腹股沟区腹膜前解剖和疝修补术

目的：重新认识腹股沟区腹膜前解剖的特点，探讨腹膜前腹股沟疝无张力修补术的技术要点。方法：（1）对5具新鲜尸体进行腹股沟区解剖研究；（2）2005年6月-2006年5月行开放式腹膜前腹股沟疝无张力修补术共330例次（292例病人），2002年11月至2006年5月行腹腔镜下无钉合全腹膜外疝修补术（TEP）共240例次（211例病人），进行术中的观察及术后随访。结果：腹股沟区存在两层腹横筋膜，腹膜前间隙在两层腹横筋膜之间，补片即置于腹膜前间隙并覆盖肌耻骨孔。开放式腹膜前腹股沟疝无张力修补术平均手术时间43min，并发症率7．3％（24／330），复发率0．91％（3／330），平均住院时间1．7d。TEP平均手术时间57min，并发症发生率6．7％（16／240），无复发病例，术后平均住院时间2．8d。结论：从腹股沟区腹膜前解剖学特点来看在肌耻骨孔后方用足够大的补片覆盖修补符合压力学原理，腹膜前腹股沟疝无张力修补术具有合理性和可行性。     

人、猪、禽戊型肝炎病毒血清学关系的研究

目的研究人、猪、禽戊型肝炎病毒（HEV）的血清学关系。方法应用ELISA分别以人、猪、禽HEVORF2重组蛋白p166human、p166swine、p268avian检测人、猪、鸡血清及其他标本中抗．HEVIs,G，用SAS软件进行统计学分析，同时进行序列同源性比较。结果p166human和p166swine对HEV实验感染动物血清、HEVORF2重组蛋白免疫血清和单克隆抗体均呈阳性反应，而p268avian均呈阴性反应。以p166human、p166swine、p268avian检测人、猪、鸡血清抗．HEVIgG，戊型肝炎患者血清检出率分别为98．5％、97．7％和1．5％，正常人血清为10．0％、10．0％和4．0％，猪血清为26．9％、25．6％和1．3％，鸡血清为4．3％、2．2％和33．3％。p268avian与p166human或p166swine的检出率差异有统计学意义（P〈0．001）。相关性分析表明，p166human和p166swine对不同样本的检测均呈直线正相关，而p268avitm与p166human或p166swine无直线相关性。人和猪HEVpORt2的序列同源性在88．2％。99．2％，而禽HEV与人、猪HEVpORt2的同源性仅为45．5％～46．1％，其中含有多个插入和缺失突变。结论人和猪HEV血清学关系密切，而禽HEV与人、猪HEV抗原性差异有统计学意义，无血清学相关性。因此禽HEV与人、猪HEV的关系应予进一步考证。     

腹膜外剖宫产应用于前置胎盘33例分析

３３例前置胎盘患者应用腹膜外剖宫产术终止妊娠，与同期３３例前置胎盘患者应用腹膜内剖宫产术相比较。结果表明：手术时间：腹膜外组平均４６．９分钟，腹膜内组平均６９分钟（Ｐ＜０．０５）；出血量：腹膜外平均８６６ｍｌ，平均输血６８７ｍｌ，腹膜内组平均１１２０ｍｌ，平均输血９４３ｍｌ（Ｐ＜０．０１）．新生儿窒息率：腹膜外组２４．７％，腹膜内组３０．３％（Ｐ＞０．０５）。产后大出血率：腹膜外组９．１％，腹膜内组６．１％（ｐ＞０．０５）。肠功能恢复时间：腹膜外组平均３０．４小时，腹膜内组６８．６小时（Ｐ＜０．０１）。术后病率：腹膜外组１８．２％，腹膜内组５４．５％（Ｐ＜０．０１）。提示前置胎盘患者腹膜外剖宫产术终止妊娠优于腹膜内剖宫产术。     

腹膜附加带的解剖学观测及其临床意义

目的 了解腹膜腔中腹膜附加带出现情况。方法 对６０例防腐尸体标本的腹膜腔进行观察测量。结果 腹膜附加带的出现率分别为：生殖肠系膜臂为５％；回肠膜为１１．７％；结肠间膜为１５％；横结肠系膜空肠膜为５％；升结肠系膜为８．３％；乙状结肠系膜带为３．３％。结论各种腹膜附加带的出现率在成人与儿童间无显著性差异，它们可使肠管发生扭转或梗阻。     

腹膜前疝修补术的解剖研究及术式进展

经腹膜前间隙进行疝修补的方法统称腹膜前疝修补术（preperitoneal herniorrhaphy），属后入路修补手术（posterior approach repair），操作上不同于通常的前入路手术，不切开腹股沟管或游离精索，直接进入腹膜前间隙，利用髂耻束和耻骨梳韧带作修补或辅以补片无张力修补。近年来应用范围不断扩大，显现其独特的优越性。现就其演变和进展作简要阐述。     

疝环填充式无张力修补术在腹股沟复发疝中的应用

目的探讨疝环填充式无张力疝修补术在腹股沟复发疝中的临床应用价值。方法回顾性对114例复发性腹股沟疝患者采用美国巴德（Bard）公司提供聚丙烯网塞、补片修补材料,行疝环填充无张力修补的效果。结果术后复发3例（2．63％）,治愈111例（97．37％）。结论疝环充填式无张力疝修补术是一种更符合腹股沟解剖和生理的手术方式,是治疗腹股沟复发疝的理想术式。     

238次肾衰患者腹膜透析植管术回顾分析

目的 探讨肾功能衰竭患者腹膜透析植管术的方法和注意事项，减少并发症的发生率。方法 对230例急、慢性肾功能衰竭患者进行的238次腹膜透析植管术的方法合并症进行回顾性分析。结果 238次腹膜透析植管术中，有37例出现并发症，发生率为15．5％。其中15例（6．3％）合并出口处感染，17例（7．2％）出现非功能性梗阻，3例（1．2％）发生腹股沟疝气，3例（1．2％）发生腹透液满出，1例（0．42％）有涤纶套突出。结论 我们肾病科的腹膜透析植管术方法安全、有效，并发症发生率较低。     

大鼠腹膜透析液和腹膜表层中磷脂含量

用Folch液提取大鼠腹膜透析液和腹膜表层中的磷脂,用比色方法作定量测定,用高效薄层层析法分析其组分,取大鼠用25mL含4．25％葡萄糖透析液透析4h后,透析液中磷脂含量为0．1219711mg,腹膜表层磷脂含量为1．1206972mg,透析液中磷脂酰胆碱占665,溶血磷脂酰胆碱和鞘磷脂为29％,磷脂酰肌醇为4．5％。腹膜表层中磷酯酰胆碱占47％,溶血磷脂酰胆碱和鞘磷脂为20．6％,磷脂酰肌醇为6．3％,磷酯酰丝氨酸为17．1％,磷脂酰乙醇胺8．9％。结果表明（1）大鼠腹膜表层含有较多磷脂。（2）大鼠透析液中磷脂酰胆碱含量与鞘磷脂＋溶血磷脂酰胆碱含量的比例和腹膜表层中一致,但腹膜表层中另有较多的磷脂酰丝氨酸及磷脂磷酰乙醇胺。（3）大鼠透析液中的磷脂可能主要是从腹膜表层中洗脱下来的。     

透明质酸对腹膜粘连的有效预防

目的　在腹腔镜疝修补手术中 ,评估透明质酸作为生物再吸收膜保护合成补片的腹膜面对粘连形成的影响。方法　应用腹腔镜在 9只猪的腹壁两侧造成直径5 .0 cm的腹膜缺失 ,用肽夹固定聚丙补片修补腹膜缺失 ,一侧补片表面覆盖透明质酸膜 (治疗组 ) ,一侧补片表面不覆盖透明质酸膜 (对照组 ) ,术后 45 d,通过解剖和组织学形态比较双侧腹膜粘连的发生率和程度 (粘连程度分 0 - 4级。0级 ,无粘连 ;1级 ,膜状无血管性粘连 ;2级 ,血管性粘连 ;3级 ,索状纤维素样粘连 ;4级 ,广泛纤维素样粘连 )。结果　对照组 9例中 ,7例发生腹膜粘连 ,粘连程度 3 -4级…     

猪的脂肪和骨髓来源间充质干细胞培养特性比较

目的明确小型猪的脂肪来源间充质干细胞（A_r_MSCs）和猪的骨髓来源间充质干细胞（BM—MSCsl体外培养特性的异同。方法广西巴马小型猪,雌雄不限,猪龄4～6个月,体质量20～30kg。AT-MSCs来源于小型猪腹股沟皮下组织．BM—MSCs来源于小型猪的骨髓组织。培养AT-MSCs和BM—MSCs并观察它们的细胞形态。流式细胞仪检测Arr_MSCs和BM—MSCs的表面标志物（CD29、CD34、CD45、CD90）。分别观察Arr-MSCs和BM—MSCs的细胞生长分化能力;实时聚合酶链反应（PCR）检测基因表达。结果流式细胞仪检测结果表明,A．r_MSCs和BM—MSCs均表达CD29[分别为（99．06±0．30）％、（99．94±0．05）％]、CD90[分别为（97．404-0．40）％、（97．43±1J29）％1阳性,CD34、CD45阴性。AT-MSCs传代需培养5～7d,而BM—MSCs需培养7～10d。与BM—MSCs比较,AT—MSCs具有更强的生长分化能力。实时PCR检测基因表达结果显示．AT—MSCs和BM—MSCs均能分化心肌特异标志物a—skeletalactin和Troponin—I．二者差异无统计学意义．表明AT—MSCs和BM—MSCs均具备多项分化潜能．结论AT—MSCs是小型猪干细胞移植治疗的理想选择．     

生物型硬脑膜补片在无眼球结膜囊成形术中的应用

目的 研究生物型硬脑膜补片用于无眼球结膜囊成形术中的可行性和临床效果.方法 对12例(12只眼)无眼球结膜囊狭窄患者,采用生物型硬脑膜补片进行结膜囊成形术,术后随访,观察植片植入后的转归及术后结膜囊成形的效果.结果 12只眼术后植入的补片无收缩、脱落、感染及坏死.术后6～12个月,所有植片均被结膜覆盖,术后结膜囊大小深度合适,配戴义眼后外观满意.结论 采用生物型硬脑膜补片修复无眼球结膜囊狭窄是一种安全有效的手术方法.     

人工硬脑膜材料的生物相容性

背景：目前研究应用的硬脑膜修补材料主要有自体组织修补材料、同种异体材料、异种生物材料和人工合成材料。 目的：评价修复硬脑膜缺损各种修补材料的性能和应用,寻找合理的硬脑膜修补材料。 方法：以 “硬脑膜,材料”中文关键词,采用计算机检索中国期刊全文数据库2000-01/2010-12中相关硬脑膜缺损修补材料学研究及各种材料在硬脑膜缺损修补临床应用情况的文章。 结果与结论：目前国内使用自体组织、同种异体材料、异种生物材料和人工合成材料等硬脑膜修补材料分别存在着来源困难、易粘连、不易保存、不易消毒或生物相容性差等缺点,自体组织修补材料在可利用的情况下仍为首选,其中异种生物材料因其良好的生物相容性及理化特性成为目前临床应用最广泛的硬脑膜修补材料。虽然异种生物材料是目前临床上大量使用的硬脑膜修补材料,但由于其存在各自不可避免的缺点,硬脑膜修复材料仍需进一步开发。     

Efficacy of Percutaneous Epidural Neuroplasty Does Not Correlate with Dural Sac Cross-Sectional Area in Single Level Disc Disease

Purpose

Percutaneous epidural neuroplasty (PEN) is a minimally invasive treatment. The efficacy of PEN has been relatively well investigated; however, the relationship between the clinical effectiveness of PEN and the severity of spinal canal stenosis by disc material has not yet been established. The purpose of this study was to compare clinical outcomes of PEN according to the dural sac cross-sectional area in single level disc disease.

Materials and Methods

This study included 363 patients with back pain from single level disc disease with and without radiculopathy. Patients were categorized into groups according to spinal canal compromise by disc material: Category 1, less or more than 50%; and Category 2, three subgroups with lesser than a third, between a third and two thirds, and more than two thirds. Clinical outcomes were assessed according to the Visual Analog Scale (VAS) score for back pain and leg pain and Odom''s criteria at 1, 3, 6, 12, and 24 months after treatment.

Results

The demographic data showed no difference between groups according to spinal canal compromise by disc material except age (older age correlated with more spinal canal compromise). The dural sac cross-sectional area did not correlate with the VAS scores for back and leg pain after PEN in single level disc disease in Groups 1 and 2. Odom''s criteria after PEN were also not different according to dural sac cross-sectional area by disc material.

Conclusion

PEN is an effective procedure in treating single level lumbar disc herniation without affecting dural sac cross-sectional area.     

Hajdu-Cheney syndrome with severe dural ectasia

Hajdu-Cheney syndrome (HCS) is an autosomal dominant condition comprising osteolysis of the terminal phalanges, characteristic craniofacial abnormalities, dental anomalies, and proportionate short stature. The clinical and radiological findings develop and progress with age. Here, we report on a HCS patient with severe scoliosis and exceptionally massive dural ectasia. Congenital scoliosis and dural ectasia have not been reported previously in HCS.     

Comprehensive analysis of dural ectasia in 150 patients with a causative FBN1 mutation

The purpose of this study was to perform a comprehensive study of dural ectasia (DE) related to FBN1 mutations. We performed a database analysis of two German metropolitan regions of 150 patients (68 men, 82 women; mean age 35 ± 16 years). All patients had a FBN1 mutation and underwent dural magnetic resonance imaging. Age was <16 years in 20, 16–25 in 27, 26–35 in 67, and >35 in 36 patients. Prevalence of dural ectasia was 89% with criteria of Oosterhof and Habermann, 83% with Fattori, 78% with Lundby, and 59% with Ahn. DE was less frequent in patients <16 years with Ahn and Fattori. DE related to skeletal manifestations with all criteria, to aortic Z‐scores and mitral valve prolapse with criteria of Habermann and Lundby, and to age with criteria of Fattori. The Fattori‐grade of DE increased with age, aortic Z‐scores, and skeletal score points. There was no consistent relationship of DE with any type of FBN1 mutation. DE is frequent in patients with FBN1 mutations irrespective of age and its severity increases during life. Criteria of Oosterhof and Habermann yielded most consistent diagnostic results. DE relates to skeletal involvement, aortic Z‐scores, and mitral valve prolapse.     

Middle meningeal artery hemorrhage: an incorrect name

Extradural hemorrhage is most commonly assumed to result from a middle meningeal artery rupture. This article challenges that assumption. The meningeal vasculature of 29 cadaveric specimens was examined macroscopically and microscopically at the level of the greater wing of the sphenoid bone and foramen spinosum. It was observed that the middle meningeal artery is accompanied by a pair of dural sinuses throughout the majority of its course, thus making exclusively arterial rupture an anatomical improbability. Furthermore, as these dural sinuses pass caudally through the foramen spinosum with the middle meningeal artery, they were seen to diverge to form a plexiform arrangement around the artery. This has not been reported before.     

生物型硬脑膜补片在兔睑板重建中的应用

探讨兔睑板重建中生物型硬脑膜补片植入替代睑板的组织相容性,观察其组织转归。方法 20只新西兰大白兔,随机数字表法分为生物型硬脑膜补片组和异体巩膜组,每组10只。去除兔左下睑8 mm×6 mm全层睑板后,分别植入生物型硬脑膜补片与异体巩膜。术后观察2组实验兔手术部位大体外观和对应结膜面的改变,术后2、4、6、8、12周行植片组织HE染色观察组织学改变;术后4、8周植片组织行CD4+、CD8+免疫组化检查。结果 生物型硬脑膜补片植入后未见明显排斥反应。免疫组化显示,术后4周、8周生物型硬脑膜补片组植片组织CD4+、CD8+细胞计数均少于异体巩膜组[术后4周:CD4+:(9±4)个/视野比(30±5)个/视野,CD8+:(8±3)个/视野比(66±10)个/视野;术后8周:CD4+:(9±-4)个/视野比(61±10)个/视野;CD8+:(7±2)个/视野比(27±7)个/视野,均P＜0.01]。组织学检查显示生物型硬脑膜补片引起的炎性反应轻微,植入初期机体新生纤维组织开始从周边融人植片,随后周边纤维组织转化成胶原纤维,外周新生血管长入,最终其纤维走行类似正常睑板纤维束。结论 生物型硬脑膜补片在植入兔眼睑后有较好的组织相容性,可以作为生物支架引导新生血管和胶原纤维长入,起到替代睑板的作用。     

Impairment of the Peritoneal Surface as a Decisive Factor for Intestinal Adhesions in Intraperitoneal Onlay Mesh Surgery - Introducing a New Rat Model

Background: Meshes implanted intraperitoneally are known to cause adhesions potentially resulting in complications such as chronic pain, enterocutaneous fistula, or mesh infection. This study introduces a model for investigation of intestine-to-mesh adhesions and evaluates as to whether missing of visceral peritoneum is causative.Methods: In 18 rats, rectangular 1.5 x 2 cm patches of an uncoated polypropylene mesh (Ultrapro^®) were sewn to the inner abdominal wall next to the cecum. Additionally, a meso-suture ensured contact between cecum and mesh. Rats were assigned to 2 groups: in 8 rats the peritoneum was left intact, in 10 the cecum was depleted from peritoneum with abrasion. Sacrifice was on day 7. Macroscopic evaluation used two adhesion scores. Specimens were evaluated microscopically, statistical analyses employed student''s t-test.Results: On day 7, rats with mesh implantation combined with locally de-peritonealization by cecal abrasion mostly showed severe cecum-to-mesh agglutination (mean Lauder score 92%, mean total Hoffmann score 90%), whereas meshes of most animals without cecal abrasion only had some coverage with intraabdominal fat (33%, 24%; p = 0.0002). Histological work-up showed adequate wall ingrowth of mesh in all rats. In animals with cecal abrasion, meshes were mostly adhesive with cecal wall. However, when the peritoneum of cecum was unimpaired, abdominal wall above the mesh as well as cecum usually revealed sub-peritoneal tissue and a mono-layer cell coverage as seen in normal peritoneum.Conclusion: This study introduces a model mimicking a clinical situation of e.g. hernia repair by intraperitoneally implanted meshes when mesh has contact with normal and with de-peritonealized intestine. The model might be useful for testing mesh types and coatings as well as other devices for their efficacy in adhesion prevention. The high adhesion scores of rats with local de-peritonealization compared with the low scores of animals with intact peritoneum indicate that the integrity of intestinal peritoneum is a decisive factor for adhesion formation.     

Middle meningeal artery: Gateway for effective transarterial Onyx embolization of dural arteriovenous fistulas

Curative transarterial embolization of noncavernous sinus dural arteriovenous fistulas (dAVFs) is challenging. We sought to evaluate the role of the middle meningeal artery (MMA) in endovascular treatment of these lesions. We performed a retrospective cohort study on patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVFs with contribution from the MMA at a major academic institution in the United States from January 2009 to January 2015. Twenty consecutive patients who underwent transarterial Onyx embolization of a noncavernous sinus dAVF were identified. One patient was excluded as there was no MMA contribution to the dAVF. All of the remaining 19 patients (61.3 ± 13.8 years of age) underwent transarterial embolization through the MMA. Six patients (31.6%) presented with intraparenchymal or subarachnoid hemorrhage from the dAVF. The overall angiographic cure rate was 73.7% upon last follow up. In 71.4% of successfully treated patients transarterial embolization of the MMA alone was sufficient to achieve angiographic cure. When robust MMA supply was present, MMA embolization resulted in angiographic cure even after embolization of other arterial feeders had failed in 92.9% of patients. A robust contribution of the MMA to the fistula was the single most important predictor for successful embolization (P = 0.00129). We attribute our findings to the fairly straight, non‐tortuous course of the MMA that facilitates microcatheter access, navigation, and Onyx penetration. Noncavernous sinus dAVF can be successfully embolized with transarterial Onyx through the MMA, as long as supply is robust. A transvenous approach is rarely necessary. Clin. Anat. 29:718–728, 2016. © 2016 Wiley Periodicals, Inc.