目的 探讨Ultrapro轻量型网片在腹腔镜腹股沟疝修补术中的优点和应用价值。方法 回顾性总结分析我院2008年8月至2010年10月期间，腹腔镜腹股沟疝修补术中应用Ultrapro轻量型网片的28例患者的临床资料。结果 28例患者共行疝修补术36例次，其中实施经腹腹膜前腹腔镜疝修补术（TAPP） 9例次，腹腔镜全腹膜外疝修补术（TEP）27例次；1例TEP中转行TAPP。平均手术时间为（103.4±39.8） min，术中平均出血量为（7.7±4.9） ml，术后平均住院时间（4.8±1.4） d。术后修补区暂时性神经异常1例，阴囊积液2例，尿潴留1例。28例均随访（15±1.6）个月（1～25个月），期间未观察到网片感染、疝复发、慢性疼痛、异物感或睾丸萎缩等并发症。结论 Ultrapro轻量型网片在腹腔镜腹股沟疝修补术中应用方便、视野清晰、柔软、硬度适中、放置定位容易，术后患者并发症少、恢复快，具有较好的临床应用价值。
Objective To investigate the effectiveness of laparoscopic Y-shaped polypropylene mesh in the treatment of uterine and vaginal vault prolapse. Methods Between June 2010 and December 2012, 24 patients with uterine and vaginal vault prolapse were treated by laparoscopic pelvic reconstruction (vagina and uterus-sacral fixation) with Y-shaped polypropylene mesh. The age of patients was 35-60 years (mean, 48.6 years). The disease duration was 2-8 years (mean, 5 years). According to the pelvic organ prolapse quatitative (POP-Q) classification by International Continence Society (ICS), 16 cases were classified as uterine prolapsed degree II and 8 cases as degree III; 15 cases were classified as vaginal prolapse degree I, 7 cases as degree II, and 2 cases as degree III. All patients received postoperative follow-up regularly. Subjective evaluation was done based on prolapse quality of life questionnaire (P-QOL), and objective evaluation based on POP-Q classification. Results All the patients were operated successfully. The operation time was 22-68 minutes (mean, 33 minutes); the blood loss was 30-80 mL (mean, 51 mL); the indwelling urethral catheter remain was 3-7 days (mean, 4 days); and the hospitalization days were 4-9 days (mean, 6.8 days). Twenty-four patients were followed up 3-12 months (mean, 9 months), of whom, 2 were followed up less than 6 months. All patients had normal urination after withdrawal of urethral catheter, and the residual urine volume was in normal range. No patients had mesh erosion and discomfort during sex, vaginal and anal bearing down. The P-QOL scores at 3, 6, and 12 months after operation were significantly improved when compared with the preoperative value (P lt; 0.05); but there was no significant difference among 3, 6, and 12 months after operation (P gt; 0.05). The postoperative POP-Q classification was degree 0 in 19 cases and degree I in 3 cases, and the objective cure rate was 91.7%. No recurrence was found during follow-up. Conclusion Laparoscopic Y-shaped polypropylene mesh for treatment of uterine and vaginal vault prolapse is a safe and effective method, especially applicable to preserve the uterus, and higher requirements of sexual life of patients.
Objective Surgical repair for giant lower ventral hernia is facing challenge owing to enormous tissue defect and the critical structures of pubis and il iac vessels. To investigate the method and curative effect of intraperitoneal onlay mesh (IPOM) combined with Sublay for compound repair of giant lower ventral hernia. Methods Between November 2008 and August 2010, 26 patients with giant lower ventral hernia were treated. There were 15 males and 11 females with an averageage of 61 years (range, 36-85 years), including 11 cases of lower midl ine incisional hernia due to radical rectal procedures, 6 cases of Pfannenstiel incisional hernia due to radical uterectomy, and 9 cases of lower midl ine incisional hernia due to radical cystectomy. Of them, 11 patients underwent previous repair procedures. The mean time from hernia to admission was 8.5 years (range, 1-15 years). All hernias were defined as M3-4-5W3 according to classification criteria of Europe Hernia Society. The mean longest diameter was 17.5 cm (range, 13-21 cm) preoperatively. Before 2 weeks of operation, abdominal binder was tightened gradually until the contents of hernia sac were reduced totally, and then reconstruction of abdominal wall was performed with compound repair of IPOM and Sublay technique. Results All of compound repair procedures were performed successfully. The mean hernia size was 112.5 cm2 (range, 76.2-160.6 cm2); the mean polypropylene mesh size was 120.4 cm2 (range, 75.3-170.5 cm2); and the mean compound mesh size was 220.0 cm2 (range, 130.4-305.3 cm2). The mean operative time was 155.5 minutes (range, 105.0-195.0 minutes) and the mean postoperative hospital ization time were 12 days (range, 7-16 days). Incisions healed by first intention; 4 seromas (15.4%) and 3 chronic pains (11.5%) occurred and were cured after symptomatic treatment. All patients were followed up 3-24 months (mean, 14.5 months). No recurrence and any other discomforts related to repair procedure occurred. Conclusion Compound repair of IPOM and Sublay is a safe and efficient surgical procedure for giant lower ventral hernia, owing to its characteristics of adequate patch overlap and low recurrence rate. Perioperative management and operative technology play the key role in the success of repair procedure.
Objective To evaluate the outcome of pedicle graft of greater omentum and polypropylene mesh in reconstruction of large defect of abdominal wall caused by surgical incision. Methods From 1994 to 2004, 12 cases of large abdominal wall defects were repaired with pedicle graft of greater omentum and polypropylene mesh after removal of abdominal wall tumor; the defect sizes of abdominal wall ranged from 10 cm×7 cm to 25 cm×17 cm. Results The abdominal wall wound in 12 cases were healed by first intention. After a follow-up of 1 to 5 years, no complications of abdominal hernia, infection and intestine obstruction occurred in all patients. Conclusion It is reliable to repair abdominal wall defect caused by surgical incision with pedicle graft of greater omentum and polypropylene mesh instead of peritoneum.
目的 探讨加用网片盆底重建术（PROSIMA）治疗盆腔器官脱垂患者的围手术期护理方法。 方法 对2010年6月－2011年6月收治的23例盆腔脏器脱垂患者施行的PROSIMA护理措施进行回顾性总结。 结果 23例患者术后尿失禁症状明显好转，舒适感增加；仅1例发生尿潴留，予重置尿管后顺利排尿；治愈率达100%。术后6个月复查时均无阴道壁膨出或穹隆脱垂，未出现下尿路感染、网片侵蚀、下肢疼痛等并发症。 结论 有效的护理措施可减少PROSIMA术后并发症，对提高手术成功率、促进患者康复有明显作用。
目的 探讨Prolift系统全盆底重建术在治疗盆腔脏器脱垂疾病中的应用价值及疗效。 方法 回顾性分析四川大学华西第二医院妇科2010年1月－2011年5月收治的119例盆腔脏器脱垂患者的临床资料，其中47例应用Prolift系统进行全盆底重建术（A组），51例应用曼氏手术治疗（B组），21例应用经阴道全子宫切除术+阴道前后壁修补术治疗（C组）。分析比较各组的临床近期疗效。术后随访1年。 结果 A、B、C组在手术时间、术中出血量、术后安置尿管天数、术后住院天数间差异均无统计学意义（P＞0.05）。A组1例、B组11例、C组4例复发，A组与B、C组复发率比较差异有统计学意义（P＜0.05）。 结论 Prolift系统全盆底重建术安全性高，不增加脏器损伤的几率，且明显降低了患者的术后复发率，近期疗效肯定，是治疗盆腔脏器脱垂的一种理想术式。
Objective To investigate the improvement effects and mechanisms of composite chitosan (CS) hydrogel on traditional polypropylene (PP) mesh for repairing abdominal wall defects. Methods CS hydrogel was prepared via physical cross-linking and then combined with PP mesh to create a CS hydrogel/PP mesh composite. The internal structure and hydrophilicity of the composite were characterized using macroscopic observation, upright metallographic microscope, scanning electron microscopy, and water contact angle measurements. The performance of the composite (experimental group) in resisting cell adhesion and supporting cell infiltration was assessed through fibroblast (NIH-3T3) infiltration experiments and human umbilical vein endothelial cells (HUVECs) tube formation assays, and simple cells were used as control group. Finally, a bilateral abdominal wall defect model (1.5 cm×1.0 cm) was established in 18 Sprague Dawley rats aged 8-10 weeks, with the composite used on one side (experimental group) and PP mesh on the other side (control group). The effects on promoting wound healing, preventing adhesion, angiogenesis, and anti-inflammation were investigated through macroscopic observation, histological staining (HE and Masson staining), and immunohistochemical staining (CD31, CD68). Results The composite appeared as a pale yellow, transparent solid with a thickness of 2-3 mm, with the PP mesh securely encapsulated within the hydrogel. Scanning electron microscopy revealed that the hydrogel contained interconnected pores measuring 100-300 μm, forming a porous structure. Contact angle measurements indicated that CS hydrogel exhibited good hydrophilicity, while PP mesh was highly hydrophobic. In vitro cell culture experiments showed that DAPI staining indicated fewer positive cells in the experimental group after 1 day of culture, while the cells in control group covered the entire well plate. After 3 days of culture, the cells in experimental group were spherical and displayed uneven fluorescence, suggesting that the material could reduce cell adhesion while supporting cell infiltration. HUVECs tube formation experiments demonstrated an increase in cell numbers in experimental group with a trend towards tube formation, while cells in control group were sparsely distributed and showed no migration. In the rat abdominal wall defect repair experiment, results showed that after 1 week post-surgery, the experimental group had tissue and blood vessels infiltrating, and by 4 weeks, the integrity was well restored with significant regeneration of muscle and blood vessels, while the control group exhibited adhesions and incomplete healing. HE staining results indicated weaker cell infiltration in the experimental group, with cell density significantly higher than that of the control group at 2 and 4 weeks post-surgery (P<0.05). Masson staining revealed that collagen fibers in the experimental group were arranged neatly, with significantly increased collagen content at 2 weeks post-surgery (P<0.05), while collagen content was similar in both groups at 4 weeks (P>0.05). Immunohistochemical staining showed that CD31-positive cells were evenly distributed between muscle layers in the experimental group, whereas the control group exhibited notable defects. At 2 weeks after operation, the CD31-positive cell ratio was significantly higher than that in the control group (P<0.05); at 2 and 4 weeks after operation, the CD68-positive cell ratio in the experimental group was significantly lower than that in the control group (P<0.05). Conclusion CS hydrogel has a positive effect on preventing adhesions and promoting wound healing, exhibiting anti-inflammatory and pro-angiogenic properties during the healing process. This provides a promising strategy to address challenges related to abdominal adhesions and reconstruction.