丝蛋白涂层轻质聚丙烯网片对兔腹壁疝模型组织学反应的影响

目的:探讨宿主对有丝蛋白涂层和无丝蛋白涂层的2种不同轻质聚丙烯网片组织学反应的差别。方法:2种聚丙烯网片(Gynemesh网片和法国G819P网片)的有丝蛋白涂层和无丝蛋白涂层网片各6片,共计24片,裁剪为30 mm×30 mm大小。6只新西兰大白兔,每只均制作6个腹壁缺损,并分别植入有丝蛋白和无丝蛋白涂层Gy-nemesh誖网片和有丝蛋白和无丝蛋白涂层G819P网片各1片,另2个腹壁缺损作为空白对照。植入后30,60和90 d时各处死2只动物,取出包括网片在内的腹壁全层,做大体观察、组织学观察以及免疫组化研究,包括炎症、纤维化反应、网片周围血管化反应以及胶原形成等。结果:所有网片均未发生侵蚀。有丝蛋白涂层网片组炎症反应和纤维化反应较轻,网片与组织融合良好。无涂层组可见少量的凋亡和坏死。结论:有丝蛋白涂层聚丙烯网片引起实验动物的组织学反应较轻,可以降低早期炎症反应和纤维化程度,减少组织粘连,降低网片相关并发症的产生。     

改良盆底重建术与传统手术治疗盆腔器官脱垂的随访评价

目的:评价经阴道全子宫切除术加改良盆底重建术和经阴道全子宫切除术加阴道前后壁修补术治疗盆腔脏器脱垂的治疗效果。方法:对2007年4月至2011年4月盆腔脏器脱垂Ⅱ～Ⅳ度102例患者进行术后3个月、6个月、12个月、36个月随访,其中经阴道子宫切除术加改良盆底重建术(重建组)65例,经阴道子宫切除术加阴道前后壁修补术(传统组)37例。采用POP-Q分度法,Ⅱ度及Ⅱ度以上判定为复发。结果:重建组2例(3.08%)复发,传统组6例(16.21%)复发,两组复发率差异有统计学意义(P<0.05);重建组复发患者均合并网片侵蚀、外露,剪除外露网片并局部雌激素治疗后放置子宫托,目前疗效满意;传统组复发患者分别行子宫托治疗、改良盆底重建术、Prolift盆底重建术、阴道封闭术,目前疗效满意;重建组35例术后恢复性生活,传统组25例术后恢复性生活,性功能问卷评分均较术前下降(P<0.05),但两组术后性功能评分无显著差异(P>0.05)。结论:改良盆底重建术作为一种新术式,能更好地修补缺陷、实现结构重建和组织替代,其复发率低,尤其是对于Ⅲ～Ⅳ度脱垂患者较传统手术更具优势。术后复发患者首选子宫托治疗,传统组可行网片再次手术治疗,阴道封闭术为最后的选择方法。     

Human acellular dermal matrix for closure of a contaminated gynecologic wound

BACKGROUND: Polypropylene mesh for abdominal wall reconstruction increases the risk of postoperative complications in previously irradiated patients or patients with contaminated operative fields. A novel alternative, acellular dermal matrix, easily incorporates into native tissue when used for fascial reconstruction, forming a strong repair with minimal adhesions and lower infection rates. CASE: We describe a patient previously treated with radiation for cervical cancer who presented with a contaminated operative field due to enteral spillage and pelvic infection. Acellular dermal matrix was used as part of a stepwise secondary closure of a large fascial defect in the anterior abdominal wall that was the result of repeated surgical procedures. CONCLUSION: Use of acellular dermal matrix rather than traditional polypropylene mesh should be considered for patients with contaminated or irradiated operative fields.     

Intrauterine repair of gastroschisis in fetal rabbits

OBJECTIVE: Infants with gastroschisis (GS) still face severe morbidity. Prenatal closure may prevent gastrointestinal organ damage, but intrauterine GS repair (GSR) has not been established yet. METHODS: In New Zealand White rabbits we developed and compared GS versus GSR: creation of GS was achieved by hysterotomy, right-sided laparotomy of the fetus and pressure on the abdominal wall to provoke evisceration. GSR was accomplished by careful reposition of eviscerated organs and a running suture of the fetal abdominal wall. For study purposes, 18 animals were divided equally into 3 groups: GS, GS with GSR after 2 h, and unmanipulated controls (C). Vitality was assessed by echocardiography. After 5 h all animals were sacrificed. RESULTS: GSR inflicted no increased mortality, because all fetuses survived GS or GS with GSR. All fetuses with GS demonstrated significant evisceration of abdominal organs. In contrast, the abdominal wall of the fetuses from GSR was intact. CONCLUSION: The present animal model demonstrated the technical feasibility and success of an intrauterine repair of GS for the first time. However, further long-term studies (leaving GS and GSR in utero for several days) will be necessary to compare survival rates and intestinal injury, motility or absorption. The clinical application of GSR in utero remains a vision so far.     

Prolift和AMS两种骨盆底修复系统临床应用分析

目的：分析Prolift（Prolift Pelvic Floor）和AMS（AMS Peep Connection Tool）两种盆底修复系统治疗女性盆腔器官脱垂（pelvic organ prolapse,POP）的临床疗效以及并发症的差异。方法：选取南京医科大学附属南京妇幼保健院2010年11月—2013年6月收治的60例POP患者,随机分为Prolift组和AMS组,Prolift组29例,AMS组31例。比较2组患者的临床疗效和并发症。结果：2组患者的手术时间、术中出血量、术后最高体温、尿管留置时间、残余尿量及住院时间比较差异均无统计学意义（P＞0.05）;排尿困难、会阴部下腹坠胀、网片暴露、阴道壁膨出等术后并发症在2组患者间差异也无统计学意义（P＞0.05）,Prolift组患者的疼痛及性生活质量下降的发生率显著高于AMS组（P＜0.05）。结论：应用Prolift和AMS两种盆底修复系统治疗POP,均能实现盆底解剖重建和功能恢复,但AMS比Prolift更具优势。     

Perioperative Complications in Vaginal Mesh Procedures Using Trocar in Pelvic Organ Prolapse Repair

Introduction and Hypothesis

This study aimed to document intraoperative and early postoperative complications associated with the use of vaginal mesh with trocar in pelvic organ prolapse (POP) repair.

Methods

This is a retrospective review of 120 cases of vaginal repair of POP using vaginal mesh. Of the 120 patients, 31 underwent anterior mesh repair (Light mesh 10, Avaulta 1, Perigee 1, and Prolift 19); 35 underwent posterior mesh repair (Light mesh 2, Posterior IVS 17, and Prolift 16); and 54 underwent anterior and posterior mesh (total) repair (Light mesh 8, Prolift 32, and Prolift M 14).

Results

Three bladder injuries (2.5%) and one distal rectal injury (0.8%) occurred during dissection. Three of four organ injuries (75%) had previous prolapse repair. Overall four patients (3%) required transfusion. Urinary retention exceeding 5 days occurred in four patients. Three of them (60%) also underwent TVT-O. Groin pain occurred in two patients one of whom underwent TVT-O. Gluteal pain occurred in one patient. Early mesh exposure occurred in the vaginal cuff of a patient who underwent hysterectomy.

Conclusions

The vaginal mesh procedures may be done with relatively few perioperative complications. However, there is a need for more randomized controlled trials with long-term follow-up to clarify its postoperative long-term complications and morbidities.     

Lysyl oxidase transcripts in peritoneal adhesions and incisional scars

OBJECTIVE: To evaluate the role of lysyl oxidase in postsurgical adhesion formation and incision wound repair. STUDY DESIGN: Female New Zealand rabbits underwent a pelvic-peritoneum adhesion-inducing operation under sterile conditions. In brief, the uterine horns were removed from the abdomen and abraded with surgical gauze and a scalpel blade. The horns were then replaced into the abdominal cavity, the incision was sutured, and the animals were allowed to recover. The animals were killed before lesion development and after 2, 4, 8, and 14 days of postsurgical recovery. The abraded uterine horns, abdominal wall incisional wound and a portion of the sidewall peritoneum were then removed. Total RNA was extracted using the guanidinium thiocyanate-phenol-chloroform method. Northern blot analysis was performed with an [alpha-32P]-labeled lysyl oxidase probe. RESULTS: Lysyl oxidase was expressed during abdominal wall incision repair on days 2 and 4 of postsurgical recovery, declining thereafter (days 8 and 14). In contrast, no increase in lysyl oxidase expression was noted in the uterine horns as compared to the control sidewall peritoneum. CONCLUSION: Lysyl oxidase plays a differential role in the early stages of abdominal wall and uterine horn repair.     

新型输卵管节育栓对兔输卵管组织中VEGF、TNF-α及TGF-β1表达的影响

目的:评估新西兰雌兔放置新型输卵管节育栓对其输卵管生殖环境和组织损伤的影响。方法:将39只雌兔随机分为置栓组(29只,双侧输卵管放置新型输卵管节育栓)和对照组(10只,仅行假手术,不放置输卵管栓)。分别于节育栓植入后第3个月、第6个月、第12个月利用光学显微镜观察输卵管黏膜的组织学改变,利用免疫组织化学法半定量分析输卵管黏膜血管内皮生长因子(VEGF)、肿瘤坏死因子-α(TNF-α)及转化生长因子-β1(TGF-β1)的表达。结果:光学显微镜下,大部分置栓组输卵管黏膜未见明显炎症细胞浸润,肌层未见充血和出血,浆膜层无明显病理异常。对照组和放栓后第3个月、第6个月、第12个月组输卵管黏膜上皮细胞VEGF、TNF-α及TGF-β1表达组间无统计学差异(P>0.05)。结论:放置新型输卵管节育栓对机体的生殖功能无明显影响,对兔输卵管组织无明显损伤。     

Preoperative leuprolide acetate combined with Interceed* optimally reduces uterine adhesions and fibrosis in a rabbit model

OBJECTIVE: To determine the optimal approach to prevent adhesions comparing leuprolide acetate (GnRH-a), Interceed (oxidized regenerated cellulose; Johnson & Johnson Medical, Inc., New Brunswick, NJ), and a combination of leuprolide with Interceed in a rabbit uterine horn adhesion model. DESIGN: Prospective, randomized, blinded study. SETTING: Certified animal care facility. ANIMAL(S): Twenty-eight sexually mature, female New Zealand White rabbits. INTERVENTION(S): Animals were prospectively randomized (by number generator) to receive GnRH-a or saline. After 6 weeks, standard surgical manipulations were performed at three sites in each uterine horn by [1]. suture, [2]. unipolar cautery, and [3]. superficial abrasion. Interceed was applied over one randomly assigned uterine horn only. Six weeks after surgery, uterine adhesions were assessed visually, and tissue fibrosis was assessed by histology. MAIN OUTCOME MEASURE(S): Presence or absence of adhesions and microscopic tissue fibrosis. RESULT(S): Gonadotropin-releasing hormone agonist significantly decreased adhesions, whereas Interceed alone did not reduce adhesions. However, GnRH agonist plus Interceed was the most effective measure to reduce tissue fibrosis. CONCLUSION(S): Preoperative GnRH-a is more effective than Interceed in preventing surgical adhesions in the rabbit uterine horn. However, preoperative GnRH-a plus Interceed may provide optimal results in this animal model, because microscopic tissue fibrosis is minimized with this combination.     

Change of potassium current density in rabbit corneal epithelial cells during maturation and cellular senescence.

BACKGROUND: Voltage-gated potassium (K+) channels may participate in cellular developmental regulation, including cell differentiation, proliferation and apoptosis. This study investigated the change of K + current densities in corneal epithelial cells during maturation and cellular senescence. METHODS: New Zealand white rabbits were divided into three age groups: newborn ( 10.0 pF. Using a whole-cell clamp technique, K+ current was recorded and current densities were calculated. Differences in K+ current densities among newborn, young and adult rabbits, as well as differences among small, medium and large cells, were analyzed. RESULTS: We delineated two types of cells manifesting different amplitudes of depolarization-activated K+ outward currents. The averaged current density of type 1 response cells was significantly larger than that of type 2 cells in newborn, young, and adult groups. For newborn epithelial cells, the depolarization-gated outward K+ current density decreased from small to medium to large cells (p = 0.049, at a membrane potential of 140 mV). A similar pattern of change in current density was also delineated for these cell sizes in young and adult rabbit corneal cells (p < 0.001 for both young and adult rabbits). An increase in depolarization-gated outward K+ current density was also delineated from newborn to young to adult rabbits (p < 0.001, p < 0.001 and p < 0.006 for small, medium and large cells, respectively, at a membrane potential of 140 mV). CONCLUSIONS: Corneal epithelial cells expressed K+ channel densities that were distinct from basal to superficial cells and from newborn to adult rabbits.     

Prolift术对盆腔器官脱垂患者盆底肌力的影响

目的：评估Prolift手术前后盆腔器官脱垂（POP）患者盆底肌力的变化情况。方法：选择2011年3月—2013年4月于上海同济大学附属同济医院入院治疗的POP Ⅱ～Ⅳ度的患者37例,采用指检法和表面肌电图法测量并评价Prolift手术前后患者盆底肌力的变化情况,并与盆底功能正常者进行比较。结果：Prolift手术可有效改善患者的POP状态,术后36例患者POP-Q分度明显降低,达到解剖复位;术后6个月盆底肌力的Oxford分级、盆底肌最大收缩电压和收缩持续时间均较术前有明显提高（P=0.000）,但均低于盆底功能正常者（P=0.000）。结论：Prolift手术可恢复盆腔器官的解剖结构,一定程度上可加强盆底肌力。     

兔卵巢组织玻璃化冷冻的实验研究

目的:探讨玻璃化冷冻法保存兔卵巢组织的效果。方法:随机将25只新西兰雌兔分为对照组(5只)、慢速冷冻组(10只)和玻璃化冷冻组(10只),比较各组冻融前后卵巢组织学、超微结构、卵泡凋亡(原位末端标记法,TUNEL)和子宫系膜内移植后卵巢功能的恢复情况。结果:新鲜组织、慢速冷冻复苏组织和玻璃化冷冻复苏组织中正常形态卵泡比例分别为87.36%、81.96%和82.72%,两冷冻组正常卵泡比例均低于对照组,差异有统计学意义?P(0.05),但玻璃化冷冻组与慢速冷冻组差异无统计学意义(P>0.05)。3组间卵泡凋亡比率分别为21.4%、13.5%和17.1%,差异无统计学意义(P>0.05);3组移植后兔动情周期出现率均为100%,动情周期出现天数差异无统计学意义?P>0.05);移植存活的卵巢组织内可见各级形态正常的卵泡发育。结论:玻璃化冷冻可有效保存卵巢组织的结构和功能,是一种简单、可行的兔卵巢组织冷冻保存法。     

Efficacy and outcome of anterior vaginal wall repair using polypropylene mesh (Gynemesh)

AIM: The aim of the present study was to assess the safety and efficacy of anterior vaginal wall repair using polypropylene mesh for the correction of anterior vaginal wall prolapse. METHODS: From May 2001 to March 2005, 38 patients with cystoceles or uterine prolapse underwent transvaginal repair with implantation of polypropylene mesh. In all 38 patients anterior vaginal wall repair was done concurrently with other procedures: vaginal hysterectomy, n = 18 (47.4%) and tension-free vaginal tapes n = 22 (57.9%). RESULTS: Preoperatively 26 patients (68.4%) had stage III/IV prolapse on pelvic organ prolapse quantification examination. After mean follow up of 23.4 months, the objective cure rate at 12 and 18 months was 94.5% and 94.3%, respectively. As for complications associated with placement of the polypropylene mesh, no tissue erosion or infection was found. CONCLUSIONS: Transvaginal implantation of polypropylene mesh is an effective and safe technique for the correction of anterior vaginal wall prolapse.     

Re-laparotomy after cesarean section: operative complications in surgical delivery

OBJECTIVE: To determine the risk factors causing re-laparotomy and the indications, management and outcomes of re-laparotomy after a cesarean section. METHODS: We had, during the study period of January 2002 to January 2007, 28,799 cesarean sections and 35 cases with re-laparotomy. We studied the patients' age, parity, indications for cesarean section and indications for re-laparotomy, time interval after cesarean section to reopening of the abdomen, type of surgery, need for blood transfusion and span of hospital stay. RESULTS: The incidence of re-laparotomy was 0.12%. Cases with placental abruption and previous cesarean >/=3 had a higher risk for re-laparotomy. Procedures that were performed at re-laparotomy were drainage and resuturing of hematomas (n = 8), resuturing of uterus and securing hemostasis with stitches (n = 10), bladder repair (n = 1), herniation repair (n = 1), total abdominal hysterectomy (n = 2), subtotal abdominal hysterectomy (n = 5), and draining and resuturing of broad ligament, parametrium, abdominal wound, and cutaneus and subcutaneous tissue due to infection and abscess formation (n = 8). Two cases required admission into the intensive care unit. We had one case with maternal mortality. Majority of the complications were revealed at an early period and these were hemorrhagic cases mostly. CONCLUSION: Although the rate of re-laparotomy after cesarean section is low, several actions must be undertaken to decrease the need for re-laparotomy. In particular, cases with placental abruption and previous cesarean >/=3 are with higher risk for re-laparotomy and have a 15-fold risk for re-laparotomy after cesarean section.     

Changes in Female Sexual Function After Vaginal Mesh Repair Versus Native Tissue Repair for Pelvic Organ Prolapse: A Meta-Analysis of Randomized Controlled Trials

Aim

To evaluate changes in female sexual function after transvaginal mesh (TVM) repair versus native tissue repair for pelvic organ prolapse.

Anatomic and functional outcomes with the prolift procedure in elderly women with advanced pelvic organ prolapse who desire uterine preservation

Study ObjectiveTo assess the clinical outcomes of total mesh repair with the Prolift technique as treatment of advanced pelvic organ prolapse in elderly patients who desire uterine preservation.DesignCase control series study (Canadian Task Force classification II-2).SettingMedical school–affiliated hospital.PatientsSixty-eight patients over the age of 70 years with advanced pelvic organ prolapse, Pelvic Organ Prolapse Quantification stage III (n = 59) or IV (n = 9), underwent a total Prolift procedure and were followed up for a minimum of 2 years.InterventionsTransvaginal pelvic floor repairs were performed with a total Prolift system. The concurrent pelvic surgery included midurethral sling operation with a TVT-O, if indicated. The assessment included intraoperative and postoperative complications, Urogenital Distress Inventory scores, and Incontinence Impact Questionnaire scores.Measurements and Main ResultsObjective and subjective data were available for 68 patients. The anatomic success rate was 97.1% after 2 years. Complications included bladder perforation in 1 patient (1.5%), de novo stress urinary incontinence in 20 patients (29.4%), dyspareunia in 4 patients (22.2%), and vaginal erosion in 1 patient (1.5%). The Pelvic Organ Prolapse Quantification stages, Urogenital Distress Inventory scores, and Incontinence Impact Questionnaire scores all improved significantly after surgery.ConclusionsThe total Prolift procedure is an alternative surgical option that uses a minimally invasive transvaginal approach to surgically treat elderly patients with advanced pelvic organ prolapse.     

Prolift网片联合尿道中段悬吊治疗POP或合并SUI患者的近期疗效

目的:探讨全阴道修复网片(total vaginal mesh,TVM)即Gynecare Prolift网片修复系统及联合经闭孔无张力阴道吊带(tensiongfree vaginal tape-obtutor,TVT-O)尿道中段悬吊手术治疗盆腔器官脱垂(pelvic organ prolapse,POP)或合并压力性尿失禁(stress urinary incontinence,SUI)的近期疗效。方法:选择Ⅱ度以上子宫和(或)阴道壁脱垂患者24例,其中本次手术前已切除子宫5例,术中同时切除子宫12例,保留子宫7例。16例用全盆底修复网片(total Prolift),8例用前盆修复网片(anterior Prolift);10例因合并压力性尿失禁同时行TVT-O尿道中段悬吊术。结果:24例患者术中均无严重并发症发生,3例(12.5%)出血量超过500ml;术后随访12～20个月,1例至术后10个月时发现阴道壁网片侵蚀(4.2%,1/24),经门诊4次修剪好转;24例患者均无复发。结论:用Prolift盆底修复网片系统进行盆底重建术,手术安全、易行、微创,近期疗效肯定;合并SUI者同时使用TVT-O不增加手术难度和并发症的发生率。     

载药纳米载体联合光敏剂的淋巴靶向性研究

目的:探讨纳米载体(PBCA-NP)联合光敏剂(HMME)应用于家兔腹腔淋巴结组织的淋巴靶向性研究。方法:制备血卟啉单甲醚-聚氰基丙烯酸正丁酯纳米载体(HMME-PBCA-NP)并检测纳米粒的理化性质和体外释放情况;将家兔随机分为两组,分别给予腹腔注射相同剂量HMME-DMSO和HMME-PBCA-NP溶液,检测血浆中HMME含量得到血卟啉单甲醚的药物代谢动力学参数,于不同时间点处死家兔,检测不同组织中的HMME含量,得到血卟啉单甲醚的组织药物分布。结果:成功制备出HMME-PBCA-NP纳米胶束,粒径为160nm左右,包封率为87.9%,载药量为13.4%;与单纯血卟啉单甲醚溶液组相比,纳米组家兔血清及组织到达药物峰浓度时间均向后推迟(6h vs 3h);腹腔注射不同剂型药物6h后,药物浓度在家兔肠系膜淋巴组织中的差值达到最大[(1.2884±0.04695)μg/ml vs(0.0438±0.00558)μg/ml],肉眼观察,纳米载体组家兔肠系膜淋巴结明显肿大。结论:纳米粒经过腹腔注射具有缓释作用;载药纳米载体经过腹腔注射途径具有淋巴靶向性作用。     

Amnion cells engineering: a new perspective in fetal membrane healing after intrauterine surgery?

In this study we aimed to set up an in vitro culture of the rabbit amnion in order to support in vivo fetal membrane healing capacity following fetoscopy. Fetal membranes were collected from a mid-gestational rabbit, and cultured on collagen support material for 14 days. 34 rabbits at 22-23 days gestational age (GA) underwent fetoscopy. The entry site was randomly allocated to 4 closure technique study groups: group I, human amnion membrane (n = 23); group II, collagen foil (n = 16); group III, collagen plug (n = 19), and group IV, collagen plug with cultured amnion cells (n = 19). In all groups membrane access sites were additionally sealed with fibrin sealant, and the myometrium was closed with sutures. Fetal survival, amnion membrane integrity, and the presence of amniotic fluid were evaluated at 30 days GA. Cultures showed good survival in the collagen support material. Increased cellularity, survival and proliferations were observed. The amnion at the access site resealed in 58-64% of cases in groups II-IV, but none of the tested techniques was significantly better than the other. Histological examination indirectly revealed the anatomic repair of the membranes, since no entrapment of the membranes could be demonstrated in the myometrial wound.     

Factors influencing choice of surgical route of repair of genitourinary fistula, and the influence of route of repair on surgical outcomes: findings from a prospective cohort study

Please cite this paper as: Frajzyngier V, Ruminjo J, Asiimwe F, Barry T, Bello A, Danladi D, Ganda S, Idris S, Inoussa M, Lynch M, Mussell F, Podder D, Barone M. Factors influencing choice of surgical route of repair of genitourinary fistula, and the influence of route of repair on surgical outcomes: findings from a prospective cohort study. BJOG 2012;119:1344-1353. Objective The abdominal route of genitourinary fistula repair may be associated with longer term hospitalisation, hospital-associated infection and increased resource requirements. We examined: (1) the factors influencing the route of repair; (2) the influence of the route of repair on fistula closure 3?months following surgery; and (3) whether the influence of the route of repair on repair outcome varied by whether or not women met the published indications for abdominal repair. Design Prospective cohort study. Setting Eleven health facilities in sub-Saharan Africa and Asia. Population The 1274 women with genitourinary fistula presenting for surgical repair services. Methods Risk ratios (RRs) and 95% confidence intervals (95% CIs) were generated using log-binomial and Poisson (log-link) regression. Multivariable regression and propensity score matching were employed to adjust for confounding. Main outcome measures Abdominal route of repair and fistula closure at 3?months following fistula repair surgery. Results Published indications for abdominal route of repair (extensive scarring or tissue loss, genital infibulation, ureteric involvement, trigonal, supratrigonal, vesico-uterine or intracervical location or other abdominal pathology) predicted the abdominal route [adjusted risk ratio (ARR), 15.56; 95% CI, 2.12-114.00]. A vaginal route of repair was associated with increased risk of failed closure (ARR, 1.41; 95% CI, 1.05-1.88); stratified analyses suggested elevated risk among women meeting indications for the abdominal route. Conclusions Additional studies powered to test effect modification hypotheses are warranted to confirm whether the abdominal route of repair is beneficial for certain women.