人工材料在腹壁切口疝修补术中的应用

目的 探讨人工材料聚丙烯补片在腹壁切口疝修补术中的应用及其疗效。方法 回顾性分析和总结5年来41例病人施行人工材料修复腹壁切口疝的临床资料。结果 本组38例病人得到随访。全组无复发病例，有2例病人术后发生切口感染并窦道形成，均经再次手术治愈。结论 人工材料对于腹壁切口疝的修补有良好的疗效．但应严格做好术中无菌操作和积极围手术期处理。     

Incarceration of umbilical hernias in children: a rare but important complication

Umbilical hernia (UH) is a common condition in infants and young children, especially in those of Afro-Caribbean origin. Spontaneous closure occurs in a majority of cases before the age of 4 years unless the neck of the sac is greater than 2 cm in diameter. Complications are rare, and conservative management is therefore advised during this time. We present three cases of incarcerated UH in boys under 4 years old, all of whom presented with small-bowel obstruction. Interestingly, in two of them undigested vegetable matter in the small bowel appeared to have precipitated the obstruction. A survey of the literature suggests that the incidence of this complication is approximately 1:1,500 UHs. We conclude that the present policy of expectant management is safe for the vast majority of children, but parents and general practitioners should be aware of the small risk and early symptoms of incarceration. Accepted: 30 September 1997     

急性颅脑损伤脑疝51例临床分析

目的:探讨急性颅脑损伤脑疝的临床特点及各种影响预后的因素,以提高急性颅脑损伤脑疝的诊断和治疗水平,降 低其病死率.方法:对 2000～ 2003年收治的 51例急性颅脑损伤合并脑疝患者的临床资料进行回顾性分析.结果: 收治的急性颅脑损伤合并脑疝患者 51例通过手术或非手术治疗方法,死亡 33例,住院病人病死率高达 64.7%.主要 死亡原因:颅内血肿及脑挫裂伤后脑水肿引起的 ICP增高形成脑疝和原发性或继发性脑干伤;其次是各种严重的并 发症.结论:急性颅脑损伤引起脑疝伤残、病死率极高,其预后与 GCS计分、瞳孔变化、损伤类型、年龄大小、手术时 机及手术指征的掌握密切相关.     

改良保留尿道前列腺切除同期行无张力疝修补

目的:进一步提高前列腺增生症合并腹外疝的诊治水平.方法:回顾性总结自2001年1月～2002年9月收治的9例前列腺增生症合并腹外疝的临床资料,均行改良的保留尿道前列腺切除术 同期无张力疝修补.结果:9例病人切口愈合良好,术后8例随访1～21个月(平均15个月),排尿通畅,无疝复发.结论:改良的保留尿道前列腺切除同期行无张力疝修补是可行的,符合正常的解剖生理结构,术后患者具有痛苦少、恢复快、疝复发率低等优点.     

应用补片修补巨大腹壁切口疝(附9例报告)

目的 总结应用补片修补巨大腹壁切口疝。方法 回顾分析应用涤纶布、聚丙烯和膨体聚四氟乙烯补片修补9例巨大腹壁切口疝患者的术前准备、手术方法和引流放置。结果 均治愈。随访4个月～12年无复发。结论 应用补片无张力修补巨大腹壁切口疝是一种简单、易行和有效的方法。     

创伤性膈疝的X线与CT诊断分析

目的分析X线与CT在创伤性膈疝中的诊断价值及影像特点。方法对经X线、CT检查的35例创伤性膈疝患者(经手术证实)进行回顾性分析。结果①创伤性膈疝多发生于左侧膈肌,该组病例中X线与CT对该病的诊断符合率分别为68.6%和100%。②CT不仅可以明确诊断膈疝,还可判断膈破裂口的位置、大小、疝入物内容。③判断多脏器复合受损情况:CT在诊断肺挫裂伤方面与X线无显著性差异(P>0.05);CT在诊断液气胸、腹腔积液方面明显优于X线(分别为P<0.01,P<0.05);X线在诊断肋骨骨折方面明显优于CT(P<0.01);X线对肝、脾、脑、肾等实质性脏器的损伤方面无诊断价值。结论X线、CT在诊断创伤性膈疝中有着极其重要的作用,且CT是一种更敏感的检查方法,对创伤性膈疝的早期诊断及治疗、挽救患者生命有重大的意义。     

老年人前列腺增生合并腹股沟疝的同期手术效果评价

目的评价70~89岁老年人前列腺增生合并腹股沟疝同期手术治疗的效果,总结临床经验。方法回顾性分析32例70~89岁患者行经尿道前列腺切除术(TURP),同时行无张力疝修补术的临床资料和随访结果。结果平均手术时间(85.0±12.8)min,平均术中出血(90.0±18.7)ml,术中、术后无死亡和危及生命的并发症发生。随访7~40个月,未见疝复发及尿失禁、尿道狭窄等并发症,国际前列腺症状评分(IPSS)、最大尿流率和残余尿量与术前比较,差异均有统计学意义。结论70~89岁老年人同期施行TURP和无张力疝修补术是安全的,效果满意。     

Richter’s hernia occurring through a 5-mm laparoscopy sheath incision

We report a case of postoperative Richter’s hernia presenting through a 5-mm sheath incision. A 58-year-old woman having undergone laparoscopic hysterectomy 8 days before presented with severe left abdominal pain, nausea and light-headedness. The hypothesis of a sigmoid volvulus was suggested based on peroperative rectum and sigmoid release, the X-ray finding, and pain evolution. A secondary laparoscopic procedure allowed both diagnosis of a Richter’s hernia through a 5-mm sheath incision and surgical repair of the hernia. The use of this sheath during the laparoscopic vagina suture caused extension of the wound. Large 5-mm sheath defect sufficient for a Richter’s hernia can be created by multiple passes with small instruments and require surgical closure at the end of laparoscopy. Laparoscopy is useful in cases of postoperative complications, particularly when other complementary examinations are less informative.     

感染因素对无张力疝修补术疗效影响的研究

目的 探讨无张力疝修补术是否适用于嵌顿性（伴有全腹膜炎）腹股沟斜疝.方法 根据疝嵌顿后腹膜炎体征情况,统一手术切口、术式及抗生素使用剂量应用天数,对75例腹股沟嵌顿性斜疝患者与同期81例择期的腹股沟疝患者分为两组对比.采用巴徳mesh prefix plug定型产品做无张力疝修补术.比较两组患者手术时间、术后并发症、切口感染率、复发率.结果 与对照组（n=81）相比,研究组（n=75）手术时间明显延长差异有统计学意义（t检验P=4.96＜0.01 ）.术后并发症、切口感染率、复发率差异无统计学意义（χ^20.55,P=0.46;χ^22.73,P=0.09;χ^20.02,P=0.888）.结论 无张力疝修补术同样适用于伴有全腹膜炎的嵌顿性腹股沟斜疝.     

Late‐presenting congenital diaphragmatic hernia in childhood

Aim: To characterize the clinical manifestations of late‐presenting diaphragmatic hernia and its associated anomalies, diagnostic methods and outcomes. Methods: The records of patients aged 1 month–18 years old diagnosed with Bochdalek diaphragmatic hernia from February 1987–June 2008 were reviewed. Results: Fifteen children (nine boys, six girls) met inclusion criteria. Median age was 1.5 years (range, 38 days–9.9 years). Eleven (73%) had left‐sided and four (27%) had right‐sided diaphragmatic hernias. Six (40%) patients presented with respiratory symptoms, six (40%) with gastrointestinal symptoms and three (20%) with both. Five (33%) patients had failure to thrive. Six (40%) were diagnosed by chest radiography alone. The others required gastrointestinal contrast series, or chest computed tomography to confirm the diagnosis. One referred patient had been misdiagnosed as having left pneumothorax. Cases of bowel malrotation and gastric volvulus associated with the hernia were found in one patient each. One patient required mechanical ventilation because of respiratory failure before surgery. Primary repair without patch was performed in all patients. The overall survival in this series was 100%. Conclusion: Late‐presenting diaphragmatic hernia should be suspected in cases of unexplained acute or chronic respiratory or gastrointestinal symptoms, and abnormal chest radiographic findings. The prognosis is favourable with correct diagnosis and prompt surgical repair.