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Objective:To explore the rehabilitation effect and safety of laparoscopic herniorrhaphy through different approaches in the treatment of inguinal hernia.Methods:The clinical data of 132 patients with inguinal hernia in Shushan Branch of Hefei First People′s Hospital from January 2018 to May 2020 were retrospectively analyzed. Laparoscopic herniorrhaphy was performed in all patients. The 46 patients who were treated with transabdominal preperitoneal patch (TAPP) repair were included in TAPP group, while another 86 patients who were treated with totally extraperitoneal patch implantation (TEP) were included in TEP group. The surgery-related indexes, influencing indexes of pneumoperitoneum on pathophysiology, inflammation indexes, pain score and postoperative complications were compared between 2 groups.Results:There were no significant differences in intraoperative blood loss, recovery time of gastrointestinal function, hospitalization time and non-surgery cost between 2 groups ( P>0.05). The operation time, leaving bed time and surgery cost in TEP group were significantly lower than those in TAPP group: (45.08 ± 4.92) min vs. (51.03 ± 5.62) min, (20.93 ± 2.64) h vs. (22.98 ± 2.01) h and (6 887 ± 603) yuan vs. (8 276 ± 813) yuan, and there were statistical differences ( P<0.01). Before pneumoperitoneum, at 10 min after pneumoperitoneum and after extubation, there were no significant differences in levels of total carbon dioxide (TCO 2), partial pressure of carbon dioxide (PaCO 2), partial pressure of oxygen (PaO 2) and bicarbonate radical between 2 groups ( P>0.05). Before and after surgery, there were no significant differences in interleukin (IL)-6, IL-10 and C-reactive protein (CRP) between 2 groups ( P>0.05). At 1, 3 and 7 d after surgery, there were no significant differences in visual analogue scale (VAS) between 2 groups ( P>0.05). There was no significant difference in the total incidence of complications between 2 groups ( P>0.05). Conclusions:Both TAPP and TEP are safe and effective in the treatment of inguinal hernia. The surgical cost of TEP is relatively lower, and operation time and leaving bed time are shorter. The choices of clinical surgical methods should base on surgeons′ experience and individualized features of patients.
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OBJECTIVE To investigate the resistance of Acinetobacter baumannii(ABA),and the mechanism of imipenem resistance in A.baumannii.METHODS All specimens were identified by VITEK-60 and the drug resistance was detected by Kirby-Bauer test.Three dimensional test was used to detect ESBLs and AmpC.PCR and DNA sequencing were performed to determine VIM,IMP,OXA-23 and OXA-24 ?-lactamases.Outer membrane protein was analyzed by SDS-PAGE,Reserpine synergistic inhibition test was used to study the active efflux mechanism.RESULTS Totally 120 strains were isolated from sputum(76.9%),and 16 strains from secretion(10.3%).ICU was the main infected department(51 strains,32.7%).The resistance to sulperazone was the lowest(20.5%),and to imipenem accounted for 38.5%,Of the 20 imipenem resistant strains,10 strains were ESBLs positive(50%),and 20 strains were AmpC positive(100%).VIM,IMP and OXA-24 ?-lactamases were not detected out,19 strains(95%) produced OXA-23.Compared to the imipenem-sensitive strains,the resistant strains lacked the outer membrane protein of 22?103,29?103 and 33?103.The MICs of A.baumannii to imipenem were not decreased by reserpine which demonstrated that excretive mechanism was negative.CONCLUSIONS ICU is the main infected department for ABA.The resistance rate is increasing for longer-term usage of carbopenem;OXA-23 production is the important resistance mechanism in ABA,AmpC production and outer membrane protein lacking show close relation to the drug-resistance in A.baumannii.