ObjectiveTo summarize the method and experience in surgical treatment for mesh infection after prosthetic patch repair of ventral hernia. MethodsThe clinical data of 16 patients with mesh infection after ventral hernia repair accepted surgical treatment in our department from June 2007 to May 2010 were analyzed retrospectively. There were 10 males and 6 females, the age range from 24 to 73 years with an average 45.2 years. The patients with mesh infection included 11 cases of infection after incisional hernia repair, 4 cases of infection after abdominal wall defects repair caused by abdominal wall tumor resection, 1 mesh infection combine with urinary fistula caused by parastomal hernia of ileal neobladder repaired by using prosthetic patch. Clinical manifestation included mesh exposion, abscess, chronic sinus, and enterocutaneous fistula. All patients accepted local treatment of change dressing by primary operative surgeon, but the wounds didn’t heal about 3 to 24 months. Then the patients performed radical removal of infected mesh and abdominal wall reconstruction. ResultsAll patients accepted affected mesh removal successfully. Five patients performed abdominal wall reconstruction by using components separation technique. Four cases accepted abdominal wall repair by using polypropylene mesh. Five patients performed abdominal wall repair by using human acelluar dermal matrix. One case accepted change dressing and vacuum aspiration on the infected wound surface without reconstruction. And one case closed the wound immediately after infected mesh removal. The postoperative hospitalization time was 9 to 25 d (average 14 d). Thirteen patients recovered with primary wound healing. The other 3 cases recovered with second healing by local change dressing. All patients were followed up from 6 to 34 months (average 22 months), no abdominal wall hernia recurrence occurred. ConclusionsIt is very difficult to deal with mesh infection after prosthetic patch repair of abdominal wall hernia or defect. The surgical treatment should be done according to specific condition of each individual so as to acquire satisfied results.
ObjectiveTo explore the feasibility and safety of the artificial pneumoperitoneum and gastrointestinal contrast CT imaging, and imaging diagnostic value on abdominal wall adhesion to intestine after operation. MethodsThirtynine patients with adhesive intestinal obstruction after operation relieved by conservative therapy were included from January 2008 to November 2009. After the artificial pneumoperitoneum established by injection of gas into abdominal cavity and gastrointestinal comparison by oral administration low concentration of meglucamine diatrizoate, CT scan imaging was performed and the radiographic results were compared with surgical findings. ResultsFour patients refused surgery and discharged, so enterolysis was performed in the remaining patients. The surgical findings were consistent with radiographic results. It was showed by laparoscopic operation that intestinal obstruction caused by the fibrous adhesions and the intestine did not adhere to the abdominal wall in eight patients with fibrous adhesion diagnosed by CT. Of eighteen patients with the abdominal wall septally adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed “M”type adhesions and omentum adhesions in sixteen patients underwent open operation, and clear fat space was showed in eight patients and close adhesion was found in another eight patients between the intestine and abdominal wall. Of thirteen patients with the abdominal wall tentiformly adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed continuous and tentiform adhesions and omentum adhesions to the intestine in eleven patients. After the followup of 6-18 months (mean 9 months), incomplete intestinal obstruction occurred in one patient and was relieved by conservative treatment. One patient with discontinuous discomfort in abdomen after operation did not receive any treatment. The other patients were cured. ConclusionThe artificial pneumoperitoneum and gastrointestinal contrast CT imaging can accurately show the location, area, and structure composition of the postoperative abdominal wall adhesion to intestine, which is safety, simple, and bly repeatable, and a better imaging method for the diagnosing of abdominal wall adhesion to intestine after operation.
1The surgical treatment for the recurrent groin herniasEver since the advent of elective surgical intervention for inguinal hernia recurrences have been observed. Indeed, many of the modern surgical techniques for herniorrhaphy were devised specifically to minimize recurrence rates. For many reasons it has been difficult to actually quantify a true recurrence rate for inguinal hernia repair. Surgeons use a variety of anatomic and “tension free” mesh repairs when fixing a symptomatic groin heria. In general the recurrence rates for each type of repair have been reported and vary from 0.5% to 10% in the current literature. One factor contributing to the broad range of recurrence is the duration 0 follow up. While most recurrences are noted within 2 to 5 years of the original repair, patients often do not seek repair of the recurrence for some 10 to 15 years following the original operation. Longterm follow up is necessary to appreciate the outcome of hernia repair.In the early 1970’s Dr L M Nyhus taught me the preperitoneal approach to the repair of groin hernia. Introduced it into my practice at the time initially restriction its use to to the repair of recurrent groin hernia but eventually enlarged the indications to include high risk patients, patients with incarcerated hernia, femoral hernia and when I felt the surgical resident needed instruction in the anatomy of the groin. I have used the preperitoneal approach for the repair of groin hernia over 3 000 times in general and specifically for the repair of recurrent groin hernia in over 750 patients. The results have been most ratifying. For first time recurrent groin hernia repair the recurrence rate for over 90% of patients followed five years was 1.6%.
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.
Test of tissue tolerance to domastic prosthetic materials (carbon fiber mesh, siliconized velvet, silk cloth and dacron cloth) as a subcutaneos transplant was performed in the adcominal wall of rabbit. These implants and their surroundding tissues were excied for studies at second , fourth, eighth and the twelfth weeks after operation. Ratio of fibroblast count to inflammatory cells count which is a common parameter of tissue tolerance was calculated in these four groups. The result shows that fibroblastic cell reaction elicited by carbon fiber mesh is the greates among the four prosthetic materials, the second one is dasron cloth. The inflammatory cell reaction elicited by silk is the greatest among the four materials, the second is carbon fiber mesh, and the dacron cloth the least. Tissure tolerance of dacron cloth is the best in the four prosthetic materials for implantation while sick is the worst.
Objective To determine the airway wall thickness at the segmental and subsegmental levels in patients with bronchial asthma and eosinophilic bronchitis ( EB) by high resolution CT scanning,and evaluate its relationship with airway hyperresponsiveness. Methods High resolution CT scanning was performed in 14 subjects with asthma,15 subjects with EB, 15 subjects with cough variant asthma ( CVA) ,and 14 healthy volunteers. Total airway and lumen diameter, total airway cross sectional area and lumen area which corrected by body surface area ( BSA) were measured. The percentage of airway wall area to total airway cross sectional area ( WA% ) and wall thickness to airway diameter ratio ( T/D) were calculated for the right upper lobe apical segmental bronchus ( RB1) and all airways clearly visualized with a transverse diameter of 1-6 mm. Results T/D/BSA and WA% in the asthma patients were all significantly higher than those in the subjects with EB, CVA and healthy volunteers. T/D/BSA and WA% in the EB patients were significantly higher than the healthy volunteers, and similar with the CVA patients. Al /BSA in the patientswith asthma and CVA was less than the subjects with EB and the healthy volunteers. However, Al /BSA in the EB patients was similar with the healthy volunteers. Conclusions The airway wall thickness and remodeling can be measured and assessed by high resolution CT. Airway wall thickness and remodeling inEB patients are milder than asthma patients, which may be associated with airway hyperresponsiveness that presents in asthma but not in EB.
Objective To investigate the risk factors of stroke associated pneumonia in stroke patients.Methods A case-control study was conducted. 114 patients who were diagnosed stroke associated pneumonia between January 2008 and December 2010 were recruited as a patient group. 205 patients who were diagnosed stroke without pneumoniawere recruited as a control group. General conditions, accompanied disease, vital sign, hematologic marker, severity of stroke, and bulbar paralysis were compared between two groups. Multifactor Logistic regression was used to screen associated factors.Results Age gt; 65 years ( OR=3. 310, 95% CI 2. 016-7. 549) , accompanied with COPD ( OR = 3. 624, 95% CI 1. 574-9. 236) , diabetes ( OR= 3. 781, 95% CI 1. 305-6. 842) , failed water swallowing test ( OR = 3. 625, 95% CI 1. 604- 8. 386) , big volume of stroke ( OR=14. 784, 95% CI 3. 737-38. 588) , NIH stroke scale ( NIHSS) score gt;6 ( OR=2. 913, 95% CI 1. 029-7. 985) , abbreviated mental test ( AMT) score lt; 8 ( OR = 4. 229, 95% CI 2. 215-9. 368) were associated with stroke associated pneumonia. Conclusion The risk factors for stroke associated pneumonia in stroke patients were age gt;65 years, accompanied with COPD, diabetes, failed WST, big volume of stroke, NIHSS score gt;6, and AMT score lt;8.
Abstract： Objective To summarize the application experience of Gore-Tex patch in clinical chest wall reconstruction. Methods A retrospective analysis was performed in 33 patients who underwent chest wall reconstruction using Gore-Tex patch from January 2001 to December 2010 in Shanghai Changhai Hospital, Second Military Medical University. There were 19 men and 14 women, ranging in age from 20 to 73 years with a median age of 45.7 years. The surgical strategies included choosing different incisions according to tumor location and size, and preserving normal chest wall soft tissue as much as possible during surgery. Gore-Tex patch was used to reconstruct the huge chest wall defect, and covered by transferred muscle flaps. Results All the 33 patients underwent surgical reconstruction successfully and there was no perioperative death. Complete tumor resection was performed in all the patients, including 25 patients with malignant tumor and 8 patients with benign tumor. The diameter of the resected tumors ranged from 8 to 20 cm. All the patients were followed up from 5 to 60 months, except that 3 patients （9.09%） were lost during follow-up. There was no rejection response, abnormal breathing and foreign body sensation during follow-up. The infection incidence was 3%（1/33）. Conclusion Gore-Tex patch is a safe and effective material for chest wall reconstruction due to its excellent biocompatibility. Appropriate selection of muscle flap for covering Gore-Tex patch can reduce postoperative complications.
Abstract: Objective To summarize the 17-year clinical experience of coronary artery bypass grafting (CABG). Methods From April 1987 to May 2004, total 253 patients with coronary artery disease underwent CABG. The operation were performed in 217 patients under cardiopulmonary bypass (CPB) with moderate hypothermia, because of calcified ascending aorta, partial replacement of ascending aorta wall with apiece of Gore-Tex graft for the proximal anastomosis were done in 10 patients. Off-pump coronary artery bypass grafting (OPCAB) were performed in 30 patients. The operation under CPB with heart beating were performed in 6 patients. Cardiac valvular operations were performed in 15patients. Left atrium myxoma operation was performed in 1 patient. Left ventricular aneurysm plasty operation were performed in 10 patients. Results Total mortality rate was 7.9% (20/253). There was significant difference between the mortality rate of the first 10 years (16.0%,8/50) and that of the last 7 years (5.9%,12/203; χ2=5.62，Plt;0.05). The causes of death were: 3 patients died on table because of low cardiac output after valvular replacement though emergent CABG were conducted, 2 patients died of multiple organ failure after valvular replacement and emergent CABG had undergone, 3 patients died of ventricular fibrillation during closing the sternum, 6 patients died of multiple organ failure caused of severe lung infection, 2 patients died of ventricular fibrillation after operation, and 4 patients died of acute renal failure. One hundred and fiftyseven patients (67.4%, 157/233) were followed up, follow-up time was 6 months to 15 years. Three of them died of unknown causes, most of them have improved life quality. There were 87 patients in New York Heart Association (NYHA) class Ⅰ, 49 patients in NYHA class Ⅱ, 16 patients in NYHA classⅢ, and 2 patients in NYHA classⅣ. Conclusion When the experience of surgery and postoperative care is matured, CABG is a safe method for treatment of coronary artery disease. Partial replacement of ascending aorta wall with GoreTex graft for proximal anastomosis of the graft is acandidate method for the treatment of patients with calcified ascending aorta.
【Abstract】 Objective To evaluate the surgical management of rigid post-traumatic thoracolumbar kyphosis (RPTK) by simultaneous posterio-anterior circumferential releasing, correction and anterior corpectomy with preserved posterior vertebral wall. Methods Twenty patients with RPTK were treated between October 2004 and October 2010 by posterior releasing, anterior subtotal corpectomy with preserved posterior vertebral wall, correction, strut graft, and short segmental fixation. There were 14 males and 6 females with an average age of 43.2 years (range, 23-63 years). The time between injury and operation was 4 months to 23 years (mean, 1.4 years). The affected locations were T11 in 1 case, T12 in 8 cases, L1 in 10 cases, and L2 in 1 case. The Cobb angle and the intervertebral height of the fractured vertebra body were measured before and after operations. The degrees of low back pain were assessed by Japanese Orthopaedic Association (JOA) scores. Results No incision infection, nerve injury, or cerebral spinal fluid leakage occurred. Seventeen patients were followed up 1-5 years with an average of 2.8 years. The JOA score at last follow-up (26.2 ± 3.9) was significantly improved when compared with the pre-operative score (14.0 ± 5.7) (t=4.536, P=0.001). One patient had aggravation of kyphosis at 3 months postoperatively, who was in stabilized condition after prolonging immobilizated time. The Cobb angle was corrected from (43.2 ± 11.5)° preoperatively to (9.8 ± 5.7)° at last follow-up, showing significant difference (P lt; 0.01). There was significant difference in the intervertebral height of the fractured vertebra body between preoperation and last follow-up (P lt; 0.05). The intervertebral height of fractured vertebra was restored to 87.0% ± 11.2% of adjacent disc height. Conclusion Posterio-anterior circumferential releasing and anterior corpectomy with preserved posterior vertebral wall can achieve satifactory clinical results, not only in pain relieving, kyphosis correction, vertebral height restoration, and spinal stability restoration, but also in the risk reduce of bleeding and spinal cord disturbance.