Sonographically guided excisional biopsy of small abdominal wall masses using vacuum-assisted biopsy device

We report the case of a 37-year-old man who underwent excision of small benign abdominal wall masses using a vacuum-assisted biopsy device designed for breast biopsy (Mammotome). To our knowledge, this is the first application of such a device to remove a soft tissue mass other than a breast lesion.     

Unusual sonographic appearance of synovial sarcoma of the anterior abdominal wall

We report a case of synovial sarcoma in a 58‐year‐old woman arising from the anterior abdominal wall. Sonography demonstrated a large mass with an unusual complex “honeycomb” echotexture. Doppler imaging displayed increased vascularity in the solid parts of the tumor. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2009     

Traumatic hernia of the anterior abdominal wall

Despite an increase in incidence of blunt abdominal trauma and despite the variations in compressive forces that occur, very few cases of traumatic hernia of the anterior abdominal wall have been recorded. Two recently treated cases of traumatic disruption of the musculature and fascia of the anterior abdominal wall with herniation of intestine into the subcutaneous space are herein reported. The occurrence of blunt abdominal trauma associated with an extra-abdominal mass believed to contain intestine signifies a severe compressive force and probable extensive associated injury. It represents an acute emergency and requires prompt resuscitative measures and surgical intervention.     

腹腔镜治疗闭合性腹部外伤的应用

目的探讨腹腔镜用于闭合性腹部外伤的优势和价值。方法回顾性分析2011年4月至2013年12月行腹腔镜探查及治疗的60例闭合性腹部外伤患者的临床资料。结果 60例患者均获得确诊。其中8例中转开腹手术,8例在腹腔镜辅助下取小切口完成手术,余44例均于镜下完成治疗,无手术死亡病例及切口相关并发症发生。结论腹腔镜手术对闭合性腹部外伤不仅可明确诊断,并同时能够及时指导治疗,提高了确诊率,降低了阴性剖腹探查率,具有安全性、准确性高、并发症少、手术病死率低等优点,值得推广应用。     

Bladder wall thickness on ultrasonographic cystourethrography: affecting factors and their implications.

OBJECTIVE: To explore factors affecting bladder wall thickness on ultrasonographic cystourethrography in female patients with lower urinary tract symptoms. METHODS: The records of 492 female patients with lower urinary tract symptoms who had undergone a urodynamic study and ultrasonography of the lower urinary tract and who had normal urinalysis findings, negative urine culture results, or both were identified from our urogynecologic database. These included 248 patients with urodynamic stress incontinence, 38 with detrusor overactivity, 39 with mixed incontinence, 35 with a hypersensitive bladder, 42 with voiding difficulty, and 90 with normal urodynamic findings. RESULTS: Age, resting bladder neck angle, urethral mobility, and maximum urethral closure pressure were significantly associated with bladder wall thickness at the trigone and dome. Bladder wall thickness at the trigone was correlated with that at the dome (P < .0001). Bladder wall thickness at the trigone was positively correlated with pressure transmission ratios in the first and second quarters of the urethra (P < .0001; P = .002, respectively), whereas that at the dome was positively correlated with intravesical pressure at maximum flow and with detrusor opening pressure (P = .027; P = .046, respectively). Age and intravesical pressure at maximum flow were independently associated with bladder wall thickness at the trigone and dome (P = .007; P = .028), respectively. A thickened bladder wall was a common finding in female lower urinary tract symptoms, except in the patients with a hypersensitive bladder. CONCLUSIONS: Demographic, anatomic, and urodynamic factors may affect the bladder wall thickness at the trigone, dome, or both.     

腹腔镜与开腹手术治疗成人腹壁疝临床疗效及对白细胞介素-6和C反应蛋白水平影响的研究

目的比较腹腔镜与开腹手术治疗成人腹壁疝临床疗效及预后情况。方法选取2011年1月-2014年4月于该院接受手术治疗的129例成人腹壁疝患者作为研究对象,回顾性分析其临床资料,按照手术方式分为对照组62例和观察组67例。对照组患者行开腹疝修补术,观察组患者行腹腔镜疝修补术。比较对照组和观察组患者手术情况、术后并发症、炎性因子水平及复发率。结果所有患者均手术成功,与对照组相比,观察组患者术中出血量减少[(21.60±5.80)vs(61.60±10.30)ml]、术后疼痛时间、下床活动时间及住院时间缩短[(30.60±6.30)vs(45.20±7.40)h,(14.70±2.50)vs(20.80±4.60)h,(5.30±0.90)vs(8.70±1.30)d],组间比较差异均有统计学意义(均P0.05),而手术时间两组间比较差异无统计学意义[(75.50±11.60)vs(79.70±16.40)min,P0.05)]。术后观察组患者并发症总发生率低于对照组(14.9%vs 33.9%,P0.05)。术后24和48 h,观察组患者血清白细胞介素-6(IL-6)、C反应蛋白(CRP)等炎性因子水平较对照组降低,组间比较差异均有统计学意义(均P0.05)。随访2年,两组患者腹壁疝复发率差异无统计学意义(1.5%vs 6.5%,P0.05)。结论腹腔镜和开腹疝修补术均是成人腹壁疝的有效手术方式,但腹腔镜疝修补术创伤小,在降低术后并发症发生率、减轻手术带来的炎症损伤方面具有更明显的优势,临床上值得应用。     

腹部手术患者围手术期的呼吸道护理

目的加强患者围手术期的呼吸道护理,减少肺部术后并发症的发生。方法 217例腹部手术患者术前针对不利因素主动采取措施、做好宣教,术后加强呼吸道护理。结果 183例患者无肺部并发症,28例轻度肺部感染,6例肺不张,经及时处理后治愈。结论腹部手术因麻醉、手术、腹胀及胃管的刺激影响患者排痰,易发生肺部感染,需加强呼吸道管理。     

手助腹腔镜与开腹、腹腔镜辅助远端胃癌根治术的临床对比研究

目的探讨手助腹腔镜在进展期远端胃癌根治术中的应用价值。 方法回顾性分析河北医科大学第二医院2015年8月至2017年12月间80例进展期胃下部癌的临床资料,其中30例行手助腹腔镜手术,25例行开腹手术,25例行腹腔镜辅助手术。采用单因素方差分析比较3组之间手术时间、出血量、清扫淋巴结数目、术后排气时间、术后近期并发症、住院时间及住院费用、切口长度等指标的差异,组间的两两比较采用单因素方差分析中的Bonferroni方法。采用χ²检验或Fisher确切概率法比较3组间性别、病理类型、腹主动脉旁有肿大淋巴结、腹部手术史及术后并发症的差异。 结果3种手术方式在术中淋巴结清扫数、术后住院费用及术后并发症方面比较,差异均无统计学意义（P>0.05）;手助腹腔镜手术组、腹腔镜辅助手术组和开腹手术组3种手术方式在手术时间［（186.30±15.27）min vs （230.80±17.06）min vs （183.36±16.03）min］、术中出血量［（93.33±46.86）ml vs（98.80±55.10）ml vs （246.80±92.90）ml］、术后排气时间［（2.3±0.6）d vs （2.42±0.44）d vs（3.04±0.56）d］、住院时间［（8.90±1.19）d vs （9.40±1.44）d vs（10.92±1.73）d］及切口长度［（7.97±0.49）cm vs （8.04±0.61）cm vs （24.04±2.11）cm］方面比较,差异均具有统计学意义（F=70.055,43.937,20.162,13.892,1385.430,P均<0.001）。手助腹腔镜手术组和腹腔镜辅助手术组切口长度、术中出血量、术后排气时间及住院时间方面<开腹手术组,差异具有统计学意义（P均<0.001）。手助腹腔镜手术组和开腹手术组在手术时间方面较腹腔镜辅助手术组更短,且差异具有统计学意义（P均<0.001）。 结论手助腹腔镜进展期远端胃癌根治术安全可行,其在肿瘤切除及淋巴结清扫上可达到与开腹手术相当的效果,并且不增加患者经济负担。手助腹腔镜手术保留了腹腔镜辅助手术的术中出血少、术后恢复快的优点,且手术时间短。     

Sonography in identification of abdominal wall lesions presenting as palpable masses.

OBJECTIVE: Abdominal wall lesions often present as palpable masses. The purpose of this presentation is to provide an overview of the sonographic appearances of different abdominal wall lesions. METHODS: Patients were scanned with high-frequency (5- to 12-MHz) linear transducers. Extended or panoramic views were recorded often to show the lesion in perspective to adjacent structures in the abdominal wall. RESULTS: The different layers of the abdominal wall could be clearly shown on high-frequency sonography, and the abdominal wall abnormalities were recognized in all the patients. CONCLUSIONS: Hernias are the most common abdominal wall lesions. Herniated bowel loops have variable appearances depending on their air-fluid content and degree of obstruction. Localized fluid collections in the abdominal wall (seromas, liquefying hematomas, and abscesses) can be well visualized. More infrequently, tumors or vascular lesions can be identified in the abdominal wall.     

艾灸+磁珠压耳穴对老年腹部手术患者术后尿潴留的预防效果

目的探讨艾灸+磁珠压耳穴对老年腹部手术患者术后尿潴留的预防效果。方法将60例老年腹部手术患者随机分为试验组(30例,基础治疗+艾灸+磁珠压耳穴治疗)和对照组(30例,基础治疗)。比较两组的临床疗效。结果试验组的治疗总有效率明显高于对照组(P<0.05)。治疗后,试验组各项中医证候积分均明显低于对照组(P<0.05)。术后1、3 d,试验组的VAS评分均明显低于对照组(P<0.05)。试验组自行排尿时间明显短于对照组,治疗2 h后排尿总量明显多于对照组(P<0.05)。试验组尿潴留发生率明显低于对照组(P<0.05)。结论艾灸+磁珠压耳穴可有效预防老年腹部手术患者术后尿潴留发生,缩短患者自行排尿时间,减轻疼痛感。     

A new technique of repair for small abdominal wall defects

Summary

Umbilical, epigastric and incisional hernias may cause incarceration and strangulation of the intra-abdominal organs. When ≥ 10 mm trocars are used, incisional herniation may occur if fascial sutures have not been used. We present a new instrument and a new method for the secure repair of small abdominal wall defects. The prototype has been produced by local steel workers.     

Early abdominal sonographic findings in patients with dengue fever

PURPOSE: This study was conducted to evaluate the early sonographic findings in dengue hemorrhagic fever. METHODS: From July 2002 to September 2002, 86 patients were referred to our center with suspected dengue fever during an outbreak of the disease in Taiwan. All the patients underwent immediate abdominal sonography when they arrived at our emergency room. The diagnosis of dengue fever was subsequently confirmed by serology in 65 patients. RESULTS: All our patients had type 2 dengue fever, as confirmed by serologic tests. The sonographic features included a thickened gallbladder wall in 38 patients (59%), ascites in 24 patients (37%), splenomegaly in 22 patients (34%), and pleural effusion in 21 patients (32%); pleural effusion was either right-sided or bilateral. CONCLUSIONS: Abdominal sonography can be used as a first-line imaging modality in patients with suspected dengue fever to detect early signs suggestive of the disease prior to obtaining serologic confirmation test results, especially in a dengue fever epidemic area.     

艾灸治疗腹部术后腹胀的效果观察

[目的]观察艾灸治疗腹部术后腹胀的临床疗效。[方法]将100例腹部术后腹胀病人随机分为观察组与对照组各50例,观察组予艾灸治疗,对照组予新斯的明肌肉注射。[结果]观察组病人治疗总有效率(94%)高于对照组(82%),经比较差异有统计学意义(P<0.05)。[结论]艾灸治疗腹部术后腹胀临床疗效确切,效果优于新斯的明肌肉注射。     

Abdominal wall endometrioma: An insidious cause of delayed diagnosis

An extremely rare extrapelvic position of endometriosis with a precise incidence of 0.07%–0.47%, leading usually to delayed and false diagnosis. Differential diagnosis should include that rare condition while ultrasonography remains a pivotal tool to unravel that enigma, especially in women with no specific symptoms and surgeries in the past.     

Laparoscopic decision‐making concerning the repair area for traumatic abdominal wall pseudohernia: A case report

Laparoscopic decision‐making may be useful for accurately determining the repair area when treating abdominal wall pseudohernia. A 31‐year‐old man was admitted with a pelvic ring fracture after a traffic accident and underwent orthopedic surgery. Five months after surgery, the patient developed a lower abdominal protrusion. CT revealed abdominal wall bulging and thinning of the abdominal muscle but no musculofascial defects, suggesting a pseudohernia. We reconstructed the abdominal wall and inserted a mesh. Because there was no musculofascial defect, it was difficult to discern the accurate repair area. We used laparoscopy to determine the repair area, which was recognized thanks to illumination transmitted through the abdominal wall. We were able to determine the appropriate size and placement of the mesh, which enabled us to repair the abdominal pseudohernia.     

有腹部手术史腹腔镜胆囊切除术的应用

目的总结有腹部手术史的患者行腹腔镜胆囊切除术的手术经验。方法避开原有切口选择第一戳孔，必要时采用开放法置入穿刺鞘，注重腹腔粘连区的分离技巧。结果本组34例其中32例成功完成手术，中转开腹2例，无手术并发症。结论有腹部手术史患者行腹腔镜胆囊切除术是安全可行的。     

Deperitoneum biological mesh repair for abdominal wall hernia: a novel wound healing promotion idea

Purpose: Nowadays, biological matrix has become more widely applied than synthetic mesh for the surgical management of ventral hernia. Conventionally, such biodegradable matrix is commonly placed in an intraperitoneal or extraperitoneal position to reinforce the abdominal wall during surgery. Herein, we introduce our novel idea to deliver such biological material.

Material and methods: After contrast-enhanced CT-scan via lateral decubitus confirmed the position of ventral hernias, 11 patients underwent deperitoneum biological mesh repair by open or laparoscopic approach. During surgery, biological material was placed in preperitoneal position with elimination of matrix-covered peritoneum meanwhile. No bridge repair was allowed for this technique. Postoperative complications were prospectively documented.

Results: Laparoscopic and open repair were performed in six and five patients, respectively. The mean operative time was 115?min, with no significant difference between the two procedures. All patients had quick recovery and returned to their normal life, with median five days (range, 3-12 days) of hospital stay after surgery. Although wound dehiscence and chronic pain occurred in three (27.3%) patients, no additional surgery was required. No recurrence case was observed within the one-year follow-up period.

Conclusion: This novel approach could be safely performed in ventral hernia patients. Early evaluation of this surgical technique demonstrates quick recovery and minimal complications.     

Pre‐, intra‐, and postoperative sonography of the abdominal wall in patients with incisional hernias repaired via a three‐layered operative suture method

We illustrate the various sonographic (US) appearances of the abdominal wall following this type of repair, including partial and complete recurrences. Correlation is made with CT imaging. The three‐layered anatomical reconstruction of an incisional hernia is described. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009