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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 explore the efficacy of debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair.Methods From January 2007 to December 2013,208 cases with nesh infections following inguinal hernia repairs were treated with debridement in Department of Hernia and Abdominal Wall Surgery of Beijing Chaoyang Hospital,147 cases were treated with primary suture (suture group) and 61 cases were treated with dressing change (open group).Results The mean time of mesh infection was (8.37 ± 6.89) months.The results of bacterial culture in the two groups were similar.First grade healing rate of suture group was 80.95％ (119/147),compared to zero percent in open group.Length of stay [(20.86 ± 7.90) d vs.(31.82 ± 11.50) d,t =3.47,P =0.034] and hospital cost [(3 200 ± 5 800) yuan vs.(26 500 ± 6 600) yuan,t =4.51,P =0.02] in suture group were less than in open group.No patients developed recurrent hernia in suture group compared with one recurrence in open group.Conclusions Debridement and primary suture for mesh-related infections after tension-free inguinal hernia repair could increase the rate of first grade healing,shorten average length of hospital stay and reduce total costs.
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Objective To compare between different hernia sac management during laparoscopic trans-abdominal preperitoneal repair (TAPP) for total scrotal hernia.Methods From Jan 2015 to Aug 2016,98 patients underwent TAPP repair (hernia sac length ＞ 10 cm),including group A (n =35) with complete sac dissection,group B (n =30) incomplete sac dissection and group C (n =33) with sac transection.Results Group C patients had shorter operation time [(36.0 ± 6.5) min,P =0.00] while suffered from more seromas (24.2％,P =0.035).The overall scrotal complications were comparable between the three groups.Statistical analysis showed no significant differences in the postoperative stay,pain or nerve sensory deficit,and recurrence between the three groups.Conclusions TAPP repair is a feasible procedure for total scrotal hernias.The different methods of hernia sac management do not have an impact on the long-term outcome.
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Objective To explore the clinical efficacy of posterior component separation (PCS) with Sublay mesh repair for complex abdominal incisional hernia.Methods The retrospective cross-sectional study was conducted.The clinical data of 30 patients with complex abdominal incisional hernia who were admitted to the Beijing Chao-Yang Hospital of Capital Medical University from July 2016 to March 2017 were collected.Patients intraoperatively received PCS with Sublay mesh repair.Observation indicators:(1) intra-and post-operative situations:defect area of incisional hernia,operation time,volume of intraoperative blood loss,time of postoperative drainage-tube removal,postoperative complications and duration of postoperative hospital stay;(2) follow-up situation.Follow-up using outpatient examination and telephone interview was performed to detect recurrence of hernia and mesh-related complications up to July 2017.Outpatient examination was done once at postoperative month 1,3 and 6 and telephone interview was done at 1 year postoperatively.Measurement data with normal distribution were represented as x±s and measurement data with skewed distribution were described as M (range).Results (1) Intra-and post-operative situations:30 patients received successful PCS with Sublay mesh repair for complex abdominal incisional hernia.Defect area of incisional hernia,operation time,volume of intraoperative blood loss and time of postoperative drainage tube removal were respectively (222± 124)cm2,100 minutes (range,40-235 minutes),80 mL (range,50-200 mL) and 5 days (range,2-15 days).Of 7 patients with postoperative complications,3 were complicated with shallow surgical site infection,including 1 with wound healing by vacuum sealing drainage and 2 with delayed healing by debridement and drainage;2 with postoperative seroma were improved by aspiration and local pressurization after 1 months;1 with fat liquefaction of abdominal incision was improved by symptomatic treatment;1 with postoperative active hemorrhage was confirmed with arteriolar hemorrhage of muscular layer and then received hemostasis by ligation.Time of postoperative hospital stay of 30 patients was 15 days (range,10-57 days).(2) Follow-up situation:30 patients were followed up for (7± 3) months,without occurrences of hernia recurrence,intestinal fistula and mesh-related complications.Conclusion PCS with Sublay mesh repair for complex abdominal incisional hernia is safe and feasible,with good clinical efficacies.
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@#Objective To observe the effect of Liu's massage technique on teenagers with cervical vertebra disease.Methods 65 teenagers with cervical vertebra disease were divided into the trial group (n=35) and control group (n=30) treated with routine physical therapy and cervical vertebra disease gymnastics, but cases in the trial group were added with treatment of Liu's massage technique. All cases of two groups were evaluated with Clinical Assessment Scale for Cervical Spondylosis (CASCS) before and after treatment.Results After treatment, the CASCS scores of all cases improved significantly ( P<0.01), but the effect of the trial group was significantly superior to that of the control group ( P<0.01).Conclusion Liu's massage technique is effective on cervical vertebra disease of teenagers.
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Objective To investigate the effect and clinical value of preoperative chemotherapy on the treatment of metastasized lymph nodes in patients with advanced esophageal carcinoma. Methods We studied the pathological results of primary lesions and lymph nodes of 97 patients with advanced esophageal cancer between 1996 and 1999,62patients were treated by preoperative chemotherapy and 35 patients were treated by surgery only. Results The metastasized rate and degree of mediastinum in preoperative group were 16. 1％ and 4.7％ ,whereas 65.7% and 34.2% in the surgery only group (P＜0. 05);That of abdomen in preoperative group were 25.8％ and 6.6％ ,whereas 48. 6％and 12.0％ in the surgery only group (P＜0.05). Conclusion Preparative chemotherapy is effective not only against the primary lesions but also the metastasized lymph nodes. The lower complete response rate of the metastasized lymph may account for the unsatisfied long-term results. Whole resection of primary lesions and lymph nodes are still very important for a better prognosis even for patients who have a good response for the preoperative chemotherapy.
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Objective To investigate the risk factors of gallbladder stone changing to gallbladder carcinoma. Methods The clinical data of 200 patients with gallbladder stone undergoing operation were retrospective analysed. Results (1) In the 200 resected gallbladder specimens, gallbladder mucosa hyperplasia was found in 144 specimens(72%), atypical hyperplasia(AHP) in 38(19%), infiltrative cancer in 7(3.5%). All the paracancer mucosa had midder or severe AHP. The incidence of atypical hyperplasia and canceration had increased with patients' age and the history lenth of cyst stone. (2) The content of DNA, the porpotion of euplpoid cells, the AgNOR content in tissues as follows: hyperplasia<mild AHP<midder AHP<severe AHP<canceration. Conclusions The results of this study indicate that the canceration of gallbladder from cyst stone may be a chronic process which from hyperplasia→AHP→canceration. So the risk factors of canceration including age≥50 years; long term history of cyst stone, espically in women; that for cases of cyst stone with age≥50 years, more long term history, especially in women, therefore periodical examinations should be done, and preventive cholecystectomy should be performed if necessary.
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0.05). Conclusion LCP enrichment formula is suitable to premature infants. Its lipid composition is more close to that of breast milk and benefit to the brain and retina development of premature infants.
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Objective:In order to enhance the early dignosis level and strengthen the understanding of pathogeny、pathology by stage and prognosis of primary gallbladder car-cinoma(PGC). Methods : The results of 679 patients of PGC from 1956 to 1998 in first affiliated hospital of Xi'an medical university were retrospectively analyzed. Results: Most of the patients belong to advanced stage when dignosised. The PGC were usually found among the old women patients. The sex ratio(female/male) was 3:1. There is a intimate relatioship between gallstone and PGC. About sixty percents of PGC might be found gallstone.The dignostic accordance rate was low between preoperation and postopera-tion.Most patients with PGC were found unexpectedly in operation due to gallstone or a-cute cholecystitis. To worse more, many of patiens with PGC were missed the opportunities of dignosis and treatment because of only paying attention to gallstone. Most of the pathological types were adenocarcinoma. The development of imaging examination is hoped to find early stage cases and improve its prognosis. Conclusion : It is a basic way for early dignosis and improving prognosis to strengthen the understanding of pathogeny, pathology by stage and prognosis and rationalize application of all kinds of exzamination means in PGC.
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Objective To evaluate prognostic value of electroencephalogram (EEG) in neonatal with hypoxic ischemic encephalopathy (HIE). Methods Sixty two infants with HIE was studied by doing physical examination, intelligence test, CT and EEG. Their clinical outcome was compared to their EEG in the first month after birth. Results Incidence of sequelae in normal or mild abnormal EEG and severe abnormal EEG were 3%, 29%, respectively. Among three infants of EEG cases, two dead and one developed cerebral palsy infant. Among four of burst suppression found in the EEGs, two cases dead, one developed cerebral palsy, one was normal. In five of hypoactive EEG, one dead, one developed cerebral palsy, and the other was with low IQ. Conlusion The prognosis is related to the background activity of EEG. The presence of a burst suppression EEG pattern and a hypoactive/flat EEG are negative prognostic criteria.
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Objective To test whether IL 6 has any harmful effects on developing brain in neonatal rats, and try to illustrate its probable pathogenesis. Methods The neonatal rats were injected with different doses of rhIL 6 intravenously or intraventricularly. Animals were killed at 24 or 48 hours after injection to observe the pathological changes of brain tissues. Results Among animals killed at 24 hours after the intravenous injection with 1 000 U or 5 000 U rhIL 6, perivascular edema and ischaemic changes of neurons appear in their brain. There is no difference in the pathological changes in the brain of the rats treated with different doses. 72 hours after the intravenous injection, edema is still obvious, and ischaemic cell change in neurons aggravates into homogenizing cell change. When the brains are examined at 24 hours after intraventricular injection with 1 000 U rhIL 6, the pathological changes are the same as those treated by intravenous injection. Subarachnoid hemorrhage occurs more frequently in animals examined at 24 hours after 5 000 U rhIL 6 intraventricular injection than in those with intravenous injection. Besides, there appears local demyelination in the brain examined at 72 hours after the intraventricular injection of 5 000 u rhIL 6. Conclusion IL 6 by intravenous injection and intraventricular injection has harmful effects on the brain of neonatal rats.
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Objective To investigate the relationship between serum prolactin(PRL) level and neonatal seizures and to evaluate the clinical significance of PRL as a neonatal seizures marker to diagnose neonatal seizures. Methods Thirty five newborn infants with acute encephalopathy were divided into two groups: the ictal group included infants with typical clinical symptom and/or electrographic seizures and the nonictal group are those without electrographic seizures or clinical behaviors. The control group included 17 newborns. Serum PRL levels were determinded by immulite assay system at 15～30 min postictally; 2 h postictally and 2～4 days after the end of seizures. Results In the ictal group, serum PRL levels were significantly higher at 15～30 min[(302.6?93.5) ?g/L] than that of 2 h [(128.1?71.4) ?g/L], nonictal[(101.2?31.4)?g/L and (89.9?36.2) ?g/L] and control group[(73.3?20.7) ?g/L and (68.6?29.5)?g/L], P