补片修补腹壁切口疝15例分析

目的 探讨补片在修补腹壁切口疝中的应用.方法 2002年1月～2009年12月采用聚丙烯补片修补腹壁切口疝15例,其中男6例,女9例,年龄37～84岁,平均65岁.15例患者疝环直径3～18 cm,平均10 cm.均采用聚丙烯补片植入肌后筋膜前或腹膜前修补.结果 全部患者手术均获成功.术口感染1例,经敞开切口,未取补片,多次换药,切口愈合.本组15例均得到随访,随访3～50个月,1例复发.结论 采用聚丙烯补片植入肌后筋膜前或腹膜前修补腹壁切口疝是一种安全有效的方法.     

腹腔镜下腹壁切口疝治疗体会

目的 探讨腹腔镜下腹壁切口疝修补术的手术技巧和临床疗效.方法 对2005年4月～2009年6月经腹腔镜下腹壁切口疝修补术的53例患者的临床资料进行回顾性分析.结果 50例顺利完成腹腔镜下补片修补手术,手术时间50～145 min,平均79 min,术后随访3～36个月,复发2例,均为腹壁巨大切口疝;3例因腹壁缺损较大,腹腔粘连严重中转开腹.全组无肠管损伤、粘连性肠梗阻及其他切口并发症发生.结论 腹腔镜下腹壁切口疝修补术安全可行、创伤小、术后恢复快、并发症少,值得临床推广应用.     

复合材料对腹壁肿瘤切除术后遗留巨大腹壁缺损修补的疗效分析(附45例报告)

目的 探讨复合材料对腹壁肿瘤切除术后遗留巨大腹壁缺损修补的疗效.方法 回顾性分析45例腹壁肿瘤患者以强生Proceed补片或巴德Composix Kugel补片进行腹壁缺损修补的手术方法及随访资料.结果 3例术中分离时切开肠管,6例术后发现皮下浆液性水肿.全部患者随访6个月至5年,3例因腹腔内肿瘤复发死亡,所有患者无感染、切口疝发生,无局部不适.结论 复合材料补片具有抗粘连、切口疝发生率低等优点,可在腹壁肿瘤切除术后遗留巨大腹壁缺损的修补手术中加以应用.     

聚丙烯平片鞘后修补皮下悬吊固定法治疗腹壁切口疝25例报告

[目的]探讨人工材料肌鞘后放置皮下悬吊固定法治疗腹壁切口疝的应用价值和技术要点。[方法]回顾性分析、总结2002年11月￣2006年5月间对25例腹壁切口疝,其中大切口疝13例、巨大切口疝8例、中切口疝4例的治疗经验。[结果]25例腹壁切口疝中24例切口一期愈合,1例因浆液肿致切口延迟愈合;1例术后1月出现迟发性感染未取出修补材料换药治愈。全部病例随访1月￣42月无复发。[结论]人工材料肌鞘后悬吊固定法是腹腔外切口疝治疗的一种设计合理和疗效肯定的无张力修补方法。     

紫杉醇诱导胰腺癌细胞凋亡Survivin表达的变化及意义

目的探讨复合材料对腹壁肿瘤切除术后遗留巨大腹壁缺损修补的疗效。方法回顾性分析45例腹壁肿瘤患者以强生Proceed补片或巴德Composix Kugel补片进行腹壁缺损修补的手术方法及随访资料。结果3例术中分离时切开肠管，6例术后发现皮下浆液性水肿。全部患者随访6个月至5年，3例因腹腔内肿瘤复发死亡，所有患者无感染、切口疝发生，无局部不适。结论复合材料补片具有抗粘连、切口疝发生率低等优点，可在腹壁肿瘤切除术后遗留巨大腹壁缺损的修补手术中加以应用。     

无张力疝修补术中网塞和补片的安放与固定

目的 探讨在无张力疝修补术中正确安放、固定网寒和补片的方法.方法 回顾性分析123例疝环充填式无张力疝修补术患者网塞和补片的安放与固定技术.观察术后积液、感染、窦道形成、皮瓣坏死、疝复发的发生率.结果 123例患者术后8 d均恢复.随访1.5～10.0年,均无切口积液、感染、皮瓣坏死,手术侧无复发,未手术侧发生腹股沟疝5例.结论 网塞和补片安放要覆盖整个腹壁缺损区,与缺损周围健康组织充分密切接触,安放平整,对正常组织结构不形成损害.固定要牢靠、持久.     

无张力疝修补术26例体会

无张力疝修补术是近年来开展的新技术,1997年起逐步在国内推广[1]。其具有符合人体解剖结构、创伤小、恢复快、复发率低等优点,目前已成为腹股沟疝修补的首选方法,我院2001年5月～2004年12月采用无张力疝修补术治疗腹股沟疝26例,报道如下。一、资料与方法1.一般资料:本组26例患者均为男性,年龄45～82岁。其中腹股沟斜疝19例,腹股沟直疝7例。2.手术方法:26例患者均采用连续硬膜外麻醉。疝环填充式无张力修补术采用网塞补片装置,由圆锥型充填网塞和成型补片组成,修补材料为聚丙烯单丝编织而成。采用疝环填充式手术,手术切口同疝修补切口,如疝…     

腹腔镜修补腹壁巨大切口疝11例治疗体会

腹壁切口疝是指腹部手术切口愈合不良而导致的疝,为外科腹部手术后常见并发症,据有关报道的发生率为2%～11%[1],腹壁切口疝好发于老年人,不能自行愈合,需手术治疗。传统有张力修补复发率高达30%～50%,应用修补材料进行无张力修补后复发率明显降低,     

腹腔镜下腹壁切口疝的治疗及并发症的防治(综述)

腹腔镜腹壁切口疝修补手术与开腹腹壁切口疝手术相比复发率更低,腹腔镜下腹壁切口疝修补可以使术后复发率进一步减低到2%左右。本文就腹腔镜下腹壁切口疝的治疗及并发症防治的文献资料,予以综述。     

碳化纤维丝网修补腹壁缺损的实验研究及临床应用

本组选用健康犬１０只，随机分两组，一组用碳化纤维丝网修补腹壁缺损，一组用涤纶网修补腹壁缺损。术后观察此两种人造网织品对伤口局部的影响。结果表明：碳化纤维丝网在受体内物理及生化性能稳定，抗拉强度，抗疲劳，抗磨损力高，柔韧性佳，可以为机体所耐受，无数敏反应及毒性作用，并可以刺激局部胶原纤维的再生，无免疫排斥反应。临床应用３例修补腹壁巨大缺损，效果良好。说明碳化纤维丝网是修补腹壁缺损的良好人造网织品材料。     

The use of prosthetics in hernia repair

Since the early 19th century different prostheses have been tried and tested to prevent recurrences after hernia repairs. This article reviews the evolution of prostheses and their use in hernia surgery. Tension-free mesh hernia repairs using polypropylene fibre seems to be associated with very low recurrence rates and minimal complications.     

The use of dermal autograft for fascial repair of TRAM flap donor sites

Closure of fascia after transverse rectus abdominis myocutaneous (TRAM) flap has usually been performed with direct closure or synthetic material. The dermal autograft removed from zone IV of the flap is an alternative to reinforce fascial closure. Record of the patients who had been undergone breast and head and neck reconstruction by TRAM flap between 1998-2008 were retrieved. In 34 cases dermal autograft and in 42 cases a synthetic mesh was used for closure of the abdominal fascial defect. All patients were followed by physical examinations for a mean period of 24 months. There were one (2.9%) bulging of the anterior abdominal wall and one (2.9%) wound infection in dermal autograft group and one (2.3%) true hernia in mesh repair group. Dermal autograft is a useful alternative to mesh repair of fascial defects after TRAM flap harvest.     

A giant pseudocyst following repair of an incisional hernia by a propylene mesh

A 79-year-old woman presented with a huge, asymptomatic, balloon-like abdomen, which gradually developed after polypropylene mesh repair of an incisional hernia following a median laparotomy. Additional CT showed a huge cyst measuring 20 x 24 cm which seemed to originate from the anterior abdominal wall and lacked communication with the inner abdominal space. Subsequently an explorative laparotomy was performed. The content of the cyst consisted of dark brown serosanguineous material. The inferior portion was firmly affixed to the mesh. The entire cyst, except for the part fixed to the mesh, was excised followed by an abdominoplasty. Histological examination showed aspecific signs of inflammation due to a foreign body, and haemorrhagic material without epithelial lining. The diagnosis 'giant pseudocyst' was established. Etiologically, this condition is probably related to postoperative formation of a seroma, which is a well-known complication after mesh repair, especially when a polypropylene mesh is used. Postoperative formation of a haematoma might be a causative factor as well. Former literature reports 11 cases of such giant cyst formation after mesh repair ofhernias. In one study a prevalence of 0.45% is mentioned. This complication may be an underreported phenomenon.     

Handlebar hernia: a rare type of abdominal wall hernia

Traumatic abdominal wall hernias are a type of acquired hernia secondary to blunt trauma Caused, by direct trauma from handlebar like objects. This rare hernia is named 'Handlebar hernia'. We report a case of such hernia without any significant intra-abdominal injury. The abdominal wall defect was repaired in layers by Jones technique. Postoperative course was uneventful. The authors recommend clinical suspicion for traumatic hernia in all patients with traumatic abdominal wall injury. Definitive treatment includes surgical exploration with primary repair of all tissue layers of the abdominal wall.     

Cost comparison of fibrin sealant versus tack screws for mesh fixation in laparoscopic repair of inguinal hernia

ABSTRACT

Objectives: Inguinal hernias of the abdominal wall are common accounting for 75% of all hernia defects. They can be treated with laparoscopic surgery using a transabdominal preperitoneal (TAPP) approach. However, in surgery there is some contention on how to conclude the hernia repair, as there are alternatives of using fibrin sealant (FS) or tack screws for fixation of a mesh implant over the defect in the abdominal wall. In this study, we evaluate the economic consequences of using FS vs. tacks for mesh fixation in TAPP inguinal hernia repair for the UK from a hospital perspective.

Methods: The model was populated with clinical inputs (theater time, hospitalization days, occurrence of seroma, and neuralgia) from a previously conducted study comparing FS and tack screws in patients who had undergone TAPP hernia repair, and cost inputs from official government sources. One-way sensitivity analyses were also conducted to evaluate key drivers of cost analyses.

Results: The average cost per case treated with FS 2 mL Tisseel® and tack screws (ProTack^TM) was £1,098 and £1,348, respectively, for resource expenses paid by the healthcare system. This would suggest a potential savings achieved of £249 per surgery using FS for mesh fixation. The sensitivity analysis showed that the key drivers for the cost difference were a variation in time to complete the surgery, followed by hospitalization days, and lower adverse outcomes such as seroma and neuralgia in the two cohorts.

Conclusion: Using FS resulted in cost savings in hospitals based on reduced time to complete surgery, hospitalization time post-op, and lower adverse outcomes. Indirect cost savings were also found in favor of FS when comparing the two alternatives from a societal perspective, as patients were able to return to work more promptly in the FS group versus the tack screws group.     

Surgical treatment for incisional hernias

BACKGROUND: A great variety of surgical techniques have been proposed to repair large abdominal incisional hernias, but the best results are achieved using synthetic grafts as in the Rives' or Ramirez' procedure. METHODS: During the period September 1993-May 2001, a total of 145 patients, 54 males and 91 females, mean age 52 (range 16-88) with large incisional hernia were observed. Ninety-two hernias were bigger than 10 cm. The average follow-up was 3 years (1-72 months). All successfully underwent surgery using the following techniques: 19 (13.1%) simple fascial sutures, 68 (46.9%) implants of retromuscolar polypropylene grafts (Rives' or Ramirez' technique), 24 (16.5%) subcutaneous meshes, 17 (11.7%) preperitoneal meshes (14 polypropylene, 2 glycolic acid, 1 Goretex), 4 (2.75%) intraperitoneal implants of polypropylene meshes, 13 (9.05%) intraperitoneal glycolic acid grafts plus retromuscular polypropylene graft. RESULTS: One patient died in postoperative for heart failure. Morbidity was 8 subcutaneous hemorrhagic suffusions, 10 seromas which were resolved by repeated percutaneous drainage, 4 suppurating wounds that did not require graft removal, 2 little recurrences treated by a new mesh repair under local anaesthesia, 2 sinus for mesh intollerance and 1 fistula requiring a new intervention. CONCLUSIONS: In this report we discuss the tolerability and reliability of mesh repair, especially in Rives' and Ramirez' technique.     

聚苯烯网片无张力疝修补术在股疝中的应用

目的探讨聚苯烯网片无张力疝修补术治疗股疝在基层医院的应用。方法 58例股疝患者采用国产聚苯烯网片行无张力疝修补术。结果 58例均手术顺利,2例术后伤口液化感染,术后随访6~24个月均无复发。结论聚苯烯网片无张力疝修补术治疗股疝在基层医院适合推广,操作简单,费用较低。     

腹股沟疝的手术治疗进展

临床中将下腹壁与大腿交界的三角区称作腹股沟区,腹腔内脏器通过腹股沟区缺损部位向体表突出所形成的包块即为腹股沟疝,俗称为“疝气”.腹股沟疝是临床中常见的男性普外科疾病,女性患者较少.腹股沟疝发病率在1％～5％,发病后患者会感到剧烈疼痛、活动受限且运动或咳嗽后症状加重,若病情迁延可继发引起感染性休克、全身性感染等严重并发症...