11例直肠内脱重伴盆底疝的外科治疗

目的 探讨出口梗阻性便秘常见病因之直肠内脱重伴盆底疝的手术治疗效果。方法 搜集我近年手术治疗的１１例直肠内脱垂伴盆底疝患者的临床资料,分析其病例特点、手术方式及疗效。结果 １１例患者９例（占８２％）术后１周症状立即缓解,２例经术后配合功能锻炼３个月后症状变缓解消失。结论 功能性直肠悬吊术附加盆底疝修术,盆底抬高,子宫固定,乙状结肠（部分）切除术是治疗直肠内脱垂伴盆底疝的有效方法。     

11例直肠内脱垂伴盆底疝外科治疗分析

目的：探讨出口梗阻性便秘常见病因之直肠内脱垂伴盆底疝的手术治疗效果。方法：搜集我院近年手术治疗的11例直肠内脱垂伴盆底疝患者的临床资料,分析春病例特点,手术方式及疗效。结果：11例患者中9例（占82％）,术后1周,症状立即缓解,2例经术后配合功能锻炼3个月症亦缓解消失,结论：功能性直肠悬吊术,附加盆疝修补术,盆底抬高,子宫固定,乙状结肠（部分）切除术是治疗直肠内脱垂伴盆底疝的有效方法。     

直肠内套叠43例手术治疗分析

报告43例手术的直肠内套叠。提出排粪造影结合盆腔造影可将直肠内套叠分为无盆底变化的直肠粘膜内套叠和有盆底腹膜过度降低或伴有盆底疝的直肠全层内套叠。 根据38例经腹手术发现患者都有盆底Douglas陷窝过度下降,直肠和乙状结肠的松弛下移,甚至有的腹腔静脉分叉下移的现象,女性患者则全有子宫内脱垂并后倒,提示有腹腔内脏下垂或下移。治疗上应恢复直肠运动功能的功能性直肠悬吊术和盆底相对抬高,不主张对盆底作过多的分离,对下垂的过长的乙状结肠主张切除,下垂和后倒的子宫亦应作相对的捉高与固定。伴有的直肠前膨出应经阴道修补。矫往过正的直肠悬吊与盆底抬高不适合此类病人。由于长期过度用力排便所造成的盆膈肌下降松弛,不宜用手术矫正,应手术前后长期的加强提肌锻炼使之恢复。改变用力摒便的习惯和多进粗纤食物与油类的方法来恢复结肠的运动等,使患者排便规律恢复。     

直肠内脱垂合并盆底疝的影像学诊断

目的评价盆腔造影结合排粪造影对直肠内脱垂合并盆底疝的诊断价值。方法回顾性分析120例直肠内脱垂合并盆底疝患者的影像学表现,观察直肠型盆底疝和不含直肠型盆底疝的其他类型疝合并直肠内脱垂的类型。结果盆腔造影结合排粪造影片上,120例盆底疝有直肠型56例、间隔型27例、阴道型12例和混合型25例,而混合型中有18例直肠型盆底疝。分组结果显示,74例直肠型盆底疝均合并全层直肠套叠,盆底疝疝囊位于套叠的直肠壁环形浆膜囊袋内;46例不含直肠型盆底疝的其他类型疝均不合并全层直肠套叠。结论盆腔造影结合排粪造影能准确诊断各型盆底疝,由于直肠型盆底疝与全层直肠套叠合并出现,因此,盆腔造影结合排粪造影也能准确区分全层直肠套叠与直肠黏膜脱垂。     

手术治疗重度直肠脱垂伴有盆底疝7例

完全性直肠脱垂严重影响患者的生活质量,唯一治疗的方法是外科手术。我院采用直肠周围消痔灵注射疗法,效果显著。但仍有部分病例先后复发,结合检查发现多数伴有盆底疝。2010年7月—2013年4月,我们采用经腹补片修补结合直肠悬吊固定治疗7例消痔灵注射后复发者,收到满意的效果。     

应用脱细胞生物材料治疗消化道腹壁瘘1例

消化道腹壁外瘘是外科手术后远期的一个严重的并发症。其中消化道重建后的吻合口瘘占消化道腹壁瘘的40%～50%[1]。目前,大部分病人可以通过充分引流、控制感染、营养支持后等待自愈,而不是等待确定性手术[1-2]。我院2008年1月1例胃体癌行近端胃切除、远端胃和食管行端侧吻合,术后吻合口瘘并形成消化道腹壁外瘘,应用脱细胞生物材料(acellular tissue matrix,ACTM)治疗成功。报告如下。     

粘膜套扎术治疗直肠粘膜内套叠260例分析

直肠粘膜内套叠是以便秘为主要症状的功能性出口梗阻综合征之一,是常见的便秘原因。虽有许多治疗手段,但至今尚无一完全根治方法。我院自1989～1995年对260例直肠粘膜内套叠患者施行粘膜套扎木,经长期随访和排粪造影观察,疗效显著,现报告     

粘膜套扎术治疗直肠粘膜内套叠260例分析

直肠粘膜内套叠是以便秘为主要症状的功能性出口梗阻综合症之一，是常见的便秘原因，约占结直肠疾病的５％［１］。虽有许多治疗手段，但至今尚无一完全根治方法［２］。我院１９８９～１９９５年对２６０例直肠粘膜内套叠患者施行粘膜套扎术，经长期随访和排粪造影观察，...     

脱细胞异体生物材料治疗男性小儿后天性肛瘘32例体会

目的探讨脱细胞异体生物材料治疗男性小儿后天性肛瘘的临床疗效。方法对我院2008年6月至2009年12月采用脱细胞异体真皮基质治疗男性小儿肛瘘32例进行回顾性分析。结果成功率100%,内口愈合,无感染,无大便失禁,无复发。结论该方法治疗小儿肛瘘安全、成功率高、创伤小、患者痛苦少、复发率低,值得临床推广应用。     

三联术治疗直肠前突合并直肠黏膜内套叠所致便秘:附42例 报告

目的:探讨三联术治疗直肠前突合并直肠黏膜内套叠所致便秘的疗效。方法:回顾性分析采用肛门后方切开加痔上直肠粘膜环形切除钉合术、直肠前壁直肠黏膜纵形柱状缝扎术治疗直肠前突合并直肠黏膜内套叠所致便秘患者42例的临床资料。结果:本组总有效率为97.6%,无效率为2.4%。随访1~4年有2例复发,复发率为4.9%。结论:直肠前突合并直肠黏膜内套叠所致便秘必须经过严格的非手术治疗确认无效后，方可考虑外科治疗，严格掌握手术适应证。本术式具有手术疗效好、方法简便、后遗症少、复发率低等优点。     

脱细胞真皮基质医用组织补片在隆乳术中的应用

目的:探索脱细胞真皮基质医用组织补片在隆乳术中的应用效果,并进行初步评价,应用脱细胞真皮基质医用组织补片进行胸大肌延长加宽隆乳术,并随访3～12个月。结果:本组129例就医者,除一例就医者因发热、出血、引流血性液体较多,取出隆乳假体及组织补片,其余就医者手术后没有排异反应,术后乳房手感好,无纤维包膜挛缩病例,效果满意。结论:该材料具有良好的组织相容性和生物力学性能,作胸大肌延长加宽无感染、无不良主诉及体症,对胸大肌的减张作用明显达到丰乳后的动感效果。     

Use of porcine acellular dermal matrix as a dermal substitute in rats

OBJECTIVE: To examine porcine acellular dermal matrix (ADM) as a xenogenic dermal substitute in a rat model. SUMMARY BACKGROUND DATA: Acellular dermal matrix has been used in the treatment of full-thickness skin injuries as an allogenic dermal substitute providing a stable wound base in human and animal studies. METHODS: Xenogenic and allogenic ADMs were produced by treating porcine or rat skin with Dispase and Triton X-100. Full-thickness skin defects (225 mm2) were created on the dorsum of rats (n = 29), porcine or rat ADMs were implanted in them, and these were overlain with ultrathin split-thickness skin grafts (STSGs). In two adjacent wounds, 0.005- or 0.017-inch-thick autografts were implanted. In other experiments, the antimicrobial agent used during ADM processing (azide or a mixture of antibiotics) and the orientation of the implanted ADM (papillary or reticular side of ADM facing the STSG) were studied. Grafts were evaluated grossly and histologically for 30 days after surgery. RESULTS: Significant wound contraction was seen at 14, 20, and 30 days after surgery in wounds receiving xenogenic ADM, allogenic ADM, and thin STSGs. Contraction of wounds containing xenogenic ADM was significantly greater than that of wounds containing allogenic ADM at 30 days after surgery. Graft take was poor in wounds containing xenogenic ADM and moderately good in those containing allogenic ADM. Wound healing was not significantly affected by the antimicrobial agent used during ADM preparation or by the ADM orientation. CONCLUSION: Dispase-Triton-treated allogenic ADM was useful as a dermal substitute in full-thickness skin defects, but healing with xenogenic ADM was poor.     

Use of acellular dermal regeneration template in a complete finger degloving injury: case report

Finger degloving injury remains one of the most difficult challenges in hand reconstructive surgery. We report the use of an acellular dermal regeneration template to create a neodermis, followed by a secondary, full-thickness skin graft on a complete finger degloving injury, achieving a satisfactory recovery of range of motion and a cosmetically acceptable result.     

Ventral hernia repair using allogenic acellular dermal matrix in a swine model

Background This study was designed to assess the long-term efficacy of allogenic acellular dermal matrix (ADM) used as an interpositional graft for ventral hernia repair in a swine model.Methods We created 12×4-cm full-thickness abdominal wall defects in 22 Yucatan miniature pigs. The defect was repaired with either two 6×4-cm pieces of AlloDerm (acellular dermal matrix processed from pig skin in order to avoid a xenogenic response, LifeCell Corporation, Branchburg, NJ USA) (n=12), or expanded polytetrafluoroethylene mesh (ePTFE) (Gore-Tex, W.L. Gore & Associates, Inc., Newark, DE USA) (n=10). In six pigs, a separate 3-cm fascial incision was made, which was then suture repaired as a control for tensiometry testing. The surgical sites were evaluated at either 3 months or 9 months for the presence of a hernia, stretching of the implant, adhesions, vascularity, and biomechanical strength.Results Two hernias occurred in both the ADM and the ePTFE groups. There was minimal stretching of the implants and minimal adhesions in both groups. Fluorescein testing and histology indicated vascular ingrowth into the ADM. There was no statistical difference between the mean breaking strengths of the ADM-fascial interface (106.5 N±SD 40.1), the interface between two pieces of ADM (149.1 N±SD 76.7), and the primary fascial repair (108.1 N±SD 20.9) at 9 months. The ADM-fascial interface had a significantly higher breaking strength than that of the ePTFE-fascia interface (66.1 N±SD 30.1) (P=0.017, t-test, P=0.043 Wilcoxon rank sum test).Conclusions In this study, we were unable to demonstrate a difference between ADM and ePTFE in their ability to repair ventral hernias at 9 months in a swine model. The ADM additionally supports vascular ingrowth and exhibits increased breaking strength at the fascia-implant interface.This paper won the Fruchaud prize for best poster presentation at the American Hernia Society meeting in Orlando, Fla., USA, on February 27, 2004.This study was funded in part by an unrestricted donation to the University of Maryland Division of Plastic Surgery research fund from LifeCell Corporation. Dr. Ronald P. Silverman also has received honoraria from LifeCell Corporation as a speaker.     

应用脱细胞真皮基质材料修补复杂腹壁切口疝

目的 探讨脱细胞真皮基质材料对复杂的腹壁切口疝的修复治疗效果.方法 回顾性分析2008年1月至2010年6月间使用脱细胞真皮基质(acellular dermal matrix,ADM)材料修补的7例复杂的腹壁切口疝的治疗方法.其中男4例,女3例,年龄43～83岁,中位年龄53岁;7例中有2例伴有腹股沟斜疝,给予同时修补;5例同时进行了胃肠道手术,其中有2例伴有小肠瘘;疝环直径为9.2 ～16.5 cm,平均(11.6±2.8)cm;5例使用腹腔内修补(intraperitoneal onlay mesh,IPOM),2例为腹膜外修补(total extraperitoneal prothesis,TEP).结果 本组患者均手术顺利,放置ADM补片至关腹结束的平均手术时间(33±12) min;术中平均出血量(16±4) ml;住院时间7～12d.所有使用ADM的患者均痊愈出院,术后未发现有慢性疼痛、感觉异常、肺炎、尿路感染等并发症,手术切口无红肿、溃破、无血清肿.7例均获随访,随访时间5 ～26个月,中位随访时间为14个月,随访期间未发现浅部感染或深部感染,无疝复发.结论 脱细胞真皮基质材料作为一种新的生物补片,适用于复杂腹壁切口疝,尤其是伴有污染的腹壁切口疝的修补.     

脱细胞异体真皮基质在结膜囊成形术中的应用

目的：探讨同种异体脱细胞真皮基质（acellular dermal matrix，ADM）组织补片在结膜囊成形术中的临床应用效果。方法：对26例羟基磷灰石（hydroxyapatite，HA）义眼台植入术后结膜囊狭窄的患者进行结膜囊成形术。随访观察6—18月，平均11月。结果：26例均获得满意效果。半年后组织补片呈正常结膜色泽外观，且稳定。无感染、坏死及排异等发生。配戴义眼片后患眼外形满意。结论：采用ADM组织补片进行结膜囊成形术，取材方便、手术安全、疗效可靠。     

Paraduodenal hernia complicated with intussusception: case report

Background

The diagnosis of paraduodenal hernia is still a challenge in clinical practice due to lacking of specific symptoms. Case presentation: An 83-yr-old male patient presented to our department due to severe abdominal pain for 8?h. Abdominal contrast enhanced computerized tomography (CT) scan indicated intussusception in the duodenum and the upper segment of jejunum, as well as internal hernia. He complaint of progression in the abdominal pain, and then laparoscope was carried out, which indicated left-sided paraduodenal hernia. Subsequently, the patient was transferred to celiotomy, during which slight ischemic changes were noticed in the intestinal canal. Meanwhile, a hernial orifice was noticed in the left orifice of the duodenum. Conclusions: In this case, we presented our experiences on the diagnosis of paraduodenal hernia and intussusception. Our study contributed to the understanding, early diagnosis and selection of surgical options for the surgeons.