Objective To prepare a self-made compound, hemostatic jelly with polylactic acid(PLA), which has the hemostatic and absorbable effect on injured cancellous bone. Methods Two bone defects of 5 mm in diameter and 4 mm in depth were subjected on 20 health rabbits by drilling through their either outside plate of the iliac, and were filled with hemostatic jelly(group A), bone wax(group B) and blank(group C) respectively. Hemostasis were observed and recorded after 1 and 10 minutes. Five specimens were harvested at 2, 4, 8 and 12 weeks postoperatively for histological observation. Results ① Hemostatic effect: Bleeding of injured spongy bone stopped within 10 minutes after the treatment of hemostatic jelly and bone wax, but bleeding of balnk did not stop. Hemostatic jelly and bone wax adhered to bone defects firmly within 10 minutes was after the treatment. ② Absorbable effect: Hemostatic jelly and bone defects have not changed visibly in the first 2 weeks. With histological observation 4 to 8 weeks after the operation, hemastatic jelly was absorbed gradually and replaced by osteogenous tissue. It was absorbed completely after 8 to 12 weeks. Bone wax was not absorbed after 12 weeks, no new bone tissue was observed at bone wax area. The blank was replaced by connective tissue and osteogenous tissue partially after 12 weeks. Conclusion The compound hemostatic jelly manifests both hemostatic and absorbable effects on injured cancellous bone and may substitute for bone wax in clinical application.
目的观察S100吸收性止血绫（absorbable stanching satin S100，ASS）在肝脏外科的止血效果。方法将40例择期行肝部分切除术的患者随机分成两组，应用ASS贴敷肝断面为ASS组（n=20），肝断面不用任何局部止血材料为对照组（n=20），分别于术后2 h、12 h、24 h及72 h观察腹腔引流情况，其中重点观察引流量。结果ASS组术后腹腔引流量较对照组明显减少，差异有显著性意义（P＜0.01）;ASS组术后无漏胆发生，对照组术后有2例发生漏胆; ASS组的腹腔引流管拔管时间及平均住院日均小于对照组，但差异无显著性意义（Pgt;0.05）。结论ASS在肝脏部分切除术中具有安全、有效的止血作用，特别是对于伴有凝血机能障碍的患者。
Objective To analyze clinicopathologic characteristics of 1 008 patients with gallbladder polyps by minimally invasive gallbladder-preserving surgery, and to explore hemostatic effect of 0–4 ℃ cold saline plus different concentrations norepinephrines in flushing gallbladder mucosa bleeding. Methods The clinical data of 1 008 patients with gallbladder polyps by the minimally invasive gallbladder-preserving surgery from 2009 to 2016 in the General Hospital of Xinjiang Military Command were retrospectively analyzed. The clinicopathologic types of gallbladder polyps and the relationship between the operation time and the recurrence of gallbladder polyps were analyzed, the hemostatic effects of 0–4 ℃ cold saline plus different concentrations (0, 16, 24, and 30 mg/L) norepinephrines in flushing gallbladder mucosa bleeding (The hemostatic effect was reflected by the time of flushing gallbladder mucosa bleeding) were compared. Results One thousand patients with non-tumorous gallbladder polyps successfully underwent the minimally invasive gallbladder-preserving surgery, another 8 cases patients with tumorous gallbladder polyps underwent the cholecystectomy immediately. There were 128 cases of single polyps and 880 cases of multiple polyps. The polyp diameters of 910 cases were 5–10 mm and 98 cases were 10–15 mm. The pathological analysis indicated that there were 912 (90.5%) cases of the cholesterol polyps, 74 (7.3%) cases of the inflammatory polyps, 14 (1.4%) cases of the adenoid hyperplasia, and 8 (0.8%) cases of the neoplastic polyps ［adenoma 6 cases, adenocarcinoma (T0N0M0) 2 cases］. The gallbladder polyps recurrences were found in 30 (3.0%) cases during 1–8 years of follow-up (average 4 years), all of them were the multiple and cholesterol polyps. The flushing gallbladder mucosa bleeding time of 0–4 ℃ cold saline plus 0, 16, 24, and 30 mg/L concentraions norepinephrine was (44±5) min, (33±6) min, (17±5) min, and (17±4) min in the 125, 230, 555, and 98 patients with gallbladder polyps, respectively. The time of flushing gallbladder mucosa bleeding between the other concentration groups had significant difference (P<0.05) except for between the 24 mg/L concentration group and the 30 mg/L concentration group (P>0.05). The operation time was (62±21) min and (60±19) min of the 30 patients with gallbladder polyps recurrence and the 970 patients without gallbladder polyps recurrence, which had no significant difference (P>0.05). Conclusions Cholesterol polyp is a common pathological type of gallbladder polyp, inflammatory polyp and adenomyosis polyp are uncommon, and multiple polyps are common. Hemostatic effects of 0–4 ℃ cold saline plus different concentraions norepinephrine in flushing gallbladder mucosa bleeding are desirable, expecially at a 24 mg/L concentraion norepinephrine is the most effective. No correlation is found between operation time and recurrence of gallbladder polyp.
Objective To evaluate the analgesic efficacy of ultrasound-guided high fascia iliaca compartment block (HFICB) in managing tourniquet-related pain following total knee arthroplasty (TKA). MethodsA prospective randomized controlled trial was conducted involving 84 patients with severe knee osteoarthritis or rheumatoid arthritis who underwent unilateral TKA between March 2024 and December 2024. Patients were randomly assigned to two groups (n=42) using a random number table. In the trial group, ultrasound-guided HFICB was performed preoperatively, with 0.2% ropivacaine injected into the fascia iliaca compartment. No intervention was administered in the control group. Baseline characteristics, including gender, age, surgical side, body mass index, and preoperative visual analogue scale (VAS) scores at rest and during movement, showed no significant difference between the two groups (P>0.05). In both groups, a tourniquet was applied after osteotomy and before pulsed lavage, and removed after the closure of the first layer of the joint capsule. Postoperative assessments were conducted at 6, 12, 24, and 48 hours, including VAS scores at the tourniquet site (at rest and during movement), Bromage motor block scores, Ramsay sedation scores, and Bruggrmann comfort scale (BCS) scores to evaluate patient comfort. Additionally, the average tramadol consumption and incidence of nausea and vomiting within 48 hours postoperatively were recorded and compared. Results In the trial group and control group, VAS scores during movement at the tourniquet site significantly improved at all postoperative time points compared to preoperative levels (P<0.05). VAS scores at rest increased transiently at 6 hours after operation in both groups, and then gradually decreased to the preoperative level. Except that there was no significant difference at 48 hours after operation in the trial group (P>0.05), there were significant differences at other time points of two groups compared to preoperative score (P<0.05). Except for VAS score at rest at 6 hours, VAS score during movement at 48 hours, and BCS comfort score at 48 hours (P>0.05), the trial group showed significantly better outcomes than the control group in terms of VAS score at rest, VAS score during movement, Ramsay sedation scores, and BCS comfort scores at all other time points (P<0.05). No significant difference was found in Bromage motor block scores between the groups (P>0.05). Tramadol was used in 3 patients in the trial group and 7 patients in the control group within 48 hours after operation, the dosage was (133.30±14.19) mg and (172.40±22.29) mg, showing significant difference (P<0.05). Nausea and vomiting occurred in 4 patients (9.5%) in the trial group and 3 patients (7.1%) in the control group, with no significant difference in incidence between groups (P>0.05). ConclusionUltrasound-guided HFICB provides effective analgesia for tourniquet-related pain following TKA, facilitates early postoperative functional recovery of the knee joint, and may serve as a valuable clinical option for postoperative pain management in TKA patients.
ObjectiveTo systematically review the hemostatic effect of traditional class Ⅲ hemostatic powder and aggregate absorbable hemostat in surgeries. MethodsThe PubMed, Embase, CENTRAL, CNKI, VIP and WanFang Data databases were electronically searched to collect controlled studies related to the objectives from inception to September 18th, 2023. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. ResultsA total of 7 randomized controlled trials, 5 cohort studies and 9 animal experiments were included. The results of analysis showed that the group with traditional class Ⅲ hemostatic powder or aggregate absorbable hemostat had a higher hemostatic success rate and shorter hemostatic time than those with no hemostatic material in animal surgeries. And the group with aggregate absorbable hemostat had a higher 10 min hemostatic success rate than those with traditional hemostatic measures. The application of traditional class Ⅲ hemostatic powder in human cardiothoracic surgeries shortened the hemostatic time and reduced drainage after surgeries, but caused more blood loss during knee arthroplasties. Aggregate absorbable hemostat caused less blood loss than traditional hemostatic measures in human hip arthroplasties, and the 5 min and 10 min success rates of aggregate absorbable hemostat group were not worse than those of hemostatic gauze. ConclusionCurrent evidence shows that the hemostatic effect of both traditional class Ⅲ hemostatic powder and aggregate absorbable hemostat are better than that of no hemostatic material in animal and human surgery, but the comparison results between the two and with other hemostatic measures are still not clear. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.