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Objective:To investigate the application value of ambulatory surgery mode for small and medium abdominal wall hernia repair.Methods:The retrospective and descriptive study was conducted. The clinical data of 33 patients with small and medium abdominal wall hernia who were admitted to Beijing Chaoyang Hospital of Capital Medical University from January 2019 to January 2021 were collected. There were 19 males and 14 females, aged 54(range, 26?85)years. Patients individually underwent Onlay repair, Sublay repair, intraperitoneal onlay mesh repair (IPOM)according to the diagnosis and treatment mode of ambulatory surgery. Observation indicators: catogaries of small and medium abdominal wall hernia, surgical methods, intraoperative measured diameter of hernia ring defect, operation time, volume of intraoperative blood loss, duration of hospital stay, delayed discharge of patients, hospitalization expenses, postoperative follow-up, complications, postoperative visual analogue scale of pain, chronic pain, postoperative satisfaction. Follow-up using telephone interview or outpatient examinations was conducted to detect hernia recurrence, surgical-related complications (wound infection, pain, hematoma or seroma, intestinal leakage, intestinal obstruction) and postoperative satisfaction at postoperative 3 days, 7 days, 1 month, 3 months, 6 months and 12 months. Measurement data with normal distribution were represented as Mean± SD. Measurement data with skewed distribution were represented as M(range), and count data were represented as absolute numbers. Results:Of the 33 patients, 16 cases had umbilical hernia, 14 cases had incisional hernia, 3 cases had lumbar hernia. There were 7 patients treated with Onlay repair, 16 with Sublay repair, and 10 cases with IPOM. The intraoperative measured diameter of hernia ring defect, operation time and volume of intraoperative blood loss of 33 patients were 2.8(range, 1.0?6.0)cm, 51(range, 20?85)minutes, 4.3(range, 1.0?10.0)mL. The duration of hospital stay of 33 patients was 24?48 hours, including 25 cases with duration of hospital stay ≤24 hours, 8 cases with duration of hospital stay >24 hours and ≤48 hours. Of the 8 patients undergoing IPOM with delayed discharge, 5 cases had postoperative pain and 3 cases had dizziness, nausea and vomiting after general anesthesia. They were recovered and discharged from hospital after observation and symptomatic support until the next morning. The hospitalization expenses were 17 139(range, 6404?34 124)yuan. All the 33 patients were followed up regularly after operation. No hernia recur-rence, wound infection, hematoma and seroma, intestinal fistula or intestinal obstruction was observed during the follow-up period. From postoperative 3 days to 12 months, the visual analogue scale of pain was from 2.90±0.10 to 0 for patients with Onlay repair, from 3.10 ±0.10 to 0 for patients with Sublay repair, from 3.50 ±0.20 to 0 for patients with IPOM. No patient suffered from chronic pain after the operation and postoperative satisfaction of patients was 100%. Conclusion:The ambulatory surgery mode has safety and feasibility in small and medium abdominal wall hernia repair.
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Objective @#To investigate the protective effects of different types of lead collars on the thyroid during radio- therapy after breast-conserving surgery. @*Methods@#Forty breast cancer patients undergoing radiotherapy after breast-con- serving surgery were randomly divided into four groups to wear different lead collars for thyroid protection: control group (0 mm Pb), common material group (0.5 mm Pb), common material group (2 mm Pb), and new radiation-shielding material group (2 mm Pb). Radiation doses inside and outside lead collars were monitored. A questionnaire survey was conducted to acquire information on patient acceptance of the lead collars.@*Results@#All the groups (except the control group) showed significant differences between scattered radiation doses inside and outside lead collars (P < 0.05). The scattered radiation was attenuated by 33.64% on average in the 2-mm new material group, which was significantly higher than in the other groups (P < 0.05). After radiotherapy, there was no significant change in the color and appearance of skin under lead collars in any group. All the patients were normal at the first thyroid ultrasound re-examination. The 2-mm new material lead collar was the most acceptable.@*Conclusion @#The lead collar made of the new radiation-shielding material has a good protective effect on the thyroid gland, and is easily accepted by patients, which can be promoted for application.
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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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Objective To investigate the effect of intermittent high glucose on oxygen-glucose deprivation/refurnish (OGD/R) neuronal survival.Methods The primary cultured hippocampal neurons of mice were sub-cultured when the cell fusion reached about 80％.Cells in logarithmic growth phase were placed in a hypoxic incubator (37 ℃,5％ CO2,95％ N2) to simulate cell hypoxia.The culture medium was replaced by glucose-free Hank equilibrium salt solution (HBSS) to simulate cell hypoglycemia.The normal glucose and oxygen control group was set up.Cell morphology was observed under inverted phase contrast microscope after 6 hours of hypoxia and hypoglycemia treatment,and cell viability was detected by CCK-8 cell proliferation assay kit,and then grouping experiment was carried out.The cells were randomly divided into four groups.The cells were cultured in different concentration glucose medium under normal oxygen,5％ CO2 and 37 ℃ for 72 hours to prepare OGD/R model of cell ischemia/reperfusion.The low-glucose control group was cultured in medium containing 5.5 mmoFL glucose.The constant high-glucose group was cultured in medium containing 33.0 mmol/L glucose.The intermittent high-glucose group was cultured in medium containing 33.0 mmol/L glucose for 3 hours then in medium containing 5.5 mmol/L glucose for 2 hours alternately for 3 times during the day,and overnight in medium containing 33.0 mmol/L glucose at night.The hyperosmotic control group was made up of 5.5 mmol/L glucose medium and mannitol.The osmotic pressure was the same as that of the constant high-glucose group,and the effective glucose concentration was the same as that of the normal glucose and oxygen group,so as to eliminate the effect of osmotic pressure changes caused by the high-glucose medium on the results.Cell morphology was observed under inverted phase contrast microscope after 72 hours of cell culture in each group.Cell viability was measured by CCK-8 kit,and apoptotic rate was measured by flow cytometry.Results The inverted phase contrast microscope showed that the cells in the normal glucose and oxygen control group were plump and refractive,and had obvious nucleus,clear processes and high cell activity.After 6 hours of hypoxia and hypoglycemia treatment,the cells were shrunk,refractive index was poor,the nucleus was unclear,the processes were not clear,and the cell activity was significantly lower than that of normal glucose and oxygen control group (A value:0.34±0.06 vs.1.09±0.06,P ＜ 0.01),which indicated that the model of oxygen-glucose deprivation (OGD) was successfully prepared.After 72 hours of culture with different concentrations of glucose,the cells in the low-glucose control group were shrunk,the cell membrane was incomplete,the nucleus was unclear,and number of necrotic cells were more.In the constant high-glucose group,the refractive index of cells was poor,a large number of cells floated,and the nucleus was not obvious.In the intermittent high-glucose group,the cell morphology was normal,the refractive rate of cells was decreased slightly,and the necrotic cells were less.In the hypertonic control group,the cell status was close to that in the constant high-glucose group.Compared with the low-glucose control group or constant high-glucose group,the cell viability in the intermittent high-glucose group was significantly increased (A value:2.04±0.15 vs.0.64±0.18,1.16±0.16,both P ＜ 0.01),the apoptotic rate was significantly decreased [(59.60 ± 2.55)％ vs.(78.15 ± 15.77)％,(95.60± 0.14)％,both P ＜ 0.05].There was no significant difference in cell activity or apoptotic rate between the hypertonic control group and the constant high-glucose group [cell activity (A value):1.07 ± 0.07 vs.1.16 ± 0.16,apoptotic rate:(87.80 ± 4.53)％ vs.(95.60 ± 0.14)％,both P ＞ 0.05].Conclusion Intermittent high glucose within a certain range had protective effect on OGD/R neuronal survival.
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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 explore the clinical application value of hysteroscopic transcervical resection of endometrium (TCRE) combined with levonorgestrel-releasing intrauterine system (Mirena) in the treatment of adenomyosis. Methods · A total of 112 cases of adenomyosis patients were divided randomly into the combination group and Mirena group. The combination group (56 cases) was treated by TCRE endometrium endometrial resection, assisted Mirena treatment after operation. Mirena group (56 cases) was treated by Mirena only. The follow-up lasted 36 months after treatment, including measures of the volumes of menstrual bleeding, hemoglobin levels, dysmenorrhea scores, uterine volume, serum CA125 levels and incidences of complications.Results · The median follow-up duration was 42 months, and the three-year follow-up rate was 73.21% for the combination group and 50% for the Mirena group. After surgery, the volumes of menstrual bleeding of patients in 3-36 months decreased significantly, with an increase in hemoglobin level and a decrease in serum CA215 level and dysmenorrhea scores. Compared with their situations before surgery, the difference was significant (P<0.05). A comparison of uterine volume before and after surgery showed that there is a significant decrease in the uterine volume in both groups in6-12 months after surgery (P<0.05).Twenty-four months after surgery, it shows thatthe combination group has a much more significant decrease in uterine volume [(171.3±34.8) mm3] than Mirena group [(213.7±38.6) mm3] (P<0.05). The hysterectomy rate in Mirena group was significantly higher than that in the combination group (12.50% vs 5.36%); the ring expulsion rate was 16.07% in Mirena group and 5.36% in the combination group, and the break through bleeding happeningrate was 8.93% in Mirena group and 3.57% in the combination group. After 36 months an irregular small amount of vaginal bleeding rate was 62.25% in Mirena group, while it was only 12.50% in the combination group. There was significant differencewhen comparing above indices between two groups (P<0.05). There was no obvious differences in most common side effects of both groups. Conclusion · HysteroscopicTCRE combined with Mirena reduces significantly the irregular menstrual bleeding caused by merely applying Mirena. It has a prominent clinical efficacy and can be an effective approach in treatment of adenomyosis.
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Hernia is ancient and common.With the emerging of new concepts,techniques,materials and equipments,treatment methods of hernia have undergone ever-changing changes in the 21st century.Hernia and abdominal wall surgery in China has been developing fast in the past 20 years,and has achieved remarkable progress.However,some problems still exist,such as unbalanced regional development,concept misunderstanding,classification confusions,less standardized technology,poor follow-up method,lack of innovation,and so on.Therefore,it's crucial to recognize the shortcomings of the current stagey,discuss the existing problems,sum up experiences and lessons,and clarify the direction of improvement,in order to provide a solid foundation for the sustainable development of hernia and abdominal surgery for our country.
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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 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 investigate the analgesic effect of lidocaine plus ropivacaine in inguinal hernia tension-free repair under local anesthesia.Methods A total of 815 patients with unilateral inguinal hernia admitted to Chaoyang Hospital from July 2013 to Jane 2014 were enrolled in this retrospective study.The patients were divided into 2 groups:local anesthesia using a combination of 1％ lidocaine (l0 ml) and 0.75％ ropivacaine (10 ml) in observation group (n =412),and 1％ lidocaine (20 ml) were administered in control group (n =403).Postoperatively heart rate (HR),mean arterial pressure (MAP),pain intensity (VAS),analgesic demand,adverse events and hospital duration were assessed.Results There was no significant difference between the 2 groups in postoperative hemodynamic monitoring (all P ＞ 0.05).VAS score in observation group were lower than those in control group at 1,3,6 and 9 h.The former needed significantly less pain killer (all P ＜ 0.05).Conclusion Ropivacaine decreases postoperative pain level after tension-free inguinal hernia repair without additional risk of perioperative events.
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Objective To study the relationship between human leukocyte antigen-DRB1 (HLA-DRB1) allele genes polymorphism and intrahepatic cholestasis of pregnancy (ICP). Methods Forty-two patients with ICP were tested for HLA-DRB1 allele genes polymorphism with the polymerase chain reaction technique and sequence specific oligonucleotide (PCR-SSO) probes hybridization, 56 normal pregnant women as control group were also tested. In addition, the phenotype frequencies of HLA-DRB1 alleles were compared with it′s clinical character in patients with ICP. Results The higher frequencies were observed for alleles DR9, DR12 and DR4 in both groups. DR6 alleles were detected in 14 cases out of 42 patients. Patients with ICP had a significantly higher frequency of the allele DR6 when compared to control group (16.7% vs 3.6%), with a relative risk (RR) as 6.5 (P