聚丙烯补片在腹壁切口疝修补术的应用

随着科技的发展 ,越来越多的高科技医疗器材在外科手术中得到广泛的应用 ,使原本复杂的手术变得更加简便快捷 ,且手术效果更为满意。本院自1 999年 2月至 2 0 0 2年 1 0月应用美国巴德公司生产的平片疝修补材料 (Bard补片 )修补腹壁切口疝 36例 ,效果满意 ,现报道如下。1　临床资料1 .1　一般资料　本组共 36例 ,男 1 5例、女 2 1例 ,平均年龄 5 4(30～ 72 )岁。其中胃次全切除术 4例 ,胃癌根治术 2例 ,胆囊切除术 6例 ,结肠癌根治术 5例 ,小肠梗阻肠部分切除术 8例 ,阑尾切除术 8例 ,子宫全切术 3例。上腹正中切口 1 0例 ,右中上腹直肌切…     

BardMesh Composix补片在腹腔镜与开放术式腹壁大、巨大切口疝修补术中的应用

目的探讨BardMesh Composix补片在腹腔镜与开放术式修补腹壁大、巨大切口疝修补术中的临床应用效果。方法回顾性分析汶上县人民医院2001年1月至2009年6月应用BardMesh Composix补片行开放术式腹壁大、巨大切口疝修补术者（开放手术组）59例和同期应用BardMesh Composix补片行腹腔镜腹壁大、巨大切口疝修补术者（腹腔镜组）32例的临床资料。结果2组均无复发病例。开放手术组术后发热5例（8.5%）,皮下积液4例（6.8%）,切口感染2例（3.4%）,无腹壁血肿形成。腹腔镜组术后发热3例（9.4%）,无皮下积液、切口感染及腹壁血肿形成。结论应用BardMesh Composix补片行开放术式和腹腔镜腹壁大、巨大切口疝修补术效果均良好,而且腹腔镜手术更具有创伤小、并发症少等优点。     

人工材料聚丙烯补片在修补腹壁切口疝中的应用

背景:如何修补腹壁巨大缺损是临床经常遇到的难题,曾有许多学者尝试各种材料进行修补,但临床效果不是很满意.目的:检索文献综合分析人工聚丙烯补片在修补腹壁切口疝中的应用效果.方法:应用计算机检索检索Pubmed 数据库(http://www.ncbi.nlm.nih.gov/pubmed/)及万方数据库(http://www.wanfangdata.com.cn)1991-01/2009-12的相关文献,在标题和摘要中以"补片,外科手术,腹壁切口疝"或"patch,surgery,incisional hernia"为检索词进行检索.选择与人工材料聚丙烯补片在修补腹壁切口疝中的应用相关,同一领域文献则选择近期发表或发表在权威杂志文章.最终纳入符合标准的文献28篇.结果与结论:临床常需要借助合适的材料来修复巨大的腹壁缺损,以维持腹壁的肌张力和外形.聚丙烯补片具有良好的生物相容性,置入体内后不会导致创口感染、排异反应及其他并发症,具有较理想的预防游离腹直肌皮瓣术后切口疝发生的作用,同时也增强了腹壁强度.临床研究表明其组织相容性良好,无排异反应,具有一定抗感染能力,是理想的疝修补材料.提示应用人工合成材料进行疝修补,操作简便、损伤小、恢复快、复发率低,并发症少.但提高修补技术,选择并研制抗张力强度大、炎症反应轻、顺应性高的补片仍是该领域研究的重点.     

Composix—Kugel复合补片修补巨大腹壁切口疝的临床分析

腹壁切口疝是腹部手术后的常见并发症之一,其发生率约为2％～11％,手术是其唯一的治疗方法。切口疝单纯缝合修补术后复发率达到25％～55％。因此目前直接缝合修补仅适用于缺损直径〈3cm的小型切口疝,或者缺损直径〈5cm但直接缝合张力不高的病例,对巨大的腹壁切口疝多应用人工补片进行无张力修补。本次研究对18例巨大腹壁切口疝患者应用Composix—Kugel复合补片进行腹腔内补片置入修补,效果满意。现报道如下。     

补片修补切口疝23例分析

目的：探讨补片修补腹壁切口疝的方法及疗效。方法：采用聚丙烯或聚丙烯与聚四氟乙烯双面材料网片修补腹壁切口疝23例，网片采用双圈间断缝合固定术式，外圈网片固定部位距缺损边缘4cm以上。结果：术后23例患者随访4～36个月无1例复发。结论：补片修补切口疝安全，可靠，复发率低。     

老年腹壁巨大切口疝腹腔镜腹腔内补片修补术的并发症护理

总结5例老年腹壁巨大切口疝采用腹腔镜腹腔内补片修补术的并发症护理。术后并发症主要为呼吸衰竭、急性心力衰竭、修补区疼痛、肠梗阻,按医嘱对并发症进行药物治疗,并予针对性护理。经治疗和护理,5例患者症状均缓解,术后住院5～10d出院。     

腹腔镜切口疝修补术治疗老年腹壁切口疝患者的疗效及安全性分析

目的:分析腹腔镜切口疝修补术治疗老年腹壁切口疝患者的疗效及安全性。方法:选取2018年5月~2019年5月收治的72例老年腹壁切口疝患者作为研究对象,根据手术方案的不同分为开腹组和腹腔镜组,各36例。开腹组行开腹手术,腹腔镜组行腹腔镜切口疝修补术。比较两组围手术期基本情况、术后恢复情况和并发症发生率。结果:腹腔镜组手术用时、术后首次下床活动时间、术后肠鸣音恢复时间、术后初次进食时间、术后伤口愈合时间及住院天数均较开腹组短,术后72 h疼痛评分较开腹组低,术中失血量较开腹组少,差异均有统计学意义(P<0.05);腹腔镜组并发症发生率(5.56%)低于开腹组(25.00%),差异有统计学意义(P<0.05)。结论:腹腔镜切口疝修补术应用于老年腹壁切口疝患者,能显著缩短手术用时,减少术中失血量,降低并发症发生率,加快术后康复进程,且安全性高。     

腹壁切口疝补片修补术后复发的再手术治疗分析

对2009年1月～2011年1月到我院接受腹壁切口疝补片修补术后复发再次手术的14例患者的临床资料进行回顾性分析。结果 10例患者在除去旧补片后置入了新补片进行修补,2例患者扩大范围后实施新、原补片重叠修补,2例患者直接在原补片上进行新补片重叠性的修补。术后患者治疗情况良好,2例发生补片上方积液,但经穿刺加压治疗后得到治愈。在腹壁切口疝补片修补术后复发性切口疝再次手术的时候需要对实际情况进行综合考虑、分析,而在再次手术的过程中需选用合理的修补方法和合适的补片,是取得满意治疗效果的基础。     

Proposal of ecographic classification for seroma after laparoscopic ventral hernia repair

Introduction

Seroma is one of the most common complications after laparoscopic ventral hernia repair (LVHR), even if the incidence brought in literature is varying because definition and criterions of evaluation employed in the different studies are not always the same. This study proposes a classification for seroma after LVHR based on ultrasound findings, useful for an assessment of this complication.

Materials and methods

On 93 patients submitted to LVHR an ultrasound of the abdominal wall after 3, 7, 15, 21 and 28 days and subsequently at a distance of 3 and 6 months was performed postoperatively. At each control site, sonomorphology characteristics and size of seroma (if present) were noted.

Results

At the end of the study using ultrasound findings obtained, a classification scheme for seroma articulated into three groups based on the parameters detected (site, sonomorphology character and volume) was developed, each of which is subdivided into five different classes to which a precise score is assigned. From the sum of the scores assigned, a value (between 3 and 15) that represents a prognostic index (PI) is obtained. A low PI is typical of small asymptomatic seroma that resolves spontaneously in a short time and without the need for invasive therapies; a high PI is typical of more or less symptomatic voluminous seroma that tends to persist for long periods and which often requires an interventional therapeutic approach.

Conclusions

This proposed classification helps to perform a precise nosological assessment of seroma after LVHR, allowing the surgeon to predict the clinical and temporal evolution of this complication and to plan appropriate therapy from time to time. Furthermore this classification can represent a tool to assess the uniqueness of seroma formation in relation to surgical technique used, to the type of material employed and to the method of mesh fixing.     

A case of Spigelian hernia after laparoscopic incisional hernia repair

Laparoscopic ventral hernia repair with intraperitoneal onlay mesh reinforcement is often performed in clinical practice. We herein describe a patient who developed a Spigelian hernia at the edge of the mesh due to rupture of the muscular layer in the abdominal wall. A 69-year-old woman developed a left-sided abdominal bulge 15 months after laparoscopic ventral hernia repair. CT showed a 33-mm defect in the abdominal wall at the lateral edge of the left abdominal rectus muscle with an intestinal prolapse through the defect. She was diagnosed with a Spigelian hernia and underwent operation. The hernia orifice was located at the aponeurosis of the transverse abdominal muscle where the thread had been used to fix the mesh through all layers of the abdominal wall. This report details a case of a Spigelian hernia after laparoscopic ventral hernia repair.     

疝环充填式无张力疝修补术治疗腹股沟疝

目的探讨聚丙烯网塞及补片在腹股沟疝修补术中的优点,以及在基层医院推广的可行性。方法采用美国巴德公司的聚丙烯锥形充填物及成型补片对40例腹股沟疝患者施行疝环充填式无张力疝修补术,观察手术时间、切口疼痛、术后自主能力的恢复、并发症及复发率：结果手术时间平均46min;术后6h后患者能下床活动;伤口疼痛时间2～3d;术后出现排尿困难1例;无复发病例。结论锥形充填物及成型补片组织兼容性好,无排异反应,有一定的抗感染能力,是理想的疝修补材料;疝环充填式无张力修补术手术操作简便,损伤小．恢复快,并发症少,复发率低,适合在基层医院推广;材料价格过高是阻碍其在基层推广的主要因素。     

腹腔镜腹股沟疝修补术与应用UHS无张力疝修补术的对比研究

目的研究比较腹腔镜腹股沟疝修补术与应用轻量型超普疝装置(UHS)补片无张力疝修补术的临床效果。方法回顾性分析2009年3月至2011年1月年腹腔镜腹股沟疝修补术87例,应用轻量型UHS补片无张力疝修补术53例的临床资料,分析比较手术时间、住院天数、并发症发生率、恢复正常生活和工作时间、术后短期复发率等指标。结果手术时间、术后住院天数、并发症发生率、恢复正常生活和工作时间、术后短期复发率等指标两组相比差异无统计学意义。结论腹腔镜腹股沟疝修补术与应用UHS补片无张力疝修补术两种无张力修补方法治疗腹股沟疝均可取得满意疗效。     

Mesh repair of sacrococcygeal hernia via a combined laparoscopic and sacrococcygeal approach: A case report

BACKGROUND Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a patient who had no history of sacrococcygeal operation, present the operative procedures of mesh repair via a combined laparoscopic and sacrococcygeal approach that has not been described,and discuss our experience in diagnosis and treatment with a review of the literature.CASE SUMMARY A 54-year-old woman who chiefly complained of a 10-year history of a reversible bulge in her right sacrococcygeal region was admitted to our hospital. The physical examination revealed a bulge in the right sacrococcygeal region upon standing, which disappeared in the prone position but relapsed when performing the Valsalva manoeuvre. Computed tomography displayed an abnormality in the structure of the tissues between the midline of the sacrococcygeal region and the right gluteus muscle. The patient was diagnosed with sacrococcygeal hernia and received hernia repair with mesh through a combined laparoscopic and sacrococcygeal approach. On laparoscopy, the rectum was dissected posterolaterally, and a defect was identified in the right anterior sacrococcygeal region through which part of the rectum protruded. This was followed by the placement of a self-gripping polyester mesh via a sacrococcygeal approach. There were no postoperative complications. The patient was discharged on postoperative day 7 and was followed for more than 6 mo with no recurrence.CONCLUSION Laparoscopic mesh repair is recommended as a priority of surgical options for sacrococcygeal hernias, while choosing a self-gripping mesh can help avoid the risk of presacral vessel injury by reducing suture fixation.