The study aims to investigate the effect of the ratio of long axis to short axis (RLS) of upright polypropylene infusion bag on discharging process and to search the best RLS. Aiming at five different RLS (1.5:1, 2:1, 3:1, 4:1 and 5:1, respectively) with the volume of 100 mL, 250 mL and 500 mL, respectively, based on finite element method, analyzing the variation of stress distribution, emptying rate, drugging space and steadiness coefficient, etc. For the bags of the same volume, emptying rate increased with increasing of RLS, but the steadiness coefficient decreased with increasing of RLS. The specific increasing amplitude of emptying rate and decreasing range of steadiness coefficient were as follows: 20% and 49% for 100mL infusion bag, 9% and 51% for 250 mL infusion bag, and 11% and 46% for 500 mL infusion bag, respectibvely, when RLS increased from 1.5:1 to 5:1. Comparatively speaking, the increasing amplitude of the emptying rate is remarkably less than the decreasing range of the steadiness coefficient. By comprehensive consideration of both emptying rate and steadiness coefficient, lower RLS is recommended for upright polypropylene infusion bag.
Objective To investigate the effectiveness of laparoscopic Y-shaped polypropylene mesh in the treatment of uterine and vaginal vault prolapse. Methods Between June 2010 and December 2012, 24 patients with uterine and vaginal vault prolapse were treated by laparoscopic pelvic reconstruction (vagina and uterus-sacral fixation) with Y-shaped polypropylene mesh. The age of patients was 35-60 years (mean, 48.6 years). The disease duration was 2-8 years (mean, 5 years). According to the pelvic organ prolapse quatitative (POP-Q) classification by International Continence Society (ICS), 16 cases were classified as uterine prolapsed degree II and 8 cases as degree III; 15 cases were classified as vaginal prolapse degree I, 7 cases as degree II, and 2 cases as degree III. All patients received postoperative follow-up regularly. Subjective evaluation was done based on prolapse quality of life questionnaire (P-QOL), and objective evaluation based on POP-Q classification. Results All the patients were operated successfully. The operation time was 22-68 minutes (mean, 33 minutes); the blood loss was 30-80 mL (mean, 51 mL); the indwelling urethral catheter remain was 3-7 days (mean, 4 days); and the hospitalization days were 4-9 days (mean, 6.8 days). Twenty-four patients were followed up 3-12 months (mean, 9 months), of whom, 2 were followed up less than 6 months. All patients had normal urination after withdrawal of urethral catheter, and the residual urine volume was in normal range. No patients had mesh erosion and discomfort during sex, vaginal and anal bearing down. The P-QOL scores at 3, 6, and 12 months after operation were significantly improved when compared with the preoperative value (P lt; 0.05); but there was no significant difference among 3, 6, and 12 months after operation (P gt; 0.05). The postoperative POP-Q classification was degree 0 in 19 cases and degree I in 3 cases, and the objective cure rate was 91.7%. No recurrence was found during follow-up. Conclusion Laparoscopic Y-shaped polypropylene mesh for treatment of uterine and vaginal vault prolapse is a safe and effective method, especially applicable to preserve the uterus, and higher requirements of sexual life of patients.
Objective To compare the efficacy of retromuscular repair of incisional hernia by using ProGrip self-gripping mesh and conventional polypropylene mesh. Methods A retrospective analysis was made on clinical data of 83 cases of incisional hernia between May 2012 and May 2016. Of 83 cases, ProGrip self-gripping mesh was used in 46 cases (self-gripping mesh group) and conventional polypropylene mesh (conventional mesh group) in 37 cases. There was no significant difference in gender, age, body mass index, types of incision hernia, hernia ring diameter, course of disease, and associated disease between 2 groups (P>0.05). The operative time, hospital stays, and visual analogue scale (VAS) were recorded and compared between 2 groups. Results The self-gripping mesh group was significantly lower than conventional mesh group in operative time and hospital stays (t=2.977,P=0.004;t=2.270,P=0.026). Primary healing of incision was obtained in 2 groups, with no seroma and mesh infection. The VAS score of self-gripping mesh group was significantly lower than that of conventional mesh group at 24 hours, 7 days, and 30 days after operation (P<0.05). The follow-up time was 5-53 months (mean, 25.8 months) in 43 patients of self-gripping mesh group, and was 7-54 months (mean, 27.4 months) in 33 patients of conventional mesh group. No chronic pain or hernia recurrence was found in both groups during follow-up time. Conclusion It is a safe and feasible curative way to use ProGrip self-gripping mesh for retromuscular repair of incisional hernia as it can reduce operative time, hospital stays, and postoperative pain.
Objective To compare the effect of small intestinal submucosa(SIS)and polypropylene mesh(PPM) on repairing abdominal wall defects in rats, and toprobe into the feasibility of using SIS to repair the abdominal wall defects. Methods 100 SD rats(50 males and 50 females)were randomly divided into 2 groups(n=50). Their weight ranged from 200 to 250 g.Full thickness abdominal wall defects (2 cm×2 cm) were created by surgery and were repaired with SIS and PPM respectively. At different postoperative time (1st, 2nd, 4th, 8th and 12th week), animals were sacrificed to make histological observation. The tensile strengthand the development of adhesions were measured and observed. Results 95 animals survived and were healthy after surgery. No inflammatory response and obvious immunoreaction were observed in both groups. One week after operation, the tensile strengthof abdominal wall in SIS group (204.30±5.13 mmHg) was lower than that in PPMgroup(240.0±10.0 mmHg) at 1st week(P＜0.05),and there were no difference at 4th, 8th, 12th week. Adhesions were more marked in PPM group thanthat in SIS group(P＜0.05). Conclusion Both SIS and PPM are histologically compatible when used in rats and can maintain sufficient tensile strength. SIS is superior to PPM in regards to tissue compatibility and adhesion formation.
【摘要】 目的 探讨腔镜技术通过不同切口方式取出聚丙烯酰胺水凝胶（polyacrylamide hydrogel，PAHG）注射隆乳剂手术的临床效果，以取得最大隆乳剂清除率。 方法 2008年1月－2011年3月双侧乳房PAHG注射隆乳术后并发症患者35例，将腔镜技术分别应用于经乳房外侧切口和经乳晕切口PAHG注射隆乳剂取出手术。经乳房外侧切口治疗21例，于乳房外侧缘隐匿部位分别选做长约0.5～1.0 cm的切口1～3个，穿刺吸刮PAHG后在腔镜结合彩色多普勒超声彻底清除PAHG；经乳晕切口14例，沿乳晕下缘做2～3 cm弧形切口，吸刮PAHG后，以长头拉钩挑起囊腔，在内镜辅助下通过刮除或吸刮交替清除残留PAHG，彩色多普勒超声扫查确认未见PAHG回声团块。总结比较两种切口中应用腔镜技术的临床经验。 结果 所有患者均顺利完成手术，达到最大限度取出隆乳剂的目的。无中转改变手术方式，无术后出血、感染、引流不畅、隆乳剂残留等并发症；患者均对切口感到满意。经乳晕切口组中6例取出隆乳剂后同期置入硅胶囊假体，该组有1例出现乳头乳晕的感觉敏感度降低。 结论 腔镜辅助下经乳腺外侧切口和经乳晕切口都能够安全、有效并最大限度地取出PAHG注射隆乳剂，具有美容、微创和可以同期切除病变组织的优势，经乳晕切口手术方便同期硅胶囊假体的置入。腔镜技术值得在PAHG注射隆乳剂取出术中进一步推广应用。【Abstract】 Objective To explore the clinical outcome of endoscopic techniques in the removal of injected breast-augmentation polyacrylamide hydrogel (PAHG) through different incision methods in order to achieve a maximal PAHG removal rate. Methods From January 2008 to March 2011, 35 patients with postoperative complications after bilateral breasts PAHG injection were diagnosed and treated in our hospital. Endoscopic techniques were applied to remove PAHG through the lateral incision of breast or the mammary areolar incision. Twenty-one patients were treated with lateral incision in which 1-3 incisions with a length of 0.5-1.0 cm were selected at hidden lateral sites of breasts, and PAHG was removed by vacuum sucking followed by endoscopic technique with Doppler color ultrasound to achieve a complete removal. Fourteen patients were treated with mammary areolar incision where an arc-shaped 2-3 cm incision was made under the lower margin of mammary areola. After vacuum sucking of PAHG, long head hook was used to lift the cyst and endoscopic technique was used along or alternate with sucking to remove the remaining PAHG. Doppler color ultrasound scanned to confirm the absence of PAHG mass. The clinical experiences of these two endoscopic techniques were compared and summarized. Results All patients successfully underwent the surgery and achieved a goal of maximal removal of PAHG. None of the patients had to switch surgery approach, and no such complications as post-surgery bleeding, infection, obstructed drainage or PAHG remaining occurred. Patients were all satisfied with the appearance of incisions. Six patients were given silicone prosthesis implantation after removing PANG through the areola incision, among whom one patient showed a decreasing sensitivity in mammary nipple and areola. Conclusions Both endoscopic techniques through the lateral incision of breast and the mammary areolar incision are safe, and can achieve maximal removal of PAHG. They both have the advantages of beautifying, minimal invasiveness and simultaneous removal of pathologic tissues. The mammary areolar incision facilitates implantation of silicone prosthesis simultaneously. The endoscopic techniques are worthy to be further applied into removal of PAHG
Objective To compare scar and incision satisfaction between Prolene polypropylene suture and conventional silk suture for dermal suture in high ligation and stripping of primary great saphenous varicose vein. Methods A total of 83 patients who met the inclusion criteria were admitted in the West China Hospital, including 27 males and 56 females. The average age was 46.7 years old, ranging from 30 to 63 years old. Forty-two patients were grade C2 and 41 were grade C3 according to the CEAP grading. Patients were divided into a polypropylene suture group (even number,n=45) and a silk suture group (odd number,n=38) according to admission date order. Prolene 5-0 polypropylene suture was used for dermal suture in the patients of the polypropylene suture group and 1# silk suture in the patients of the silk suture group. The pigments of incision area and suture area and their widths, and the points of Patient and Observer Scar Assessment Scale score (POSAS) and patient and observer satisfaction score of incision were observed on month 6 for following-up. Results ① The gender, age, body mass index, and proportion of C2 of the CEAP grading or smoking had no significant difference between these two groups (P>0.05). ② All the operations were successful and all the patients were followed up. All the incisions healed well and had no infection. There was a few subcutaneous hematoma in one incisionof the 2 patients on day 3 after operation in the two groups, which markedly improved after dressing treatment. The sutures of all the patients were removed on day 14 after operation. ③ The pigment of incision area and its width, and the points of POSAS had no significant differences between the two groups (P>0.05). The pigment of suture area and its width, and the points of patient and observer satisfaction score of the incision in the polypropylene suture group were significantly better than those in the silk suture group (P<0.05). Conclusion Prolene polypropylene suture is preference to conventional silk suture in aesthetic results and patient satisfaction for dermal suture of great saphenous varicose vein surgery.
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 outcome of pedicle graft of greater omentum and polypropylene mesh in reconstruction of large defect of abdominal wall caused by surgical incision. Methods From 1994 to 2004, 12 cases of large abdominal wall defects were repaired with pedicle graft of greater omentum and polypropylene mesh after removal of abdominal wall tumor; the defect sizes of abdominal wall ranged from 10 cm×7 cm to 25 cm×17 cm. Results The abdominal wall wound in 12 cases were healed by first intention. After a follow-up of 1 to 5 years, no complications of abdominal hernia, infection and intestine obstruction occurred in all patients. Conclusion It is reliable to repair abdominal wall defect caused by surgical incision with pedicle graft of greater omentum and polypropylene mesh instead of peritoneum.