Objective To study the advances in clinical application of hernioplasty by high molecular material. Methods The literature in the recent years on the advances of hernioplasty by high molecular material was reviewed. Results At present time many operative techniques of hernioplasty by high molecular material have been developed. The representative techniques were ①Rives-Stoppa′s mesh inlay hernioplasty; ②Lichtenstein′s tesion-free herniorrhaphy; ③mesh plug hernioplasty; ④Gilbert′s sutureless hernioplasty; ⑤laparoscopic inguinal hernioplasty. The reparing high molecular material was divided into absorbable and unabsorbable material, the former included polyglycolic-acid and polyglaction, the later consists of polypropylene polyester and expanded polytetrafluoroethylene.Conclusion The clinical application of henioplasty by high molecular material is increasing. According to the hernia type and patient condition, excellent outcome will be achieved by the application of proper repairing method and repair material.
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.
Congenital deformities of the diaphragm include (1) Hiatus hernia; (2) Congenital diaphragmatic hernia; (3) Eventration of deaphragm. Fifty-one cases were seen by the authors in the past 30 years. Each type of the pathologic feature and the experiences in the surgical repair were suggested in this paper. Choice of an appropriate surgical procedure on the basis of its pathoanatomic and pathophysiologic features was emphasized in order to enhance the efficacy of treatment.
目的 探討腹股溝疝的病因及如何降低無張力疝修補術后的復發率。方法 對716例行無張力疝修補術的腹股溝疝患者的臨床資料進行回顧性分析。 結果 所有患者手術均順利，無手術死亡和切口感染。術后出現陰囊積液11例，經穿刺抽液后痊愈； 并發尿潴留23例，經導尿處理后24～48 h恢復正常。術后隨訪3～51個月，復發1例，復發率為0.1%。結論 腹內高壓是導致成人腹股溝疝的重要因素，為有效降低無張力疝修補術后復發率，除了建立腹股溝區現代解剖生理的新概念外，必須注意防治腹內高壓及遵循手術治療中的“個體化” 原則。
Objective To explore the mechanism of pulmonary hypoplasia in case of congenital diaphragmatic hernia (CDH), and study the ultramicrostructural features of lung tissue of CDH fetal rat models at different developmental stages. Methods Seven SpragueDawley (SD) pregnant rats were randomly divided into CDH group (n=4) and control group (n=3). For the rats in the CDH group, Nitrofen was used to fill in the stomach once at day 9.5 of pregnancy (125 mg of Nitrofen dissolved in 2 ml of olive oil each), and 3, 10, 17 fetal rats were collected at day 16, 18 and 21 of pregnancy respectively. For the rats in the control group, 2 ml of olive oil was used to fill in the stomach, and 10 fetal rats were collected at day 16, 18, and 21 of pregnancy respectively. The lung tissue sections of the fetal rats collected on day 16 were observed under transmission electron microscope (TEM). For the lung tissue of the fetal rats collected on day 18, hematoxylineosin (HE) staining and TEM observation were performed and the incident of CDH was detected. Besides the procedures carried out for the rats collected on day 18, the ratio of fetal lung to body weight was observed for the lung tissue of the fetal rats collected on day 21. Results (1) The ratio of fetal lung to body weight of fetal rats in the CDH group was significantly lower than that of fetal rats in the control group (0.0238 vs. 0.0430, Plt;0.01). The incidences of CDH in the 18thday and 21stday fetal rats in the CDH group were 90.00% and 82.35%respectively, while no CDH was observed in the corresponding fetal rats in the control group, suggesting pulmonary hypoplasia in the CDH group. (2) The ultramicrostructural observation showed that compared with the control group, pulmonary hypoplasia appeared in 16thday fetal lungs in the CDH group, i.e., broad breathing barrier substrate, little contents, predominant euchromatin and rich ribosomes in the alveolar epithelial cells, and no microvilli in the bronchial lumen. The observation on the 18thday and 21stday samples suggested that, with the progressing of pregnancy, the abovementioned features became more obvious. (3) Typical lamellated body was observed in fetal lung type Ⅱ alveolar epithelial cells from the 21stday fetuses in both the CDH group and the control group, suggesting that some late subcellular structures were normal. Conclusion Lung hypoplasia develops in the early period of fetal rats with CDH rather than in the late period, implying that the treatment of pulmonary hypoplasia of diaphragmatic hernia should be performed in the early stage of lung development.
腹壁巨大切口疝的修補是很困難的手術，在一些特殊的病例中，由于患者的全身情況嚴重惡化使得切口疝無法修補，如年老、病態性肥胖及呼吸功能嚴重紊亂的患者。近年來，隨著生物材料在疝和腹壁外科的廣泛應用，對巨大腹壁切口疝的治療已取得了明顯進展。
Morgagni hernia is a rare form (accounting for 2%) of congenital diaphragmatic hernia. The traditional treatment for Morgagni hernia includes thoracotomy and laparotomy. However, surgical trauma limits its adoption. We reported the results of 2 patients with congenital Morgagni hernias in adults and described the operation methods of the patients. The 2 patients recovered uneventfully. No evidence of recurrence was found after 5 years follow-up. Laparoscopic repair for Morgagni hernia with mesh is applicable for obese, aged and bilateral Morgagni hernias patients.
【Abstract】ObjectiveTo evaluate the therapeutic benefits of three styles of hernioplasties such as the traditional hernioplasty, the mesh only hernioplasty and the plug amp; mesh hernioplasty. MethodsThe traditional hernioplasty in 534 cases(583 sides), the mesh only hernioplasty in 57 cases(60 sides) and the plug amp; mesh hernioplasty in 51 cases(54 sides) were performed. The comparing studies on the operative time, the postoperative complications, the recurrent rate and so on were analyzed. ResultsThe average operative time of the traditional styles group was (34.26±4.56) min, which was significantly shorter than the mesh only group 〔(40.35±6.24) min, P＜0.05〕 and the plug amp; mesh group 〔(49.12±8.69) min, P＜0.01〕 respectively. This significant difference between the mesh only group and the plug amp; mesh group was also identified (P＜0.05). Postoperative complications in the traditional styles group, the mesh only group and the plug amp; mesh group were 1.12%, 1.75% and zero,respectively (Pgt;0.05). Recurrent rate in the traditional styles group was 5.99%(32/534), which was significantly higher than that of the mesh only and the plug amp; mesh group (no recurrence). The average hospitalizing time in the traditional styles group, the mesh only group and the plug amp; mesh group was (7.11±3.06) days，（5.38±2.53） days and （6.19±3.61） days, respectively, in which there was no significant difference among groups. The activityrecovering time in the traditional styles group was (16.98±4.35) days, which was significantly longer than （7.26±2.46） days in the mesh only group and （8.02±3.35） days in the plug amp; mesh group. Conclusion The mesh only hernioplasty or the plug amp; mesh hernioplasty have a lower recurrent rate comparing with that in the traditional hernioplasty, which should be much more popularly applied in the treatment of inguinal hernia.
Objective To evaluate the clinical effectiveness of laparoscopic and open tension-free hernia repairs in adults. Methods A fully recursive literature search was conducted in PubMed (2002 to September, 2009), EMBASE (2002 to September, 2009), Cochrane Central Register of Controlled Trials (Issue 3, 2009), CBM (2002 to September, 2009) , CNKI and VIP Chinese Scientific Journals Full-text Database (2002 to September, 2009) in any language. Randomized or quasi-randomized controlled trials of inguinal hernia treated by laparoscopic and open methods in adults were considered for inclusion. The four analyzed outcome variables were chronic pain, long term recurrence, intraoperative complications and postoperative complication. Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out using RevMan 5.0 software. Results Eighteen published reports of eligible studies involving 5816 participants met the inclusion criteria. Compared with open methods, laparoscopic inguinal hernia had no significant differences in long-term recurrence rate [OR 1.53, 95%CI (1.00 to 2.34), P=0.05] and postoperative complication rate [OR 0.74, 95%CI (0.52 to 1.05), P=0.09], and had lower tendency chronic pain [OR 0.45, 95%CI (0.34 to 0.59) , Plt;0.000 01] with statistical significance. There were significant differences in intraoperative complications between the two groups [OR 2.15, 95%CI (1.32 to 3.53), P=0.002]. Conclusion Current evidence suggests that laparoscopic hernia repair is superior to open methods in chronic pain .There is no significant difference in long-term recurrence rate and postoperative complications between the two methods. More studies are needed for intraoperative complications and other long-term postoperative complications.
目的 總結腹股溝疝無張力疝修補術的手術經驗。方法 回顧性分析我院2002年2月至2009年1月期間126例腹股溝疝患者行無張力疝修補術的臨床資料及手術方法。結果 本組126例患者無圍手術期死亡者,并發癥主要有局部腫脹、異物感、疼痛等,隨訪6個月～6年(平均38個月)有6例(4.8%)復發。結論 無張力疝修補術是治療腹股溝疝較為理想的術式。