】ObjectiveTo review the recent studies on the diagnosis and treatment of abdominal incisional hernia. MethodsThe literatures in recent years on the etiological factor,pathology,epidemiology, diagnosis and therapeusis were reviewed and summarized. ResultsThe abdominal incisional hernia is a serious complication of abdominal operation which affect the patient’s quality of life severely. The etiological factors and treatments were complex. Conclusion Prophylaxis of abdominal incisional hernia is important. The tension free hernioplasty using synthetic materials is very popular and effective.
ObjectiveTo study the influence of infection in incision of abdominal wall on peritoneal adhesion. MethodsOne hundred and twenty white rats were divided into low, medium, high concentration (LC, MC, HC) groups and control group, 30 rats each, and were made animal models of abdominal incision infection, then were respectively given hypodermic injections in incisional wound of 0.2 ml quantitative mixture of Escherichia coli, staphylococcus aureus and pseudomonas aeruginosa in the concentration of 1×102, 1×105 and 1×108 cfu/ml. While the control group,normal saline was given. All the subjects were killed 8 days after operation and compared the peritoneal adhesion among the four groups.ResultsInfection rate of the incisional wounds was 81.48%, 86.67%, 90.00% and 50.00% respectively in LC, MC, HC and the control, peritoneal adhesion rate was 53.33%, 60.00%, 70.00% and 26.67% respectively. There was significant difference between LC and the control (P＜0.05), between MC or HC and the control (P＜0.01). While no difference was among LC, MC and HC (P＞0.05).Conclusion Infection of incision may increase peritoneal adhesion which might not be closely related to the number of the bacteria. This suggests that the prevention of infection plays an important role in preventing peritoneal adhesion.
Objective Mesh infection may occur after incisional hernia repair using prosthetic mesh. Preparation of antibiotics-bonded meshes to prevent infection is one of the solutions. To evaluate the anti-infection effect of polypropylene mesh bonded norvancomycin slow-release microsphere by preparing the rat model of incisional hernia repair contaminatedwith Staphylococcus aureus. Methods The norvancomycin slow-release microspheres were prepared by emulsion and solvent evaporation method and they were bonded to polypropylene mesh (50 mg/mesh). The appearance of the microspheres was observed using scanning electronic microscope (SEM). The content of norvancomycin in microspheres and the release rate of the norvancomycin in norvancomycin-bonded polypropylene mesh were detected using high performance l iquid chromatography method. The rat models of incisional hernia were developed in 40 healthy Sprague Dawley rats, aged 10-11 weeks and weighing 200-250 g. The rats were divided randomly into the experimental group (norvancomycin-bonded polypropylene mesh repair, n=20) and the control group (polypropylene mesh repair, n=20). And then the mesh was contaminated with Staphylococcus aureus. The wound heal ing was observed after operation. At 3 weeks after operation, the mesh and the tissue around the mesh were harvested to perform histological observation and to classify the inflammatory reaction degree. Results The norvancomycin microsphere had integrated appearance and smooth surface with uniform particle diameter, 64% of particlediameter at 60 to 100 μm, and the loading-capacity of norvancomycin was 19.79%. The norvancomycin-bonded polypropylene patch had well-distributed surface and the loading-capacity of norvancomycin was (7.90 ± 0.85) mg/cm2. The release time of norvancomycin in vitro could last above 28 days and the accumulative release rate was 72.6%. The rats of 2 groups all survived to experiment completion. Wound infection occurred in 2 rats of the experimental group (10%) and 20 rats of the control group (100%), showing significant difference (χ2=32.727 3, P=0.000 0). The inflammatory reaction in experimental group was not obvious, grade I in 16 rats and grade II in 4 rats, and numerous inflammatory cell infiltration occurred in the control group, grade II in 3 rats and grade III in 17 rats, showing significant difference (Z=32.314, P=0.000). Conclusion The polypropylene mesh bonded norvancomycin slow-release microsphere has definite anti-infection effect in rat model of incisional hernia repair contaminated by Staphylococcus aureus.
Objective To observe the operative technique and cl inical effects of hidden tension suture after tibiofibular fracture fixation with absorbable thread. Methods From October 2003 to October 2008, 203 patients (220 sides) with tibiofibular fracture underwent hidden tension suture (test group, 102 cases of 112 sides) and the common interrupted suture (control group, 101 cases of 108 sides), including 179 males and 24 females with an median age of 36 years (3-75 years). Fracture was caused by traffic accident in 170 cases, by heavy bruise in 21 cases, and by fall ing from height in 12 cases. Therewere 186 cases of single-side fracture, and 17 cases of double-side fracture. Of them, 127 sides were closed fracture, and 93 sides were open fracture (including 38 sides of type I, 45 sides of type II, and 10 sides of type IIIA according to Gustilo classification for the open fracture). The locations were upper tibia in 55 sides, middle tibia in 126 sides, and lower tibia in 39 sides. The X-ray films showed that there were transverse fractures in 65 sides, obl ique fractures in 53 sides, spiral fractures in 45 sides, and comminuted fractures in 57 sides. No blood vessel injury, osteofascial compartment syndrome and pressure syndrome were observed. The time from injury to operation was 2 hours to 7 days with an average of 2 days. Of 220 sides, 45 sides were fixed by interlocking nails, others by internal steel plate. Results In control group, heal ing by first intention was achieved in 70 cases (69.3%) and heal ing by secondary intention in 31 cases (30.7%); in test group, heal ing by first intention was achieved in 93 cases (91.2%) and heal ing by secondary intention in 9 cases (8.8%); and showing significant difference (P lt; 0.05). All patients were followed up for 6 months to 2 years (average 9 months). No compl ication occurred in test group, and scar was obvious in the control group. Conclusion The hidden tension suture with absorbable thread can be a good alternative for the incision heal ing after tibiofibular fracture fixation. It deals with the problems of the incision tension and difficult-to-suture, and is good for the incision heal ing after operation.
Objective To evaluate the usefulness of minimal incision technique in total knee arthroplasty (TKA) by comparing the early compl ications after minimal incision TKA and those after traditional incision. Methods From May 2004 to July 2005, 38 patients (46 knees) underwent TKA using the minimal incision technique (minimal incision group), and 43 patients (54 knees) underwent TKA using the traditional incision technique at the same period (traditional incision group). The inimal incision group included 12 male patients (12 knees) and 26 female patients (34 knees), and their ages ranged from 52 to 76 years. Twenty-four patients (28 knees) had osteoarthritis and 14 patients (18 knees) had rheumatic arthritis. The varus deformity of the knee was found in 30 patients (34 knees) and valgus deformity was found in 8 patients (12 knees). TheAmerican Knee Society Score (AKSS) score was 37.5 ± 12.6, and the disease course was (7.5 ± 2.3) years. The raditional incision group included 15 male patients (19 knees) and 28 female patients (35 knees), and their ages ranged from 55 to 82 years. Thirtytwo patients (37 knees) had osteoarthritis and 11 patients (17 knees) had rheumatic arthritis. Varus deformity of the knee was found in 34 patients (41 knees) and valgus deformity was found in 9 patients (13 knees). The AKSS score was 31.1 ± 10.2, and the disease course was (10.1 ± 4.2) years. There were no statistically significant differences in the general data between two groups (P gt; 0.05). Results The incision length, the operation time and the drainage flow were (12.6 ± 1.2) cm, (95 ± 15) minutes and (650.1 ± 10.0) mL in the minimal incision group and (18.7 ± 2.3) cm, (63 ± 11) minutes and (300.0 ± 20.0) mL in the traditional incision group; showing statistically significant differences between two groups (P lt; 0.05). In the minimal incision group, 4 patients (4 knees) developed infections at the operated knees, including 2 early infection and 2 late infection, which were all cured by corresponding treatment. Deep vein thrombosis occurred in 1 patient on the third day after operation and was managed successfully by thrombolytic therapy. Cutaneous necrosis was found in 2 patients on the seventh and ninth postoperative day separately, which healed uneventfully after intensive local treatment. On the twelfth postoperative month, 1 patient had femoral fractured at the site of supracondylar region after a careless fall, but the prosthesis was stable. The fracture was fixed by a plate and healed uneventfully. In the traditional incision group, only 1 patient (1 knee) developed early infection at the operated knee on the tenth postoperative day, which was managed by corresponding treatment. And there were no periprosthetic fracture, cutaneous necrosis or deep vein thrombosis. The patients were followed up for (3.7 ± 0.4) years in the minimalincision group and (3.9 ± 0.6) years in the traditional incision group. At the latest follow-up, the AKSS scores were 78.2 ± 6.7 in the minimal incision group and 81.2 ± 7.3 in the traditional incision group, showing statistically significant ifferences (P lt; 0.05) when compared with those before operation and no statistically significant difference between two groups (P gt; 0.05). Conclusion Minimally invasive TKA has relatively higher compl ication rate than traditional incision. Strict patient inclusion criteria, competent surgery skill, proper instrument and intensive perioperative management are essential to success.
Objective To study the effect of sodium hyaluronate hydrogel in treating residual cavity on body surface after abscess drainage so as to provide new method to speed up the heal ing of residual cavity after body surface abscess drainageand reduce the frequency of dressing change and cl inic nursing workload. Methods From June 2007 to March 2008, 60 outpatients with body surface abscess drainage were randomly divided into hydrogel group (group A, 30 cases) and the control group (group B, 30 cases). In group A, there were 16 males and 14 females aged (49.5 ± 6.1) years, the disease course was (3.8 ± 0.6) days, and the volume of residual cavity was (4.19 ± 1.31) mL. In group B, there were 18 males and 12 females aged (50.2 ± 7.6) years, the disease course was (4.3 ± 0.5) days, and the volume of residual cavity was (4.04 ± 1.22) mL. There was no significant difference between two groups in gender, age, disease course and volume of residual cavity (P gt; 0.05). Residual cavity was smeared with 1 mL/cm2 sodium hyaluronate hydrogel in group A and drained by sal ine gauze in group B, the dressing was changed every two to three days. Residual cavity volume was recorded every four days, and the residual cavity volume, the frequency of out-patient dressing and the heal ing time residual of cavity were compared. Results The volume of residual cavity was (3.11 ± 1.12), (1.75 ± 0.95) and (0.55 ± 0.56) mL in group A, and was (3.39 ± 1.12), (2.64 ± 0.99) and (1.81 ± 0.81) mL in group B at 4, 8 and 12 days after treatment respectively, showing no significant differences at 4 days (P gt; 0. 05), but significant difference at 8 and 12 days (P lt; 0.01). Residual cavity heal ing time was (12.70 ± 2.78) days in group A and (20.27 ± 3.89) days in group B, and the frequency of dressing change was 5.53 ± 1.33 in group A and 9.13 ± 1.81 in group B, indicating significant differences between two groups (P lt; 0.01). Conclusion Sodium hyaluronate hydrogel can promote residual cavity heal ing, reduce the frequency of dressing change of out-patient and decrease the cl inic nursing care workload.
OBJECTIVE To repair the huge incisional hernia of abdominal wall, a new surgical method was introduced. METHODS Eight cases of huge ventral incisional hernia, developed in 3 months to 12 months after operation, were treated in this new method with the defects ranged from 8 cm x 4 cm to 12 cm x 6 cm. RESULTS They were followed up for 6 months to 18 months after operation. The clinical results showed that all of the 8 cases recovered satisfactorily without recurrence. CONCLUSION The new method was recommendable for its advantages of easier manipulation, shortened time, no tissue reaction and less tissue trauma from operation.
The soft-tissue-cutaneous flap adjacent to the abdominal incisional hernia was ultilized to repair huge hernia in 6 cases with success. Patients were followed up for 2y7 years without recurrence. The operative planning, the technique and the matters needing attention were introduced in details. The soft tissues and skin adjacent to hernia used for repair was easy to obtain and a simple technique. The adoption of this operation in hospitals at the grassroots level was feasible.
【摘要】目的探讨喉癌手术后患者对两种不同雾化方式的耐受性,为选择最佳雾化方式提供参考。方法将49例喉癌手术后患者随机分为观察组(25例)和对照组(24例),观察组采用氧气雾化吸入,对照组采用空气压缩泵雾化吸入。分别记录两组患者雾化吸入前及吸入15 min时脉搏血氧饱和度(SpO2)及心率;雾化过程中患者有无心慌、气紧等不适以及雾化后痰液的性质及量。采用SPSS 13.0软件进行统计分析。结果两组患者雾化吸入15 min时的SpO2差异有统计学意义(Plt;001),观察组高于对照组;而两组患者雾化吸入前SpO2、心率、不适主诉及雾化后痰液的性质差异均无统计学意义(Pgt;005)。结论氧气雾化吸入可以提高喉癌手术后患者雾化过程中的SpO2,使患者感觉更加舒适。【Abstract】Objective To investigate postoperative patients with laryngeal carcinoma atomization of two different forms of tolerance, in order to choose the best means of atomization. Methods Fifty postoperative patients with laryngeal carcinoma were divided into observation group using oxygen inhalation and control group using the air compression pump inhalation. Two groups of patients were recorded the value of SpO2 and heart rate before 15 minutes after the inhalation,as well as the discomforts such as flustered,gas tight during the atomization process and the nature and olume of sputum. Results The results of two groups of patients at the time of 15 minutes inhalation SpO2 statistically significant difference (Plt;001), the observation group than in the control group average SpO2 high; and two groups of patients with preinhalation SpO2 average, average heart rate, Discomfort chief complaint and the nature of sputum after aerosol compared no significant difference (Pgt;005). Conclusion Oxygen inhalation in patients with laryngeal cancer can improve the atomization process SpO2 value, so that patients feel more comfortable.
Objective To summarize the experiences and methods on reoperation of recurrent incisional hernia after mesh repair with prosthetic patch. Methods Sixteen patients who got reoperation from January 2007 to December 2010 because of recurrent incisional hernia after mesh repair were analyzed retrospectively. Results All patients received prosthetic patch repair for reoperation. Thirteen patients received new mesh repair accompanied with old mesh removal, repair conducted by suturing new mesh with old mesh together in two patients, and repair performed by new mesh overlapping the old mesh in one patient. All patients recovered with primary wound healing. Fluid upon the mesh occurred in 3 patients and cured by percutaneous puncture and pressure dressing. Postoperative hospital stay was 7 to 16 days and the average 9 days. The drainage was removed 2 to 7 days after operation and the average was 4 days. All the 16 patients were followed up. And during a follow-up range of 5 to 36 months and the average 20 months, there was slight foreign body sensation in one patient, no chronic pain in wound area occurred. And no abdominal wall hernia recurrence occurred. Conclusions Reoperation of recurrent incisional hernia after mesh repair need to consider the recurrent position, material of the previous mesh, and the previous surgical methods, and should select appropriate prosthetic patch and surgical procedure, then could gain satisfied results.