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51.
52.
Open mesh versus non-mesh repair of groin hernia meta-analysis of randomized trials leased on individual patient data 总被引:1,自引:1,他引:0
Abstract
Background. The EU Hernia Trialists Collaboration was established to provide reliable evaluation of newer methods of groin hernia repair.
It involved 70 investigators in 20 countries.
Materials and methods. Twenty eligible trials (5016 participants) of open mesh vs. non-mesh groin hernia repair were identified. Meta-analysis was
performed using raw individual patient data where possible.
Results. Fewer hernia recurrences were reported after mesh repair. There were no clear differences between mesh and non-mesh groups
in complications. Overall, those in the mesh groups had a shorter hospital stay, quicker return to usual activities and less
frequent persisting pain, but individual trial results varied.
Conclusions. The review provides strong evidence that open mesh repair is associated with a reduction in the risk of recurrence of between
50% and 75%. There is also some evidence of quicker recovery and of lower rates of persisting pain following open mesh repair.
Electronic Publication 相似文献
53.
Preliminary experience with new bioactive prosthetic material for repair of hernias in infected fields 总被引:15,自引:5,他引:10
Surgisis (Cook Surgical, Bloomington, Ind., USA) is a new four-ply bioactive, prosthetic mesh for hernia repair derived from
porcine small-intestinal submucosa. It is a naturally occurring extracellular matrix which is easily absorbed, supports early
and abundant new vessel growth, and serves as a template for the constructive remodeling of many tissues. As such, we believe
that Surgisis mesh is ideal for use in contaminated or potentially contaminated fields in which ventral, incisional, or inguinal
hernia repairs are required. From November 2000 through May 2002, 25 patients (11 male, 14 female) underwent placement of
Surgisis mesh for a variety of different hernia repairs. A total of 25 hernia repairs were performed in our patient population.
Fourteen procedures (56%) were performed in a potentially contaminated setting (i.e. with incarcerated/strangulated bowel
within the hernia or coincident with a laparoscopic cholecystectomy/colectomy). Eleven repairs (44%) were performed in a grossly
contaminated field, including one in which an infected polypropylene mesh from a previous inguinal hernia repair was replaced
with Surgisis and one in which necrotic bowel was discovered within the hernial sac. Median follow-up was 15 months with a
range of 1–20 months. Of the 25 total repairs, there was one wound infection complicated by enterocutaneous fistula in a patient
originally operated on for ischemic bowel. The fistula was in a location independent of the Surgisis mesh. There were no mesh-related
complications or recurrent hernias in our early postoperative follow-up period. Surgisis mesh appears to be a promising new
prosthetic material for hernia repair, especially in contaminated or potentially contaminated fields. Obviously, long-term
follow-up is still required.
Electronic Publication 相似文献
54.
Desmond Bohn 《Pediatric surgery international》1987,2(6):336-340
Blood gas analysis can be used to reliably predict outcome in infants with congenital diaphragmatic hernia (CDH) both before and after surgical repair, providing these values are indexed to some measurement of alveolar ventilation. Until recently there has been difficulty in interpreting some of the published data because of differing sampling sites and the fact that ventilatory parameters, which have major influences on all blood gas values in this anomaly, were not included. Application of this information enables us to identify infants with similar degrees of severity of CDH in order to evaluate the efficacy of novel forms of therapy and to determine whether they represent a genuine advance in management where more conventional forms of treatment have failed. 相似文献
55.
回顾5例由于神经根变异或特殊类型椎间盘突出引起的腰腿痛病人,对其病理及术中处理做了介绍,认为由于神经根的解剖变异,更容易受到椎间盘突出的卡压。手术中如临床症状符合椎间盘突出症,而预定探查间隙未发现突出物,或与临床症状不符者,应根据神经根激惹及松紧程度,扩大探查范围,查明造成疼痛的原因,避免二次手术。 相似文献
56.
Long-term result and current status of the Lichtenstein open tension-free hernioplasty 总被引:12,自引:6,他引:6
Summary The tension-free hernioplasty project began in 1984 at the Lichtenstein Hernia Institute. The method consists of complete reinforcement of the inguinal floor with a large sheet of mesh, with adequate mesh tissue interface beyond the boundary of the inguinal floor and creation of a new internal ring made of prosthesis. The preliminary report of this operation was published in 1989, with no recurrence at that point in time. Shortly after the submission of the report, several recurrences were encountered. Based on the lesson learned from those recurrences, the operation was slightly modified and reported in 1991 [Amid 1993]. Since then, the Lichtenstein technique has gained world-wide popularity. Outcome measures identical to ours and other authors have been achieved by even those surgeons who have no special interest or expertise in herniology. The purpose of this article is to report the current state of the open tension-free hernioplasty for the repair of primary and recurrent inguinal hernias. 相似文献
57.
Cassio V. Penteado 《Surgical and radiologic anatomy : SRA》1983,5(2):125-127
Summary An anatomical study of the superficial and deep circumflex iliac arteries in 43 formalin-fixed cadavers is presented. The origin, calibre, course, branches, symmetry and variations of the vessels are pointed out as well as their special features related to surgical applications.
Etude anatomochirurgicale des artères circonflexes iliaques superficielle et profonde: bases anatomiques de la confection du lambeau libre iliaque composé cutanéo-osseux
Résumé Une étude anatomique des artères circonflexes iliaque superficielle et profonde est effectuée sur 43 cadavres formulés. L'origine, le calibre, le trajet, les branches, la symétrie et les variations des vaisseaux sont mis en évidence ainsi que leurs caractères particuliers en vue d'une application chirurgicale.相似文献
58.
M. E. De Paepe Konstantinos Papadakis Brian D. Johnson Francois I. Luks 《Virchows Archiv : an international journal of pathology》1998,432(1):7-16
Tracheal occlusion in utero has been shown to cause accelerated fetal lung growth and is now being considered as a therapeutic
modality for pulmonary hypoplasia. We report the effects of tracheal ligation on the surfactant-producing type II pneumocyte
population. Three groups of fetal lambs underwent tracheal ligation of 2 weeks’, 4 weeks’ and 6 weeks’ duration, respectively,
and all were sacrificed at 136 days’ gestation (9 days pre-term). Nonoperated twins served as controls. The type II pneumocyte
population was studied morphometrically using a combination of anti-surfactant protein B immunohistochemistry and computer-assisted
stereologic morphometry at light and electron microscopic levels. Single-factor ANOVA was used for statistical analysis. Two
weeks of tracheal ligation resulted in doubling of the total lung volume as a result of airspace distension and, to lesser
extent, growth of the tissue compartment. With increasing duration of tracheal ligation, there was no additional lung growth.
However, more prolonged tracheal occlusion was found to result in significant reduction of the surfactant system, as reflected
in the marked decrease of total pneumocyte type II volume (3.14 cm3, 0.95 cm3, and 0.46 cm3, after 2, 4, and 6 weeks of ligation, compared with 5.96 cm3 for controls) and total pneumocyte type II number (13.9 × 109, 3.8 × 109, and 2.4 × 109, compared with 53.2 × 109 for controls). Ultrastructural analysis of the type II cells in obstructed lungs showed vacuolar degenerative changes that,
after 6 weeks of ligation, were apparently irreversible. In utero tracheal ligation causes fetal lung hyperplasia, but results
in reduction of and injury to the surfactant-producing cell population. Before tracheal occlusion can find widespread clinical
application, its pathophysiology needs to be further elucidated.
Received: 30 April 1997 / Accepted: 10 July 1997 相似文献
59.
Respiratory failure from pulmonary hypoplasia continues to be the major cause of death in newborn infants with diaphragmatic hernia. Recent investigations have suggested that postnatally induced pulmonary injury can result from excessive positive or negative intrathoracic pressure and contribute to the respiratory deterioration. Therefore, the method of thoracic drainage on the side of the diaphragmatic hernia is critical in controlling and maintaining normal intrathoracic pressure in both intrathoracic spaces. No chest tube or an ipsilateral chest tube connected to water seal, can result in either excessive negative or positive intrathoracic pressure and, therefore, both methods should be avoided. Recently, we employed a "balanced" intrathoracic drainage system which maintains the ipsilateral intrathoracic pressure within the normal physiologic range of +2 to -8 cm H2O regardless of the degree of pulmonary hypoplasia, presence of an ipsilateral pulmonary air leak, straining by the infant, or mechanical ventilation. This system is simple, requires no suction apparatus, and is easily assembled with equipment readily available within the hospital. This technique has been utilized in 18 newborn infants with diaphragmatic hernia and pulmonary hypoplasia. There have been no complications which specifically could be related to the balanced drainage system. 相似文献
60.
目的:探讨腰椎间盘突出症合并神经根管狭窄的临床诊断和手术治疗。方法:对1996-1999年间,因腰椎间盘突出症合并神经根管狭窄38例行手术治疗,术中均行神经根管探查并彻底松解受压神经根。结果:术后随访38例,优20例,良15例,一般2例,差1例,优良率92.11%。结论:神经根管扩大和神经根探查彻底减压是手术成功的关键。 相似文献