ObjectiveTo investigate the importance of nursing observation and intervention for extrahepatic bile duct stones with gallbladder stones treated by electronic duodenoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). MethodsFrom July 2011 to February 2014, 157 patients with extrahepatic bile duct stones with gallbladder stones underwent EST and LC at the same time in our department. Combined with the surgery characteristics, we focused on the close observation and nursing of postoperative complications and drainage tubes for patients' timely recovery. ResultsOne patient with duodenal diverticulum papilla did not complete EST and LC surgery, which was then transformed to LC, bile duct incision and choledochoscopy with T tube drainage. All the remaining 156 patients completed endoscopic retrograde cholangio-pancreatography and LC with a completion rate of 99.36%. Under close observation and careful nursing care, this group of patients did not have duodenum perforation, bile leakage or other complications. No patient died. Seven to thirteen days after hospitalization, all the patients were cured and discharged from the hospital. ConclusionFor patients undergoing EST and LC at the same time, observation and timely intervention are very important in reducing serious complications, improving the quality of surgery, enhancing patients' comfort, and promoting postoperative recovery.
目的 探讨减少和预防腹腔镜胆囊切除术(LC)并发症的措施。方法 对我院2004年1月至2008年12月期间1 050例LC患者的临床资料进行回顾性分析。结果 手术时间11～86 min，平均32 min; 术中出血2～106 ml，平均21 ml。18例(1.7%)患者中转开腹，其中7例为术中无法完成胆囊三角解剖，4例胆管损伤，2例Mirizzi综合征，1例胆肠内瘘和4例发生无法控制性出血。6例患者术后出现胆漏，其中胆囊床迷走胆管漏2例，肝外胆管漏4例; 8例患者术后继发胆总管结石，2例术后胆囊管残石; 51例术后诊断为胆囊切除术后综合征，其中胆总管下端狭窄24例，残余胆囊管过长（≥1 cm）或残余胆囊结石16例，11例无明显原因。术后1例患者因肺栓塞死亡，2例胆心综合征患者未改善转心内科继续治疗。结论 掌握好LC手术适应证、成熟的LC操作技巧、术中仔细处理胆囊三角和胆囊床、选择性安置腹腔引流管、适时中转开腹是减少术中、术后并发症发生的关键。
目的 应用联合微创介入方法治疗中晚期肝癌并探讨其疗效。方法 我院自1998年4月至2008年11月期间采用联合介入治疗的方法，即行经皮股动脉插管肝动脉化疗栓塞术，同期行B超引导下经皮穿刺瘤内乙醇注射(PEI)治疗中晚期肝癌175例。结果 左肝动脉行肝动脉化疗栓塞7例，右肝动脉行125例，单行化疗而未栓塞43例； 175例均行B超引导下PEI。随访6～28个月，平均19.3个月，死亡15例，其中8例死于肝功能衰竭，7例死于上消化道大出血伴肝癌广泛转移。29例存活6～12个月； 146例存活13～28个月，其中27例存活已超过26个月。结论 对于不能切除的中晚期肝癌采用联合介入治疗，因其具有操作简单、疗效可靠、经济、安全等优点，值得临床推广应用。
Latissimus dorsi muscle flap (LDMF) is an important autogenous tissue for autogenous breast reconstruction after mastectomy. LDMF harvesting using a conventional open method is traumatic, and the scar is obvious. With the application of minimally invasive technology in various surgical fields, endoscopic and robotic technology for breast surgery, especially LDMF breast reconstruction, is also becoming mature. Endoscopic or robotic LDMF breast reconstruction has the advantages of no incision in the back, superior cosmetic effect of back, clear vision of surgical field, and low incidence of postoperative complications. It is a safe and effective method of breast reconstruction.
Objective To explore the effectiveness and failure causes of large-head metal-on-metal total hip arthroplasty (large-head MoM THA). Methods Between March 2007 and May 2010, 159 patients (183 hips) underwent large-head MoM THA, and the clinical data were analyzed. There were 50 females (54 hips) and 109 males (129 hips) with an average age of 50 years (range, 20-78 years). Single hip was involved in 135 cases (left hip in 69 cases and right hip in 66 cases) and double hips in 24 cases. The causes included femoral head necrosis in 74 cases (93 hips), Legg-Calve-Perthes in 1 case (1 hip), osteoarthritis in 18 cases (19 hips), developmental dysplasia of the hip in 17 cases (18 hips), osteoarthritis after hip septic infection in 8 cases (8 hips), traumatic arthritis of the hip in 6 cases (6 hips), femoral neck fracture in 17 cases (17 hips), ankylosing spondylitis in 8 cases (11 hips), rheumatoid arthritis of hip in 9 cases (9 hips), and adult onset Still’s disease in 1 case (1 hip). Before operation, visual analogue scale (VAS) was 6.59±0.87; Harris score was 45.99±8.07. Results Healing of incisions by first intention was achieved, and no operative complication occurred. The patients were followed up 1.2-8.2 years (mean, 6.1 years). Implant failure was observed in 15 cases (17 hips), and the 5-year survival rate of large-head MoM THA was 91.80% (168/183). The causes of implant failure after THA were inflammatory pseudotumor in 4 cases (4 hips), acetabular aseptic loosening in 3 cases (3 hips), osteolysis in 4 cases (5 hips), acetabular aseptic loosening combined with inflammatory pseudotumor in 3 cases (3 hips), and functional disused in 1 case (2 hips). Of them, 9 cases (11 hips) did not receive revision surgery for various reasons, while 6 cases (6 hips) underwent revision surgery at 1.2-5.4 years (mean 3.7 years) after large-head MoM THA. At last follow-up, VAS and Harris score were 1.72±1.48 and 81.37±10.75 respectively, showing significant differences when compared with preoperative scores (t=–35.547，P=0.000；t=33.823，P=0.000). The function was excellent in 44 hips, good in 89 hips, fair in 33 hips, and poor in 17 hips. Conclusion Large-head MoM THA has a high revision rate during mid- and long-term follow-up because of inflammatory pseudotumor, acetabular aseptic loosening, and osteolysis. Early revision can effectively improve the function of the hip and improve patients’quality of life.
Objective To evaluate the safety and efficacy of total hip arthroplasty (THA) in patients with end stage renal disease (ESRD). Methods Between December 2009 and May 2016, 30 THAs were performed in 28 patients with dialysis-dependent renal failure (18 patients) or renal transplantation (10 patients). A retrospective case control study was carried out to compare these 28 ESRD patients (ESRD group) with a matched cohort of 28 nonrenal patients (control group). There was no significant difference in gender, age, hip side, American Society of Anesthesiology (ASA) classification, comorbidities, and preoperative Harris score and hemoglobin (Hb) level between 2 groups (P>0.05). The complications during hospitalization, Hb level changes, perioperative transfusion rate, hospital stay, and hospitalization costs in 2 groups were evaluated; and the creatinine changes of dialysis patients in ESRD group were evaluated. During the follow-up period, 90 days readmissions, periprosthetic infection, prosthesis loosening, hip Harris score, and deaths were recorded. Results There was no loss of follow-up. The mean postoperative follow-up of ESRD group was 3.4 years (range, 1.0-7.4 years) and control group was 3.5 years (range, 1.0-7.4 years). Differences in hospital stay and the drop of Hb was not significant between 2 groups (P>0.05). The hospitalization costs and perioperative transfusion rate were significantly higher in ESRD group than in control group (P<0.05). There was no significant difference in creatinine value of dialysis patients in ESRD group between pre- and post-operation (t=1.804, P=0.089). At last follow-up, the Harris score was significantly higher than preoperative score in both groups (P<0.05); however, there was no significant difference in Harris score between groups (t=1.278, P=0.207). In ESRD group, 5 patients presented complications, 1 patient was readmitted to hospital, and 2 patients died during the follow-up. In control group, 1 patient presented complications, and there was no 90 days readmission and no death. During the follow-up period, there was no loosening or revision in 2 groups and the prosthesis was in good position. Conclusion THA can improve joint function and life quality of ESRD patients, but the risks of operation, perioperative complications, transfusion rate, and cost are high. Correct perioperative evaluation and management can help ESRD patients safely go through the perioperative period.