腹直肌后腹膜前置入人工补片修补腹壁巨大切口疝

目的：探讨利用生物材料修补腹壁巨大切口疝的疗效.方法：经腹直肌后腹膜前置入人工补片手术修复腹壁巨大切口疝16例,其中初发切口疝12例,复发切口疝4例.结果：16例全部治愈,术后发生皮下积液3例.随访10个月～4a,无复发病例.结论：采用腹直肌后腹膜前置入人工补片治疗腹壁巨大切口疝是安全、有效的.     

双层复合补片在腹壁大切口疝及巨大切口疝中的应用

背景：传统缝合修补与自体组织移植修补较大腹壁缺损时具有一定的局限性。 目的：分析人工合成材料双层复合补片修补腹壁大切口疝及巨大切口疝的效果。 方法：回顾性分析郑州大学第一附属医院2008-12/2010-12收治的71例腹壁大切口疝及巨大切口疝患者的临床资料,所有患者均采用双层复合补片行切口疝无张力修补。 结果与结论：全部病例术后恢复顺利,无严重并发症。发生皮下积液5例,经换药治疗后痊愈。术后随访6个月~2.5年,无复发病例,无切口感染病例。提示双层复合补片是目前治疗腹壁大切口疝和巨大切口疝安全可靠的修补材料。     

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。     

人工补片无张力疝修补术59例临床分析

目的：探讨人工补片无张力疝修补术的疗效和优点。方法：对59例71个腹外疝在疝囊高位结扎后行人工补片无张力修补术的临床效果进行回顾性分析。结果：本组51例63个腹股沟疝和股疝的手术时间为30—80min，平均55min。术后切口均一期愈合，无切口感染、硬结、异物反应等并发症；术后并发短暂尿潴留2例；阴囊血肿2例、积液4例5侧。腹股沟疝术后5～7天(平均6天)出院，切口疝术后8-11天(平均9天)出院。随访5—51个月，复发2例。结论：人工补片无张力疝修补术是一种简单、安全、痛苦小、恢复快、效果好的疝修补方法，适用于腹壁缺损不严重的各种腹外侧及复发疝。     

腹横筋膜与腹膜前疝修补术103例分析

目的重新认识腹横筋膜的解剖特点,从解剖学角度探讨腹膜前疝修补术的合理性。方法对术中腹横筋膜以及腹膜前间隙的解剖观察,回顾性分析腹膜前修补腹股沟疝103例的临床资料。结果耻骨肌孔由腹横筋膜的前层覆盖,腹横筋膜由两层构成,腹壁下血管位于两层之间。3种方法放置的补片在不同的腹膜前间隙覆盖耻骨肌孔。103例均成功,无切口感染、髂腹股沟神经痛病例。术后随访1～6年无复发。结论从解剖学特点看,覆盖耻骨肌孔的腹膜前疝修补具有合理性。前后入路腹膜前疝修补补片放置的间隙不同。     

腹直肌肌皮瓣修复胸部慢性放射性溃疡的应用

目的总结应用腹直肌肌皮瓣修复胸部慢性放射性溃疡的经验。方法 2010年以来收治胸部深度放射性溃疡6例,全身麻醉下行胸壁放射性溃疡创面清创,切除坏死软组织及变性肋骨,根据缺损大小及形状,切取带有腹壁上动静脉血管蒂的腹直肌肌皮瓣转移修复胸壁缺损,重建胸壁。其中4例采用纵行腹直肌肌皮瓣;2例采用横行腹直肌肌皮瓣修复,供瓣区给予游离皮片移植或缝合修复。结果 1例患者皮瓣边缘与创缘愈合不佳,给予扩大切除局部病变皮肤范围后缝合修复。其余皮瓣成活良好,创面修复满意。术后随访1~3年,溃疡无复发,供瓣区无腹壁疝形成。结论清创后,应用血运丰富的腹直肌肌皮瓣覆盖,可有效修复胸部慢性放射性溃疡,是一种简单、安全、有效的治疗方法。     

补片修补术治疗腹壁巨大切口疝的临床体会

目的探讨补片修补术在治疗腹壁巨大切口疝上的临床效果。方法对我院2012年10月~2013年10月收治的40例腹壁巨大切口疝患者的临床资料进行回顾性分析,患者全部给予补片修补术进行治疗,观察患者的临床疗效及并发症发生情况。结果40例患者全部痊愈出院,住院时间9~16d,平均(12.3±2.1)d,且患者术后均未出现如切口感染、补片排异反应以及肠梗塞等并发症现象。所有患者术后随访3~6个月,并无复发病例出现。结论补片修补术治疗腹壁巨大切口疝的临床疗效令人满意,具有术后恢复快、并发症发生率低和复发率低等优点,是临床上治疗腹壁切口疝的最佳手段之一。     

聚四氟乙烯补片修复巨大腹壁缺损

很多修补腹壁缺损的人工材料因易感染组织而不理想,作者对28例巨大腹壁切口疝病人,包括12例修补后复发者,以2mm厚的聚四氟乙烯补片进行修补取得满意效果。结果表明,伤口感染2例(7.1％),均发生于术前合并肠瘘的病人,其中1例经换药愈合,另一例折除补片,仍有切口疝,补片组织学检查,仅见轻微的炎症反应。疝复发3例(10.7％),其中1例5个月后再次手术,发现因缝合不牢引起。组织学发现补片上有牢固粘连的纤维组织,补片间隙中有成纤维细胞,胶元纤维已长入200μm     

巨大腹白线缺损一例

<正> 21岁的女病人,以腹壁疝入院。全麻下腹正中切口长28cm的术野中,直到腹直肌内侧缘,未见腹白线。作腹直肌前鞘纵行减张切口多处,腹正中上联合缝合腹直肌前鞘后鞘。术后三年未复发。     

低张力疝修补术36例临床分析

目的：探讨低张力疝修补术的优点和近期疗效。方法：采用美国Bard公司生产的聚丙烯疝修补网片（Bard Perfix Mesh)、美国强生公司生产的Prolene疝修补网片补片及美国戈尔公司的聚四乙烯疝补片对36例41侧腹外疝在疝囊高位结扎后行低张力修补术。结果;本组腹股沟疝的手术时间30－80min,平均55min,术后1例双侧斜疝者使用度冷丁1次,其余病人均疼痛轻微,未使用止痛药;术后进食时间6－24h,平均12h,下地活动时间3－48h,平均24h;出院时间为术后3－7d,平均5d,无切口感染,硬结,血肿,异物反应,尿潴留等并发症;阴囊血肿1例,积液3例4侧,复发1例。结论：低张力疝修补术是一种简单,安全,痛苦小,恢复快,效果好,经济的疝修补方法,实用于疝环相对较小,腹壁缺损不严重的各种腹外疝及复发疝。     

江西汉族体质特征

目的 探讨江西城市、乡村汉族的体质特征.方法 按照Martin、<人体测量手册>和<人体测量方法>规定的方法,2010年5月赴江西省丰城市调查了城市汉族307例(男性151例,女性156例)、乡村汉族398例(男性203例,女性195例)成人86项体质指标.结果 江西汉族上眼睑皱褶率中等,有蒙古褶率较低,眼裂高度多为中等型;半数人为水平眼裂,鼻根高度中等型率最高;鼻背侧面观多为直型;颧骨突出度约一半为中等型,鼻基部多水平;鼻翼高度多为中等,鼻孔最大径多为斜位,耳垂圆形率最高;发色多为黑色,眼色多为褐色、肤色以黄色率与浅黄色率接近;鼻翼宽以中等型率最高;上唇皮肤部高度多为中等型,红唇厚度多为窄型.江西男女性均为圆头型、高头型、中头型、中面型、中鼻型.汉族城市男性与女性均为中等身材,农村男性与女性均为亚中等身材.城乡男女性均为长躯干型、中骨盆宽型、中胸型.城市男性、城市女性还为窄肩型、亚短腿型,乡村男性还为中肩型、中腿型.乡村女性还为中肩型、亚短腿型.头面部和身体高度、宽度方面的指标方面,江西汉族较接近南亚类型族群,而头面部、体部指数方面,显示江西汉族体质也受到北亚类型族群的一定影响.结论 江西汉族人具有南亚类型族群的体质特征.     

Non-HTLV-1-associated primary gastric T-cell lymphomas show cytotoxic activity: clinicopathological,immunohistochemical characteristics and TIA-1 expression in 31 cases

AIMS: Most primary gastrointestinal lymphomas are of B-cell origin and T-cell origin is very rare. Recent studies have suggested that human T-cell lymphotrophic virus type 1 (HTLV-1) may be involved in the development of primary gastric T-cell lymphoma. We analysed 31 patients with primary gastric T-cell lymphoma in south-west Japan, an area endemic for HTLV-1, and determined their phenotypes, genotypes, and HTLV-1 status. METHODS AND RESULTS: Here we present 31 cases of primary gastric T-cell lymphoma in a HTLV-1-endemic area in Japan and analyse the clinical status, histology, phenotype and virus status. The median age at onset of primary gastric T-cell lymphoma was 57 years with a gender ratio of M:F = 1.58:1. Six of the 31 primary gastric T-cell lymphoma cases had HTLV-1 proviral DNA (five males, one female), nine of the 31 cases were positive for anti-adult T cell leukaemia antibody, without examination of HTLV-1 proviral DNA (five males, four females), eight were non-HTLV-1-associated primary gastric T-cell lymphoma (four males, four females) and the other eight cases were unknown. Primary gastric T-cell lymphoma usually presented as a large ulcerated tumour at the corpus to the antrum and histologically consisted of anaplastic large cell type (n = 2), pleomorphic large cell type (n = 3), pleomorphic medium and large cell type (n = 14), pleomorphic medium cell type (n = 11), and angioimmunoblastic T-cell lymphoma type (n = 1). There were no clear macroscopic and microscopic differences between HTLV-1-associated and non-HTLV-1-associated primary gastric T-cell lymphoma. Most patients died within 2 years of diagnosis, and both types of primary gastric T-cell lymphoma (with and without HTLV-1) were associated with poor prognosis. Cytotoxic marker analysis showed that HTLV-1-associated lymphomas were negative for TIA-1, while non-HTLV-1-associated lymphomas were positive for TIA-1. CONCLUSIONS: Our results suggest that in HTLV-1-endemic areas, patients with HTLV-1-associated primary gastric T-cell lymphoma should be managed carefully and that TIA-1 seems to be useful for identifying the aetiology of this lesion.     

Morphometry of the nasal bones and piriform apertures in Koreans

In order to understand the morphological characteristics of Korean noses, the nasal bones and piriform apertures were measured and classified in the dried skulls of Korean adults. The shapes of the nasal bones were classified into five types (Type A-E). Among the types of the nasal bone, Type A, in which the nasomaxillary sutures initially descended vertically and then obliquely, was present in 43.2% and Type B, in which the nasomaxillary sutures were concave in the middle part, was present in 52.3% of the noses examined. The height of the nasal bone was 25.9 +/- 3.8 mm in males, 24.5 +/- 3.7 mm in females; the width was 9.2 +/- 2.4 mm in males, 8.8 +/- 2.6 mm in females. The height of the piriform aperture was 30.1 +/- 2.6 mm in males, 28.0 +/- 2.8 mm in females; the upper width was 16.8+2.6 mm in males, 17.0 +/- 2.0 mm in females; the lower width was 25.7 +/- 1.7 mm in males, 25.4 +/- 2.1 mm in females. Each measurement was compared with those carried out in other populations.     

浙江汉族的体质特征

目的 探讨中国浙江汉族人的体质特征并分析其在蒙古人种中的分型地位。方法 采用国际学术界规定方法，在浙江绍兴地区调查了330例男性（城市男性为144例，乡村男性为186例）和357例女性（城市女性为153例，乡村女性为204例）成人的86项体质指标，计算了24项体质指数，统计了指数分型情况，与我国族群资料进行了比较，对浙江汉族体质特征进行了初步分析。结果 浙江汉族人上眼睑有皱褶率较低，有蒙古褶率低，眼裂高度多为狭窄型，眼外角多高于眼内角，鼻根高度多为中等型，鼻背侧面观多为直型，颧部突出度男性多为微弱型，女性多为中等型；鼻基部多呈水平；鼻翼高度多为中等，鼻孔最大径多为斜位，鼻翼较宽；耳垂多为圆形；上唇皮肤部高度多为低，红唇男性中等型较高，女性中等型率最高、薄型率次之。发黑，肤黄、眼褐。总体说来，浙江汉族头面部测量指标值接近于北亚类型族群。浙江汉族头面部指数值介于南亚、北亚类型族群之间。浙江汉族的体部指标值接近于北亚类型族群，体部指数值更接近于北亚类型族群，但亦有南亚类型族群特点。从指数均值来看，浙江汉族男性女性均为圆头型、高头型、中头型、阔面型，中鼻型。按体部指数均值，浙江汉族男女性均为长躯干型、窄肩型、中骨盆型；男性为中胸型，女性为窄胸型；城乡男性和城市女性为中腿型，乡村女性为亚短腿型。结论 浙江汉族体质更接近于北亚类型族群。聚类分析结果表明，9个汉族族群未能聚在一起。汉族族源的多元性，导致不同地区汉族体质的较大差异。将整个汉族笼统地归入一个体质类型，可能并不恰当。     

骶髂关节正位放射学分型及其临床意义

目的　探讨骨盆正位X线片上骶髂关节的放射学分型,以指导临床对骶髂关节的认知。 方法　对950例（男475,女475）正常骶髂关节的骨盆正位X线片进行观测。根据骶髂关节间隙的数量及间隙的走行特点,对骶髂关节进行放射学分型。 结果　正常骶髂关节的放射学分型大致可分为3种类型：① I型为双侧单间隙型,男女分别为8.8%（42例)和25.7%（122例);②Ⅱ型为双侧双间隙型,男女分别为79.2%（376例)和46.7%（222例);③Ⅲ型为一侧单间隙,一侧双间隙型,男女分别为12%（57例)和27.6%（131例)。II型又分为四个亚型：①“2”型双间隙,男女分别为0.8%（3例）和6.6%（15例）;②“12”型双间隙,男女分别为56.4%（212例）和69.8%（155例）;③“21”型双间隙,男女分别为2.1%（8例）和1.8%（4例）;④“121”型双间隙,男女分别为41.8%（157例）和19.8%（44例）;III型也分为两个亚型：①左侧单间隙,右侧双间隙型的男女分别为26.3%（15例)和49.6% (65例);②左侧双间隙,右侧单间隙型的男女分别为73.7% (42例)和50.4% (66例)。 结论　正常人骶髂关节的放射学分型以双侧双间隙型最常见,其中又以“12”型双间隙所占构成比最大,但各型构成上有性别差异。     

腹股沟疝修补术的解剖基础

目的探讨腹股沟管的有关解剖结构,为腹股沟疝修补术提供解剖学基础。方法解剖33具(66侧)成人尸体标本,观察腹股沟韧带、腹股沟镰、腹股沟管等结构,并测量了相关数据。结果腹股沟韧带长度,男性约11.9cm,女性约11.4cm;宽度男性约0.7cm,女性约0.6cm;腹股沟管长度,男性约4.9cm,女性约4.5m;腹股沟管后壁可分为两层紧贴的筋膜层,并形成一个卵圆形的区域,其纵径长度男性约2.9cm,女性约2.6cm,横径约1.4cm;腹股沟镰长度,男性约2.4cm,女性约2.0cm。腹股沟镰可分为4种类型;腹内斜肌起始有3种类型,肌腱移行处呈现3种类型;腹横肌起始有两种类型。结论测量值为腹股沟疝修补术提供了解剖学依据     

Regional variation of intracortical porosity in the midshaft of the human femur: age and sex differences

This study investigated age and sex differences in patterns of porosity distribution in the midshaft of the human femur. Cross-sections were obtained from 168 individuals from a modern Australian population. The sample comprised 73 females and 95 males, aged between 20 and 97 years. Microradiographs were made of 100-microm sections and pore and bone areas were determined using image processing software. Initially the sample was divided by age: young (20-44 years), middle (45-64 years) and old (65+ years), but it was found that analysis on the basis of the ratio of medullary area to total subperiosteal area gave clearer results. The cortex was divided into three rings radially and into octants circumferentially and the porosity of each segment was calculated. Results showed that a pattern with raised porosity in the posterior and anterolateral regions, and with greater porosity in the inner parts of the cortex, becomes more pronounced with age. In males this pattern develops steadily; in females there are much greater differences between the middle and older groups than earlier in life. The patterns observed are consistent with progressive bone loss occurring along a neutral axis of the cortex where bending stress is lowest and the mechanical advantage of the bone is least.     

A case of herniated gravid uterus through a laparotomy scar

A 36-year-old manual worker presented in her second pregnancy at 34 weeks of gestation with an unusual bulge of her abdomen. The lower abdominal bulge turned out to be her gravid uterus herniated through an anterior abdominal wall incisional hernia which is a rare but serious obstetric situation with complications such as premature labour, intrauterine growth retardation, strangulation, intrauterine death and rupture of the lower uterine segment been reported. We had a successful outcome by conservative treatment till 38 weeks of gestation followed by an elective lower segment Caesarean section with hernia repair. Incisional hernia is a frequent complication of abdominal wall closure and the management of pregnancy with a large incisional hernia with gravid uterus in its sac is challenging.