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%.
Objective To evaluate the feasibil ity of intrauterine abdominal wall defect repair of fetal lamb at late pregnancy. Methods Eight healthy pregnant ewes at 110-115 days of gestation (weighing 14-22 kg) were randomly divided into 2 groups. In group A (n=3), the abdominal wall defect of 5 cm × 1 cm was made in the fetal lambs, then was closed by strengthening suture; in group B (n=5), the abdominal wall defect of 5 cm × 2 cm was made in the fetal lambs, then was repairedby 2 layers of biological patches. After the lambs del ivered naturally, the lambs and their wounds were observed; at 10th day after birth, the scars were harvested for biomechanical and histological observations. Results One ewe of group A and 2 ewes of group B aborted, while the others were successfully del ivered. In group A, the abdominal incisions of 2 lambs healed well with a l ine-l ike scar and mild intra-abdominal adhesion, and the scar thickness was 4-5 mm. In group B, the abdominal incisions of 3 lambs did not heal completely with minor intra-abdominal adhesions, and the scar thickness was 3-4 mm. The wound breaking strength was 16, 20 N in group A and 10, 14, and 18 N in group B, respectively. A sl ight scar was seen in group A; skin ulcer and underlying fibrous connective tissue with inflammatory cell infiltration were seen in group B. Conclusion It was feasible to repair the abdominal wall defect of fetal lamb at late pregnancy in uterine. Small abdominal wall defect can be sutured directly; biological patch can be used to repair larger abdominal wall defect.
Objective To research the effect of porcine acellular dermal matrix in the reconstruction of abdominal wall defects in rabbits, and to investigate the appl ication feasibil ity of xeno-transplantation of acellular dermal matrix. Methods The porcine acellular dermal matrix was prepared from a health white pig. Twenty-six Japanese white rabbits (weighing 2.2-2.3 kg, female or male) were randomly assigned to 2 groups: the control group (n=6) and the experimental group (n=20). In the control group, the full-thickness abdominal wall defect of 5.0 cm × 0.5 cm was made, and the defect wassutured directly; in the experimental group, the full-thickness abdominal wall defect of 5.0 cm × 2.5 cm was made, and the defect was repaired with porcine acellular dermal matrix patch at the same size as the defect. At 5 weeks after surgery, the incidence of hernia and the intra-abdominal adhesions were observed and the wound breaking strength was compared between the patchfascia interface and the fascia-fascia interface. The graft vascularization was evaluated through histological analysis at 6 months after surgery in the experimental group. Results No hernia occurred in all rabbits of 2 groups. At 5 weeks after surgery, heal ing was observed between patch and the muscularfascia; the vascularization was seen in the porcine acellular dermal matrix patch. There was no significant difference in the adhesion grade (Z= —0.798, P=0.425) between the experimental group (grade 2 in 1 rabbit, grade 1 in 5, and grade 0 in 12) and the control group (grade 1 in 1 and grade 0 in 5). No significant difference was found (t= —0.410, P=0.683) in the breaking strength between the patch-fascia interface in the experimental group [(13.0 ± 5.5) N] and the fascia-fascia interface in control group [(13.6 ± 4.0) N]. In the experimental group, the small vessels and the infiltration of inflammatory cells were observed in the porcine acellular dermal matrix patch after 5 weeks through histological observations. The junctions of the patch-fascia interface healed with fibrous connective tissue. At 6 months after surgery, the inflammation was subsided and the collagen fiber of the patch was reconstructed. Conclusion The porcine acellular dermal matrix patchhas good results in repairing full-thickness abdominal wall defect. The patch-fascia interface has siml iar breaking strength to the fascia-fascia interface. The collagen fibers of the patch are reconstructed.
Objective To determine the frequencies and patterns of gastrointestinal wall thickening at muti-slice computed tomography (MSCT) in patients with hepatic cirrhosis. Methods One hundred and nine patients with cirrhosis and 130 patients without cirrhosis for gastrointestinal wall thickening were retrospectively analyzed by the abdominal MSCT scans. The frequencies of wall thickening were determined in the cirrhosis patients and in those without cirrhosis. The segmental distribution, symmetry and enhancement pattern were evaluated in all patients with cirrhosis for gastrointestinal wall thickening. Results Gastrointestinal wall thickening was seen in 72 cases (66%) with cirrhosis patients and in 12 cases (9%) without cirrhosis patients (Plt;0.005). The jejunum and ascending colon were the most common sites of gastrointestinal wall thickening, which was involved in 32 and 31 patients respectively. The scans of 46 (64%) patients with gastrointestinal wall thickening showed multisegmental distribution. Gastrointestinal wall thickening was concentric and homogeneous in all patients with cirrhosis. Conclusion Gastrointestinal wall thickening is common in patients with hepatic cirrhosis. It frequently involves multiple segments. The jejunum and ascending colon are the most common sites of involvement. MSCT plays an invaluable role in diagnostic evaluation of bowel wall thickening in patients with hepatic cirrhosis.
OBJECTIVE To investigate the reconstructional method of posterior wall of vagina after the resection of rectum carcinoma. METHODS From August 1991 to March 1996, 10 patients with rectum carcinoma were adopted in this study, among them, there were 4 cases belong to B stage of Dukas, and 6 cases belong to C stage of Dukes. In operation, rectum carcinoma and posterior wall of vagina were resected, and concurrent reconstruction was finished by using pedicled muscular flap of uterus. RESULTS The effect of operation were satisfactory except one case who was failed because of insufficient blood supply of the flap. Followed-up for 3-6 months, the posterior wall of vagina healed in 7 cases, the width of vagina was 2-3 fingers and the depth was 5-6 cm. CONCLUSION Reconstruction of the posterior wall of vagina with pedicled muscular flap of uterus was available in clinic. For its simplicity and feasibility, it’s suitable for the resection of rectum carcinoma in which the posterior wall of vagina was infiltrated.
Objective To observe the anti-adhesion and repair effect of 3 composite patches which composed of polylactide-co-caprolactone (PLC), hyaluronic acid (HA), collagen, and polypropylene (PP) mesh repairing abdominal wall defectin rats under contaminated environment, and to investigate the characteristics of 3 composite patches and the feasibil ity of onestage repair. Methods Ninety-three adult male Wistar rats (weighing 150-250 g) were randomly divided into 3 groups (n=31): PP/PLC composite patches (group A), PP/HA/PLC composite patches (group B), and PP/collagen/PLC composite patches (group C). One rat was selected from each group to prepare the contaminated homogenate of the small intestine. The abdominal wall defect models (1 cm in diameter) were established in other rats, and the defects were repaired with 3 composite patches (1.5 cm in diameter) according to grouping method. At 30, 60, and 90 days postoperatively, the adhesions was observed, and the patch and adjacent tissue was harvested for histological observation. Results Six rats died at 10-70 days postoperatively (2 in group A, 3 in group B, and 1 in group C). No wound infection, intestinal obstruction, or hernia occurred in 3 groups. Adhesion was observed between abdominal viscera and the patch, especially intestine, epiploon, and l iver. According to the modified Katada criteria, no significant difference in the adhesion score was found among 3 groups at 30 and 60 days (P gt; 0.05); the adhesion score was significantly lower in group C than in groups A and B at 90 days (P lt; 0.05). The histological results showed that inflammatory cell infiltration, fibroblasts, secreted collagen, and the residual absorbable material were observed around the patch at 30 days in 3groups. Decreased inflammatory cell infiltration, increased fibroblasts and residual PLC were observed at 60 days in 3 groups. At 90 days, the fibroblasts became increasingly mature, collagen deposited, the mesothelium formed gradually, and the residual PLC decreased. Conclusion In contaminated environment, PP/collagen/PLC composite patch is superior to PP/PLC and PP/HA/ PLC composite patches in aspect of abdominal adhesion and inflammatory reaction, and it is more applicable to one-stage repair of rat abdominal wall defect. But it is necessary to further study in the long-term efficacy and the security of the composite patch.
According to the working principle of vertical ultrasonic vial washing machine, receiving respective force of small water droplets on the inside wall of vials and the minimum air velocity of blowing off water droplets can be obtained based on the analysis of water-droplet-related parameters. The inside wall model of 7 mL vial created by GAMBIT was divided into fine grids. Then the Realizable k-epsilon Two Equation Turbulence Model was adopted and the flow field of vial by FLUENT software was simulated when air was flushing inside the wall. In that case, the optimal position, inner diameter and the corresponding minimum air velocity of needle can be acquired to meet the needs of vial washing machine applied to 7 mL vial.
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.
OBJECTIVE: To explore an effective method to repair the abdominal wall defect. METHODS: From July 1996 to December 2000, 7 cases with abdominal wall defect were repaired by pedicle graft of intestine seromuscular layer and skin graft, among them, intestinal fistula caused by previous injury during operation in 4 cases, abdominal wall defect caused by infection after primary fistulization of colon tumor in 2 cases, abdominal wall invaded by intestinal tumor in 1 case. Exploratory laparotomy was performed under general anesthesia, the infective and edematous tissue around abdominal wall defect was gotten rid off, and the pathologic intestine was removed. A segment of intestine with mesentery was intercepted, and the intestine along the longitudinal axis offside mesentery was cutted, the mucous layer of intestine was scraped. The intestine seromuscular layer was sutured to the margin of abdominal wall defect, and grafted by intermediate split thickness skin. RESULTS: The abdominal wall wound in 6 cases were healed by first intention, but part of grafted skin was necrosed, and it was healed by second skin graft. No intestinal anastomotic leakage was observed in all cases. Followed up 1 to 2 years, there were no abdominal hernia or abdominal internal hernia. All the cases could normally defecate. The nutriture of all cases were improved remarkably. CONCLUSION: Pedicle graft of intestine seromuscular layer is a reliable method to repair abdominal wall defect with low regional tension, abundant blood supply and high successful rate.
Objective To analyze the application value of swallowing function therapeutic instrument in dysphagia after stroke. Methods Stroke patients with dysphagia treated in the Department of Rehabilitation Medicine of Qinghai University Affiliated Hospital between July 2018 and April 2020 were selected. The patients were randomly divided into experimental group and control group. The control group was treated with comprehensive rehabilitation treatment, and the experimental group was treated with comprehensive rehabilitation treatment and swallowing function therapeutic instrument. The improvement of dysphagia and the changes of clinical indexes were observed in the two groups. Results A total of 100 patients were included, with 50 patients in each group. Before the intervention, there was no significant difference between the two groups in Standardized Swallowing Assessment (SSA), video fluoroscopy swallowing study (VFSS), ultrasonic exercise amplitude and duration (P>0.05). After 4 weeks of intervention, the SSA score, VFSS score, ultrasonic exercise amplitude and duration of the two groups were improved compared with those before intervention (P<0.05), and the experimental group was better than the control group (P<0.05). The improvement of dysphagia between the two groups was statistically significant (Z=?2.452, P=0.014). The total effective rate of dysphagia improvement in the experimental group (92.00%) was higher than that in the control group (82.00%), but there was no significant difference between the two groups (χ2=2.210, P=0.137). Conclusion The application of swallowing function therapeutic instrument in the adjuvant treatment of dysphagia after stroke is helpful to improve the clinical symptoms of patients and obtain ideal therapeutic effect, which is worth popularizing.