皮瓣重建兔阴囊诱导精原细胞凋亡与热休克蛋白70表达

目的:探讨皮瓣重建阴囊后睾丸表面的温度变化、生精细胞凋亡及热休克蛋白70(HSP70)的表达。方法:以健康育龄期新西兰大白兔为实验动物,雄性24只、雌性12只。将雄兔随机分成实验组12只,对照组12只。采用温度计埋藏法测量实验组阴囊内睾丸表面的温度,手术切除实验组动物阴囊,建立皮瓣重建阴囊动物模型,对照组未作处理。动物模型建立后第8周末对照组随机取6只动物进行睾丸活检,实验组随机取6只动物测量睾丸表面温度后行睾丸活检。睾丸组织行HE染色、原位末端标记(TUNEL)法检测生精细胞凋亡、免疫组化法结合图象分析仪检测睾丸生精细胞HSP70的表达。模型建立后第8周末,将两组未行睾丸活检的各6只动物分别与雌兔配对喂养观察生育情况。结果:实验组模型建立前睾丸表面温度为(36.0±0.3)℃,模型建立后第8周末睾丸表面温度为(38.1±0.6)℃(P<0.05)。模型建立后第8周末实验组睾丸生精小管中生精细胞的凋亡指数(AI)为(71.85±2.69)%,对照组为(7.73±4.95)%(P<0.05)。对照组HSP70主要在圆形精子细胞中表达,实验组主要表达在精原细胞。配对喂养结果显示,实验组没有生育,对照组生育幼兔(6.0±1.3)只(P<0.05)。结论:皮瓣重建家兔阴囊后睾丸局部温度升高诱导生精细胞凋亡增加,动物丧失生育能力。HSP70参与保护皮瓣重建阴囊诱导的精原细胞凋亡。     

营养性肥胖对青春期雄性大鼠睾丸生精细胞凋亡的影响

目的:探讨营养性肥胖对青春期雄性大鼠睾丸生精细胞凋亡的影响。方法:健康雄性W istar大鼠40只,随机分为两组,每组20只,对照组给予普通饲料喂养,高脂组用高脂、高热量饲料喂养建立营养性肥胖大鼠模型,10周末处死大鼠摘取睾丸。全自动生化分析仪(ACA)检测外周血总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C);光镜观察睾丸组织病理学改变;TUNEL检测睾丸组织凋亡细胞;免疫组化法检测Bc l-2和Bax蛋白的分布和表达;RT-PCR法检测睾丸组织Bc l-2 mRNA和Bax mRNA的表达。结果:高脂组TC、TG、HDL-C和LDL-C(5.17±0.17、1.18±0.09、1.76±0.11、5.08±0.18)较对照组(1.38±0.12、0.39±0.05、0.97±0.07、0.75±0.06)显著升高(P<0.05);高脂组生精细胞凋亡指数(37.17±2.74)较对照组(5.16±0.81)显著升高(P<0.01),凋亡细胞以精原细胞和精母细胞为主;高脂组Bax蛋白和Bax mRNA(153.26±8.74、1.08±0.12)表达较对照组(101.81±6.14、0.37±0.04)明显升高(P<0.01);高脂组Bc l-2蛋白和Bc l-2 mRNA(139.26±7.21、0.46±0.05)表达较对照组(159.37±8.96、1.05±0.11)明显降低(P<0.01)。结论:营养性肥胖诱导大鼠睾丸生精细胞凋亡增多,其机制可能与Bc l-2表达降低和Bax表达升高相关。     

单侧隐睾大鼠对侧睾丸的损害与Bcl-2和Bax基因表达

目的:探讨单侧隐睾大鼠对侧睾丸生精细胞凋亡与Bcl-2/Bax基因表达的关系。方法:20只健康SD雄性大鼠(22日龄)随机分成隐睾组和对照组,每组10只。通过手术建立单侧隐睾动物模型。术后90 d取对侧睾丸,采用原位缺口末端标记(TUNEL)法检测生精细胞凋亡,免疫组化SP法检测Bcl-2/Bax基因表达。结果:与对照组相比,隐睾组对侧睾丸生精细胞凋亡显著增多(P<0.01),重量显著减轻(P<0.01),Bax表达显著升高(P<0.01),Bcl-2表达显著降低(P<0.01)。凋亡细胞主要是初级精母细胞和圆形精子细胞。结论:单侧隐睾大鼠对侧睾丸的生精细胞凋亡增多与Bcl-2基因表达降低、Bax基因表达升高密切相关。细胞内Bc l-2/Bax比值是影响生精细胞凋亡的重要因素之一。     

己烯雌酚摄入对大鼠生精细胞凋亡及Bax和Bcl-2蛋白表达的影响

目的研究青春期己烯雌酚(diethylstilbestrol,DES)摄入对SD(Sprague-Dawley)大鼠性成熟后睾丸生精细胞凋亡的影响,并初步探讨其机制。方法30只35d龄雄性SD大鼠,随机分为DES 0.01、0.1、1.0、10.0μg/kg·d~(-1)4个实验组和1个对照组(编码为BDa、BDb、BDc、BDd和BC组,每组n=6)。于青春期[出生后第36天(postnatal day 36,PND 36)至49d(PND 49)],实验组每日皮下注射相应剂量的DES,对照组仅注射溶媒。于大鼠性成熟后(PND 64)处死各组大鼠切取双侧睾丸,采用TUNEL法检测大鼠睾丸生精细胞凋亡,用免疫组化方法检测凋亡相关蛋白Bcl-2和Bax在生精细胞中的表达。结果与对照组相比,BDa组大鼠性成熟后生精细胞凋亡无明显变化,BDb、BDc和BDd 3组生精细胞凋亡增加,且随DES摄入剂量增加而有增加趋势。BC、BDa组生精细胞Bax相对弱表达而Bcl-2强表达,伴随DES摄入剂量增加,Bax表达逐渐增强而Bcl-2表达逐渐减弱,BDd组Bax强表达而Bcl-2弱表达。结论青春期较大剂量DES摄入可使大鼠性成熟后睾丸生精细胞凋亡增加,且随DES摄入剂量增加而有加强趋势。凋亡相关蛋白Bax和Bcl-2参与青春期DES摄入所致的生精细胞凋亡过程。     

低氧对大鼠睾丸生殖细胞凋亡的影响

目的:研究低氧对大鼠睾丸生殖细胞凋亡和Bax、Bcl-2表达的影响。方法:雄性成年Wistar大鼠随机分为4组:常氧对照组、低氧5 d组、低氧15 d组和低氧30 d组(各组n=6)。常氧对照组在平原喂养;低氧5 d组、15 d组和30 d组分别在低压舱内模拟5 000 m高原喂养5、15、30 d。采用流式细胞术和TUNEL法检测低氧对睾丸生殖细胞凋亡的影响。运用Western印迹技术检测低氧对大鼠睾丸内凋亡相关蛋白Bax、Bcl-2表达的影响。结果:低氧5 d组、15 d组和30 d组睾丸内发生生殖细胞凋亡的生精小管数量[每100个生精小管中,含有凋亡生殖细胞的生精小管数分别为(20.50±5.07)、(21.25±7.85)、(14.00±2.45)个]均非常显著地高于常氧对照组[(6.00±2.16)个,P<0.01]。凋亡的生殖细胞以精原和精母细胞为主。低氧15 d组睾丸组织亚单倍体细胞百分率[(2.18±0.82)%]显著高于常氧对照组[(1.30±0.33)%,P<0.05],低氧30 d组[(3.08±0.93)%]极显著高于常氧对照组(P<0.01)。低氧30 d组睾丸组织Bax表达显著高于常氧对照组(P<0.05),其灰度值分别为17.34±4.54和10.50±2.82。低氧30 d组睾丸组织Bax/Bcl-2比值显著高于常氧对照组(P<0.01),比值分别为0.40±0.10和0.27±0.04。结论:低氧诱导大鼠睾丸生殖细胞凋亡增多,慢性低氧引起的睾丸生殖细胞凋亡增多与Bax表达增加有关。     

铅致大鼠睾丸细胞凋亡的实验研究及临床意义

目的探讨铅致大鼠睾丸生精细胞凋亡及其机制。方法40只成年雄性Wistar大鼠随机均分为4组:对照组,低、中、高剂量实验组。实验组分别腹腔注射醋酸铅5、10、20mg/kg体重,对照组注射等体积生理盐水,3周后手术取睾丸,用原位末端脱氧核苷酸转移酶标记(Tunel法)及免疫组化技术检测睾丸组织生精细胞凋亡及凋亡相关蛋白Bcl-2、Bax的表达。结果3周后,中、高剂量组细胞凋亡及Bax基因表达较对照组差异有显著性(P<0.01),低剂量组较对照组无显著性。3个实验组的Bcl-2基因表达较对照组差异有显著性,且各组间亦有显著性(P<0.01)。结论铅负荷至一定程度时可致大鼠生精细胞凋亡,且呈一定量效关系,这种作用可能与Bcl-2基因低表达和Bax基因高表达有关。     

腹股沟区皮下埋藏睾丸对兔精子发生的影响

目的探讨采用腹股沟区皮下埋藏睾丸的方式修复阴囊皮肤缺损对睾丸精子发生的影响。方法普通级健康6～8月龄新西兰大白兔60只，雄性36只，雌性24只，体重2．5～2．7kg。将雄兔随机分为实验组及对照组，每组各18只。实验组动物将双侧睾丸分别移位埋藏至双侧腹股沟区皮下，以制备睾丸埋藏修复阴囊皮肤缺损模型；对照组未作处理。两组于造模后8周末时采集精液进行常规分析，每组随机取6只兔测量睾丸表面温度，另随机每组取6只兔的睾丸进行活检，应用TUNEL法检测生精细胞凋亡情况。同时将两组未采集活检的雄兔分别与雌兔一一配对喂养，观察生育情况。结果对照组精液密度为（237．3&#177;39．7）&#215;10^9／L，精子活动率为76．9％&#177;3．8％；实验组精液密度为（4．7&#177;2．7）&#215;10^9／L，精子活动率为0；两组比较差异有统计学意义（P〈0．05）。对照组的睾丸表面温度为（36．15&#177;0．64）℃，实验组为（38．02&#177;0．36）℃，两组比较差异有统计学意义（P〈0．05）。TUNEL检测示：实验组生精上皮变薄，仅存的精原细胞和初级精母见明显凋亡，凋亡指数（apoptotic index，AI）为89．69％&#177;3．76％；对照组可见散在精母细胞和精子细胞凋亡，AI为7．73％&#177;4．95％；两组比较差异有统计学意义（P〈0．05）。实验组配对后对应的母兔均未受孕生崽；对照组配对后对应母兔均受孕生崽，平均生崽数为6只；两组比较差异有统计学意义（P〈0．05）。结论与皮瓣重建阴囊一样，腹股沟区埋藏睾丸修复阴囊皮肤缺损将导致兔生殖功能障碍，主要因睾丸局部环境温度升高诱导生精细胞过度凋亡所致。     

全阴囊Ⅲ度烧伤不同方式重建阴囊对生精功能的晚期影响的实验研究

目的:探讨全阴囊Ⅲ度烧伤不同方式重建阴囊对睾丸生精细胞凋亡及bcl-2蛋白表达的影响。方法:以2月龄贵州小型猪为实验动物,雄性40只,雌性24只。雄性随机分正常对照组(Ⅰ),自然愈合组(Ⅱ),植皮组(Ⅲ),皮瓣组(Ⅳ),每组10只。建模10月末雄性对照组及实验组每组6只与同期饲养的雌猪一一配对饲养,配对3周后雌猪继续喂养4个月观察生育情况,雄猪1年末取各组双侧睾丸标本,原位末端标记法(TUNEL)检测睾丸生精细胞凋亡指数(AI),免疫组化(SABC法)检测bcl-2蛋白表达。对数据行单因素方差分析。结果:细胞凋亡结果:Ⅰ、Ⅱ、Ⅲ、Ⅳ的AI值(x±s)%分别为:7.07±3.50、40.34±4.85、15.14±1.36、39.29±5.73,Ⅰ与Ⅱ、Ⅲ、Ⅳ相比差异均有显著性(P<0.05),Ⅱ与Ⅳ相比差异无显著性(P>0.05),Ⅲ与Ⅱ、Ⅳ相比差异均有显著性(P<0.05)。bcl-2蛋白表达结果:Ⅰ、Ⅱ、Ⅲ、Ⅳ的bcl-2蛋白表达(x±s)%分别为:75.07±3.74、54.93±4.03、66.85±3.06、53.33±5.22,Ⅰ与Ⅱ、Ⅲ、Ⅳ相比差异均有显著性(P<0.05),Ⅱ与Ⅳ相比差异无显著性(P>0.05),Ⅲ与Ⅱ、Ⅳ相比差异均有显著性(P<0.05)。配对喂养结果:Ⅱ、Ⅳ组配种没有成功,Ⅰ组全部配对成功,生育幼猪(10.0±1.18)头,Ⅲ组4头配种成功,生育(9.92±1.31)头,Ⅰ组与Ⅱ、Ⅲ、Ⅳ组相比差异均有显著性(P<0.05),Ⅲ组与Ⅱ、Ⅳ组相比差异均有显著性(P<0.05),Ⅱ与Ⅳ组相比差异无显著性(P>0.05)。结论:全阴囊Ⅲ度烧伤不同方式重建阴囊1年后对生精功能均有抑制作用,导致生精细胞凋亡增加,bcl-2蛋白表达降低,其中植皮重建阴囊对睾丸生精功能影响最小,建议阴囊Ⅲ度烧伤创面采用植皮修复。     

雷公藤多甙抑制大鼠精子发生的研究

目的探讨雷公藤多甙对大鼠精子发生的抑制作用及其可能的信号通路。方法成年雄性大鼠给予雷公藤多甙(16 mg/kg)灌胃,每日1次,在2及6周检测血清睾酮(T)、卵泡刺激素(FSH)、黄体生成素(LH)和可的松水平;光镜观察睾丸组织的形态学变化;原位末端标记法(TUNEL)观察睾丸生精细胞凋亡;免疫组织化学法观察凋亡通路相关蛋白Bax/Bcl-2的表达。结果给药组与对照组相比,性激素、肾上腺皮质激素均无显著变化(P均>0.05);给药2周后精子数下降和畸形率上升(P<0.05),给药4和6周精子数下降和畸形率升高更显著(P<0.001);组织学检查给药组大鼠生精小管内各级精母细胞和精子细胞数明显减少,生精细胞排列紊乱,原始精原细胞和支持细胞(Sertoli细胞)未见明显改变。与正常对照组相比,生精小管内生精细胞凋亡显著增加(2周P<0.05,4和6周P<0.001)。凋亡相关蛋白Bax表达明显上调,Bcl-2表达无显著差异。结论雷公藤对大鼠精子发生的抑制作用表现为增加生精细胞凋亡,导致精子计数下降,精子的畸形率升高。雷公藤多甙使睾丸Bax表达增加,与诱导生精细胞凋亡相关,可能是相关的信号通路之一。进一步研究雷公藤多甙作用的分子信号机制有助于今后降低剂量、减少毒副作用,探讨其作为一种安全的男性避孕药可能性。     

青春期前己烯雌酚暴露对大鼠性成熟后生精细胞凋亡的影响及其机制初探

目的:研究青春期前己烯雌酚(d iethylstilbestrol,DES)暴露对SD大鼠性成熟后睾丸生精细胞凋亡的影响并初步探讨其机制。方法:30只21日龄雄性SD大鼠,随机分为DES 0.01、0.1、1.0、10.0μg/(kg.d)4个实验组和1个对照组(编码为ADa、ADb、AD c、ADd和AC组,每组6只)。于青春期前[出生后第22 d(postnatal day 22,PND22)至35 d(PND35)],实验组每日皮下注射相应剂量的DES,对照组仅注射溶媒。于大鼠性成熟后(PND 64)处死各组大鼠切取双侧睾丸,采用TUNEL法检测大鼠睾丸生精细胞凋亡,用免疫组化方法检测凋亡相关蛋白Bc l-2和Bax在生精细胞中的表达。结果:与对照组相比,ADa组大鼠性成熟后生精细胞凋亡无明显变化,ADb、AD c和ADd 3组生精细胞凋亡增加,且随DES暴露剂量增加而有增加趋势。AC、ADa组生精细胞Bax相对弱表达而Bc l-2强表达,伴随DES暴露剂量增加,Bax表达逐渐增强而Bc l-2表达逐渐减弱,ADd组Bax强表达而Bc l-2弱表达。结论:青春期前较大剂量DES暴露可使大鼠性成熟后睾丸生精细胞凋亡增加,且随DES暴露剂量增加而有加强趋势。凋亡相关蛋白Bax和Bc l-2参与青春期前DES暴露所致的生精细胞凋亡过程。     

股部皮下埋藏睾丸对精子发生影响的实验研究

目的 探讨采用股部埋藏睾丸的方式修复阴囊皮肤缺损对睾丸精子发生的影响。方法 以育龄期贵州小型猪为实验动物，随机将雄性小型猪分为实验组和对照组。实验组动物手术切开阴囊制作股部埋藏睾丸动物模型，对照组手术处理同实验组但睾丸不移位。3个月后实验组、对照组随机各取2只行睾丸活检，观察睾丸的病理变化。然后将实验组、对照组6只分别与雌猪配对喂养3个月，观察有无生育，并在动物模型建立6个月后再次对所有实验组和对照组动物进行睾丸活检。结果 术后3个月和6个月实验组病理检查均发现睾丸曲细精管内各级生精细胞明显减少，未见成熟精子；而对照组睾丸曲细精管内各级生精细胞正常，可见成熟精子。术后3个月后，实验组动物与雌性动物配对喂养3个月无生育；而对照组生育正常。结论 猪股部埋藏睾丸的方法影响睾丸的精子发生，建议临床上最好不用此方法修复阴囊皮肤缺损，尤其是对希望保留生育能力的患者。     

Effect of preoperative preoperative visualization therapy on postoperative outcome after inguinal hernia surgery and thyroid resection

This randomized controlled trial aims to evaluate the influence of preoperative relaxation techniques on postoperative outcomes. From January 1997 to June 1998 208 patients were operated on for primary inguinal hernia or goiter. The patients were randomized into two groups: Group A (n = 103) underwent the surgical treatment with a preoperative visualization therapy. Group B (n = 105) underwent the surgical treatment without a preoperative therapy. Patients with age under 18 years, ASA-status IV-V, recurrent inguinal hernia or recurrent goiter and malignant neoplasms were excluded from the study. There were no differences in age, sex, duration of the operation, training of the surgeon, and preoperative blood parameters between the two groups. RESULTS: During the postoperative follow-up we observed more hematomas (group A with visualization therapy: 30.3%, group B without visualization therapy: 44.4%) as well as more pain (group A: 4.2, group B: 5.2) and analgesic consumption (group A: 59.7 mg Tramadol HCL, group B: 72.5 mg Tramadol HCL) in group B (p < 0.05). There were no significant differences in infections, nausea, hypocalcemia, tetania, recurrent nerve palsy, fever. CONCLUSIONS: Preoperative visualization therapy reduces significantly the number of postoperative hematomas after inguinal hernia repair. Furthermore a decrease of analgesic requirements after surgical treatment was observed.     

假体材料在85例腹股沟疝修补术中临床应用的研究

目的探讨假体材料在腹股沟疝急诊手术中应用的可行性及价值。方法对我院2000年1月至2005年7月假体材料在腹股沟疝85例中运用的病例进行回顾性分析。结果85例中71例择期行假体材料修补术后,5例出现阴囊血肿,2例发生腹股沟血肿,3例发生血清肿,1例表皮脓肿,均经局部治疗治愈。14例疝行急诊术网片修补术后出现阴囊血肿3例,腹股沟血肿及腹壁下积液各1例,除1例为肠切除半年内并发肠粘连梗阻经保守治疗治愈外,无一例复发及其他严重并发症。择期手术组和急诊手术组的术后感染率为8.5%(6/71)及14.3%(2/14),两组血肿及感染发生率相比显著无统计学意义(P>0.05)。但两组病例都无须移除网片且无一例复发及其他严重并发症。结论注意术前患者合理的选择、合理的围手术期处理及积极的术中、术后早期抗感染处理,假体材料在腹股沟疝急诊手术中的应用是可行的。其运用能克服传统手术的缺点,缩短患者治疗时间,避免二次手术风险。     

Classifying Postherniorrhaphy Pain Syndromes Following Elective Inguinal Hernia Repair

BACKGROUND: Chronic post-herniorrhaphy pain is diverse in origin. The aim of our study was to classify post-herniorrhaphy pain syndromes following elective inguinal hernia repair. PATIENTS AND METHODS: All patients with an elective inguinal hernia repair performed between January 2000 and August 2005 received a questionnaire evaluating chronic inguinal pain (visual analog scale, VAS 0-10). Patients with moderate to severe pain complaints (VAS score >or= 3) were invited for an interview and an outpatient department physical examination. RESULTS: A total of 2,164 cases underwent an elective hernia repair and received the questionnaire; 1,766 individuals responded (response rate: 81.6%). Moderate to severe pain was present in 211 patients (11.9%). Follow-up was performed in 148 patients. Three separate groups of diagnoses were identified. Group I: neuropathic pain (n = 72) indicating inguinal nerve damage; group II: non-neuropathic pain (n = 40) due to an array of diagnoses including periostitis (n = 18) and recurrent hernia (n = 13); and group III: a tender spermatic cord and/or a tight feeling in the lower abdomen (n = 43). CONCLUSIONS: Chronic pain following elective hernia repair is common and diverse in etiology but may allow for a classification contributing to the development of tailored treatment regimens.     

Ilioinguinal/iliohypogastric nerve block for pediatric inguinal herniorrhaphy; evaluation of the dose of ropivacaine

BACKGROUND: The aim of this study was to investigate the appropriate dose of ropivacaine in efficacy and safety when administered for ilioinguinal/iliohypogastric nerve block in children undergoing inguinal herniorrhaphy. METHODS: Forty six children (aged 1-8 yr, classified ASA I-II) undergoing ambulatory surgery for inguinal herniotomy were randomly assigned to one of the three groups, according to the dosage of ropivacaine: group I (n = 15), group II (n = 16) and III (n = 15) received 1.875, 0.9375 and 0.5625 mg x kg(-1) of ropivacaine, respectively. Intraoperative hemodynamics and modified CHEOPS score at 1, 3 and 5 hours after operation were recorded. RESULTS: There were no significant differences among the three groups in the intraoperative hemodynamics, whereas postoperative modified CHEOPS scores were significantly higher in group III than the other groups. Trivial femoral nerve palsy occurred in one patient of the group II, and no other adverse effects were seen in any groups. CONCLUSIONS: These results suggest that more than 0.9375 mg x kg(-1) of ropivacaine might be recommended to obtain sufficient postoperative analgesia for the ilioinguinal/iliohypogastric nerve block in children undergoing inguinal herniorrhaphy.     

二次内环重建双平片全腹股沟疝修补

目的：探讨自制双平片二次内环重建全腹股沟疝修补的应用价值。方法：选取2007年1月—2009年1月收治的125例腹股沟疝患者,根据手术方式不同分为3组：内环重建组35例,平片组45例,疝环充填组45例。对3组患者术中情况、术后并发症以及恢复情况进行比较。内环重建组将一张自行裁剪的10 cm×10 cm的平片直视下放置于肌耻骨孔的腹膜前间隙,并进行第一次内环重建,加强肌耻骨孔上1/3薄弱区域,封闭肌耻骨孔的缺损;另一张5 cm×5 cm的平片放置于腹横筋膜之上,并行第二次内环重建,着重加强了精索旁薄弱区域。结果：经对比发现,内环重建组在平均手术时间、切口下积血/液、阴囊血肿、局部异物感、术后疼痛感、每例材料消耗及复发例数方面与其他2组比较差异有统计学意义（P〈0.05）;3组在平均手术时间、平均下床活动时间、平均住院时间、切口裂开及感染、瘘道形成方面比较差异均无统计学意义（P〉0.05）。结论：自制双平片二次内环重建达到全腹股沟疝修补,从手术学和人体工程学理论上,符合全腹股沟肌耻骨孔疝修补,具有可操作性,该方法可广泛推广应用。     

Repair of indirect inguinal hernias by "laparoscopic joining of the edges"

PURPOSE: To evaluate a new laparoscopic technique for the treatment of indirect inguinal hernias. TECHNIQUE: Using the rabbit model of indirect inguinal hernia, nitinol U-clips (Medtronic Inc, Minneapolis, MN) were applied to the edges of the internal inguinal ring to close the defect and induce a scar. The procedure required only a "needle-scope" and a 3-mm needle holder. MATERIAL AND METHODS: Ten male New Zealand rabbits were divided in 2 groups: A=experimental (n=8 animals) and B=control (n=2 animals). Group A underwent laparoscopic placement of clips on day 1, with subsequent laparoscopic assessment on days 15, 30, and 60, and euthanized for histologic assessment on days 90 (n=4) and 120 (n=4). Group B underwent laparoscopy on day 0 (to confirm the presence of the hernias) and were euthanized on day 120. RESULTS: All treated inguinal hernias developed a thick layer of fibrous tissue around the clips and were completely closed (8 out of 8). At day 15 after surgery, all clipped areas showed some fibrosis, and at day 30, the clips were totally covered by scar tissue. The fibrosis involved not only the clips, but also a surrounding area of 2 to 3 cm. Mean operative time was 39 minutes (from skin incision to skin closure), and the mean time for clip placement was 2 minutes. CONCLUSION: The use of nitinol U-clips proved to be a simple, safe, and effective technique for the laparoscopic treatment of inguinal hernias in this animal model, which has a remarkable correlation with the anatomy of human pediatric indirect inguinal hernias.     

经腹腹膜前疝修补术后腹内疝性肠梗阻的发生情况及其影响因素分析

目的分析腹腔镜经腹腹膜前疝修补术（TAPP）后腹内疝性肠梗阻的发生情况及其影响因素。 方法选取2018年1月至2021年12月北京同仁医院收治的404例腹股沟疝行TAPP术后患者作为研究对象,根据腹内疝性肠梗阻的发生情况将其分为发生组（38例）和未发生组（366例）,分析所选腹股沟疝行TAPP术后患者的临床资料,采用单因素和Logistic回归分析筛选腹股沟疝患者行TAPP术后发生腹内疝性肠梗阻的影响因素。 结果404例患者术后发生腹内疝性肠梗阻38例（9.41%）;2组患者临床资料对比显示年龄、体质量指数（BMI）、疝囊直径、是否嵌顿疝、手术时间以及术中出血量等资料比较,差异均有统计学意义（均P<0.05）;Logistic回归分析结果表明,BMI>24 kg/m²（OR=3.278,95% CI：1.561～6.886,P=0.002）、疝囊直径>5 cm（OR=3.353,95% CI：1.602～7.022,P=0.001）、嵌顿疝（OR=3.208,95% CI：1.546～6.657,P=0.002）、手术时间>100 min（OR=2.437,95% CI：1.174～5.058,P=0.017）、术中出血量>10 ml（OR=2.733,95% CI：1.303～5.735,P=0.008）是TAPP术后发生腹内疝性肠梗阻的独立危险因素。 结论BMI>24 kg/m²、疝囊直径>5 cm、嵌顿疝、手术时间>100 min、术中出血量>10 ml是TAPP术后发生腹内疝性肠梗阻的独立危险因素,医务人员可以通过危险因素尽早识别高风险患者,还可对可以控制的危险因素给予一定的干预措施,以最大能力防止腹内疝性肠梗阻的发生。     

Laparoscopic injection of dermabond tissue adhesive for the repair of inguinal hernia: short- and long-term follow-up

Purpose

Is laparoscopic injection of 2-octyl-cyanoacrylate tissue adhesive (Dermabond: Db) into the inguinal hernia sac (IHS) effective for inguinal hernia repair?

Methods

Thirty male 4-week-old Lewis rats were used as subjects for this study. In the right Db (R-Db) group (n = 10), a fine catheter was passed through an 18-guage indwelling intravenous cannula inserted in the right lower quadrant, and 0.2 mL Db was injected into the right IHS under laparoscopic control. The left side was not treated. Both IHSs were treated in the bilateral Db (B-Db) group (n = 10). In the no Db (N-Db or control) group (n = 10), only laparoscope insertion was performed. Herniography was performed before death. B-Db and N-Db rats were mated 50 days after treatment. Half of all rats were killed 2 months after treatment and the remaining half 12 months after treatment.

Results

All rats survived until killing. Macroscopic findings postdeath confirmed herniography results; treated IHS were closed, and untreated IHS were patent. There were minor adhesions in 3 of 20 treated rats. Sperm were identified in the vaginas of all mated rats.

Conclusions

These results suggest that our new technique is simple, safe, and reliable as an alternative to standard operative repair for inguinal hernia.