经阴道植入TiLOOP网片的盆底重建术的临床疗效和安全性分析

目的:评价经阴道植入轻型钛化聚丙烯网片TiLOOP的盆底重建术的临床短期疗效和安全性。方法:回顾性分析南京医科大学附属无锡妇幼保健院2017年11月至2019年7月,以阴道前壁膨出Ⅲ~Ⅳ度为主的50例盆腔器官脱垂（POP）患者,对其实施经阴道植入TiLOOP网片的盆底重建术,其中自行裁剪TiLOOP网片的“协和式”盆底...     

精索肥厚型腹股沟斜疝行无张力修补术的应用

目的 精索肥厚型腹股沟斜疝患者行无张力修补术的可行性.方法 回顾性分析2011年2月至2013年2月,元江县中医院收治的精索肥厚型腹股沟斜疝患者66例,均应用聚丙烯补片行腹膜前间隙无张力修补.观察患者术后并发症发生情况.结果 本组患者手术均获得成功,手术时间40~50 min,平均（40±5）min,住院时间4~7 d,平均（5.0±1.5）d.术后出现尿潴留4例,行留置导尿处理;浆液性水肿1例,2个月左右自行消失;慢性疼痛、异物感3例,无补片取出患者.术后随访3~12个月,无复发.结论 精索肥厚型腹股沟斜疝采用聚丙烯补片行腹膜前间隙无张力修补术安全、有效、复发率低,值得临床推广应用.     

腹壁切口疝64例治疗体会

目的探讨腹壁切口疝的治疗及其围手术期处理。方法回顾性分析我院2000年1月~2004年10月64例腹壁切口疝的治疗经过。结果行单纯性疝修补术20例,无张力补片修补术44例。随访8~45月,无一例复发。结论应用聚丙烯补片、术前腹带加压包扎2周、术前预防性应用抗生素及常规肠道准备对于防治腹壁切口疝是安全、经济、可靠的方法。     

3 DMax补片应用于前入路腹膜前间隙疝修补术

目的：探讨3 DMax补片用于前入路腹膜前间隙疝修补术的应用技巧。方法回顾性分析2012年10月至2013年10月,江苏省中西医结合医院收治的23例腹股沟疝患者,均在连续性硬膜外间隙阻滞麻醉下行前入路腹膜前间隙疝修补术,分析总结其手术时间、术后并发症、随访术后复发等情况。结果手术时间45～70 min,术后手术区域有轻微的坠胀感6例,未发生切口感染、血清肿、腹膜前间隙血肿等情况。随访1～13个月,未发生慢性疼痛及复发。结论3 DMax补片用于前入路腹膜前间隙疝修补术是安全可行的。     

股管内环口网塞填塞联合腹膜前间隙平片在股疝无张力修补术中的应用

目的 分析经股环股管网塞填塞联合应用平片在腹膜前间隙无张力疝修补术中的应用价值。方法 回顾性分析2010年2月至2013年12月,上海交通大学医学院附属新华医院崇明分院收治的的女性股疝患者17例。从患侧腹股沟韧带中点上方2cm,向同侧耻骨结节作一切口。在子宫圆韧带的内下方,切开腹横筋膜,进入腹膜前间隙,将疝从股管中拉出。将网塞从股环处置人股管并妥善固定。将平片越过耻骨梳韧带下方2em,于腹膜前间隙摊平。结果 所有患者手术均顺利结束,手术时间49～78min,平均62min。术中出血少,没有股静脉损伤。术后无局部红肿,切口愈合佳。术手术区域不适感2例,不影响生活和工作。下肢活动正常。术后随访3～48个月,无复发。结论 将网塞经股环置人股管联合腹膜前间隙平片治疗股疝,是一种安全可靠的股疝修补方法。     

污染伤口清洗后放置聚丙烯网片的可行性研究

目的通过动物实验研究污染伤口被清洗后放置聚丙烯网片能否一期愈合,探讨嵌顿性腹股沟疝肠坏死患者用聚丙烯网片作无张力修补术的可行性。方法30只新西兰兔（简称家兔）左右背部伤口用大肠杆菌液污染后20min再用双氧水、生理盐水及0．5％甲硝唑液清洗。伤口清洗前、后均做细菌培养;左背部伤口放置聚丙烯网片,右背部伤口作为对照组,不放置网片,左右背部伤口均予以缝合。术后60d观察伤口愈合情况和感染率并取标本作病理检查。结果伤口清洗前细菌培养,大肠杆菌污染率100％,清洗后左背部伤口污染率16．0％,右背部污染率12．0％,左右两侧差异无统计学意义。6只家兔在实验中死亡,最终存活的24只家兔中,左背部伤口发生脓肿3例,右背部脓肿1例,感染率分别为12．5％和4．17％,两者比较虽有差异,但无统计学意义。病理报告鼎示：放置网片的左背部组织100％有不同稗度的炎性细胞浸润,未放置网片的右背部组织12．5％有炎性细胞浸润,两者比较差异有统计学意义（P〈0．0001）。结论伤口经过大肠杆菌液污染后机体组织可发生不同程度的炎性反应,放置聚丙烯网片可增加组织的炎性反应,嵌顿性腹股沟疝所致肠坏死患者行疝修补术时应慎用或不用聚丙烯网片。     

丝蛋白涂层轻质聚丙烯网片对兔腹壁疝模型组织学反应的影响

目的:探讨宿主对有丝蛋白涂层和无丝蛋白涂层的2种不同轻质聚丙烯网片组织学反应的差别。方法:2种聚丙烯网片(Gynemesh网片和法国G819P网片)的有丝蛋白涂层和无丝蛋白涂层网片各6片,共计24片,裁剪为30 mm×30 mm大小。6只新西兰大白兔,每只均制作6个腹壁缺损,并分别植入有丝蛋白和无丝蛋白涂层Gy-nemesh誖网片和有丝蛋白和无丝蛋白涂层G819P网片各1片,另2个腹壁缺损作为空白对照。植入后30,60和90 d时各处死2只动物,取出包括网片在内的腹壁全层,做大体观察、组织学观察以及免疫组化研究,包括炎症、纤维化反应、网片周围血管化反应以及胶原形成等。结果:所有网片均未发生侵蚀。有丝蛋白涂层网片组炎症反应和纤维化反应较轻,网片与组织融合良好。无涂层组可见少量的凋亡和坏死。结论:有丝蛋白涂层聚丙烯网片引起实验动物的组织学反应较轻,可以降低早期炎症反应和纤维化程度,减少组织粘连,降低网片相关并发症的产生。     

医用热熔胶的研究与应用

BACKGROUND: Hot-melt adhesive is safe and environmental friendly adhesive due to free of solvent, which is particularly suitable for medical applications. OBJECTIVE: To describe the types and characteristics of currently used hot-melt adhesives and to prospect the technical research and development of hot-melt adhesive for polyolefin tubes or catheters as well as to point out the corresponding key points to the hot-melt adhesion. METHODS: Literature search was carried out in SCI, Elsevier, and CNKI with the key words of “hot melt adhesive, medical application” in English and Chinese, respectively, for the initial retrieval of relevant articles or patents published January 1995 to December 2015. RESULTS AND CONCLUSION: To date, the medical hot-melt adhesives reported in the literature could be grouped as amorphous polyolefin, thermoplastic elastomer, acrylic and polyurethane types. The heat resistance of the most of the hot-melt adhesives does not meet the requirement for steam sterilizing process. In the present review, a strategy is proposed to develop a novel hot-melt adhesive which is good for binding polyolefin parts and can undergo the sterilization process. Given this, it is essential to choose a kind of polypropylene random copolymer with a suitable melting point as a substrate. With the aid of an adjuvant agent, therefore, we can develop a novel hot-melt adhesive that exhibits a lower melting point than the polyolefin tube, withstands steam sterilization temperature to ensure that the tube is not deformed during melt adhesion and is not become invalid during sterilization.      

Significance of tension in tension-free mid-urethral sling procedures: a preliminary study

We report the results of the release and tape-shortening techniques in polypropylene pubovaginal slings. Of female patients who had undergone mid-urethral sling procedures [tension-free vaginal tape procedure and suburethral polypropylene (SPARC)], in cases in which postoperative retention occurred, the patients were offered release or tape cutting. Women reporting postoperative urinary incontinence underwent a tape-shortening procedure. In these patients, the tape was shortened by the use of clips. Mean follow-up time after the release and/or the shortening operations was 9.9 months (range 6–18). A total of 15 women, ranging from 41 to 75 years old (mean 58.3) were included in this study. Upon the latest follow-up, six women exhibited prolonged urinary retention and subsequently underwent a release procedure (n=5) or a tape-cutting procedure (n=1). After the release procedure, all patients remained continent, but one patient’s urinary retention issues were not resolved, and she subsequently underwent a tape-cutting. Both of the patients who underwent the cutting procedure then developed recurrent stress urinary incontinence. The tape-shortening technique was conducted with nine patients. Seven of these patients recovered their continence, and no one patient experienced any urinary retention or other voiding difficulties. Two patients reported only minimal stress leakage and elected to undergo no further interventions. Our findings suggest that tension plays a substantial role in tension-free mid-urethral sling procedures.     

睾酮贴片的制备工艺研究

目的：寻找以聚丙烯酸酯为骨架的睾酮贴片的最适制备工艺条件。方法：按照美国药典中透皮给药系统（ＴＤＳ）释放度的测定方法,考察了不同固化方式、固化温度、固化时间对贴片胶粘性能和药物释放的影响。结果：缓慢升温方式比恒温方式所得贴片释工经速度快,低温所需固化时间长,高温所需固化时间短,在１００℃固化温度下,固化时间从３ｍｉｎ至３０ｍｉｎ,药物释放速率无显著差异。结论：以聚丙烯酸酯为骨架的睾酮贴片最适制备工艺为以２℃／ｍｉｎ的速度缓慢升温至１００℃后恒定３ｍｉｎ。