Objective To explore the method and effectiveness of laparoscopic bundled fastigiated mesh in repairing inguinal hernia. Methods Between January 2003 and December 2009, 1 215 patients (1 363 sides) with inguinal hernia were treated. There were 1 132 males (1 268 sides) and 83 females (95 sides), aged from 18 to 89 years (median, 58 years). The cases included 1 187 cases (1 329 sides) of primary hernia and 28 cases (34 sides) of recurrent hernia. There were indirect inguinal hernia in 728 cases (786 sides), direct inguinal hernia in 416 cases (499 sides), femoral hernia in 43 cases (45 sides), and unusual hernia in 28 cases (33 sides). According to the hernia classification criteria, there were 31 cases (38 sides) in type I, 683 cases (754 sides) of type II, 403 cases (452 sides) of type III, and 98 cases (119 sides) of type IV. The disease duration was 1 to 9 days with an average of 3.8 days. To repair the hernia, the bundled fastigiated mesh was patched through the internal inguinal ring and fixed on the internal inguinal fascia by three-point fixation. The mesh would be wrapped in the peritoneum by purse-string suture. Results The surgeries were performd successfully. The operative time ranged from 18-32 minutes (mean, 22 minutes). Postoperative tractional pain in the inguinal region occurred in 19 cases (21 sides), acute uroschesis in 8 cases, and far-end hernial sac effusion in 2 cases (2 sides); all were cured after symptomatic treatment. All incisions healed by first intention, and no complications of fever, infection, or hematoma occurred. A total of 1 095 cases (1 182 sides) were followed up 1 to 7 years (median, 3 years and 9 months). Five patients died of medical illnesses at 1-3 years after operation. Three cases recurred and then were cured by a second surgery. No intestinal adhesion or obstruction occurred. Conclusion The bundled fastigiated mesh in laparoscopic inguinal hernia repair has the advantages of minimal invasiveness, easy-to-operate, less complications, and lower recurrence rate.
目的 探讨应用人工合成材料双层聚丙烯补片修补腹壁切口疝的效果。方法 21例腹壁切口疝（15例大切口疝和及6例巨大切口疝）患者采用双层聚丙烯补片行无张力修补，对术中及术后情况进行分析。结果 全组病例手术顺利，手术时间 87～189 min，平均123 min。无严重并发症发生，痊愈出院。术后随访5～36个月（平均 17个月），无复发病例。结论 双层聚丙烯补片修补中下腹壁大切口疝及巨大切口疝是一种安全、有效的方法，是临床上治疗切口疝可供选择的一种手术方式。
Objective To explore whether 125I-vascular endothel ial growth factor (VEGF)-coated artificial vascular patch accelerate the vessel endothel ial ization and inhibit thrombosis. Methods Ten adult male New Zealand rabbits (weighing 2.5-3.0 kg) were allocated into experimental group (n=5) and control group (n=5). In experimental group, the right common jugular vein was exposed for vascular clamping between proximal location and distal location, and then a 10 mm × 5 mm 125I-VEGF-coated artificial vascular patch was implanted into the right common jugular vein and sutured with 8-0 thread.In control group, the artificial vascular patch was implanted. After 2 weeks, the vein specimens were collected to measure the residues of 125I-VEGF by γ-ray counter. HE staining and immunohistochemical staining for smooth muscle actin (SMA) and CD34 were performed. The vascular endothel ial cells were counted and the intimal thickness was measured. Results The γ-ray counter showed the residues of 125I-VEGF in experimental group was (427.5 ± 194.9) CPM after 2 weeks, equivalent to 2.0% ± 0.8% of the preoperative value. Thrombosis formed in 2 rabbits of control group; no thrombosis formed in experimental group. There was significant difference in the intimal thickness [(41.1 ± 6.6) μm vs (49.0 ± 6.9) μm, P lt; 0.05]; but no significant difference in the vascular endothel ial cells count between experimental group and control group (60.0 ± 6.8 vs 58.0 ± 5.7, P gt; 0.05). Conclusion 125I-VEGF-coated artificial vascular patch can reduce thrombosis and inhibit intimal prol iferation at the acute phase. A consecutive l ine of endothel ial cells can form after implantation of patch in the rabbit jugular vein, however, the function of endothel ial cells may be premature.
摘要:目的:回顾性研究大动脉转换术同时进行主动脉弓矫治的I期手术治疗完全性大动脉错位或TaussigBing合并主动脉弓畸形的早中期效果。方法:2000年1月至2008年12月,连续对26例存在主动脉弓畸形的完全性大动脉错位或TaussigBing畸形的小婴儿进行了I期手术矫治,其中完全性大动脉错位13例(TGA/VSD 11例,TGA/IVS 2例),TaussigBing 13例;主动脉弓畸形中主动脉弓中断(A型)7例,CoA19例,6例伴有冠状动脉异常类型。平均手术年龄(28±35) d,lt;2个月占62％,手术平均体重为(4.19±1.15) kg。在深低温停循环或深低温低流量下进行主动脉弓畸形矫治,采用自身组织直接吻合扩大或重建弓,伴有弓部发育不良者补片扩大成形。伴有冠状动脉畸形者在大动脉转换手术中冠状动脉移植方法予改良处理。〖HTH〗结果〖HTSS〗:手术住院死亡3例(11.5%),死因与冠脉移植无关。平均插管时间102 h,监护室时间平均8 d。术后早期生存者主动脉瓣上压力阶差gt;30 mm Hg有2例,主动脉瓣反流轻度2例。单因素分析中伴有冠状动脉异常类型者与术后早期死亡或并发症的风险相关,多因素分析示其与手术年龄、肺动脉高压、术前FS、主动脉阻断时间、术后血清乳酸水平相关。随访期3个月~7年,无死亡,术后5年实际生存率为88.5％(95％ 可信度范围CI 76％～96％),术后1年、5年无需介入干预或手术分别为91.4％、87％。结论:TGA和TaussigBing伴有主动脉弓畸形者I 期进行大动脉转换术和主动脉弓畸形矫治早中期效果良好,早期手术并发症和死亡的风险因素为年龄偏大,肺高压严重,把握手术时机是手术成功要则之一。Abstract: Objective: The study was to evaluate earlymid term results after onestage arterial switch operation (ASO) associated with aortic arch repair for D Transposition of the great arteries (DTGA) and TaussigBing Anomaly with arch abnormally in infant. 〖WTHZ〗Methods〖WTBZ〗: Between January 2000 and December 2008, a primary operation including aortic arch repair through a midline sternotomy was performed in 26 patients, 13 patients with DTGA and 13 TaussigBing. Most patients (62%) underwent operation during the first two months. The repair of arch was accomplished under deep hypothermic circulatory arrest or low flow, employing a wide pericardial patch to reconstruction of arch in some patients or direct ananstomosis. Results: There were 3 (11.5%) hospital deaths. The high risk factors for early mortality and morbidity were unsuitable reconstructed arch, higher age, severe pulmonary hypertension and longer aortic crossclamp time. There were no late deaths. Actuarial 5year survival was 88.5% (95% CI 70% to 96%). Actuarial freedom from overall reintervention, reoperation among operative survivors was 91.4% at 1 year and 87% at 5 years, respectively. Conclusion: the singlestage repair for DTGA and TaussigBing with aortic arch abnormally is suitable choice for infant, and followup of operative survivors is favorable. Optimal operative time was as sooner as possible.
Objective Mesh infection may occur after incisional hernia repair using prosthetic mesh. Preparation of antibiotics-bonded meshes to prevent infection is one of the solutions. To evaluate the anti-infection effect of polypropylene mesh bonded norvancomycin slow-release microsphere by preparing the rat model of incisional hernia repair contaminatedwith Staphylococcus aureus. Methods The norvancomycin slow-release microspheres were prepared by emulsion and solvent evaporation method and they were bonded to polypropylene mesh (50 mg/mesh). The appearance of the microspheres was observed using scanning electronic microscope (SEM). The content of norvancomycin in microspheres and the release rate of the norvancomycin in norvancomycin-bonded polypropylene mesh were detected using high performance l iquid chromatography method. The rat models of incisional hernia were developed in 40 healthy Sprague Dawley rats, aged 10-11 weeks and weighing 200-250 g. The rats were divided randomly into the experimental group (norvancomycin-bonded polypropylene mesh repair, n=20) and the control group (polypropylene mesh repair, n=20). And then the mesh was contaminated with Staphylococcus aureus. The wound heal ing was observed after operation. At 3 weeks after operation, the mesh and the tissue around the mesh were harvested to perform histological observation and to classify the inflammatory reaction degree. Results The norvancomycin microsphere had integrated appearance and smooth surface with uniform particle diameter, 64% of particlediameter at 60 to 100 μm, and the loading-capacity of norvancomycin was 19.79%. The norvancomycin-bonded polypropylene patch had well-distributed surface and the loading-capacity of norvancomycin was (7.90 ± 0.85) mg/cm2. The release time of norvancomycin in vitro could last above 28 days and the accumulative release rate was 72.6%. The rats of 2 groups all survived to experiment completion. Wound infection occurred in 2 rats of the experimental group (10%) and 20 rats of the control group (100%), showing significant difference (χ2=32.727 3, P=0.000 0). The inflammatory reaction in experimental group was not obvious, grade I in 16 rats and grade II in 4 rats, and numerous inflammatory cell infiltration occurred in the control group, grade II in 3 rats and grade III in 17 rats, showing significant difference (Z=32.314, P=0.000). Conclusion The polypropylene mesh bonded norvancomycin slow-release microsphere has definite anti-infection effect in rat model of incisional hernia repair contaminated by Staphylococcus aureus.
Objective To evaluate the feasibil ity of intrauterine abdominal wall defect repair of fetal lamb at late pregnancy. Methods Eight healthy pregnant ewes at 110-115 days of gestation (weighing 14-22 kg) were randomly divided into 2 groups. In group A (n=3), the abdominal wall defect of 5 cm × 1 cm was made in the fetal lambs, then was closed by strengthening suture; in group B (n=5), the abdominal wall defect of 5 cm × 2 cm was made in the fetal lambs, then was repairedby 2 layers of biological patches. After the lambs del ivered naturally, the lambs and their wounds were observed; at 10th day after birth, the scars were harvested for biomechanical and histological observations. Results One ewe of group A and 2 ewes of group B aborted, while the others were successfully del ivered. In group A, the abdominal incisions of 2 lambs healed well with a l ine-l ike scar and mild intra-abdominal adhesion, and the scar thickness was 4-5 mm. In group B, the abdominal incisions of 3 lambs did not heal completely with minor intra-abdominal adhesions, and the scar thickness was 3-4 mm. The wound breaking strength was 16, 20 N in group A and 10, 14, and 18 N in group B, respectively. A sl ight scar was seen in group A; skin ulcer and underlying fibrous connective tissue with inflammatory cell infiltration were seen in group B. Conclusion It was feasible to repair the abdominal wall defect of fetal lamb at late pregnancy in uterine. Small abdominal wall defect can be sutured directly; biological patch can be used to repair larger abdominal wall defect.
ObjectiveTo study the external biocompatibility bewteen the mouse induced pluripotent stem cells (miPSCs) and poly-3-hydroxybutyrate-co-3-hydroxyhexanoate (PHBHHx). MethodsAfter we recovered and subcultured miPSCs, we divided them into two groups. There was one group cultured with material of PHBHHx films outside the body. We observed the adhesive pattern of miPSCs on film by fluorescence of 4, 6-diamidino-2-phenylindole (DAPI) staining. The cell vitality was detected by cell counting kit-8 (CCK-8). The morphology of miPSCs attached on the film was visualized under scanning electron microscope (SEM). We used the traditional petri dish to culture miPSCs and detect the cell activity by CCK-8. ResultsMiPSCs can adhere and proliferate on PHBHHx films. The result of cell vitality which detected by CCK-8 showed that there was a statistical difference in OD value between culturing on PHBHHx films and traditional cultivation (0.617±0.019 vs. 0.312±0.004, P < 0.05). ConclusionThere are adhesion and proliferation on the surface of cells patch made by miPSCs co-culturing with PHBHHx film. Compared with traditional culturing in the cell culture dish, culturing in PHBHHx films have great advantages in the process of adhesion and proliferation. PHBHHx can be used as one of the scaffold for stem cells treating various disease.
Objective To prepare a new sirolimus drug-coated polypropylene (SRL-PP) mesh by grafting he sirolimus onto the surface of the polypropylene (PP) mesh via chemical reaction, and to apply the new mesh to animal experiment to explore its anti-adhesion properties.MethodsThe sirolimus was grafted onto the surface of the mesh by chemical reaction to prepare the SRL-PP mesh, which was compared with the PP mesh and the polyethylene glycol modified polypropylene (PEG-PP) mesh. The three groups of meshes were respectively characterized (infrared spectroscopy test, contact angle measurement), and their tensile property was measured. These meshes were implanted into the abdominal cavity of the rats respectively. The anti-adhesion properties of the new sirolimus drug-coated mesh was studied by intraperitoneal adhesion and histopathological change in rats.ResultsThe results of infrared spectrum analysis showed that there was a new absorption peak at the wavelength 1 643 cm–1 (amide group) of SRL-PP mesh, suggesting that sirolimus drug was successfully uploaded onto the surface of the mesh; the SRL-PP mesh was excellent in hydrophilicity, which provided a favorable condition for the growth of peritoneal mesothelial cells. There was no significant difference in mechanical properties between SRL-PP mesh and PP mesh or PEG-PP mesh, which provided a good mechanical guarantee for clinical application. The degree of abdominal adhesion in SRL-PP mesh group (1.00±0.58) was significantly lower than that in PP mesh group (5.17±0.69) and PEG-PP mesh group (4.00±0.58), and the tD value between SRL-PP mesh group and PP mesh group was 2.76 (P<0.05). The number of inflammatory cells and the expression of inflammatory cytokines in the adhesion tissue in SRL-PP mesh group were significantly lower than those in PP mesh group and PEG-PP mesh group.ConclusionsThe sirolimus is successfully loaded onto the surface in the PP mesh by chemical reaction. Animal experiment shows that the sirolimus drug-coated mesh can significantly reduce the abdominal adhesion of the rats, which provides a basis for clinical trial and application.
Objective Polylactic acid (PLA) patch has proper steric configuration, sufficient mechanic strength, and flexibil ity, to investigate the blocking effect on the intra-discal inflammation after annulus puncture sticked by medical glue so as to seal the pinhole left after annulus puncture. Methods Twenty healthy New Zealand white rabbits (weighing 2.0-2.5 kg) were randomly divided into 4 groups (n=5): groups A, B, C, and D. In group A, the rabbits underwent exposure of intervertebral disc and transverse process at L2-7 as a control; in group B, the rabbits received annulus puncture at L2-7 with an 18-gauge needle; and in groups C and D, the pinholes were sealed respectively with a PLA patch sticked with medical gel and medical gel alone after annulus puncture at L2-7. General condition of rabbits was observed after operation. The intervertebral disc tissue was harvested 1 week after operation. The tissue structure was observed by HE and Masson staining. And the expressions of inflammatory factors l ike interleukin 1β (IL-1β), tumor necrosis factor α (TNF-α), and inducible nitric oxide synthase (iNOs) were detected with immunohistochemistry and ELISA. Results All the animals survived till the end of the experiment. In group A at 1 week, the nucleus pulposus tissue had normal structure. In group B at 1 week, leak of nucleus pulposus from the pinhole and sl ight adhesion to the adjacent tissue could be seen, and the nucleus pulposus tissue had significant degenerative change by histological observation. In groups C and D, clots of coagulated medical gel and extensive adhesion to the adjacent tissue could be seen; histological observation suggested that the nucleus pulposus tissue of group C had similar histology manifestation to that of group A; while group D had similar histology manifestation to group B with obviously-decreased cells and disorder of matrix. ELISA test showed remarkably elevated expression level of inflammatory factors including IL-1β, TNF-α, and iNOs in groups B and D when compared with groups A and C, showing significant differences (P lt; 0.05), and similar expression level were observed in groups A and C, groups B and D (P gt; 0.05). Conclusion The PLA patch sticked with medical gel is effective in blocking the intra-discal inflammation 1 week after annulus puncture.
ObjectiveTo investigate the effectiveness of repair procedure using biological mesh with Onlay-Reinforce technique in patients with perineal hernia. MethodsBetween January 2005 and December 2012, 9 patients with perineal hernia after laparoscopic abdominoperineal resection for rectal cancer (Miles operation) were treated. There were 3males and 6 females with a mean age of 70 years (range, 61-78 years). The disease duration was 1-9 months (mean, 4.5 months). The most beginning symptom was distending pain in perineal region, and then reducible mass was found without bowel incarceration. All patients underwent hernia repair using biological mesh with Onlay-Reinforce technique through original perineal incision. ResultsThe hernial size was 9.8-20.5 cm2 (mean, 16.0 cm2); the size of biological mesh was 58-80 cm2 (mean, 70.2 cm2); and the intraoperative blood loss was 10-80 mL (mean, 50.5 mL). All of the patients underwent repair operation successfully. The operation time was 45-90 minutes (mean, 60.6 minutes); and the hospitalization time was 4-7 days (mean, 5.9 days). One patient had urine retention, which was relieved after 7 days indwelling catheter. All the wounds healed by first intention without infection. The patients were followed up 14.5-60.7 months (mean, 37.8months). No chronic pain, obvious foreign body sensation, or hernia recurrence developed. ConclusionUse of biological mesh with Onlay-Reinforce technique for the repair of perineal hernia after Miles operation is safe and effective.