ObjectiveTo explore the feasibility and safety of the artificial pneumoperitoneum and gastrointestinal contrast CT imaging, and imaging diagnostic value on abdominal wall adhesion to intestine after operation. MethodsThirtynine patients with adhesive intestinal obstruction after operation relieved by conservative therapy were included from January 2008 to November 2009. After the artificial pneumoperitoneum established by injection of gas into abdominal cavity and gastrointestinal comparison by oral administration low concentration of meglucamine diatrizoate, CT scan imaging was performed and the radiographic results were compared with surgical findings. ResultsFour patients refused surgery and discharged, so enterolysis was performed in the remaining patients. The surgical findings were consistent with radiographic results. It was showed by laparoscopic operation that intestinal obstruction caused by the fibrous adhesions and the intestine did not adhere to the abdominal wall in eight patients with fibrous adhesion diagnosed by CT. Of eighteen patients with the abdominal wall septally adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed “M”type adhesions and omentum adhesions in sixteen patients underwent open operation, and clear fat space was showed in eight patients and close adhesion was found in another eight patients between the intestine and abdominal wall. Of thirteen patients with the abdominal wall tentiformly adhered to the intestinal, the surgical findings showed the intestine and the abdominal wall formed continuous and tentiform adhesions and omentum adhesions to the intestine in eleven patients. After the followup of 6-18 months (mean 9 months), incomplete intestinal obstruction occurred in one patient and was relieved by conservative treatment. One patient with discontinuous discomfort in abdomen after operation did not receive any treatment. The other patients were cured. ConclusionThe artificial pneumoperitoneum and gastrointestinal contrast CT imaging can accurately show the location, area, and structure composition of the postoperative abdominal wall adhesion to intestine, which is safety, simple, and bly repeatable, and a better imaging method for the diagnosing of abdominal wall adhesion to intestine after operation.
Objective To study the effect of Fe 3+ -modified carborymethyl celluiose (Fe 3+ -CMC ) on preventing postoperative adhesion and inhibiting the expressions of tumor necrosis factor-α (TNF-α) and fibroblast growth factor (FGF) in the injured parts of postoperative peritoneum. Methods Fourty Wistar mice were divided into 2 groups randomly, and abdominal adhesion models were made, then 0.9% NaCl (control group) and Fe 3+ -CMC (experimental group) were sprayed into the wound surface of abdominal cavity. All mice were killed to observe the adhesion condition on day 14 after operation. Another 120 Wistar mice were divided into 2 groups randomly, and abdominal adhesion models were made as mentioned above. Ten mice were killed which were chosen randomly from 2 groups on day 1, 3, 5, 7, 14 and 60, respectively. The expressions of TNF-α and FGF in the peritoneal injured and adhesion tissues were observed by immunohistochemistry technique. Results The adhesion grade in experimental group was much lower than that in control group ( P ＜ 0.01). The expression of TNF-α (day 3-7 after operation) and FGF (day 5-7 after operation) in experimental group were lower than those in control group ( P ＜ 0.05).Conclusion Fe 3+ -CMC can decrease postoperative adhesion grade and prevent the expressions of TNF-α and FGF in injured parts of postoperative peritoneum.
Objective To analyze the effect of meglumine diatrizoate on diagnosing and treating adhesiveness small intestinal obstruction. Methods The clinic data of 484 cases of adhesiveness small intestinal obstruction were analyzed retrospectively. Those patients were treated with radiography with 76% of meglumine diatrizoate by orally or injected. Results After taking meglumine diatrizoate, 362 patients were cured, and the other 122 cases were diagnosed clearly and treated with surgery. Conclusions Meglumine diatrizoate can be used to diagnose adhesiveness small intestinal obstruction and confirm where the obstruction is. It can be the routine treatment for adhesiveness small intestinal obstruction and can be used repeatedly. It also can provide evidence to surgical treatment and guide to make the surgical project.
【Abstract】ObjectiveTo study the applicatble value of absorbable biomedical membrane (ABMM) in thyroid operation.MethodsABMM (size 0.02 cm) was placed between trachea and the skin flap trachea and the anterior muscles of the neck, and between anterior muscles of neck and the skin flap after radical cure for thyroid cancer of thyroidectomy including one or two lobes. ResultsConglutination under the incision was significantly lighter in experiment group (153 cases ) than control group (139 cases) ( P＜0.05）, but the difference of complication between two groups was insignificant after postoperative followup for 6 weeks. ConclusionABMM can effectively prevent conglutination under the incision without increasing of postoperative complications.
【Abstract】ObjectiveTo study the application of ultrasonically activated scalpel in laparoscopic intestinal adhesion release.MethodsIntestinal adhesion release with ultrasonically activated scalpel under laparoscope was performed in 29 patients suffered from intestinal adhesive obstruction after gynecological operation. ResultsAll operations were successfully performed, and none of them converted into open surgery. Intestinal disruption occurred durring operation in 2 patients with extensive intestinal denseadhesion which were mended successfully under laparoscope. The operative duration was 30-150 min (mean 45 min). Postoperative complications such as bowel leakage, bleeding, abdominal infection were not experienced. Postoperative hospital stay was 3-7 days (mean 4 days). No case had relapse symptom such as abdominal distention or pain after 1-24 months of followup. ConclusionCompared with electric scalpel, ultrasonically activated scalpel can improve the operative safety, lessen tissue damage, shorten operative time, and reduce the chance of relapse in laparoscopic operation in gynecology.
ObjectiveTo study the influence of infection in incision of abdominal wall on peritoneal adhesion. MethodsOne hundred and twenty white rats were divided into low, medium, high concentration (LC, MC, HC) groups and control group, 30 rats each, and were made animal models of abdominal incision infection, then were respectively given hypodermic injections in incisional wound of 0.2 ml quantitative mixture of Escherichia coli, staphylococcus aureus and pseudomonas aeruginosa in the concentration of 1×102, 1×105 and 1×108 cfu/ml. While the control group,normal saline was given. All the subjects were killed 8 days after operation and compared the peritoneal adhesion among the four groups.ResultsInfection rate of the incisional wounds was 81.48%, 86.67%, 90.00% and 50.00% respectively in LC, MC, HC and the control, peritoneal adhesion rate was 53.33%, 60.00%, 70.00% and 26.67% respectively. There was significant difference between LC and the control (P＜0.05), between MC or HC and the control (P＜0.01). While no difference was among LC, MC and HC (P＞0.05).Conclusion Infection of incision may increase peritoneal adhesion which might not be closely related to the number of the bacteria. This suggests that the prevention of infection plays an important role in preventing peritoneal adhesion.
腹部手术后腹腔粘连是一种常见的临床现象，可导致严重的并发症，如肠梗阻、腹腔和盆腔疼痛、不孕和不育等。严重的腹腔粘连常给再次手术造成极大困难，由于粘连形成过程复杂，治疗效果又十分不理想，所以探索其形成机理及预防措施成为当今外科领域的重点内容之一，本文就此分述如下。
目的提高广泛粘连性肠梗阻的治疗效果，预防粘连性肠梗阻复发。方法分析我院1994年1月至2000年5月6年间手术治疗28例广泛粘连性肠梗阻的临床资料。结果手术后无肠梗阻复发，术后8例发生切口感染，无手术死亡及肠瘘发生。结论把握好手术时机是提高粘连性肠梗阻治疗效果的关键，肠排列术是预防粘连性肠梗阻的一个有效方法。
ObjectiveTo investigate the synergetic effects of the combination methylene blue or/and aprotinin on preventing postoperative intestinal adhesions (POIA).MethodsFourtyeight rabbits were divided into control group (group A), methylene blue group (group B), aprotinin group (group C), methylene blue+aprotinin group (group D). Each group contained 12 rabbits and established models of intestinal adhesions through laporotomy. Fourteen days after operation, the rabbits were reoperated to see whether there were adhesions and the degree of adhesions. ResultsThe adhesions of group A was the most serious, then in sequence were group B, C, group D showed very light adhesion. Group A was much more severe than B, C, D group (Plt;0.01); group D was very different from B, C group (P＜0.05). ConclusionMethylene blue and aprotinin have significant effects on preventing POIA and the combination of the two drugs can have a synergetic effects on POIA.