精细化护理干预在腹腔镜食管裂孔疝修补术护理配合中的作用

ObjectiveTo explore the role of fine nursing in laparoscopic repair of hiatal hernia. Methods the clinical data of 300 patients who underwent laparoscopic esophageal hiatus repair in the operating room of people's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019 were retrospectively analyzed. Methods150 cases of patients with laparoscopic hiatal hernia repair from January to December 2018 were selected as the control group, and 150 cases from January to December 2019 were selected as the experimental group. The operation nursing cooperation of the experimental group was treated with fine nursing, while the control group was treated with conventional management methods. The occurrence of intraoperative complications, operating room efficiency, patient satisfaction and physician satisfaction of the two groups before and after the implementation were compared It's a matter of intention. The measurement data were expressed as mean ± standard deviation (±s) by t test, and the count data were expressed as percentage (%) by chi square test. Resultsthe incidence of intraoperative pressure injury, hypothermia, deep venous thrombosis and other complications in the experimental group was lower than that in the control group, and the difference was statistically significant (χ²=4.147, 4.253, 4.124; P＜0.05). The turnover time, preparation time and operation time of the experimental group were shorter than those of the control group (F=69.437, 48.394; P＜0.05). The difference of satisfaction between the two groups was statistically significant (χ²=4.353, P＜0.05). There was a significant difference in the satisfaction of the two groups (χ²=0.605, P＜0.05). Conclusionthe application of fine nursing intervention in laparoscopic hiatal hernia repair has obvious effect, which is worthy of promotion.     

食管裂孔疝抗反流术保留迷走神经对术后复发风险影响的Meta分析

目的分析比较食管裂孔疝抗反流手术中迷走神经切断与保留对减少术后复发风险的影响。 方法检索Pubmed、Web of Science、Embase、ScienceDirect、ovid、CNKI数据库,检索建库至2019年9月,有关食管裂孔疝术中切断迷走神与保留迷走神经的临床研究,进行文献筛选、资料提取及质量评估,使用Cochrane5.1.0系统评价手册进行Meta分析。根据Cochrane循证医学指南的建议,二分类数据（食管裂孔疝复发与否）表示为比值比（odds ratio,OR）和95%可信区间。合并效应量的统计推断采用Z检验,以P＜0.05为差异有统计学意义。纳入研究结果间的异质性统计推断采用Q检验计算I²,如果I²＜50%,并且P＞0.1,则说明合并不存在异质性,采用固定效应模型进行合并,反之则用随机效应模型进行合并。明显的临床异质性采用亚组分析或敏感性分析等方法进行处理。 结果共纳入11项回顾性对照研究,根据术后食管裂孔疝复发的诊断方式将各研究分为解剖复发组和临床复发组。解剖复发组中,迷走神经切断430例,迷走神经保留383例;迷走神经切断复发风险大于迷走神经保留组（P＜0.05）,相对危险度为1.96,95%可信区间（CI）=1.45~2.64。临床复发组中,迷走神经切断337例,迷走神经保留420例;迷走神经切断复发风险大于迷走神经保留（P＜0.05）。合并组分析显示,迷走神经切断术后复发风险大于迷走神经保留,相对危险度为1.78,95%可信区间（CI）=1.42~2.24,差异具有统计学意义（P＜0.05）。 结论抗反流术中保留迷走神经对减少食管裂孔疝术后复发可能具有积极意义,还需进一步临床试验进行验证。     

Morgagni hernia with respiratory failure aggravated by noninvasive positive pressure ventilation: A case report and overview of the literature

An elderly woman diagnosed with multiple myeloma (MM) in 2007 had improved with chemotherapy. She had severe kyphosis and a diaphragmatic hernia (DH), but no respiratory symptoms. In 2011, because of thoracic deformity and emaciation, we advised her to continue the previously prescribed domiciliary noninvasive positive pressure ventilation (NPPV) therapy for chronic type II respiratory failure. However, she refused to continue NPPV. She was later admitted for deterioration in respiratory status and carbon dioxide (CO₂) narcosis. We believed her low adherence to domiciliary NPPV caused CO₂ narcosis; hence, we advised her to continue domiciliary NPPV and she complied. In May 2012, the now 79-year-old patient was admitted for acute exacerbation of chronic respiratory failure and CO₂ narcosis. Chest imaging suggested that DH had caused a deterioration of her status. She underwent laparoscopic diaphragmatic hernia repair. Operative findings revealed a retrosternal hernia sac, and she was diagnosed as having a Morgagni hernia (MH). Her respiratory status subsequently improved. We hypothesize that NPPV increased intra-abdominal pressure, thereby worsening the MH and exacerbating respiratory failure. We believe that clinicians should be cautious when prescribing NPPV for MH patients.     

Transabdominal preperitoneal versus totally extraperitoneal repair of inguinal hernia: a meta-analysis of randomized studies

Background

The aim of the present study was to comparatively evaluate the outcomes of laparoscopic transabdominal preperitoneal inguinal hernia repair and totally extraperitoneal repair.

Methods

The electronic databases of Medline, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, and a meta-analysis of randomized clinical trials was undertaken.

Results

Seven studies comprising 516 patients with 538 inguinal hernia defects were identified. A shorter recovery time (P = .02) was found for totally extraperitoneal repair in comparison with transabdominal preperitoneal inguinal hernia repair (weighted mean difference = −.29; 95% confidence interval [CI], −.71 to .07) although the length of hospitalization (P = .89) was similar in the 2 treatment arms (weighted mean difference = .01; 95% CI, −.13 to .15). Operative morbidity (P = .004) was higher for the preperitoneal approach (odds ratio = 2.15; 95% CI, 1.29 to 3.61). No differences were found with regard to the incidence of recurrence, long-term neuralgia, and operative time.

Conclusions

Current evidence suggests similar operative results for endoscopic and laparoscopic inguinal hernia repair, with a trend toward higher morbidity for the preperitoneal approach. Randomized trials with a longer-term follow-up are needed in order to assess the effect of each approach on the prevention of recurrence.     

An Unusual Finding in the Follow-Up of a Transabdominal Pre-Peritoneal (TAPP) Implanted Mesh for Inguinal Hernia

Background: Abnormalities around titanium stapled sites are not well described in the literature. Existence

of staple granulomas or neoplasms on titanium stapled sites used in TAPP procedures is unknown.

Case: We report a case in which differentiation of suspected staple granuloma or neoplasm around a titanium staple,

used to secure the mesh in a TAPP procedure, could not be made other than by pathologic examination.

Conclusion: This case emphasises that although the appearance of the lesion may be suspected for staple granuloma,

the possibility of a malignant neoplasm should always be considered.     

First 24-h SNAP-II score and highest PaCO2 predict the need for ECMO in congenital diaphragmatic hernia

Background/Purpose

Early clinical predictors for the use of ECMO in patients with congenital diaphragmatic hernia (CDH) are lacking. We sought to evaluate the first 24-h SNAP-II score and highest PaCO₂ as predictors of ECMO support and in-hospital mortality in neonates with CDH.

Methods

Retrospective review of 47 consecutive neonates with CDH admitted to our institution from January 2007 to December 2010 was performed. Covariates of ECMO use including SNAP-II score and highest PaCO₂ within the first 24 h of NICU admission were evaluated.

Results

Of the 47 infants in this study, 24 patients were supported with ECMO. The ECMO group had a higher incidence of pulmonary hypertension, higher PaCO₂, and higher 24-h SNAP-II scores. Only the SNAP-II score and not highest PaCO₂ predicted mortality following multivariate adjustment.

Conclusions

The first 24-h SNAP-II score and highest PaCO₂ may provide some prognostic value in identifying neonates who undergo ECMO support; however neither measure was independently associated with the use of therapy. Only the SNAP-II score was associated with in-hospital mortality following multivariate adjustment. Additional study is needed to validate these results in a larger data set.