目的 探讨应用改良Kugel补片后入路腹膜前修补腹股沟斜疝的优点、手术效果及其体会。方法 回顾性分析2006年12月至2007年6月期间我院采用改良Kugel补片施行腹股沟斜疝无张力修补术15例患者的临床资料。观察手术时间、伤口疼痛、术后恢复情况、并发症和复发率。结果 手术时间35～90 min，平均（50±10） min； 术后1 d能下床活动，术后均未使用止痛剂，术后住院时间3～5 d。全组切口一期愈合，无感染发生，1例切口周围有青紫，微波治疗1周后青紫消失。随访半年无不适和复发。结论 改良Kugel补片后入路腹膜前疝修补术具有微创、无张力、免缝合、疼痛轻、恢复快、并发症少等特点
ObjectiveTo compare the clinical efficacy of abdominal preperitoneal laparoscopic hernia repair with 3DMax patch and plain film for treatment of inguinal hernia. MethodsThe clinical and follow-up survey data of 120 patients with inguinal hernia in The Second Affiliated Hospital of Harbin Medical University, between January 2009 and May 2014, which were treated by laparoscopic transabdominal preperitoneal repair (TAPP) were retrospectively analyzed. One hundred and twenty cases were divided into two groups:plain film group (45 cases) and 3DMax group (75 cases) according to the intraoperative use of different patchs. The patches of 3DMax group were not fixed, the patches of plain film group were fixed with metal nails. The postoperative clinical effect of two groups were analyzed. ResultsThe operative time, intraoperative blood loss, and postoperative hospitalization days of two groups were no statistical significance (P > 0.05). The postoperative off bed activity time of patients in 3DMax group and plain film group was (20.2±8.1) h and (26.3±9.2) h, respectively, the average off bed activity time in 3DMax group was significantly earlier than that in plain film group (P=0.041). The material expenses and hospitalization expenses of the 3DMax group were significantly lower than those of the plain film group (P=0.001, P=0.038). The incidence of foreign body sensation of inguinal region in 1, 3, and 9 months after operation of 3DMax group were lower than those of plain film group (P=0.045). The VAS score in 1 and 3 months after operation of 3DMax group were lower than those of plain film group (P < 0.05), but there was no statistically significant in 6 months after operation of 2 groups (P > 0.05). There was no recurrence case in two groups. ConclusionsThe use of 3DMax patch in laparoscopic TAPP operation have more simple operation, hospitalization expenses decreased, recovery faster, postoperative inguinal nerve pain and foreign body sensation more lighter, and complications more less. It is worthy of clinical popularization and Application.
Objective To study the clinical effect of laparoscopic repair of abdominal incision hernia. Methods The clinical data of 41 abdominal incision hernia patients undergone laparoscopic repair were retrospectively analyzed. Results 〗The operation was successfully performed for 38 cases, and 3 cases were conversed to open. Operative time ranged from 78 to 186 minutes, with an average of 95 minutes. Pain was minor after operation. The first flatus and defecation ranged from 25 to 41 hours, with an average of 32 hours. Food intake started on day 2 after operation. The average length of hospitalization was 6 days (range 5-7 days). After a mean follow-up of 9 (6-16) months, no incision hernia occurred. Conclusion 〗Laparoscopic abdominal incision repair with composite patch is a safe and effective method, which is worthy of clinical application.
Objective To study the reconstruction method and effectiveness of titanium plate and Teflon patch for the chest wall after resection of sternal tumors. Methods Between October 2006 and November 2009, 4 patients with sternal tumors were treated and the thoracic cages were reconstructed. There were 2 males and 2 females, aged 30-55 years. The patientswere admitted because of chest lump or pain. The sizes of palpable lump ranged from 4 cm × 3 cm to 10 cm × 8 cm. CT examination showed bone destruction. After sternal tumor resection, defect size ranged from 10 cm × 8 cm to 18 cm × 14 cm, and titanium plate and Teflon patch were used to repair and reconstruct the chest wall defect. Results The operations of the tumor resection and reconstruction of chest wall defect were successfully performed in 4 cases. Incisions healed by first intention with no abnormal breath, subcutaneous emphysema, pneumothorax, and infection. One case failed to be followed up after 6 months; 1 case died of intracranial hemorrhage; and 2 cases were followed up 1 and 4 years respectively without tumor recurrence. The chest wall had good remodel ing. No loosening and exposure of titanium plate, difficulty in breathing, chest distress, and chest pain were observed during followup. Conclusion Surgical resection of sternal tumors will cause large chest wall defect which can be repaired by titanium plate and Teflon patch because it had the advantages of easy operation, satisfactory remodel ing, and less compl ication.
The engineered heart tissues (EHTs) present a promising alternative to current materials for native myocardial tissue due to the unique characteristics. However, until now, the clinical application of EHTs is limited by a serial of practical problems yet. Generally, the challenges need to further optimize include biomaterials, cell sources, and strategies of revascularization or establishment of EHTs. This review focuses on the newly progress on these aspects to encourage the emergence of novel EHTs that can meet clinic requirement properly.
Abstract: Objective To investigate the prognosis of residual shunt after surgical repair in infants. Methods We selected 407consecutive infant patients (255 males and 152 females) with venticular septal defects(VSD) between January 2008 and June 2008 in Shanghai Children’s Medical Center, Shanghai Jiaotong University. Of the patients, 273 were less than 1 yearold, 88 were 12 yearsold, and 46 were 23 years old. All of whom underwent surgical repair of the ventricular septal defect with autologous pericardial defect treated by glutaraldehyde. Results Of the 407 patients, 29 had residual ventricular septal defects, there was no significant difference among age groups in the rate of residual shunts （χ2=0.054，P=0.973）.Twentynine patients were followedup,and in the followup period of 1.5 months to 2 years postsurgery, 26 patients had spontaneous closure, while the other 3 patients did not heal. None of the patients needed reoperation. There was no significant difference amongage groups or type of ventricular septal defect in the rate of residual shunts (χ2=1.035，P=0.596). Conclusions Postsurgical residual ventricular septal defects smaller than 0.4 cm will close spontaneously in most infants.
目的 探讨应用人工合成材料双层聚丙烯补片修补腹壁切口疝的效果。方法 21例腹壁切口疝（15例大切口疝和及6例巨大切口疝）患者采用双层聚丙烯补片行无张力修补，对术中及术后情况进行分析。结果 全组病例手术顺利，手术时间 87～189 min，平均123 min。无严重并发症发生，痊愈出院。术后随访5～36个月（平均 17个月），无复发病例。结论 双层聚丙烯补片修补中下腹壁大切口疝及巨大切口疝是一种安全、有效的方法，是临床上治疗切口疝可供选择的一种手术方式。
Objective To explore whether 125I-vascular endothel ial growth factor (VEGF)-coated artificial vascular patch accelerate the vessel endothel ial ization and inhibit thrombosis. Methods Ten adult male New Zealand rabbits (weighing 2.5-3.0 kg) were allocated into experimental group (n=5) and control group (n=5). In experimental group, the right common jugular vein was exposed for vascular clamping between proximal location and distal location, and then a 10 mm × 5 mm 125I-VEGF-coated artificial vascular patch was implanted into the right common jugular vein and sutured with 8-0 thread.In control group, the artificial vascular patch was implanted. After 2 weeks, the vein specimens were collected to measure the residues of 125I-VEGF by γ-ray counter. HE staining and immunohistochemical staining for smooth muscle actin (SMA) and CD34 were performed. The vascular endothel ial cells were counted and the intimal thickness was measured. Results The γ-ray counter showed the residues of 125I-VEGF in experimental group was (427.5 ± 194.9) CPM after 2 weeks, equivalent to 2.0% ± 0.8% of the preoperative value. Thrombosis formed in 2 rabbits of control group; no thrombosis formed in experimental group. There was significant difference in the intimal thickness [(41.1 ± 6.6) μm vs (49.0 ± 6.9) μm, P lt; 0.05]; but no significant difference in the vascular endothel ial cells count between experimental group and control group (60.0 ± 6.8 vs 58.0 ± 5.7, P gt; 0.05). Conclusion 125I-VEGF-coated artificial vascular patch can reduce thrombosis and inhibit intimal prol iferation at the acute phase. A consecutive l ine of endothel ial cells can form after implantation of patch in the rabbit jugular vein, however, the function of endothel ial cells may be premature.
Objective To prepare a new sirolimus drug-coated polypropylene (SRL-PP) mesh by grafting he sirolimus onto the surface of the polypropylene (PP) mesh via chemical reaction, and to apply the new mesh to animal experiment to explore its anti-adhesion properties.MethodsThe sirolimus was grafted onto the surface of the mesh by chemical reaction to prepare the SRL-PP mesh, which was compared with the PP mesh and the polyethylene glycol modified polypropylene (PEG-PP) mesh. The three groups of meshes were respectively characterized (infrared spectroscopy test, contact angle measurement), and their tensile property was measured. These meshes were implanted into the abdominal cavity of the rats respectively. The anti-adhesion properties of the new sirolimus drug-coated mesh was studied by intraperitoneal adhesion and histopathological change in rats.ResultsThe results of infrared spectrum analysis showed that there was a new absorption peak at the wavelength 1 643 cm–1 (amide group) of SRL-PP mesh, suggesting that sirolimus drug was successfully uploaded onto the surface of the mesh; the SRL-PP mesh was excellent in hydrophilicity, which provided a favorable condition for the growth of peritoneal mesothelial cells. There was no significant difference in mechanical properties between SRL-PP mesh and PP mesh or PEG-PP mesh, which provided a good mechanical guarantee for clinical application. The degree of abdominal adhesion in SRL-PP mesh group (1.00±0.58) was significantly lower than that in PP mesh group (5.17±0.69) and PEG-PP mesh group (4.00±0.58), and the tD value between SRL-PP mesh group and PP mesh group was 2.76 (P<0.05). The number of inflammatory cells and the expression of inflammatory cytokines in the adhesion tissue in SRL-PP mesh group were significantly lower than those in PP mesh group and PEG-PP mesh group.ConclusionsThe sirolimus is successfully loaded onto the surface in the PP mesh by chemical reaction. Animal experiment shows that the sirolimus drug-coated mesh can significantly reduce the abdominal adhesion of the rats, which provides a basis for clinical trial and application.
Objective Polylactic acid (PLA) patch has proper steric configuration, sufficient mechanic strength, and flexibil ity, to investigate the blocking effect on the intra-discal inflammation after annulus puncture sticked by medical glue so as to seal the pinhole left after annulus puncture. Methods Twenty healthy New Zealand white rabbits (weighing 2.0-2.5 kg) were randomly divided into 4 groups (n=5): groups A, B, C, and D. In group A, the rabbits underwent exposure of intervertebral disc and transverse process at L2-7 as a control; in group B, the rabbits received annulus puncture at L2-7 with an 18-gauge needle; and in groups C and D, the pinholes were sealed respectively with a PLA patch sticked with medical gel and medical gel alone after annulus puncture at L2-7. General condition of rabbits was observed after operation. The intervertebral disc tissue was harvested 1 week after operation. The tissue structure was observed by HE and Masson staining. And the expressions of inflammatory factors l ike interleukin 1β (IL-1β), tumor necrosis factor α (TNF-α), and inducible nitric oxide synthase (iNOs) were detected with immunohistochemistry and ELISA. Results All the animals survived till the end of the experiment. In group A at 1 week, the nucleus pulposus tissue had normal structure. In group B at 1 week, leak of nucleus pulposus from the pinhole and sl ight adhesion to the adjacent tissue could be seen, and the nucleus pulposus tissue had significant degenerative change by histological observation. In groups C and D, clots of coagulated medical gel and extensive adhesion to the adjacent tissue could be seen; histological observation suggested that the nucleus pulposus tissue of group C had similar histology manifestation to that of group A; while group D had similar histology manifestation to group B with obviously-decreased cells and disorder of matrix. ELISA test showed remarkably elevated expression level of inflammatory factors including IL-1β, TNF-α, and iNOs in groups B and D when compared with groups A and C, showing significant differences (P lt; 0.05), and similar expression level were observed in groups A and C, groups B and D (P gt; 0.05). Conclusion The PLA patch sticked with medical gel is effective in blocking the intra-discal inflammation 1 week after annulus puncture.