片填充腹股沟管壁之间的组织空隙,并提出无张力修补这个新概念,从而使疝修补手术进入使用补片的无张力修补时代.随着材料学的进展,目前疝修补材料呈现多样化的趋势.     

传统腹股沟疝修补、开放性无张力疝修补及腹腔镜疝修补术的临床对比研究

研究比较传统腹股沟疝修补、开放性无张力疝修补术及腹腔镜疝修补术的临床结果。方法:从1998年12月～2001年12月,共收治300例腹股沟疝修补术病人作回顾性分析,其中有传统疝修补术93例,开放性无张力疝修补术102例,腹腔镜疝修补术105例。传统疝修补术分别采用Bassini或McVay法;开放性无张力疝修补术采用Marlex网塞和补片;腹腔镜疝修补术采用腹腔镜下内环口荷包缝扎和腹膜内置网法。结果:传统疝修补组平均手术时间为1.9h±0.6h,无张力组为1.5h±0.5h,腹腔镜组为1.2h±0.4h。术后随访1～2年,传统疝修补组有8例复发,腹腔镜组有1例复发,无张力组无复发。恢复正常活动的时间腹腔镜组为6.5d,无张力组为8.3d,传统手术组为16.5d。结论:开放性无张力疝修补是一种简单、手术时间短、痛苦小且可靠的手术,适用于腹股沟原发疝或复发疝;腹腔镜疝修补病人术后恢复工作时间比其他两组短,但复发率比无张力组稍高,除适用于腹股沟原发疝外,更适用于双侧疝和复发疝。     

腹股沟疝无张力疝修补术的临床探讨

目的探讨不同手术方法治疗腹股沟疝的效果。方法对我院2004年1月至2008年4月共收住的200例腹股沟疝患者的手术情况进行回顾性分析。结果住院的时间短、术后疼痛轻、复发率低。结论无张力疝修补术与传统手术方法相比值得推广应用。     

应用无张力疝修补术修补腹股沟疝100例分析

<正>2009-03—2012-12,我科在腰硬联合麻醉下应用无张力疝修补术治疗腹股沟疝100例,效果良好,现报告如下。1资料与方法1.1一般资料本组患者100例均为男性,年龄40～95岁,平均60岁。腹股沟斜疝88例,腹股沟直疝12例。腹股沟原发疝98例,复发疝2例。1.2方法 (1)材料:贝朗公司生产的10 cm×7 cm聚丙烯平片。使用前先将其折叠,修剪成刀型,并在中间剪一开口,以便     

疝环充填式无张力疝修补术在成人腹股沟疝的临床应用

目的　评价疝环充填式无张力疝修补术治疗腹股沟疝的临床价值。方法　应用聚丙烯网塞及网状补片治疗腹股沟疝 14 4例 ,对手术时间、手术方法、术式的优点、并发症及术中注意事项进行回顾性总结。结果　全组均痊愈 ,手术时间平均 43 .5min ,术后疼痛轻微 ,平均 6h后即可下床活动 ,无感染病例 ,主要并发症为 6例尿潴留和 5例阴囊积液。 63例出现术后低热。随访无复发病例。结论　该方法操作简便 ,符合腹股沟区生理解剖特点 ,术后疼痛轻 ,患者恢复快 ,复发率低 ,是治疗腹股沟疝的理想方法     

腹腔镜疝修补术与无张力疝修补术临床疗效比较

目的探讨腹腔镜下全腹膜外疝修补术与开放式无张力疝修补术治疗腹股沟疝(inguinal hernia IH)临床疗效。方法将104例腹股沟疝患者按手术治疗方式分为开放式无张力疝修补术(Tension-free hernia repair,TFHR)组51例和腹腔镜下全腹膜外疝修补术(total extraperitoneal prosthetic,TEP)组53例。比较2组患者术后临床疗效。结果 TFHR组与TEP患者均顺利完成手术,TEP组与TFHR组相比,出血量较少、术后疼痛较轻、下床活动较早,但总费用较高。TEP组术后尿潴留、血肿等并发症明显低于TRHR组。但切口感染,手术时间及2年内疝复发无明显差别。结论与TRHR相比,TEP术创伤小,恢复快,并发症低,但费用相对较高。     

疝环充填式无张力疝修补术在老年腹股沟疝中的应用

目的总结老年疝环充填式无张力疝修补术的近期治疗效果。方法全部采用mesh-plug定型产品行疝环充填式无张力修补。结果121例均手术过程顺利。术后并发尿潴留6例,阴囊积液4例,伤口持续疼痛2例,局部轻度隆起伴异物感2例,切口下血肿2例。随访1-24个月,短期复发2例。结论疝环充填式无张力疝修补术是一种完全符合生理解剖,具有手术方法操作简单、创伤小、无张力、省时、近期疗效满意及复发率低的理想疝修补手术。尤其适合老年和(或)伴有其它疾病者。     

Pain and its effects on physical activity and quality of life before operation in patients undergoing elective inguinal and ventral hernia repair

Background

Pain is the most common symptom associated with hernias. The aim was to assess the frequency of pain and its effects on physical activity and quality of life in patients with inguinal and ventral hernias.

Methods

All patients undergoing elective inguinal or ventral hernia repair over a 16-month period were asked to complete a questionnaire including a 4-point Verbal Rating Scale, Visual Analog Scale, and Brief Pain Inventory (BPI) to assess pain severity and interference.

Results

One hundred twenty-four patients (72 inguinal, 52 ventral) completed the questionnaire and 75% registered pain on the BPI. There was good correlation between scoring systems (correlation coefficient >.8). Ventral hernia patients had more pain (P = .037), interference with mood (P = .027), sleep (P = .004), relation with other people (P = .019), and enjoyment of life (P = .029) than their inguinal hernia counterparts.

Conclusions

The BPI is an easy and effective way of assessing pain and its impact on physical activity and quality of life in patients with an inguinal or ventral hernia with most experiencing mild to moderate chronic pain and disability.     

HERNIOPLASTY WITH AND WITHOUT MESH: ANALYSIS OF THE IMMEDIATE COMPLICATIONS IN A RANDOMIZED CONTROLLED CLINICAL TRIAL

Background:

Inguinal hernia repair is the most common procedure in general surgery and 80,000 operations are performed annually in Great Britain, 100,000 in France and 700,000 in the US. Given its high frequency has a major impact, both in the medical and economic aspects.

Aim:

Analyze the immediate postoperative complications comparing mesh versus non mesh hernioplasty.

Method:

Randomized control trial, with the enrollment of 263 patients underwent surgery for inguinal hernia randomized by randomization table. Treatment (mesh, Lichtenstein or without mesh, Bassini technique) was assigned using sequentially numbered opaque envelopes having fulfilled the inclusion criteria. The variables analyzed were: postoperative pain, seroma, hematoma, infection, return to normal activities and recurrence.

Results:

The mean age was 55.5 years, 88% patients were male and 12% female. The pain was higher in patients operated with mesh.

Conclusions:

The inguinal hernia repair mesh group had less immediate postoperative complications and significantly earlier return to work than hernioplasty without mesh, this being one of the most important conclusions.     

医用聚丙烯酰胺水凝胶临床应用的国内外进展

1 历史性回顾与国外进展 注射性软组织填充材料是科技发展过程中填充材料的第1,2代产品,经临床验证均因术后出现难以治愈的并发症和造成的不良后果已被临床淘汰,并给人们留下了深刻的教训.20世纪八九十年代始产生了第3代软组织填充材料[1],目前国际上分为3大类:即人工合成的永久性可注射性填充材料,临时性注射和半永久性注射性填充材料,它有近40种,后者是组织工程的产物.     

胃癌淋巴结清扫的临床应用解剖

目的 为胃癌的临床、病理描述提供一个通用的语言,有助于提高胃癌的诊治水平。方法采用文献回顾的方法对胃周淋巴结的构成分布解剖、胃癌的分期及相应的手术要求加以综述。结果 胃癌周围淋巴结沿胃周围血管及其邻近器官分布,解剖结构的熟悉,能使胃癌台术做到合理化、科学化。结论 有效的淋巴结清扫可使胃癌患者获得最佳疗效。     

Hernia repair in patients with chronic liver disease - A 15-year single-center experience

Background

Elective hernia repairs in chronic liver disease (CLD) patients are often avoided due to the fear of hepatic decompensation and mortality, leaving the patient susceptible to an emergent presentation.

Infection control in a hernia clinic: 24 year results of aseptic and antiseptic measure implementation in 4,620 “clean cases”

Post Mesh Herniorrhaphy Infection [PMHI] occurs between 3 to 4% of inguinal and 8 to 14% of ventral herniorrhaphies producing an unacceptably high morbidity. Before opening a Hernia Clinic, our infection rate was around 5% for “clean” inguinals and 8% for “clean” ventral herniorrhaphies. Starting in 1982 we implemented a stricter operative aseptic protocol plus the per-operative administration of 1 g of intravenous Cefazolin. In addition, wounds were irrigated with a solution containing 80 mgs of Gentamycin Sulphate dissolved in 250 ml of Normal Saline Solution. During a period of 25 years these measures were used in 4300 consecutive “clean “Inguinal and 320 “clean” Ventral herniorrhaphies. Since the implementation of the above-mentioned aseptic and antiseptic steps no further wound infections were encountered. In our hands, the combination of rigorous aseptic operating room routine plus intravenous and topical antibiotics have, up to now, effectively eliminated wound infections in “clean” herniorrhaphy cases.     

乳腺癌肿瘤标志物的研究和临床应用进展

乳腺癌是危及女性生命的恶性肿瘤之一 ,长期以来人们对乳腺癌的肿瘤标志物的研究非常重视 ,尤其近年来对癌基因、抑癌基因、各种异种蛋白及肿瘤抗原的深入研究 ,应用乳腺癌肿瘤标志物发现早期病变、预测肿瘤的预后、检测乳腺癌的转移复发、针对某些肿瘤标志物的药物开发和应用都取得了很大的进展。1　血清学肿瘤标志物1.1　ＣＡ15 3血清学肿瘤标志物ＣＡ15 3同ＣＥＡ一样 ,对乳腺癌诊断敏感性低 ,但是可作为监测乳腺癌手术后有无复发及治疗效果的一种方法 ,尤其对缺乏测量手段的转移病灶 (如骨转移 ) ,治疗后ＣＡ15 3值降低超过 2 5 %者…     

人工材料填充修复外伤后面部骨性凹陷

目的：总结目前常用的人工合成材料充填修复外伤性面部凹陷畸形的临床效果。方法：自1995年以来，对209例各种外伤性面部骨性缺损与凹陷畸形患者应用固体硅橡胶、羟基磷灰石微粒人工骨、膨体聚四氟乙烯填充材料进行修复。结果：全部病例填充后均获得了满意效果，总体并发症占3.3％，主要为材料排斥与感染，经处理后痊愈。结论：人工合成材料来源方便，填充效果较好，安全可靠，手术简便易行；三种材料各有自身的特点，可根据具体情况选择合适的材料进行充填。     

QUALITY OF LIFE OF IN PATIENTS SUBMITTED TO ANTERIOR ABDOMINAL WALL LAPAROSCOPIC HERNIOPLASTY

Background

The laparoscopic ventral hernia repair technique made possible surgeries with smaller skin incisions and smaller dissection of the soft tissue around the hernia, therefore with a better wound, a quicker postoperative recovery and a lower complication rate.

Aim

To evaluate the applicability of a quality of life survey based on the molds of the American Hernia Society, European Hernia Society and Carolinas Equation for Quality of Life, through telephone in patients submitted to laparoscopic hernioplasty by IPOM technique.

Methods

A retrospective cohort study was made to evaluate the quality of life of 21 patients that underwent anterior abdominal wall laparoscopic hernioplasty by intraperitoneal onlay mesh technique. Questionnaire was applied through telephone.

Results

Of the 21 patients, 19% felt that the hernia recurred. Also 19% passed through another abdominal wall surgery, and among these, 75% was related to the previously hernia correction. Finally, 81% of patients did not undergo any other abdominal wall surgery.

Conclusion

It was possible to apply the quality of life questionnary by telephone on patients who underwent an anterior abdominal wall. The results, in its turn, were satisfactory and showed that patients, in general, were satisfied with the surgical procedure.     

甲状腺癌的分子生物学研究进展

随着分子生物学技术的发展 ,在甲状癌的研究中 ,从基础和临床各个方面都极大地加深了对其原有知识的认识。已有研究表明 ,甲状腺癌的发生、增殖、分化状态以及浸润转移等各种细胞生物学变化的基础是分子生物学改变。现重点介绍近年与临床相关的甲状腺癌分子生物学的研究成果。1　家族性甲状腺髓样癌遗传学研究甲状腺癌遗传学研究的重要进展是在家族性甲状腺髓样癌中ｃ ｒｅｔ基因突变。ｃ ｒｅｔ基因表达产物为截断的受体样蛋白 ,由胞膜外区 (包括钙粘着蛋白样配基结合区及半胱氨酸富集区 )、跨膜区和胞内酪氨酸蛋白激酶功能区组成。在散发…