膨体聚四氟乙烯补片在腹股沟疝修补中的应用

无张力疝修补术已逐渐成为疝修补术的主流术式 ,主要有平片修补和疝环充填式修补两种手术方式。目前所用的补片有多种 ,我科 2 0 0 1年 9月～ 2 0 0 3年 12月采用膨体聚四氟乙烯补片对 3 6例腹股沟疝患者行无张力疝修补术 ,取得满意效果 ,现报告如下。临床资料1.一般资料 :本组病例 3 6例 ,男 2 9例 ,女 7例。年龄 2 8～75岁 ,平均 5 5 .3岁。单侧腹股沟斜疝 3 1例 (其中复发性斜疝2例 ,嵌顿性斜疝 2例 ,滑疝 1例 ) ,双侧斜疝 2例 ,直疝 2例 ,马鞍疝 1例。术前患有各种合并病 8例 (高血压、糖尿病、慢性支气管炎、前列腺增生症等 )。2 .手术…     

不同人工补片修补腹股沟疝的临床对比研究

应用现代合成补片进行疝修补术现已被认为是一种简单、快速、无痛并且不扰乱正常解剖的新技术。这种新技术的核心是人工补片的选择[1] 。我们以聚丙烯补片 (ｐｏｌｙｐｒｏｐｙ ｌｅｎｅｍｅｓｈ)、膨化聚四氟乙烯补片 (ｅ ＰＴＦＥ)、以及 3层结构的三明治复合补片 (ｓａｎｄｗｉｃｈｐａｔｃｈ)应用于巨大腹股沟疝的修补术 ,并对其进行对比性研究。临床资料1.一般资料 :1992年 6月至 2 0 0 1年 6月共收治巨大腹股沟疝患者 189例 ,均为男性 ,年龄 12～ 83岁。其中选择聚丙烯补片患者 5 4例 ,平均年龄为 5 4 2岁 ;膨化聚四氟乙烯补片患者 6…     

Proloop补片修补腹股沟疝52例手术体会

<正>Proloop补片是一种用于腹股沟疝修补治疗的新型修补材料。其是一种轻量型聚丙烯材料,具有永久性植入异物减少、纤维少、网孔大、柔软、异物反应小、弹性好等特点。我院从2006年1月至2009年6月成功应用Proloop补片修补腹     

应用善愈补片修补成人腹股沟疝100例体会

我中心自2007年11月至2009年2月应用善愈补片对100例成人腹股沟疝患者实施修补手术,取得良好效果,现报告如下。     

内存记忆弹力环补片(Kugel补片)微创修补腹股沟疝

目的 探讨内存记忆弹力环补片(Kugel补片)在腹股沟疝修补术中的应用价值。方法 回顾总结22例24侧腹股沟疝,Nyhus分型Ⅰ型4例侧、Ⅱ型16例侧、Ⅲ型4例。均应用内存记忆弹力环补片行微创腹股沟疝修补术。结果 每侧手术时间30～45分钟,术后6～24小时下床活动,术后4～8天恢复正常日常活动。无一例伤口感染、阴囊血肿、阴囊积液。术后随访1个月至6个月,无复发,无髂腹股沟神经综合症。结论 内存记忆弹力环补片微创腹股沟疝修补术是微创、无张力、全腹股沟修补术,具有创伤小、病人恢复正常活动早等特点,同时其学习曲线短,容易掌握。     

双层补片在腹股沟疝修补术中的应用

为进一步降低无张力疝修补术后复发及再发率 ,我们用双层补片 (ｂｉｌａｙｅｒｐａｔｃｈ) ,对 32例腹股沟疝患者进行了治疗 ,现报告如下。临床资料1.一般资料 :本组 4 2例 ,均为腹股沟疝患者 ,其中双侧疝 4例 ,共 4 6例次 (右侧 2 4例 ,左侧 2 2例 ) ;32例患者均为男性 ,年龄 2 4～ 78岁 ,>6 0岁者占 80 % ;斜疝 18例次 ,直疝 15例次 ,骑跨疝 3例 ,滑疝 6例 ;原发疝 32例 ,复发疝 9例 ,再发1例 ;可复性 4 1例 ,难复 1例。合并双下肺炎变 11例 ,原发性高血压 1例 ,房颤 2例 ,前列腺肥大 4例 ,脾大 1例 ,血小板低于正常 10例 ,但凝血机能正常…     

可吸收补片在腹股沟疝修补术中的应用

疝外科学的发展推动了材料学的进步,目前临床上充斥着各种各样的疝修补材料。可吸收补片作为一种新的腹股沟疝修补材料,特别是部分可吸收补片,短短十余年时间,逐渐得到了全球外科医师的认可,在临床上的应用呈现增长的趋势。其中生物补片的出现,因其在材料工艺上的进步,无疑给腹股沟疝修补技术的发展带来了福音。然而随着大量临床研究的深入,生物补片在腹股沟疝修补术后的远期疗效方面受到较多质疑。近年来,随着材料学的飞速发展,合成可吸收补片的出现,因其更少的副作用而逐渐引起外科医师的注意,但合成可吸收补片的应用是否真正使病人利益最大化,目前尚缺乏多中心、前瞻性的大量临床随机对照研究。因此,在腹股沟疝手术过程中如何选择一种合适的补片,成了外科医师治疗腹股沟疝的最大难题之一。本文就近年来可吸收补片的进展加以综述。     

腹股沟疝补片修补术后补片感染外科处理方法的研究

目的探讨腹股沟疝补片修补术后补片感染的外科处理方法和经验。方法回顾性分析北京朝阳医院疝和腹壁外科2011年1月至2012年6月期间收治的67例腹股沟疝补片修补术后发生补片感染患者的临床资料,对患者的伤口愈合情况加以分析。结果67例患者均行清除感染补片及周围感染组织,未再重新放置补片,均行一期全层缝合伤口,同时放置伤口引流管。均成功清除了感染的补片;术后住院时间10～25d,平均16d;术后伤口一期愈合51例,拆线后伤口存在浅部感染、经局部换药后延期愈合16例。术后66例患者获访,随访时间为6～24个月（平均20个月）。随访期间,均无切口下积液、伤口感染、肠瘘、术后疼痛等并发症发生,无腹股沟疝复发。结论腹股沟疝补片修补术后补片感染的外科处理十分复杂,采用去除补片、彻底清创、一期缝合及放置伤口引流管的综合手术治疗方法可以获得比较满意的疗效。     

涤纶补片无张力修补腹股沟疝84例报告

腹股沟疝修补术历史长，方法多，但术后复发问题仍未彻底解决。有张力缝合和组织结构破坏是手术失败的基本因素〔１〕。近几年出现无张力修补术新概念，国外开展日益增多，国内少有报道。我院自１９９３年２月开始，用涤纶补片无张力修补腹股沟疝８４例，效果良好，报道如...     

巨大切口疝的开放式无张力修补术

目的:总结无张力技术修补巨大切口疝的临床经验及其围手术期处理要点.方法:对我院2002年5月至2007年5月收治的38例巨大切口疝临床资料进行回顾性分析,其中30例应用肌后修补法(sublay法)修补,8例采用腹腔内补片修补法(underlay法)修补,所用补片材料为聚丙烯(68.0%)或复合补片(32%).随访1～5年,统计病人的并发症和复发率.结果:80%病人有术前合并症,包括肥胖(45%)、糖尿病(16.4%)、慢性阻塞性肺疾病(12.5%)和腹主动脉瘤(2.7%).无张力疝修补后2～3周病人均痊愈出院.随访结果,复发2例(5.3%),伤口感染3例(7.9%),血清肿5例(13.1%).结论:人工材料无张力修补术是治疗腹壁大切口疝的优良术式,手术创伤小、术后恢复快.对于疝环巨大或疝内容物多、突出时间长的特大切口疝病人应给予充分的术前准备.     

A novel approach for salvaging infected prosthetic mesh after ventral hernia repair

Background  

Salvaging infected prosthetic material after ventral hernia repair is rarely successful. Most cases require mesh excision and complex abdominal wall reconstruction, with variable success rates. We report two cases of mesh salvage with a novel use of percutaneous drainage and antibiotic irrigation.     

Preventing parastomal hernia with a prosthetic mesh

HYPOTHESIS: Parastomal hernia is a common complication following colostomy. The lowest recurrence rate has been produced when repair is with a prosthetic mesh. This study evaluated the effect on stoma complications of using a mesh during the primary operation. DESIGN: Randomized clinical study. METHODS: Patients undergoing permanent colostomy were randomized to have either a conventional stoma or the addition of a mesh placed in a sublay position. The mesh used was a large-pore lightweight mesh with a reduced polypropylene content and a high proportion of absorbable material. RESULTS: Twenty-seven patients had a conventional stoma, and in 27 patients the mesh was used. No infection, fistula formation, or pain occurred (observation time, 12-38 months). At the 12-month follow-up, parastomal hernia was present in 13 of 26 patients without a mesh and in 1 of 21 patients in whom the mesh was used. CONCLUSIONS: A lightweight mesh with a reduced polypropylene content and a high proportion of absorbable material placed in a sublay position at the stoma site is not associated with complications and significantly reduces the rate of parastomal hernia.     

Slit mesh for hernia repair

A precise method of placing synthetic material during inguinal hernia repair is described. The material is slit at the inferior position to the internal ring so that its continuity is least compromised.     

Ubiquitous use of prosthetic mesh in inguinal hernia repair: the dilemma

Summary The omnipresence of prosthetic materials (mesh) used in hernia repairs throughout the world deserves careful review. The propensity to develop operative techniques wherein prosthetic mesh is used routinely, regardless of type hernia, has reached an unacceptable level of practice. Being foreign bodies, postoperative complications occur which directly can be traced to the implanted meshes. Recent interest in mesh complications, i.e., infection, mesh shrinkage, migration and fistula formation, has escalated. Although mesh foreign body tumorigenesis has not been seen in humans following hernia repair, there is sufficient animal data to cause concern. Similarly, neural complications following use of mesh, particularly after the open anterior notension repair methods, are being reported at alarming rates. Many types of inguinal hernias do not need mesh repairs. It is our premise that these hernias must be identified preoperatively. Certainly, type I, II and III C inguinal hernias of our classification, should not receive a prosthetic mesh repair. If prosthetic mesh is to be used, it should be placed to buttress the inguinal wall posteriorly so that advantage of Pascal's law may be assured.     

Use of fibrin sealant for prosthetic mesh fixation in laparoscopic extraperitoneal inguinal hernia repair

OBJECTIVE: To evaluate the efficacy of mesh fixation with fibrin sealant (FS) in laparoscopic preperitoneal inguinal hernia repair and to compare it with stapled fixation. SUMMARY BACKGROUND DATA: Laparoscopic hernia repair involves the fixation of the prosthetic mesh in the preperitoneal space with staples to avoid displacement leading to recurrence. The use of staples is associated with a small but significant number of complications, mainly nerve injury and hematomas. FS (Tisseel) is a biodegradable adhesive obtained by a combination of human-derived fibrinogen and thrombin, duplicating the last step of the coagulation cascade. It can be used as an alternative method of fixation. METHODS: A prosthetic mesh was placed laparoscopically into the preperitoneal space in both groins in 25 female pigs and fixed with either FS or staples or left without fixation. The method of fixation was chosen by randomization. The pigs were killed after 12 days to assess early graft incorporation. The following outcome measures were evaluated: macroscopic findings, including graft alignment and motion, tensile strength between the grafts and surrounding tissues, and histologic findings (fibrous reaction and inflammatory response). RESULTS: The procedures were completed laparoscopically in 49 sites. Eighteen grafts were fixed with FS and 16 with staples; 15 were not fixed. There was no significant difference in graft motion between the FS and stapled groups, but the nonfixed mesh had significantly more graft motion than in either of the fixed groups. There was no significant difference in median tensile strength between the FS and stapled groups. The tensile strength in the nonfixed group was significantly lower than the other two groups. FS triggered a significantly stronger fibrous reaction and inflammatory response than in the stapled and control groups. No infection related to method of fixation was observed in any group. CONCLUSION: An adequate mesh fixation in the extraperitoneal inguinal area can be accomplished using FS. This method is mechanically equivalent to the fixation achieved by staples and superior to nonfixed grafts. Biologic soft fixation with FS will prevent early graft migration and will avoid the complications associated with staple use.     

Simplified technique for incisional hernia repair with mesh prosthesis

This paper describes a simplified technique for the repair of incisional hernias. The previous scar is resected, and the peritoneal sac is carefully dissected until it is completely exposed. The sac is opened to liberate structures adherent to the sac or to the area immediately surrounding the defect. The peritoneum is closed and invaginated to form a sac bed underlying the entire extent of the defect, and the mesh is laid on this sac bed. The mesh is then fixed with "U" stitches, reinforcing these by inserting a second line from the edge of the defect to the mesh. Suture material used is polypropylene 1/0 or 2/0. This procedure has been carried out on 15 patients, and after 1 year of follow-up, there has been no recurrence of the hernia. Operating time was reduced, and the surgical technique was found to be easier. Placing a mesh prosthesis inside the hernia sac and fixing it to the abdominal wall with two lines of suturing simplifies the repair procedure, reduces operating time, and is effective in the repair of all incisional hernias. A study is required to compare this outcome with the different mesh repair techniques.