老年腹股沟疝无张力修补术与传统修补术的比较

目的 比较无张力腹股沟疝修补术与传统腹股沟疝修补术在老年患者中应用的临床结果、术后生活质量和经济开支。方法 自2000～2001年60岁以上的老年患者42例行腹股沟疝无张力修补术与42例行传统腹股沟疝修补术者，分类比较。结果　无张力腹股沟疝修补术对于老年患者在复发率、术后镇痛、手术时间和术后下地时间方面均明显优于传统腹股沟疝修补术。结论　无张力腹股沟疝修补术运用在老年患者中，近远期效果均优于传统修补手术。     

膨化聚四氟乙烯平片在无张力腹股沟疝修补术的临床应用

目的 探讨平片在腹股沟疝无张力疝修补术中的应用。方法 对我科2003年10-2006年10月收冶的125例腹股沟疝患者采用平片无张力腹股沟疝修补术的疗效进行回顾性分析。结果 所有患者均治愈出院，术后无切口感染，除2例残留疝囊处血肿外无其他不良并发症，随访2个月～36月无复发。结论 平片应用于腹股沟疝的修补，具有易掌握，疗效好，费用低，值得广泛开展应用。     

Laparoscopic repair of recurrent childhood inguinal hernias after open herniotomy

Background Open repair of recurrent paediatric inguinal hernias (IH) is difficult and there is definite risk of damaging the vas deferens and testicular vessels during dissection of the previous open herniotomy field. Laparoscopic repair (LR) has the benefit of avoiding the previous operative site. Method Records of patients with recurrent IH that had LR after open repair were reviewed and evaluated retrospectively. The results were compared with data from cases in which the LR method was used in the initial IH repair. Results From September 2002 to October 2005, four boys and one girl (mean age 58.8 months) were treated in our institution for recurrent IH after open repair. Operative time, success rate and complications did not show any statistically significant difference when compared with our previous prospectively collected data for primary repairs. Conclusion Laparoscopic repair is the preferred operation for recurrent childhood IH after open repair.     

Criteria for conservative treatment of supratentorial acute subdural haematomas

Summary In this report we describe 3 patients with syringomyelia in association with tumours of the posterior fossa. In each patient the syrinx was demonstrated on pre-operative magnetic resonance imaging (MRI). After total or partial removal of the tumour the syrinx collapsed. It is concluded that the pathogenesis of syrinx formation in this entity requires interference with normal cerebrospinal fluid (CSF) flow at the foramen magnum. We suggest that the obstruction to the flow of CSF causes alterations in the passage of extracellular fluid (ECF) in the spinal cord which lead to syringomyelia.     

Open mesh versus non-mesh repair of groin hernia meta-analysis of randomized trials leased on individual patient data

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     

Preliminary experience with new bioactive prosthetic material for repair of hernias in infected fields

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     

Blood gas and ventilatory parameters in predicting survival in congenital diaphragmatic hernia

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.     

神经根变异与特殊型椎间盘突出症

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。     

Long-term result and current status of the Lichtenstein open tension-free hernioplasty

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.