补中益气汤在腹股沟疝术后康复中的应用

为明确补中益气汤联合生物补片治疗腹股沟疝的疗效及预后,通过临床对照及随访研究,将腹股沟疝患者随机分为聚丙烯补片组、生物补片组和联合组,指标包括围手术期临床指标、术后疼痛视觉模拟量表（VAS）评分,以及1年随访期间的并发症、复发和再手术发生率。结果显示,联合组的术后住院时间,术后1、3和7 d的VAS评分均显著短于其他2组,术后1年随访时联合组及生物补片组的慢性疼痛、异物感、总并发症发生率及复发率均低于聚丙烯组;说明补中益气汤联合生物补片治疗腹股沟疝的安全性好,可促进术后康复,具有缓解术后疼痛、缩短住院天数的优势。     

Multifunctional Fluorinated Lubricant-Infused Poly(4-Hydroxybutyrate) (P4HB) Membranes for Full-Thickness Abdominal Wall Defect Repair

Abdominal wall defect caused by surgical trauma, congenital rupture, or tumor resection may result in hernia formation or even death. Tension-free abdominal wall defect repair by using patches is the gold standard to solve such problems. However, adhesions following patch implantation remain one of the most challenging issues in surgical practice. The development of new kinds of barriers is key to addressing peritoneal adhesions and repairing abdominal wall defects. It is already well recognized that ideal barrier materials need to have good resistance to nonspecific protein adsorption, cell adhesion, and bacterial colonization for preventing the initial development of adhesion. Herein, electrospun poly(4-hydroxybutyrate) (P4HB) membranes infused with perfluorocarbon oil are used as physical barriers. The oil-infused P4HB membranes can greatly prevent protein attachment and reduce blood cell adhesion in vitro. It is further shown that the perfluorocarbon oil-infused P4HB membranes can reduce bacterial colonization. The in vivo study reveals that perfluoro(decahydronaphthalene)-infused P4HB membranes can significantly prevent peritoneal adhesions in the classic abdominal wall defects’ model and accelerate defect repair, as evidenced by gross examination and histological evaluation. This work provides a safe fluorinated lubricant-impregnated P4HB physical barrier to inhibit the formation of postoperative peritoneal adhesions and efficiently repair soft-tissue defects.     

腹腔镜下食管裂孔疝无张力修补术

 为探讨腹腔镜下应用补片行食管裂孔疝修补的临床效果,2006年8月至2009年4月对本院40例食管裂孔疝患者在腹腔镜下用超声刀进行食管裂孔疝游离后,应用腔内缝合器将补片钉合食管裂孔边缘,完成食管裂孔疝修补术,并同期给予部分胃底折叠术。40例患者均成功地在腹腔镜下行食管裂孔疝无张力修补术,其中Ⅰ型13例,Ⅱ型4例,Ⅲ型15例,Ⅳ型8例。所有患者均有明显的烧心返酸症状;部分患者伴有胸骨后及剑突下疼痛、恶心、呕吐、夜间睡眠时呛咳、吞咽困难等症状。手术用时70～170min,平均90min。术中出血10～110mL,平均20mL,均无输血。无死亡病例。所有患者术后症状完全缓解。术后住院3～30d,中位平均住院日为5d。对40例患者术后进行3～25个月的随访（平均12个月）,未发现食管裂孔疝复发病例及有关补片并发症的发生。证明腹腔镜下食管裂孔疝无张力修补术是一种安全有效的微创方法,具有创伤少、恢复快、术后复发率低等特点。     

腹腔镜疝囊高位结扎术治疗小儿斜疝156例临床分析

分析2002年10月至2008年3月应用小儿微型腹腔镜配合自行设计的带线雪橇钩针开展小儿腹股沟斜疝的腹腔镜疝囊高位结扎术156例,探讨应用小儿微型腹腔镜治疗小儿腹股沟斜疝的疗效、并发症及预防措施。结果表明,应用小儿微型腹腔镜治疗腹股沟斜疝比传统手术优越,具有手术时间短、创伤小、切口小、瘢痕小、复发率低、并发症少、患儿痛苦少、恢复快、住院时间短等优点,可同时发现及处理隐性内环口未闭,且在双侧腹股沟斜疝及复发性斜疝治疗上有明显优势,值得临床推广应用。     

疝环充填式无张力疝修补术与传疝修补术的比较

目的：总结比较疝环充填式无张力疝修补术与传统疝修补术的治疗效果。方法;使用美国巴德公司的疝环充填物及网状补片,对68例病人从手术方法及时间、手术指征、术后病人自主能力的恢复、术后并发症、住院时间和复发率等进行比较观察。结果：该术式与传统疝修补术相比较具有方法简便、手术指征宽、恢复快、住院时间短、并发症少和复发率低的优点。结论：疝环充填式无张力疝修补术是一种完全符合生理解剖的手术方法,尤其适合老年和伴有其它疾病者,具有传统术式无法比拟的优点。     

Shouldice手术治疗腹股沟疝

通过对采用 Shouldice手术治疗的 92例病例进行回顾性的研究 ,讨论 Shouldice手术治疗腹股沟疝 ,并与其它手术方法进行比较。Shouldice手术治疗腹股沟疝近期并发症少 ,远期复发率低 ,是首选方法。     

不同手术方式治疗腹股沟疝气效果分析

目的:对比不同手术方式治疗腹股沟疝气的临床疗效,为选择合理有效的手术方式提供指导。方法 :收集我院2010年11月到2012年3月期间110例行腹股沟疝气手术患者的临床资料,按照不同的手术方式将其分为平片式无张力疝修补术组(56例)及填充式无张力疝修补术组(54例),比较两组手术患者围手术期的临床指标(手术时间、出血量、住院时间、术后疼痛、并发症),术后随访1年,对比其术后恢复情况。结果:两组手术患者临床指标差异无统计学意义(P>0.05)。结论:较填充式无张力疝修补术相比,平片无张力疝修补术具有解剖清晰、术后并发症发生率低等特点,但是需根据个体化选择手术方式和修补材料,能够有效地降低甚至是避免并发症的产生。     

Effect of Heat-Setting on Structural Parameters and Mechanical Properties of PP Monofilament Hernia Patch

General surgery hernia is a common and frequently- occurring disease in the world. In the tension-free hernia repair surgery, polypropylene （PP） patch has been confirmed as the most popular surgical implants. In this study, domestic medical PP monofilament was selected as raw material whose diameter was 0.15 mm, and the patch was knitted in the warp knitting machine of 12E gauge with one bar. Using the method of orthogonal experiment with three factors and three levels, the best heat-setting process of PP mesh was determined at the temperature of 130 ~C with 10 min under tension-free conditions. The relationship between heat-setting tension and performance of the patch was discussed. Patches with different porosity were prepared, and then structural parameters including density, thickness, porosity, and mechanical properties including tensile breaking strength, bursting strength, tearing strength, flexural rigidity and suture pulling out strength were tested and compared. The experimental results show that： the smaller of the patch＇s density, the higher of the porosity; other properties including density, thickness, bending stiffness, tensile breaking strength, bursting strength, tear strength, and suture pulling out strength reduce in varying degrees. This different degree of reduction is worth summarizing.     

平片无张力腹股沟疝修补术101例报告

为探讨提高腹股沟疝治疗水平，回顾性地总结了武汉钢铁(集团)公司职工总医院1999年6月至2002年6月101例腹股沟疝无张力修补术。经随访2—5年，术后无一例复发。结果表明，无张力疝修补术较传统的疝修补术术后疼痛轻，康复时间短，并可防止腹股沟疝复发。     

局麻下个体化无张力疝修补手术的临床应用（附80例对照研究）

目的总结我院开展局麻下个体化无张力疝修补手术的经验,探讨进一步提高腹股沟疝治疗总体疗效和减轻痛苦的方法。方法采用对照研究的方法对我院2006年1月～2008年8月间进行的无张力修补手术80例,其中40例为局部麻醉下进行的个体化无张力性修补手术进行临床研究。观察内容包括手术时间、住院时间、并发症、费用、疼痛评分,复发情况、病人恢复时间等指标。结果局麻下个体化无张力疝修补手术在住院时间、病人费用、并发症以及术后复发率方面具有优势,在手术时间、疼痛评分方面和同期进行的硬膜外麻下疝环充填式疝修补手术没有明显区别。结论局麻下个体化腹股沟疝修补手术简单易行,疗效可靠,是值得推广的腹股沟疝修补手术方式。