幼龄大鼠颅骨缺损及钛网修补后对其颅骨生长和智力发育的影响

目的:针对目前小儿颅骨缺损的多种治疗观念及课题组前期研究提出的“滑行理论”,利用幼龄SD大鼠模型探究颅骨缺损及钛网修补后对其颅骨生长和智力发育的影响。方法:将3周幼龄SD大鼠随机分成假手术对照组(SOC)、颅骨缺损组(SD)和钛网修补组(TMR),术前排除组间差异,术后同环境下饲养至性成熟进行旷场实验和Morris水迷宫实验后处死,测量体质量、颅骨径线、颅骨厚度、缺损内径和脑容积等指标。结果:术前体质量及颅骨径线显示三组间差异无统计学意义(P>0.05),具有可比性;性成熟时体质量、颅骨径线、脑容积三组间均无差异(P>0.05),仅SOC组平均颅骨厚度较大(P<0.05);缺损内径方面SD组与TMR组无差异(P>0.05),且与术前相比均呈狭长形变;旷场实验中总路程、平均速度和静止时间及部分区域数据方面SD组与其他组有差异(P<0.05);Morris水迷宫实验显示第5天逃避潜伏期、首次穿越平台时间和目标象限时间占比等SD组与其他组均有差异(P<0.05)。结论:颅骨缺损未行修补对幼龄大鼠颅骨的正常生长无明显影响,但可能影响其智力发育;钛网修补并不会...     

Management of mesh complications and vaginal constriction: a urogynecology perspective

Once thought of as a long-term solution to pelvic organ prolapse, currently synthetic mesh augmentation is regarded as a dark area that is being critically assessed by surgeons, hospitals, industry, and most importantly the Food and Drug Administration. The development of midurethral sling kits has revolutionized the surgical treatment of stress incontinence. These systems, however, were not rigorously tested but instead marketed after being cleared by the Food and Drug Administration through a simple regulatory process using a previously approved predescent material. This article reviews the management of mesh complications of synthetic slings and mesh used to augment prolapse repair.     

腹腔镜复合补片无张力修补术治疗腹壁切口疝的临床体会

目的:探讨腹腔镜复合补片无张力修补术治疗腹壁切口疝的应用价值及可靠性。方法:回顾分析2007年1月至2012年1月为56例患者行腹腔镜复合补片修补术的临床资料。结果:3例因广泛粘连中转开腹,53例成功完成手术。手术时间70～320 min,中位手术时间110 min。术中发现隐匿性疝2例。术后Ⅰ级护理时间1天,术后24 h即恢复进食并下床活动。术后发生较长时间疼痛1例、感染1例。随访至今均未发现复发。结论:术后并发切口疝的患者于腹腔镜下分离粘连、采用复合补片修补是安全可行的。     

Long-Term Durability and Comfort of Laparoscopic Ventral Hernia Repair

Background:

Repair of ventral hernias, including primary ventral hernias and incisional ventral hernias, is performed in the United States 90,000 times per year. Open or traditional ventral hernia repairs involve the significant morbidity and expense of a laparotomy and a significant risk of recurrent herniation. Laparoscopic ventral hernia repair (LVHR) may offer a less-invasive alternative with shorter length of hospital stay, fewer cardiopulmonary complications, and low recurrence rates.

Methods:

225 patients underwent laparoscopic ventral hernia repairs in which carboxymethylcellulose-sodium hyaluronate coating (Sepramesh, Davol, Providence, RI) was used primarily. All cases were included prospectively from the study period of 2002 through 2009. Patient characteristics were recorded, and follow-up analysis was performed over a period of 42 mo following surgery. Recurrence, reoperations, and all complications were recorded. Mesh awareness and mesh-related pain were assessed using the hernia-specific Carolinas Comfort Scale (CCS) instrument, completed by 72 patients.

Results:

Over 42 mo of follow-up, 2 ventral hernias have recurred, and no long-term bowel erosion or fistulization has occurred. Little or no mesh-related symptoms were reported, and mean scores for mesh awareness and mesh pain were 3.6 and 3.2, respectively, on a scale from 0–40 (lower scores signify less pain or awareness). Two serious early complications occurred related to intestinal ileus and metal tacks producing intestinal perforation, and this led to a change in the tacking devices used.

Conclusions:

LVHR with carboxymethylcellulose-sodium hyaluronate coating (Sepramesh) is safe and effective. Complications are rare, the repair is durable, and long-term results are good with rare recurrences, low awareness of mesh, and little pain. Technical lessons include use of at least one transfascial suture and the avoidance of metal tacks for fixation.     

腹股沟疝腹腔镜腹腔内网片植入术后并发症的分析

目的 探讨腹腔镜下腹腔内网片植入术(intraperitoneal onlay mesh,IPOM)治疗腹股沟疝并发症的原因及预防.方法 回顾性分析2005年5月至2009年2月在我院行腹腔镜下腹腔内网片植入术治疗腹股沟疝患者335例.结果 术后疼痛3例,占0.90%;复发3例,复发率0.90%;血清肿2例,占0.60%;术后无1例出现补片感染及粘连性肠梗阻临床表现.结论 腹腔镜下腹腔内网片植入术治疗腹股沟疝方法简单,创伤小,术后并发症少,是一种安全的微创治疗腹股沟疝的手术方法,随着手术技巧的提高,并发症可进一步减少.     

“Sports” hernia: treatment with biologic mesh (Surgisis)

Background Groin pain in athletes is caused by a wide range of musculoskeletal disorders. Occasionally, a palpable bulge at the external ring or ultrasound may not demonstrate a hernia. When athletes do not respond to conservative treatment, a “sports” hernia should be considered. Methods A retrospective review of 750 laparoscopic preperitoneal hernias was performed. A sports hernia was defined as a tear in the transversalis fascia that was not evident by preoperative physical exam. A 7 × 10-cm biologic mesh, Surgisis, was placed, uncut, over the myopectinate orifice and fixed with five tacks or fibrin glue. Patients were followed up at 2 and 6 weeks, 6 months, and 1 year. Results Ten professional and amateur athletes were found to have sports hernias. Operative time averaged 32 min. There were no major complications. All athletes returned to full activities in 4 weeks. Only one patient did not show improvement in his symptoms. No patient developed a recurrent hernia. Conclusions Laparoscopic exploration should be considered in athletes with chronic groin pain that does not improve after conventional treatments have failed. Furthermore, biologic mesh (Surgisis) should be considered for the repair of inguinal sports hernias.     

New Superconvergent Structures with Optional Superconvergent Points for the Finite Volume Element Method

New superconvergent structures are proposed and analyzed for the finitevolume element (FVE) method over tensorial meshes in general dimension $d$ (for $d≥2$);we call these orthogonal superconvergent structures. In this framework, one has the freedom to choose the superconvergent points of tensorial $k$-order FVE schemes (for $k≥3$).This flexibility contrasts with the superconvergent points (such as Gauss points andLobatto points) for current FE schemes and FVE schemes, which are fixed. The orthogonality condition and the modified M-decomposition (MMD) technique that aredeveloped over tensorial meshes help in the construction of proper superclose functions for the FVE solutions and in ensuring the new superconvergence properties of theFVE schemes. Numerical experiments are provided to validate our theoretical results.     

钛网结合钛钢板在多节段颈椎前柱结构重建中的作用

目的:探讨钛网钛钢板内固定在多节段颈椎间盘突出症中的应用价值.方法:采用钛网钛板内固定的方法治疗颈椎间盘突出18例,平均随访时间为18个月,观察病人的植骨融合率、椎间高度、颈椎生理曲度、内植物的并发症及进行功能评定.结果:18例均获得骨性愈合,术后椎间高度和生理曲度维持满意,未发生内植物并发症.功能评定优14例,良3例,可1例.优良率为94%.结论:采用钛板钛网内固定可使脊柱立即获得稳定,植骨愈合率高,有效地维持椎间高度和生理曲度,早期下床活动.     

腹腔镜腹腔内补片置入术在腹壁切口疝修补中的应用

目的探讨腹腔镜腹腔内补片置入术在腹壁切口疝修补中临床应用价值。方法腹腔镜经腹腔内使用膨化聚四氟乙烯双层补片治疗13例腹壁切口疝。结果13例手术均获成功,手术时间45—120min,平均73min,无手术死亡病例及并发症发生,患者术后8～24h后下床活动,1～2d排气,术后疼痛轻,2～3d后完全缓解,3～7d（平均4d）患者顺利康复出院。随访12～24个月无复发。结论腹腔镜腹壁切口疝修补术安全可靠,具有创伤小、术后康复快、并发症少、不增加手术穿刺孔、可完成联合手术等优点,临床应用前景广阔。     

应用钛网支架及前臂游离皮瓣修复上颌部肿瘤切除后洞穿缺损

目的 探讨应用钛网支架与前臂游离皮瓣即刻修复上颌骨部分洞穿缺损的手术方法.方法 对2004年至2008年收治的19例上颌部肿瘤患者,于切除肿瘤后即刻应用钛网支架修复骨质缺损,并以前臂游离皮瓣覆盖于钛网支架表面修复口腔黏膜缺损.结果 19例中16例患者术后功能与外形均获得较为满意的效果,患者发音清晰,进食时无口鼻腔返流现象;有3例术后钛网支架部分外露、感染,遂去除钛网支架,将挛缩的前臂游离皮瓣重新展开,并缝合于缺损部位,口鼻腔瘘得到关闭,患者的发音、进食功能无明显影响,仅面中部有轻度塌陷.结论 应用钛网支架与前臂游离皮瓣修复上颌部缺损是一种简单、可行的方法,吞咽与语言功能得到较好的维护,同时也获得了较为满意的面部外形.