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Objective:To investigate the application value of transversus abdominis muscle release technique in giant ventral hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 72 patients with giant ventral hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2017 to January 2020 were collected. There were 47 males and 25 females, aged from 29 to 79 years, with a median age of 56 years. All patients underwent ventral hernia repair with transversus abdominis muscle release technique and preperitoneal/retro-muscular polypropylene mesh reinforcement. Observation indicators: (1) surgical situations; (2) postoperative complications; (3) hernia-related quality of life. Follow-up was conducted using outpatient examination and telephone interview to detect postoperative complications at postoperative 1, 6 and 12 months. Follow-up was up to January 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison within groups was analyzed using the paired t test. Measurement data with skewed distribution were represented as M (range). Count data were described as absolute numbers. Results:(1) Surgical situations: all 72 patients underwent ventral hernia repair with transversus abdominis muscle release technique and preperitoneal/retro-muscular polypropylene mesh reinforcement successfully. The operation time, volume of intraoperative blood loss and mesh size of the 72 patients were (105±46)minutes, (55±15)mL and (680±225)cm 2, respectively. (2) Postoperative complications: 72 patients were followed up for 12 to 48 months, with a median follow-up time of 16 months. During the follow-up, 7 of the 72 patients were diagnosed with seroma by abdominal computed tomography (CT) scan at postoperative 1 week, the size of which was (460±130)mm 2. The 7 patients with seroma were followed up and results of abdominal CT scan at postoperative 6 months showed that the seroma was completely absorbed. Two of the 72 patients had postoperative intestinal obstruction, which was considered as postoperative paralytic ileus. After conservative treatment, the 2 patients were improved 2 weeks after operation. None of the 72 patients had surgical site infection, intestinal fistula or hernia recurrence. (3) Hernia-related quality of life: the score of hernia-related quality of life of 72 patients before operation and at postoperative 12 months were 40±12 and 73±17, respectively, showing a significant difference ( t=12.527, P<0.05). Conclusion:Transversus abdominis muscle release technique in the giant ventral hernia repair is safe and effective, which can improve hernia-related quality of life of patients.
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Abdominal rectus diastasis is common in postpartum women and obese people, with clinical manifestations of midline abdominal bulge and lower back pain. Severe cases may affect the function of abdominal wall muscle groups, which cause a series of physiological dysfunction. There are few studies on the diagnosis and optimal management of abdominal rectus diastasis, especially on its surgical indications, and no uniform conclusion is achieved. The authors comprehensively analyze the research progress at home and abroad, exploring the etiology, diagnosis, treatment options and surgical indications of abdominal rectus diastasis, in order to provide references for clinical practice.
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Objective:To investigate the surgical treatment strategies of mesh infection after tension-free repair of inguinal hernia.Methods:The retrospective and descriptive study was conducted. The clinical data of 88 patients with mesh infection after tension-free inguinal hernia repair who were admitted to Beijing Chaoyang Hospital Affiliated to Capital Medical University from March 2013 to May 2018 were collected. There were 85 males and 3 females, aged from 14-84 years, with an average age of 58 years. All patients underwent debridement. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examination or telephone interview was conducted to detect wound healing, recurrence of inguinal hernia, postoperative pain and reinfection after operation up to July 2019. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M (range). Count data was described as absolute numbers. Results:(1) Surgical and postoperative situations: 88 patients underwent debridement successfully. Of the 88 patients, 71 cases underwent laparoscopic exploration before undergoing debridement, and 17 cases underwent open debridement directly. Of the 71 patients who underwent laparoscopic exploration, 63 cases had intact peritoneum with no infection observed in intestine and bladder after laparoscopic abdominal exploration, and then were transferred to open debridement. Four cases with small bowel fistula confirmed by laparoscopic exploration were transferred to open debridement combined with small bowel resection and anastomosis after separating tissue adhesion. Three cases with mesh infection confirmed by laparoscopic exploration underwent the treatment of opening peritoneum and removing the infection mesh through posterior approach under laparoscopy. One case with bladder fistula confirmed by laparoscopic exploration underwent bladder repair after removing infection mesh under laparoscopy. Of the 88 patients, 82 cases had mesh infection including 31 cases with mesh completely removed, 51 cases with the infected part of mesh removed; 28 cases had the sutures co-infected removed. Six of the 88 patients who only suffered from superficial infection underwent the treatment of removal of infected sinus tract. Of the 84 patients who underwent open debridement, 65 cases underwent primary suture after indwelling drainage tube, 19 cases kept incision opening including 13 cases undergoing continuous drainage with vacuum sealing drainage device after postoperative dressing change and 6 cases undergoing the treatment of dressing change. The operation time, volume of intraoperative blood loss and duration of postoperative hospital stay of 88 patients were 60 minutes(range, 15-175 minutes), 14 mL(range, 2-200 mL) and 22 days (range, 1-101 days), respectively. All patients underwent postoperative extubation successfully. There were 56 cases of class A healing, 15 cases of class B healing and 17 cases of class C healing in 88 patients. Seventy-one of 88 patients underwent bacterial culture examination of intraoperative pyogenic fluid and sutures, of which 27 cases had negative results, 32 cases had staphylococcus aureus infection, 5 cases had staphylococcus haemolyticus infection, 5 cases had pseudomonas aeruginosa infection, 5 cases had enterococcus faecium infection, 4 cases had staphylococcus hominis subsp infection, 3 cases had proteus mirabilis infection, 2 cases had serratia marcescens infection, 2 cases had streptococcus agalactiae infection, 2 cases had escherichia coli infection and 1 case had achromobacter xylose oxidation subsp infection. There were some cases undergoing more than 2 kinds of bacterial infection. (2) Follow-up: 88 patients underwent postoperative follow-up for 14 to 76 months, with a media follow-up time of 32 months. Of the 88 patients, 5 cases underwent postoperative recurrence of inguinal hernia including 3 undergoing transabdominal preperitoneal inguinal hernia repair, 1 undergoing open preperitoneal inguinal hernia repair and 1 undergoing partial extraperitoneal inguinal hernia repair. One case had postoperative pain with the visual simulation score of 2-4 and received no special treatment. Seventeen cases had postoperative reinfection, in which 3 achieved wound healing after dressing change and 14 achieved wound healing after surgical removal of the infected tissue completely including 7 cases with residual mesh infection and 2 cases with residual suture infection.Conclusions:Surgical strategy of mesh infection after tension-free repair of inguinal hernia is complicated. Removal of the infected mesh by surgery is an effective treatment.
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Objective To investigate the safety and efficacy of tension-free mesh repair in the treatment of incarcerated groin hernia,and to compare the outcome of biological mesh and polypropylene mesh repairment.Methods A retrospective study was conducted on 118 patients admitted from Jan 2013 to Dec 2017 receiving emergency incarcerated groin hernia repair in Beijing Chao-Yang Hospital.The incidence of surgical site infection (SSI),perioperative mortality,sepsis and ileus were compared.In the follow-up,the postoperative foreign body sensation,chronic pain,seroma/hematoma and recurrence were recorded.The outcome of different surgical procedures (with mesh/without mesh,biological mesh/polypropylene mesh,TAPP/Lichtenstein repair) were compared and analyzed.Results 14 cases received suture repair (group A),104 cases underwent TAPP (n=44) repair or Lichtenstein repair (n =60) with meshes,including 23 cases using biological mesh (group B) and 81 cases using polypropylene mesh (group C).After 20.5 months of follow-up (ranging from 6-65 months),3 cases in group A (21.4％) developed recurrence,the rate was significantly higher than that of group B (4.3％) and group C (0).The incidence of seroma/hematoma in group B was higher than that in group A (7.1％) and group C (7.4％).There were no significant differences between the 3 groups regarding the postoperative adverse events rate,SSI,mortality,sepsis and ileus (all P ＞ 0.05).Conclusions Tension-free mesh repair in the treatment of emergency incarcerated groin hernia is safe and effective,which can reduce the recurrence rate of hernia,without increasing the risk of infection.
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Objective To investigate the application value of DynaMesh-IPST stoma dedicated mesh in parastomal hernia repair.Methods The retrospective cohort study was conducted.The clinical data of 281 patients with parastomal hernia of abdominal wall who were admitted to Beijing Chao-Yang Hospital of Capital Medical University between March 2013 and April 2017 were collected.Of 281 patients undergoing laparoscopic combined with open parastomal hernia repair with artificial materials,151 using DynaMesh-IPST stoma dedicated mesh and 130 using ordinary anti-adhesive mesh were respectively allocated into the DynaMesh-lPST mesh group and ordinary mesh group.Observation indicators:(1) intra-and post-operative situations;(2) follow-up.Follow-up using outpatient examination and telephone interview was performed to detect hernia recurrence and long-term complications at 1-,3-,6-month and 1 year postoperatively up to June 2018.Measurement data with normal distribution were represented as (x)±s and comparison between groups was done by the t test.Measurement data with skewed distribution were described as M (P25,P75) and M (range),and comparison between groups was done using rank sum test.Comparison of count data between groups was analyzed using the chi-square test.Results (1) Intra-and post-operative situations:281 patients underwent successfully laparoscopic combined with open parastomal hernia repair with artificial materials.The operation time,volume of intraoperative blood loss and duration of postoperative hospital stay were 100 minutes (60 minutes,120 minutes),(34± 15)mL,17 days (13 days,24 days) in the DynaMesh-IPST mesh group and 100 minutes (85 minutes,120 minutes),(42± 36)mL and 20 days (16 days,25 days) in the ordinary mesh group,with statistically significant differences between groups (Z=2.166,t=2.654,Z=2.795,P＜0.05).The postoperative incisional infection and intestinal leakage were respectively detected in 18 and 2 patients in the DynaMesh-IPST mesh group and 36 and 7 patients in the ordinary mesh group,showing a statistically significant difference of incisional infection between groups (x2 =11.194,P＜0.05),and no statistically significant difference of intestinal leakage between groups (x2 =4.234,P＞ 0.05).Of 54 patients with postoperative incisional infection,4 were cured after removing mesh and clearing up infection,50 were cured after dressing change,local debridement and drainage.(2) Follow-up:279 of 281 patients including 149 in the DynaMesh-IPST mesh group and 130 in the ordinary mesh group were followed up for 20-44 months with a median time of 32 months.During the follow-up,10 patients had hernia recurrence including 4 in the DynaMesh-IPST mesh group and 6 in the ordinary mesh group.Six of them underwent reoperation (4 with keyhole hernia recurrence,1 with mesh bulging out because of abdominal weakness at stoma,1 with parastomal recurrence after mesh removal due to intestinal leakage) and 4 had regular reexamination after fixation with abdominal belt.There was no statistically significant difference of hernia recurrence between groups (x2 =0.318,P＞0.05).Twenty-seven patients (14 in the DynaMesh-IPST mesh group and 13 in the ordinary mesh group) with intestinal obstruction were improved by conservative treatment,showing no statistically significant difference between groups (x2 =0.043,P＞0.05).Ten patients (6 in the DynaMesh-IPST mesh group and 4 in the ordinary mesh group) with stoma stenosis were improved after local stoma remodeling,showing no statistically significant difference between groups (x2=0.007,P＞ 0.05).Ninteen patients (4 in the DynaMesh-IPST mesh group including 1 complicated with hernia recurrence and 15 in the ordinary mesh group including 2 complicated with hernia recurrence) with stoma prolapse were improved after local stoma remodeling,showing a statistically significant difference between groups (x2 =8.756,P ＜ 0.05).Conclusion Parastomal hernia repair with DynaMesh-IPST stoma dedicated mesh is safe and feasible,with satisfactory effects.
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Objective To investigate the effects of lead on the vitality, differentiation, special functional markers and morphological changes of the osteoblasts in newborn rats, which helps to clarify the toxicity mechanism of lead on the skeleton development in children. Methods The osteoblasts were isolated from the calvariae in newborn Wistar rats and cultured in DMEM medium. Lead acetate at different concentration (0, 0.1, 0.5, 1, 5, 10, 50, 100 ?mol/L) was added for 24 h, 48 h, 72 h. The vitality of the osteoblasts was measured by MTT methods; The activity of alkaline phosphatase(ALP) was measured by pNPP method. The protein content of the osteoblasts was determined by Coomassie brilliant blue method. The levels of osteocalcin in both secreted (in medium) and cellular of osteoblasts were determined by radiate immunochemistry methods. The optical structure was determined by LM. Results The vitality decreased significantly when the dose was at more than 50 ?mol/L, especially after 72 h. The activity of ALP decreased significantly when more than 0.5 ?mol/L, whereas the levels of secreted osteocalcin decreased significantly when at 0.1 ?mol/L. It appeared lead had some toxicity on the shape and number on the osteoblasts. Conclusion Lead acetate has adverse effect, at higher doses, on the vitality, protein content, ALP, osteocalcin and optical structure, maybe it is one of the mechanisms of lead influencing the development of the osteoblasts even the skeleton.
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Objective To research the protective effects of alkaline electrolytic water on lipid peroxidation in blood,liver,kidney and brain of mice. Methods Total forty-five Kunming mice were randomly divided into three groups,control group:tap water;peroxidation model group:100 mg/kg D-galactose subcutaneous injection (once a day) + tap water;experimental group:100 mg/kg D-galactose subcutaneous injection (once a day) + alkaline electrolytic water. After 18 weeks of exposure,the mice were sacrificed,and the blood,liver,kidney and brain of mice were collected for further study. The MDA levels were measured by TBA method; The GSH levels and GSH-Px activities were measured by modified DNTB method; The SOD activities were measured by Xanthine oxidase method; The lipofuscin levels were detrmined by Sohal method. Results Compared with the control group,MDA and lipofuscin level increased,GSH content decreased,the activities of GSH-Px and SOD decreased in all detected organs and blood in the peroxidation model group,and compared with the peroxidation model group,MDA and lipofuscin level decreased,GSH content increased,the activities of GSH-Px and SOD increased significantly in D-galactose +alkaline electrolytic water group. Conclusion Alkaline electrolytic water has some antagonistic effects on the lipid peroxidation induced by D-galactose.
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Objective To study genital toxicity and didymus lipid peroxidation level on rats after sub-acute exposure to di-2-ethylhexyl phthalate(DEHP).Methods The weaning Wistar andro-rats were dividied into four group randomly,and there were 10 rats in each group.Compared with the corn oil control,the experiment groups were gavaged consecutively for 30 days with the DEHP dose of 10,100,1 000 mg/(kg.d),The change of body weight was observed dynamically.All rats were executed by decapitation four weeks later and the didymium was removed immediately,at the same time viscera coefficient were measured.The level of MDA were detected by TBA method,meanwhile GSH level and GSH-Px activity were analyzed by modified DTNB method,the activity of SOD were measured by xanthine oxidase method.Results With the increasement of DEHP concentration,the body weight growth of rats in 1 000 mg/(kg.d) DEHP group is restricted compared with the control(P