Objective To provide evidence-based therapeutic schedule for an adult patient with Lumber Isthmic Spondylolisthesis grading II. Methods Based on fully assessing the patient’s conditions, the clinical problems were put forward according to PICO principles. Such database as The Cochrane Library (2005 to April 2011), DARE (April 2011), CENTRAL (April 2011), MEDLINE (April 2011), EMbase and CBM were searched to collect high quality clinical evidence, and then we told a patient information about treatment plans. The plan was chosen by the patient for she knew her conditions and the plans. Results We included 1 meta-analysis, 3 randomized controlled trials, 5 systematic reviews and 1 prospective study on the natural course of isthmic spondylolisthesis were included. Literature evidence indicated that the prognosis of isthmic spondylolisthesis was good. Surgery should be selected when there was neither no remission of symptom, nor progression of lumber olisthy with conservative treatment. The long-term effect of surgery may be good, but it cannot change the natural course of the disease. Based on literature evidence, the patient chose the conservative treatment. After one year’s treatment the patient recovered, her sciatica relieved, and CT showed no progression of lumber olisthy. Conclusion Patient with low grand isthmic spondylolisthesis chose conservative treatment may achieves good effects, whereas on the process of the treatment, regular follow-up to monitor the progression of lumber olisthy should be conducted.
ObjectiveTo compare the effect of da Vinci Surgical System and video-assisted mini-thoractomy (VAMT) on postoperative pain of patients with lungs or mediastinal tumor. MethodsWe retrospectively analyzed the clinical data of 88 patients with lung or mediastinal tumor who underwent surgical treatment in our hospital from January 2015 through April 2015. The patients were divided into two groups including a robot group and a VAMT group. There were 49 patients in the robot group with 23 males and 26 females at age of 55.14±13.03 years and 39 patients with 23 males and 16 females at age of 56.92±8.98 years in the VAMT group. ResultsCompared with the VAMT group, shorter operation time (t=-2.298, P=0.024) and shorter time of drainage (t=-2.421, P=0.018) were found in the robot group with statistical differences. There was a statistical difference in visual analogue scale (VAS) scores of postoperative 24 hours between the robot group and the VAMT group (1.00±0.74 vs. 2.33±1.64, t=-4.704, P=0.000). While no statistical difference was found in VAS scores of postoperative 48 hours (t=-0.244, P=0.808) between the two groups. ConclusionCompared with VAMT, da Vinci Surgical System can be used in the treatment of lung and mediastinal tumor with shorter operation time, shorter time of drainage, less pain, and less invasiveness.
Objective To systematically review the effects of problem-based learning (PBL) versus lecture-based learning (LBL) teaching models on students in surgery education in China. Methods Such databases as CNKI, WanFang Data and PubMed were electronically searched for literature on PBL versus LBL applied in surgery education in China up to June 30th, 2013. According to the inclusion and exclusion criteria, we screened literature, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was performed using RevMan 5.2 software. Results Sixteen studies were included totally, all of which were low in quality. Compared with LBL, PBL was superior in surgery comprehensive scores (WMD=4.98, 95%CI 3.88 to 6.09, Plt;0.000 01), fundamental theoretical knowledge (WMD=3.09, 95%CI 0.81 to 5.38, P=0.008), clinical manipulation skills (WMD=4.70, 95%CI 2.69 to 6.71, Plt;0.000 01), and practical ability (WMD=2.13, 95%CI 1.11 to 3.15, Plt;0.000 1) with significant differences. Conclusion PBL teaching method is superior to LBL in surgery education.
Objective To summarize and analyze the treatment options and prognostic factors of gastric stump carcinoma （GSC）. Methods The clinical data of 114 patients with GSC treated in The Second Affiliated Hospital of Northern Sichuan Medical College and The General Hospital of Chinese People’s Liberation Army from Mar. 2000 to May.2008 were reviewed， and influencing factors of surgical resection and prognosis were analyzed. Results For all patients，the ratios of surgical resection and curative resection（R0 resection） were 57.0%（65/114） and 54.4% （62/114）， respec-tively. The ratios of total gastrectomy， distal gastrectomy， proximal gastrectomy， endoscopic mucosal resection （EMR），and endoscopic submucosal dissection （ESD） were 73.8%（48/65）， 16.9%（11/65）， 3.1%（2/65）， 4.6%（3/65）， and 1.5%（1/65）in resection cases， and were 75.8%（47/62）， 16.1%（10/62）， 3.2%（2/62）， 4.8%（3/62）， and 0 in R0 resection cases， respectively. Seventy-five patients were followed-up for 0.3-79 months （median 12 months）， the mediansurvival time was 19.5 months， and 1-， 3-， and 5-year overall survival rates were 61.8%， 42.3%， and 30.1%， respectively. The results of multivariate analysis showed that resection rate was higher in patients with initial distalgastrectomy （P=0.002）， kps score≥80 （P=0.016）,lower macroscopic type （P=0.013）， and cM0 （P=0.000）. R0 resection （P=0.000）， macroscopic type （P=0.005）， and cT stage （P=0.006） were the independent prognostic factors. There were both no significant difference on survival between the patients with previous benign disease and those with original malignant disease when analyzed with univariate or multivariate method （P＞0.05）. There were no significant difference on overall survival curve among patients treated with palliative resection， palliative chemotherapy， simple laparotomy， and best supportive care （P＞0.05）. Conclusions The treatment options and prognosis of GSC were not influenced by the primary benign diseases or malignant diseases， and R0 resection is the most important prognostic factor. Removal of total remnant stomach is the best surgical procedure for GSC， and palliative laparotomy should be avoided.
Objective To analyze the citation classics articles， and approach the research development history and the research direction in the future about surgical treatment for type 2 diabetes. Methods The most frequently cited articles had published in Social Sciences Citation Index database by the end of October 30， 2012 were retrieved. The 50 most frequently cited articles were selected. Articles were evaluated for several characteristics， including number of citations， publication time， country of origin， institution， journal， publication type of article， and authorship. Results The most frequently cited article received 1 751 citations and the least frequently cited article received 73 citations， with a mean of 242.76 citations per article. These citation classics were published in 18 high-impact journals， led by Annals of Surgery and Obesity Research as 10 papers. Of the 50 articles， 18 articles were clinical observational study， 20 articles concerned basic science， 10 articles were review articles， and 2 articles were commentary. These citation classics were published from 1990 to 2009， most of them （40） from 2000 to 2009. Three institutions produced 2 top-cited articles， including Medical College of Virginia， Monash University， and East Carolina University. These articles originated from 14 countries， the top was USA （22 articles）. Two persons authored 3 published papers （Cummings DE and Rubino F）. Conclusion Most “citation classics” in research about surgery for type 2 diabetes are observational studies published in high-impact journals by US-based authors after 1990.
Objective To discuss the clinical characteristics and surgical treatment for gastric cancer in the elderly. MethodsRelated literatures were reviewed to summarize the characteristics of elderly patients with gastric cancer, thus to evaluate the feasibility and strategy of surgical treatment for elderly patients with gastric cancer. Results Elderly gastric cancer patients often had one or more comorbidities, but most patients could accept gastrectomy and had a good prognosis. Conclusions Age is not the contraindication for surgery. Dealing with comorbidities in elderly patients, preventing the complications and performing the appropriate surgical method can result in a good therapeutic effect.
Objective To analyse the clinical features of Peutz-Jeghers syndrome and its canceration, and to summarize the management and the follow-up strategy for patients with Peutz-Jeghers syndrome. Methods Clinical data of 30 patients with Peutz-Jeghers syndrome dating from October 1985 to September 2005 in West China Hospital of Sichuan University were analyzed retrospectively. Results Fourteen (46.67%) definite family histories of Peutz-Jeghers syndrome were found. Pigmentation of skin and mucosa, abdominalgia and hematochezia were major clinical manifestations of the syndrome. There were 18 patients (60.00%) complicated with intussusception and acute intestinal obstructions, 16 patients (53.33%) with gastrointestinal bleeding, and 6 patients (20.00%) developed malignancy. The frequent types of malignancy were carcinoma of small intestine (3 cases), colon carcinoma (2 cases) and gastric carcinoma (1 case) in order. The mean age of the canceration-diagnosed patients was 32 years old. The type of pathohistology of all the malignancy was poorly differentiated mucus adenocarcinoma. High-frequency endoscopic electroresection, orthdox polypectomy and enterectomy were the major means of treatment. Conclusion Patients with Peutz-Jeghers syndrome are at high risk of canceration at relatively early ages and usually the differentiation of the tumor is poor. Endoscopy should be performed regularly and the high-frequency electroresection is an effective therapy in disposing intestinal polyp. Screening can also improve the efficacy of Peutz-Jeghers syndrome.
Objective To investigate the clinicopathological characteristics of proximal gastric cancer (PGC). MethodsThe clinical course and pathologic feature of 118 PGC patients were analyzed, and compared with those of 310 distal gastric cancer (DGC) patients. ResultsThe incidence of PGC was lower than DGC, the percentage of Ⅲ,Ⅳ stages and undifferentiated type in the PGC group were significantly higher than in DGC. For the surgical procedure, patients in the PGC had significantly higher percentages of total gastrectomy and other organ resection than in DGC. The percentage of patients with positive margin and lymph node metastasis in PGC was also significantly higher than in DGC. Esophageal invasion and lymph node metastasis were much more in PGC. The 5year survival of patients with PGC was significantly lower than that with DGC. No significant differences were found between the two groups with respect to the mortality rates and complications. Conclusion The relatively poor prognosis associated with PGC is mainly from advanced cases and esophageal invasion. Early detection and treatment is the most important strategy to improve the survival of patients with PGC.
Objective To investigate the surgical techniques for management of left colon carcinoma obstruction. MethodsThe techniques used in left colon carcinoma obstruction and the corresponding efficiencies reported in foreign literatures were reviewed. ResultsThe surgical techniques for management of left colon carcinoma obstruction involve palliative operation, staged operation and onestage operation. These methods had their own virtues as well as shortages. But on all accounts, onestage operation was favorable for both the patients and docters. ConclusionDifferent methods for management of left colon carcinoma obstruction have different adaptation index, first you must ensure safety, then you should try your best to do onestage operation.
ObjectiveTo determine the characters of symptomatic pancreatic pseudocyst due to acute pancreatitis and effects of surgical treatment with two kinds of procedure （internal drainage or external drainage）. MethodsOne hundred and fifteen cases hospitalized during recent ten years were retrospectively analyzed.ResultsWe found that necrotic tissue existed in the pseudocyst in most cases and infection might occur in these pseudocyst. Although effect of two kinds of surgery was similar, the clinical course was different. The complications after surgery were fewer in patients underwent internal drainage than that with procedure of external drainage, and average hospital day was 7d in cases with internal drainage and 11d in cases with external one respectively. Surgery of internal drainage used in treatment was not only successful in noninfectious and single pseudocyst, but in infectious or multiple seudocyst.ConclusionInternal drainage should be used in most cases and considered as the first selection in surgery of pseudocyst due to acute pancreatitis.