Umbilical Disorders in Surgical Practice--论文代写范文精选

脐障碍形成的一个重要组疾病实体，需要手术干预。脐作为血液通道，除了在在肠道和泌尿系统中扮演主要角色，脐疝是最常见的外科疾病,约10%的脐疝发生在上腹区域。下面的paper代写范文将进行详述。

Abstract

Umbilical disorders form an important part of general surgical practice. The disorders may be congenital or acquired and manifest in both genders and affects all age groups. This article analyses the profile of adult umbilical disorders as seen in a surgical division of a medical college in Kashmir valley over a period of two years. 
Introduction

 Umbilicus is an important embryological, anatomical and aesthetic landmark in the anterior abdominal wall. With the advent and widespread use of laparoscopic surgeries, umbilicus has virtually become a gateway to abdominal access. But umbilicus may itself be a site of various lesions.(1) This article analyses the profile of adult umbilical disorders as managed in a surgical division of a medical college in Kashmir valley.

 Materials and Methods

The study was undertaken retrospectively and the data was retrieved from verified surgical log books of the authors and the departmental data of surgical division of the medical college of SKIMS, Srinagar, Kashmir. The data included demographics, presentation, management and complications of all the patients above the age of 16 years managed as inpatients/ day care cases for umbilical disorders from June 2011- June 2013. All the cases that had incomplete records or had been referred to other specialties for definitive management were excluded from the study. The data was analysed with Microsoft Excel – 2007 and SPSS -10.

Discussion

Umbilical disorders form an important group of disease entities requiring surgical intervention worldwide. Umbilicus functions as a blood channel during intrauterine life besides playing a major role in development of intestine and urinary system. At birth, however no function should persist and anomalies in this development lead to most of the umbilical disorders. 

Hernia is the commonest surgical disorder in umbilicus and about 10% of all hernia occurs in umbilical/epigastric area.(2) Depending on the available facilities/expertise, the features of the hernia and general condition of the patient, multiple techniques are available for hernia repair. In recent times and particularly in economically developed world, laparoscopic hernia repairs have increasingly been undertaken and proven to be found to be safe, comfortable and effective (3), though Mayo’s repair or suture herniorrhaphy is still widely used(4-7) due to simplicity and cost effectiveness. Higher recurrence rates have been a major drawback for Mayo’s and suture repair as compared to other techniques, as reported in literature. 

Lau and Patel (3) reported recurrence rate of 8.7% in suture repair whereas Sanjay et al (5) reported 11.5 % recurrence after Mayo/suture herniorrhaphy as compared to none after mesh repair. Our series has recurrence rate of 10.2%. Venclauskas L et al (8) studied the factors responsible for recurrence and found out that the bigger size of hernia (greater than 2 cm) and higher body mass index (BMI) to be more important than the repair undertaken. However Mayo’s and suture repair offer an important advantage of being able to be accomplished under local anaesthesia safely. This distinct feature besides being cost effective has the potential to avoid complications like obstruction and strangulation due to delay, while awaiting the surgical procedures under GA as stressed by Menon and Brown.(6) In our series 37 (62.7 %) of hernia repairs were undertaken under LA by Mayo’s / suture repair as compared to 22 (37.3%) under GA by other techniques. 

No laparoscopic techniques had been applied due to lack of facilities. However, ventral patch as used in 2 (3.5%) cases was found to be technically easy and effective on the long term, though cost could be limiting factor unless indigenous modified versions are devised. This technique seem to offer the advantage of being lesser extensive with lesser possibility of recurrences.(9) Two cases of umbilical endometriosis (one primary and one post surgical) were managed over the period of three years. Pelvic endometriosis is a common condition but umbilical endometriosis (either spontaneous or secondary to surgery) is uncommon and accounts for only 0.5% to 1% of all endometriosis cases.(10-11) Patient may present with umbilical bleeding / painful lump during periods of menstruation (12) or else presentations may be atypical and pose diagnostic difficulty, mimicking other acute diseases but it should be suspected in any female presenting with a painful or bleeding mass close to the umbilicus or abdominal surgical scar.(13-14) Management comprises of histological diagnosis and excision with 2mm margin (15) though drugs such as oral contraceptives and gonadotropin releasing analogues may also be given a trial.(16)

Conclusion

Umbilicus is an important land mark and can harbour a wide range of lesions and hence it is important for the physicians to be aware of umbilical disorders. A significant proportion of umbilical lesions can be managed under local anaesthesia in minor operating room or day care settings.(paper代写)

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