Objective To summarize the visual outcome of patients with severe ocular trauma treated with vitreous surgery. Methods Clinical data of 188(191 eyes) with severe ocular trauma treated with vitreous surgery in a period from November 1996 to April 1998 were analysed retrospectively. Results The study included penetrating injury in 56 eyes, foreign bodies in the posterior segment in 70 eyes, blunt injury in 41 eyes , and globe rupture in 24 eyes. Main complications included endophthalmitis in 35 eyes, choroidal bleeding in 20 eyes, retinal detachment in 60 eyes, and vitreous hemorrhage in 97 eyes. Post-opera-tively, out of 188 eyes, except for 3 of patients too young to examine, visual acuity improved in 133(70.7%), including 85(45.2%) with visal acuity 0.02-1.0, 46(24.5%) remained unchanged; and 9(4.8%) had worse vision. Among 34 with no-light-perception, 12 had light-perception or over. Conclusion A majority of severe trauma eyes can be salvaged with considerable visual recovery after adequate and timely vitreous surgery. (Chin J Ocul Fundus Dis,1999,15:4-6)
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 clinical effectiveness and safety of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Methods Databases including The Cochrane Library (Issue 3, 2013), the database of the Cochrane Anesthesia Group, MEDLINE, EMbase, PubMed, Ovid, Springer, CNKI, VIP and WanFang Data were electronically searched from inception to May 2013 for the randomized controlled trials (RCTs) of sufentanil-propofol versus remifentanil-propofol during total intravenous anesthesia for neurosurgery. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the quality of included studies. Then, meta-analysis was performed using RevMan 5.1 software. Results Thirteen trials involving 647 patients were finally included. The results of meta-analysis showed that: a) for hemodynamic changes, MAP decreased in the remifentanil-propofol group after induction and decreased 5 minutes after intubation, but no significant difference was found between the two groups; the two groups were alike in MAP changes during craniotomy and extubation, and in HR changes after induction, 5 minutes after intubation, during craniotomy and extubation, with no significant difference. b) The result of intra-operative wake-up test showed that, there was no significant difference in the sedative effect and the time of awaking between the two groups. c) For emergence time and extubation time, compared with the sufentanil-propofol group, emergence time and extubation time were significantly shorter than those in the remifentanil-propofol group. d) For side effects, there was no significant difference in side effects (such as post-operative nausea, vomiting, respiratory depression, restlessness, chills and hypotension) between the two groups. And e) for post-operative pain, compared with the remifentanil-propofol group, post-operative 1-h and 2-h VAS were lower and the number of who need additional analgesic drugs within 24 h after operation was less in the sufentanil-propofol group, with significant differences. Both groups used the similar dosage of propofol with no significant difference. Conclusion Compared with the remifentanil-propofol group, hemodynamics changes in the sufentanil-propofol group is steadier after induction and during intubation. Patients in the sufentanil-propofol group are better in postoperative awakening quality. But they are alike in the incidence of side effects and propofol dosage.
Objective To investigate the influence of preoperative assessment by transrectal ultrasound (TRUS) on the development of operative procedures for rectal cancer. Methods A total of 110 patients with pathologically proven rectal cancer and distance between tumor to dentate line ≤10 cm were enrolled and randomized into group A (n=55) and group B (n=55) according to a computer-generated random sequence. Both TRUS staging and Clinical Staging System (CS staging) were performed preoperatively in group A, while only CS staging was conducted in group B. Preoperative TRUS stage, CS stage, and proposed operative procedures were recorded to compare with the postoperative pathological stage and practical operative procedures. Results A total of 99 patients were assessed. They were randomized into group A (n=49) and B (n=50), and there were no significant differences in baseline characteristics between the two groups. The difference in staging accuracy was statistically significant (P=0.000) between group A (91.8%) and group B (48.0%). Statistically significant improvement (P=0.013) in the accuracy of proposing operative procedures for rectal cancer was observed in group A (93.9%) compared with group B (76.0%). Conclusion TRUS is evidently superior to CS staging in preoperative assessment for rectal cancer, and may remarkably enhance the accuracy of proposing operative procedures. Therefore, TRUS is valuable in preoperative assessment which may help to guide the selection of operative procedures for rectal cancer surgery.
目的 通过对二腹肌后腹大体和显微解剖，观察二腹肌后腹的位置与毗邻关系，为临床治疗提供依据。 方法 2011年2月－2012年6月，对10具20侧成人尸体标本作解剖学研究，观察二腹肌后腹与周围相邻组织结构的位置。 结果 二腹肌后腹位置恒定，其深面有重要的神经血管。依次有寰椎横突、颈内静脉、枕动脉、副神经、颈外动脉、面动脉、舌下神经及耳后动脉等重要结构。 结论 掌握二腹肌后腹的外科解剖特点，在进行颌面外科手术时，可以避免损伤有关神经和血管等重要结构，具有重要的临床指导意义。
目的：研究比较松果体区肿瘤的显微外科手术切除不同手术入路及其优缺点。方法：回顾分析收治的48例松果体区肿瘤患者的手术情况及术后表现，并进行分析。结果：48例患者中，经枕小脑幕切开（Poppen）入路31例，幕下小脑上（Krause）入路8例，经胼胝体-穹窿间入路6例，经胼胝体后部（Dandy）入路2例，颞部侧脑室三角部入路1例。肿瘤全切除40例，次全切除5例，大部分切除3例。8例未全切者及病理证实为恶性的病变术后行放疗和（或）化疗，5例术后并发脑积水行分流术，偏盲1例，死亡2例,随访6个月～6年，KPS大于80分者约43例。结论：松果体区肿瘤的手术治疗效果较好，全切率高、死亡率低，合理的入路及体位，娴熟的显微外科手术技巧是手术成功的关键，Poppen入路和Krause入路是符合微创理念的理想入路。
Objective To discuss the surgical treatment and experience of mesh infection after prosthetic patch repair of inguinal hernia. Methods The clinical data of 67 cases of mesh infection after prosthetic patch repair who were treated in Chao-Yang Hospital from Jan. 2011 to Jun. 2012 were retrospectively analyzed. Results All patients were treated with surgical operation successfully， including removing the infected mesh and surrounding tissues， primary suture， and a placement of wound drainage， without replacement of a new patch substitute. The hospital stay of the patients was 10-25days with an average of 16days. Of the 67 patients， 51 patients got primary healed and the other 16 patients healed delayed after local dressing change due to the superficial infection following stitch removal. Sixty-six patients were followed-up for 6-24 months （average of 20 months） after operation without recurrence and complication， including seroma， wound infection， intestinal fistula， and postoperative pain. Conclusions The treatment of mesh infection after inguinal hernia repair is very complicated， but the primary suture repair and a placement of wound drainage after removing infected mesh with complete debridement is a effective therapy for it.