ObjectiveTo investigate the clinical effects of laparoscopic hiatus reconstruction with Bard Crurosoft patch associated with Nissen fundoplication in elderly patients with gastroesophageal reflux disease (GERD). MethodsFrom July 2006 to July 2009, 22 consecutive elderly patients （≥65 years） with GERD underwent laparoscopic hiatus reconstruction associated with Nissen fundoplication， 10 of them underwent laparoscopic Crurosoft patch hiatus reconstruction (hiatus diameter≥5 cm in 2 patients， lt;5 cm in 8 patients) and 12 underwent laparoscopic simple sutured hiatus reconstruction (hiatus diameter≥5 cm in 2 patients， lt;5 cm in 10 patients). Intra and perioperative data including symptoms (heartburn, regurgitation, dysphagia, and respiratory complications), functional evaluations (esophagogastroscopy, manometric evaluations in lower esophageal segment, and 24 h pH-monitoring values) were compared and analyzed. ResultsPatients in 2 groups had similar preoperative values in demographics, symptom scores, functional evaluations, as well as operative data except for mean operative time. Three-month and 1-year follow-up after operation, the results of symptoms scores and functional evaluations of patients in 2 groups compared with preoperative values wear improved （Plt;0.05）, but symptoms scores and functional evaluations of patients in patch group were evaluated to demonstrate more significant improvement than suture group （Plt;0.05）. In suture group, the results of 3 months after operation were better than 1 year after operation, with statistically significant difference （Plt;0.05）. Two patients underwent postoperative intrathoracic immigration of wrap in suture group, but this complication did not happen in patch group （Plt;0.05）. ConclusionsLaparoscopic hiatus reconstruction with Bard Crurosoft patch associated with Nissen fundoplication is a safe and effective treatment for elderly patients(≥65 years) with GERD.
【摘要】 目的 分析腦中心疝對腦出血患者預后的影響，明確早期判定的重要性。 方法 回顧分析2005年2月－2010年8月所有因腦出血行手術治療的173例患者的臨床資料，其中并發小腦幕切跡疝48例，并發腦中心疝37例。 結果 173例患者治愈97例，輕殘25例，中殘30例，持續植物狀態2例，死亡19例；死亡原因：腦功能衰竭11例，顱內感染2例，肺功能衰竭2例，腎功能衰竭3例，彌散性血管內凝血1例。腦中心疝患者病死率（27.03%）高于非腦中心疝患者（6.62%），差異有統計學意義（χ2=10.393，P=0.001）。腦中心疝分期與GOS分級呈負相關關系（rs=-0.827，P=0.000），分期越早，GOS分級越高；腦中心疝存活的27例患者日常生活、活動分級與腦中心疝分期呈正相關關系（rs=0.630，P=0.000），分期越早，ADL分級越低。 結論 腦中心疝的早期判定可以減少患者并發癥的發生，降低病死率及傷殘率。【Abstract】 Objective To Analyze the effect of brain center hernia on the prognosis of cerebral hemorrhage patients, and clarify the importance of early judgment of brain center hernia. Methods The recorded data of 173 patients undergoing surgery for cerebral hemorrhage in our hospital from February 2005 to August 2010 were retrospectively analyzed. Among them, there were 48 cases of combined transtentorial herniation and 37 cases of combined brain center hernia. Results Among the 173 patients, 97 were cured, 25 were slightly disabled, 30 were moderately disabled, 2 were in persistent vegetative state (PVS), and 19 died. In the 19 dead patients, 11 died of brain function failure, 2 of intracranial infection, 2 of lung failure, 3 of renal failure, and 1 of disseminated intravascular coagulation (DIC). The mortality of patients with brain center hernia (27.03%) was significantly higher than that of non-brain center hernia patients (6.62%) (χ2=10.393, P=0.001). The period of brain center hernia was negatively correlated with GOS′s stage (rs=-0.827, P=0.000), and the earlier the period, the higher the GOS stage. The brain center hernia period in the 27 survival patients was positively correlated with their ADL stage (rs=0.630, P=0.000), and the earlier the period, the lower the ADL stage. Conclusion Early judgement of brain center hernia can reduce patients′ complications, their mortality and disability rate.
Objective To review the clinical operation methods of abdominal incisional hernia. Methods Classification, operation method and fellow-up of 78 patients with abdominal incisional hernia were retrospectively analyzed. Results The average time of fellow-up was 26 months. Nineteen cases were repaired with simple suture with 3 cases (15.8%) recurrence, 57 cases were repaired with man-made material with 2 case （3.4%） recurrence. Conclusions Individual operation method should be chosen according to body condition, classification of the size of abdominal loss and abdominal hypertension. It is an effective method to repair the hernia of abdominal incision with man-made material.
