彩色多普勒超声诊断先天性膈疝的产前分析

目的：探讨先天性膈疝的产前超声表现。材料和方法：回顾性分析6例先天性膈疝胎儿声像图表现特征,并与病理结果相对照。结果：左侧膈疝5例,右侧膈疝1例,其中2例伴有其它复杂畸形。超声显示胎心、纵隔受压移位,心轴偏移明显。疝入器官见有胃泡、肠管、肝脏,胎儿呼吸样运动可致疝入器官运动幅度增加。结论：先天性膈疝的特征性声像图表现,可作为诊断的重要依据。     

全腹膜外补片植入术中补片不固定的实验研究

目的评价全腹膜外补片植入术中补片不固定的安全性和有效性。方法将50只SD大鼠建立疝缺损(3cm2)模型,按随机数字表分为2组,使用聚丙烯补片(12 cm2)采用腹膜外补片植入术进行修复。甲组为补片固定组,乙组为补片不固定组。大鼠于术后不同时间分批处死,记录补片的挛缩度、腹壁抗张强度以及组织细胞学变化。结果所有大鼠术后腹腔均无粘连。2组大鼠在术后7 d、14 d、30 d、60 d和90 d补片的挛缩度分别为6.7%±1.3%vs 7.3%±1.5%、12.3%±1.3%vs 12.4%±1.6%、14.0%±2.0%vs 14.5%±1.3%、17.4%±2.1%vs 18.4%±1.5%和18.9%±2.2%vs19.5%±2.6%(P>0.05);2组大鼠的腹壁抗张强度分别为(288.4±8.4)mm Hg vs(286.6±10.2)mm Hg、(300.4±11.2)mm Hg vs(298.8±11.4)mm Hg、(305.0±11.7)mm Hg vs(303.3±16.1)mm Hg、(309.0±10.8)mm Hg vs(307.6±8.9)mm Hg和(311.8±9.8)mm Hg vs(310.0±8.6)mm Hg(P>0.05);2组大鼠的组织细胞学变化一致。结论当补片面积是大鼠疝缺损的4倍以上时,不固定的腹膜外补片植入术是安全有效的。     

Decision analysis model of incisional hernia after open abdominal surgery

Background The incidence rate of incisional hernias after open surgery has been reported to be higher than that of port site hernias after laparoscopic surgery. No studies have compared the costs for the health care system in treating those two types of hernia. Methods A systematic review was conducted to obtain the baseline data, and a decision analysis model was created to simulate the occurrence and recurrence of incisional and port site hernias. Results The overall risk of having incisional hernias was eight-times higher than that of having port site hernias (7.4% vs 0.9%). A cost savings of ￡93 per patient can be generated for the health care system in the UK. Similar results were obtained for Germany, Italy and France. Conclusions The additional treatment costs for incisional hernia should be taken into account when the costs of a surgery performed by open approach are compared with by laparoscopy.     

Inguinal hernia is a common complication in lower midline incision surgery

Inguinal hernia is a known complication after radical retropubic prostatectomy (RRP). We have investigated whether other types of lower midline incision surgery in males increase the risk of inguinal hernia. Male patients operated with open prostatectomy for benign prostate hyperplasia (n = 95), pelvic lymph node dissection for staging of prostate cancer (n = 88), or cystectomy for bladder cancer (n = 76) were identified and were sent questionnaires in which they were asked about postoperative inguinal hernia morbidity. Two-hundred and seventy-one men operated with RRP had previously received a similar questionnaire. The answers were compared with those from a control group of 953 men who had not undergone surgery. Annual attributional hernia morbidity and Kaplan–Meier hernia-free survival were calculated. The cumulative incidence of post-operative inguinal hernia and annual attributional hernia morbidity after the respective surgical procedures were clearly higher during the early years post-operation than for nonoperated patients. Inguinal hernia is a common postoperative complication in males after all the lower midline incision surgery investigated.     

刃厚皮片联合微型带真皮下血管网全厚皮片修复截瘫褥疮

目的：应用刃厚皮片联合微型真皮下血管网全厚皮片修复截瘫褥疮。方法：对6例截瘫褥疮，增强全身支持治疗，彻底清除褥疮的炎性肉芽组织及坏死组织后，采用刃厚皮片联合微型真皮下血管网全厚皮片修复．结果：5例Ⅰ期愈合，1例Ⅱ期愈合。结论：本法操作简单，愈合较快，具有一定的耐磨性，为进一步皮瓣修复奠定了基础，是修复难治性截瘫褥疮较理想的方法．     

Internal Hernias: Clinical Findings,Management, and Outcomes in 49 Nonbariatric Cases

Internal hernia, the protrusion of a viscus through a peritoneal or mesenteric aperture, is a rare cause of small bowel obstruction. We report the clinical presentation, surgical management, and outcomes of one of the largest series of nonbariatric internal hernias. Ten-year retrospective review of patients at our institution yielded 49 cases of internal hernias. Majority of patients presented with symptoms of acute (75%) or intermittent (22%) small bowel obstruction. While 16% of CT scans were suspicious for internal hernia, in no cases the preoperative diagnosis of internal hernia was made. The most frequent internal hernias were transmesenteric (57.0%) and 34 hernias (69%) were caused by previous surgery. All internal hernias were reduced and the defects were repaired. Compromised bowel was present in 22 cases and 11 patients underwent small bowel resection. The mean postoperative hospitalization was 10.9 days. The overall mortality rate from our series is 2%, and the morbidity rate is 12%. Transmesenteric hernias, as complications of previous surgeries, are the most prevalent internal hernias. Preoperative diagnosis of internal hernia is extremely difficult because of the nonspecific clinical presentation. However, if discovered promptly, internal hernias can be repaired with acceptable morbidity and mortality. Poster presentation at Digestive Disease Week, May 22, 2006, Los Angeles, California, USA.     

膝以下严重开放性创伤的修复

[目的]研究膝以下严重开放性创伤的修复。[方法]自1995年3月～2005年3月收治膝以下严重开放性损伤153例，Ⅰ期修复106例，Ⅱ期修复47例，7种内固定方法，11种皮瓣修复方法。[结果]153例中随访132例，时间6个月～5年，平均17个月，术后功能优良率85．7％，皮瓣成活率良好。皮瓣局部坏死25例，骨不连4例，慢性感染8例，骨髓炎3例。[结论]改进的腓肠神经营养血管皮瓣和皮瓣桥手术扩大了皮瓣的应用范围，减少了并发症的发生。本研究为膝以下严重开放性损伤的修复提供了良好的方法；熟练的显微外科技术和各种组织瓣的合理应用是修复成功的关键。     

两种阴道缩窄术矫正阴道松弛症的疗效分析

目的探讨改良阴道后壁修补术和阴道后壁环肌紧缩术的手术要点和效果,评价两种手术的优点及适应证。方法将42例不同程度阴道松弛的患者分为两组,其中24例行改良阴道后壁修补术,18例行阴道后壁环肌紧缩术,分析观察两组患者手术时间、术中出血量、术后伤口愈合情况,1年后评价两组患者的性生活满意度及阴道的松紧度。结果两种手术方法的手术时间、术中出血量及术后伤口愈合情况无明显差异,但1年后的远期效果包括性生活满意度和阴道的松紧度有明显差异。结论矫正阴道松弛症的目的不仅要达到解剖的恢复,更重要的是恢复功能。要根据患者的实际情况选择最佳的手术方法(A组优于B组)。     

Mesh fixation with human fibrin glue (Tissucol) in open tension-free inguinal hernia repair: a preliminary report

Background: The Lichtenstein technique for inguinal hernia repair is easy to learn and associated with few complications. However, recent studies have suggested that this technique is inferior to some ‘sutureless’ repair systems in terms of perceived difficulty, operating time, surgeon satisfaction, etc. Methods: We employed a sutureless Lichtenstein technique in 80 consecutive patients with primary unilateral inguinal hernia, to assess patient and trainee surgeon outcomes. Human fibrin glue was used in place of conventional sutures. Results: The mean operating time was 36 min and all patients were discharged 5–6 h after the operation. On a 100-point visual analogue scale, the surgeons rated the difficulty of the operation as low (mean score, 31), and perceived satisfaction as high (mean score, 84). No complications were observed at 12-month follow-up. Conclusion: This study confirms the efficacy of mesh fixation with human fibrin glue, and supports the viability of a sutureless Lichtenstein procedure.     

Exacerbation of occult femoral hernia during laparoscopic prostatectomy.

Laparoscopic prostatectomy has been accepted as an appropriate treatment for prostate cancer because of the shorter hospital stay and quicker recovery. We present a rare complication of groin hernia with incarceration and necrosis of small bowel following laparoscopic prostatectomy. Occult hernias and small fascia defects may not always be apparent pre-operatively, but extension of pneumoperitoneal insufflation to extraperitoneal compartments should alert the surgeon to the possible presence of such a defect.