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Objective To explore the causes and managements of peritoneal laceration in the laparoscopic totally extraperitoneal (TEP) hernia repair during learning curve.Methods The retrospective cross-sectional study was conducted.The clinical data of 120 patients with inguinal hernia who underwent laparoscopic TEP hernia repair in the Third Affiliated Hospital of Anhui Medical University (98 patients) and Anhui Provincial Hospital (22 patients) during surgeons' learning curve between February 2012 and January 2017 were collected.Patients underwent laparoscopic TEP hernia repair,meshes were intraoperatively placed and then fixed by medical glue.Observation indicators:(1) intraoperative situations:surgical procedure,operation time,using of mesh,intraoperative peritoneal laceration;(2) postoperative situations:time to anal exsufflation,time for fluid diet intake,occurrence of complications,duration of hospital stay;(3) follow-up:number of patients receiving follow-up,follow-up time,recurrence of hernia during follow-up,pain in inguinal region,intestinal adhesion and obstruction induced abdominal pain,incisional infection.Follow-up using outpatient examination and telephone interview within 10 days postoperatively and using telephone interview at 10 days postoperatively was performed to detect the recurrence of inguinal hernia,pain in inguinal region,intestinal adhesion and obstruction induced abdominal pain and incisional infection up to May 2017.Measurement data with normal distribution were represented as （x）±s.Results (1) Intraoperative situations:of 120 patients,112 underwent laparoscopic TEP hernia repair,5 converted to laparoscopic transabdominal preperitoneal hernia repair and 3 converted to open surgery due to adhesion between hernial sac and surrounding tissues induced bleeding of separation.Total operation time of 120 patients was (71 ± 13) minutes,including (63± 7) minutes in 106 patients with unilateral hernia and (79 ± 11)minutes in 14 patients with bilateral hernia.All the patients used intraoperatively meshes of 10.0 cm×15.0 cm and 16.0 cm× 10.8 cm.Forty-eight patients had intraoperative peritoneal laceration,peritoneal laceration occurred for reconstruction of preperitoneal space in 10 patients,separation of anterolateral preperitoneal space in 11 patients and improperly operating equipment or hernial sac in 27 patients.Of 48 patients with peritoneal laceration,40 continued to finish operation through acupuncturing into the abdominal cavity for exsufflation and then received peritoneal suture and repair,including 5 with recurrence of indirect inguinal hernia (receiving tissue repair) undergoing peritoneal repair through opening hernial sac,and 8 intraoperatively converted to other or open surgery.(2) Postoperative situations:time to anal exsufflation and time for fluid diet intake in 120 patients were (18± 4) hours and (15±6) hours.Of 120 patients,14 had postoperative complications,scrotal emphysema of 6 patients disappeared in 24 hours anti inguinal and scrotal seroma of 8 patients disappeared after puncture treatment.All the patients were discharged from hospital in 2 days postoperatively.(3) Follow-up:112 of 120 patients were followed up for 3-65 months,with a median time of 31 months.During follow-up,there was no occurrence of recurrence of hernia,pain in inguinal region,intestinal adhesion and obstruction induced abdominal pain and incisional infection.Conclusion During surgeons' learning curve,identifying anatomy of the groin clearly,a right way to treat the hernia sac and broken peritoneum in the operation can ensure the smooth completion of the laparoscopic TEP hernia repair.
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Objective To observe effectiveness of Chinese herbal fumigation therapy combined with six-step knee-release massage on patients with knee osteoarthritis. Methods 80 cases with knee osteoarthritis were randomly divided into a treatment group and a control group, 40 in each. The treatment group was given Chinese herbal fumigation therapy combined with six-step knee-release massage, while the control group was treated only by six-step knee-release massage. 20 days of treatment was considered as 1 course, after which major symptoms and signs were observed and X-ray examination was applied to determine the curative effect. Results① As for clinical effectiveness, the total effective rate was 92.5%in the treatment group and 70%in the control group. There was statistical difference between two groups(χ2=11.087, P0.05),there was statistical difference in terms of pain, functionality, motion, fixed deformity, stability, subtractions and total score between two groups(t values were 8.081, 10.977, 3.846, 9.450, 9.611, 9.450, 15.984 respectively, P<0.01). Conclusion Chinese herbal fumigation therapy combined with six-step knee-release massage could effectively relieve clinical symptoms like joint pain, morning stiffness and inflexibility. It is worth popularizing in clinical treatment of knee osteoarthritis.
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Objective To investigate the effects on rat hearts induced by three kinds of band electromagnetic radiation (X-band, S-band and Electromagnetic pulse (EMP))and the differences of injury grade. Methods 180 healthy male Wistar rats were randomly divided into four groups:control group (n = 36) and three experimental groups (n = 48) treated with X-band, S-band high power microwave and EMP, respectively. At different time-points (6 hours,1, 3, 7, 14, 28 days,6 months and 12 months) after irradiation, the rats were killed and the pathological changes of the heart tissues were observed. Results The rat hearts of three experimental groups were differently injured, but the change character was similar. The injury was more and more serious at 6 hours -7 days:deranged cardiomyofilaments, decreased glycogen, Pyknosis;lysed Purkinje cells;swelling matrix and serous exudates. The injured hearts showed convalesecence at 14-28 days, and returned to normal progressively at 6-12 months.compared with the injured hearts irradiated by the three different band wave electromagnetic at the same time: the hearts were injured most seriously irradiated by X-band high power microwave(HPM), and slighter for those by S-band HPM, most slightest for those by EMP. Those in control group were normal. Conclusions Three kinds of band wave electromagnetic radiation injure the rat hearts differently. The injury grades are X > S > EMP. The research indicates that the shorter wave length or higher frequency make rat hearts injure more seriously, and need the longer time to resume.
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AIM: To study effects of hypericin associated with light emitting diode irradiation on nasopharyngeal carcinoma cell line of human in vitro. METHODS: CNE-2 cells were exposed respectively to different concentration of hypericin,and compared with hematoporphyrin as positive control group,and incubated for 6 h in the dark, then accumulative radiated energe of yellow and red light irradiation equivalent to 5. 67 J/cm2 were given throughout 90 min,killing effect and apoptosis of CNE-2 cells were detected by MTT assay after incubation of 24 h and flow cytometry. RESULTS: MTT assay showed that cytotoxicity of hypericin and hematoporphyrin with light irradiation presented in dose-dependent way,their IC50 values were 0. 049 and 0. 650 ?g/mL,respectively. Flow cytometry showed that hypericin with light irradiation could block cell growth at S phase and G2 phase,when CNE-2 cells were exposed to hypericin at 0. 20 ?g/mL for 18,28 and 48 h,the apoptosis rate reached at 9. 97% ,72. 19% and 92. 24% . CONCLUSION: Hypericin with light irradiation could obviously inhibit the growth of CNE-2 cells and induce apoptosis.