ObjectiveTo investigate the effectiveness of repair procedure using biological mesh with Onlay-Reinforce technique in patients with perineal hernia. MethodsBetween January 2005 and December 2012, 9 patients with perineal hernia after laparoscopic abdominoperineal resection for rectal cancer (Miles operation) were treated. There were 3males and 6 females with a mean age of 70 years (range, 61-78 years). The disease duration was 1-9 months (mean, 4.5 months). The most beginning symptom was distending pain in perineal region, and then reducible mass was found without bowel incarceration. All patients underwent hernia repair using biological mesh with Onlay-Reinforce technique through original perineal incision. ResultsThe hernial size was 9.8-20.5 cm2 (mean, 16.0 cm2); the size of biological mesh was 58-80 cm2 (mean, 70.2 cm2); and the intraoperative blood loss was 10-80 mL (mean, 50.5 mL). All of the patients underwent repair operation successfully. The operation time was 45-90 minutes (mean, 60.6 minutes); and the hospitalization time was 4-7 days (mean, 5.9 days). One patient had urine retention, which was relieved after 7 days indwelling catheter. All the wounds healed by first intention without infection. The patients were followed up 14.5-60.7 months (mean, 37.8months). No chronic pain, obvious foreign body sensation, or hernia recurrence developed. ConclusionUse of biological mesh with Onlay-Reinforce technique for the repair of perineal hernia after Miles operation is safe and effective.
目的 探討加用網片盆底重建術（PROSIMA）治療盆腔器官脫垂患者的圍手術期護理方法。 方法 對2010年6月－2011年6月收治的23例盆腔臟器脫垂患者施行的PROSIMA護理措施進行回顧性總結。 結果 23例患者術后尿失禁癥狀明顯好轉，舒適感增加；僅1例發生尿潴留，予重置尿管后順利排尿；治愈率達100%。術后6個月復查時均無陰道壁膨出或穹隆脫垂，未出現下尿路感染、網片侵蝕、下肢疼痛等并發癥。 結論 有效的護理措施可減少PROSIMA術后并發癥，對提高手術成功率、促進患者康復有明顯作用。
ObjectiveTo observe the effect of anti-embolism stocking and air pressure therapeutic apparatus on the prevention of lower extremity deep vein thrombosis (DVT) after pelvic floor reconstruction. MethodsNinety-one patients who were treated with pelvic floor reconstruction between June 2011 and May 2013 were divided into trial group (n=42) and control group (n=49) according to random number table method. The patient age, body mass index (BMI), level of education, general anesthesia and surgery time between the two groups had no difference of statistical significance (P>0.05). The control group was treated traditionally. The trial group used anti-embolism stocking 30 minutes before surgery, and from 6 hours after operation until 3 days later when the patient could walk with the combined use of pneumatic therapeutic treatment. Between day 5 and 7 after surgery, lower limb vascular color Doppler ultrasound was done to observe the occurrence of lower limb DVT in both the two groups. ResultsThe incidence of lower extremity DVT was 2.38% and 18.36% in the trial and the control group respectively. There was a statistically significant difference between the two groups (P<0.05). ConclusionCombined use of anti-embolism stocking 30 minutes before operation and pneumatic therapeutic treatment 6 hours postoperatively can be effective in preventing the formation of DVT after total pelvic floor reconstruction.
目的 探討Prolift系統全盆底重建術在治療盆腔臟器脫垂疾病中的應用價值及療效。 方法 回顧性分析四川大學華西第二醫院婦科2010年1月－2011年5月收治的119例盆腔臟器脫垂患者的臨床資料，其中47例應用Prolift系統進行全盆底重建術（A組），51例應用曼氏手術治療（B組），21例應用經陰道全子宮切除術+陰道前后壁修補術治療（C組）。分析比較各組的臨床近期療效。術后隨訪1年。 結果 A、B、C組在手術時間、術中出血量、術后安置尿管天數、術后住院天數間差異均無統計學意義（P＞0.05）。A組1例、B組11例、C組4例復發，A組與B、C組復發率比較差異有統計學意義（P＜0.05）。 結論 Prolift系統全盆底重建術安全性高，不增加臟器損傷的幾率，且明顯降低了患者的術后復發率，近期療效肯定，是治療盆腔臟器脫垂的一種理想術式。
A retrospective study of 65 cases of huge sacrococcygcal teratomas were surveyed. The long term functional prospect of the benign tumor was excellent. The characteristics of the normal and pathological anatomy of the pelvic floor were mentioncd. Based on these, the authors described some personal experiences of the procedures, and discussed some problems of the reconstruction of the pelvic floor.
(承2007年第6期) 6.2 盆腹膜重建的種類和方法 6.2.1 盆底隔離法如前所述,因超低位直腸/肛管癌浸潤會陰直腸隔、盆側壁及肛周擴約肌群而實施了新腹會陰局部擴大切除術,因T4期直腸癌浸潤子宮陰道或膀胱前列腺部分組織而實施了盆腔臟器局部擴大切除術,因局部復發性直腸癌而實施了腹會陰聯合再切除術,因各種原因對中晚期直腸癌實施了Hartmann手術,以及因技術不確定性而實施了傳統腹會陰聯合切除術,無論手術切除范圍或術者的操作技巧如何,由于病變性質決定了這類手術只能定位于根治性(R0)與姑息性(R2)之間的程度.因此,初次切除只是獲得治愈或延長生存期的第一步,接下來是盆腔放療或局部內放射治療,最后,尚存在局部復發的高風險,若發生,可經會陰骶尾部再次甚至多次對復發癌行局部姑息性切除.因而預先有效的盆底隔離就可避免再手術時的小腸損傷,這就是盆底重建術的主要功能和適應證之一.……