ObjectiveTo evaluate the safety and short-term outcome of laparoscopic total mesorectal excision (TME) for the middle-lower rectal cancer in municipal hospital.MethodsThe pathological data of 94 patients with middle-lower rectal cancer (49 cases underwent laparoscopic TME, while 45 cases received open TME), who treated in The First People’s Hospital of Ziyang from Jan. 2015 to Jun. 2017, were retrospectively collected and analyzed.ResultsTwo patients (4.1%) in laparoscopy group were converted to open surgery. Compared with the laparotomy group, the laparoscopic group had significantly less volume of intraoperative bleeding, shorter abdominal incision, earlier time to the first flatus and liquid diet, and lower rate of 30-day postoperative complication (P<0.05), but had longer operative time (P=0.033). While there were no significant difference on postoperative stay, the specimen length, distal margin, and number of harvested lymph nodes between the 2 groups (P>0.05).ConclusionLaparoscopic TME is a feasible, safe, and minimally invasive technique for middle-lower rectal cancer, and produce more favourable short-term outcome than open surgery in municipal hospital.
Objective To identify the postoperative function and short-term outcome of Global Modular Replacement System (GMRS) for reconstruction of defect after removal of tumor so as to supply information for cl inical appl ication. Methods Between March 2007 and May 2009, 30 l imb-salvage cases reconstructed with GMRS were retrospectively reviewed, including 18 males and 12 females with a median age of 25 years (range, 11-57 years). The preoperative diagnoses were osteosarcoma in 15 cases, mal ignant fibro-histiocytoma in 4, giant cell tumor in 3, chondrosarcoma in 2, and Ewing’s sarcoma and angiosarcoma in 1 respectively. The duration of symptom ranged from 1 to 15 months with an average of 5.6 months. There were 4 revision cases at mean time of 3.4 years after index surgeries. The locations were the proximal femur in 3 cases, distal femur in 22 cases, and proximal tibia in 5 cases. According to Enneking stage, 2 cases were rated as stage IB, 1 as stage IIA, and 27 as stage IIB. Four cases were compl icated by pathologic fracture. Results The average operation time was 165 minutes (range, 120-240 minutes); the mean blood loss was 448.3 mL (range, 100-1 500 mL); and the mean resection length was 14.1 cm (range, 7.5-22.5 cm). All the wounds healed by first intention. All 30 patients were followed up 10-35 months (22.3 months on average). Local recurrence occurred in 2 cases (6.7%) at 5 and 14 months respectively and distal metastasis occurred in 5 cases (16.7%) at 4-12 months (7.3 months on average) postoperatively. One patient died of multiple lung metastases at 10 months postoperatively. Twenty-nine patients survived at last follow-up, including 25 cases of tumor-free survival and 4 cases of tumor bearing survival. Aseptic loosening occurred in 2 cases (6.7%) at 1.5 years and 2 years postoperatively respectively. Deep infection occurred in 1 case (3.3%) at 1 year postoperatively. At last follow-up, the Musculoskeletal Tumor Society (MSTS) 93 scores were 4.6% ± 0.7% for pain, 3.7% ± 0.9% for function, 3.2% ± 1.3% for satisfactory degree, 4.3% ± 0.9% for orthesis, 3.7% ± 0.7% for walking, 3.3% ± 1.0% for gait; total score was 75.9% ± 14.2%. The Toronto Extremity Salvage Score (TESS) score was 87.0 ± 7.0. Conclusion Reconstruction for defect after removal of tumor with GMRS has satisfactory short-term outcome with good function recovery and low compl ication rate.
Objective To evaluate the early cl inical results of total knee arthroplasty (TKA) with JOURNEY prosthesis. Methods From September 2006 to May 2007, TKA with JOURNEY prosthesis was used to treat 32 patients in ATOS Cl inic, Germany. There were 21 males and 11 femals, aged 40-84 years old (average 65.6 years old). The locations were left knee in 13 cases and right knee in 19 cases, including 5 cases of traumatic arthritis, 19 cases of osteoarthritis and 8 cases of rheumatoid arthritis. All patients had pain and l imited range of motion (ROM) of knee. MRI scanning showed that cartilageand miniscus damaged in all cases. The disease course was 1 to 4 years (average 2.2 years). The CPM practice started 2 days after operation. Results The operative time was (75.0 ± 21.7) minutes. The blood loss was (280 ± 130) mL. All incision healed by first intention. Thirty-two patients were followed up 12 to 18 months (average 14.2 months). Hydrarthrosis occurred in 8 cases at 3-6 months postoperatively. Femur paraprosthesis fracture and implant dislocation occurred at 1 week and at 6 months in 2 cases, respectively. There were statistically significant differences in KSS score between preoperation and 3, 6, 12 months after operation (P lt; 0.05), between 3 months and 6, 12 months after operation (P lt; 0.05); there was no statistically significant difference in KSS score between 6 months and 12 months after operation (P gt; 0.05). There were statistically significant differences in pain score between preoperation and 3, 6, 12 months after operation (P lt; 0.05), and in ROM between 3 months and 6, 12 months after operation (P lt; 0.05). There was no statistically significant difference in ROM between preoperation and 3 months after operation (P gt; 0.05). Conclusion Ii is a simple way to TKA with JOURNEY prosthesis, which has a good results in early follow-up period.
Objective To investigate the short-term effectiveness of reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach for complex acetabular fractures. Methods Between January 2015 and January 2020, 30 patients with complex acetabular fractures were treated with reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach. There were 20 males and 10 females with an average age of 52.1 years (range, 25-71 years). The cause of injury included traffic accident in 17 cases and falling from height in 13 cases. Among them, 14 cases were left acetabular fractures and 16 cases were right acetabular fractures. According to Letournel classification, there were 16 cases of double column fractures, 2 cases of transverse fracture with posterior wall fracture, 4 cases of anterior column and posterior hemi-transverse fractures, 8 cases of T-shaped fracture. The displacement distance of fracture ranged from 6 to 30 mm (mean, 11.6 mm). The time from injury to operation was 6-14 days (mean, 8.7 days). Results The operation time was 2.0-4.5 hours (mean, 3.0 hours). The intraoperative blood loss was 200-800 mL (mean, 450.0 mL). All patients were treated with autologous blood transfusion during operation. All incisions healed by first intention after operation, and no infection occurred. All patients were followed up 12-15 months (mean, 13.4 months). The drainage tube was removed at 2-3 days after operation. After extubation, X-ray film and three-dimensional CT were performed to recheck the fracture reduction. According to Matta score system, 20 cases were excellent, 5 were good, and 5 were poor, the excellent and good rate was 83.3%. All fractures healed with the healing time of 16-25 weeks (mean, 17.7 weeks). According to Merle d’Aubigne-Postel score system, the hip function at 1 year after operation was rated as excellent in 18 cases, good in 6 cases, and fair in 6 cases, and the excellent and good rate was 80.0%. Two cases suffered from sciatic nerve injury due to traction during operation, 7 cases had heterotopic ossification, 2 cases had traumatic hip arthritis, and no other complications occurred. Conclusion For complex acetabular fractures, the reconstruction plate internal fixation via improved Stoppa approach combined with iliac fossa approach and Kocher-Langenbeck approach can obtain good short-term effectiveness with good reduction and hip joint function, and less complications.
Objective To investigate short-term effectiveness of robot-guided femoral neck system (FNS) combined with cannulated compression screw (CCS) fixation in treatment of femoral neck fracture in young and middle-aged patients. Methods A clinical data of 49 young and middle-aged patients with femoral neck fractures, who met the selection criteria and admitted between January 2021 and June 2023, was retrospectively analyzed. After reduction of femoral neck fractures, 27 cases were treated with robot-guided FNS fixation (FNS group) and 22 cases with robot-guided FNS and CCS fixation (FNS+CCS group). There was no significant difference in baseline data such as gender, age, cause of fracture, time from fracture to operation, fracture side, and classification (Garden classification and Pauwels classification) between the two groups (P>0.05). The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, the time when the patient began bearing weight, and hip joint pain and functional scores (VAS score and Harris score) at last follow-up for two groups were recorded. Imaging re-examination was taken to evaluate the quality of fracture reduction, fracture healing, as well as the occurrence of fracture non-union, osteonecrosis of the femoral head, and femoral neck shortening. Results All operations were successfully completed and the incisions healed by first intention. There was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05), and the intraoperative fluoroscopy frequency in FNS+CCS group significantly increased compared to FNS group (P<0.05). All patients were followed up 12-18 months (mean, 14.1 months). Imaging re-examination showed that there was no significant difference in fracture reduction quality between the two groups (P>0.05), but the fracture healing time was significantly shorter in FNS+CCS group than in FNS group, and weight-bearing began earlier (P<0.05). The incidences of femoral neck shortening, fracture non-union, and osteonecrosis of the femoral head were lower in FNS+CCS group than in FNS group, and there was significant difference in the incidence of femoral neck shortening between groups (P<0.05). At last follow-up, there was no significant difference in VAS scores between the two groups (P>0.05). However, the Harris score was significantly higher in FNS+CCS group than in FNS group (P<0.05). ConclusionCompared with FNS fixation alone, robot-guided FNS combined with CCS fixation in the treatment of femoral neck fractures in young and middle-aged patients has obvious advantages in terms of early weight bearing and fracture healing, improves fracture healing rate, effectively prevents postoperative complications, and can obtain good short-term effectiveness.
目的 探讨Prolift系统全盆底重建术在治疗盆腔脏器脱垂疾病中的应用价值及疗效。 方法 回顾性分析四川大学华西第二医院妇科2010年1月－2011年5月收治的119例盆腔脏器脱垂患者的临床资料，其中47例应用Prolift系统进行全盆底重建术（A组），51例应用曼氏手术治疗（B组），21例应用经阴道全子宫切除术+阴道前后壁修补术治疗（C组）。分析比较各组的临床近期疗效。术后随访1年。 结果 A、B、C组在手术时间、术中出血量、术后安置尿管天数、术后住院天数间差异均无统计学意义（P＞0.05）。A组1例、B组11例、C组4例复发，A组与B、C组复发率比较差异有统计学意义（P＜0.05）。 结论 Prolift系统全盆底重建术安全性高，不增加脏器损伤的几率，且明显降低了患者的术后复发率，近期疗效肯定，是治疗盆腔脏器脱垂的一种理想术式。
Objective To review the l iterature about the multiple level artificial disc replacement and investigate the prel iminary the cl inical outcome of the first case in China applying three-level PRESTIGE® LP artificial disc replacement for cervical disc degenerative disease. Methods In April 2009, one female patient aged 44 years old was treated. She was diagnosed as disc protrusion at the C4, 5, C5, 6, and C6, 7 level. She had paresthesia, decreased muscle strength and positivepathological reflex in her left upper extremity. The neck disabil ity index (NDI) was 43. The visual analogue scale (VAS) of the neck and the upper l imb was 6.6 and 8.1, respectively. SF-36 physical and psychological score was 28 and 36, respectively. The surgery was performed via routine anterior cervical approach. After complete decompression of three segments, prostheses were implanted from the cephal ic to the caudal end under radiographic monitoring. The patient was followed up 1 and 3 months after operation, respectively. Results The time of operation was 220 minutes and the blood loss during operation was 270 mL. The incision healed by first intention. There was no occurrence of compl ications such as aggravation of nerve symptoms, hoarse voice, difficult in swallow, and cerebrospinal fluid leakage. At 3 months after the operation, the patient had pain rel ief, muscle force recovery and improvement of l ife qual ity. X-ray films showed that the sequence of cervical vertebra was well-maintained, there was no loosening and displacement of prosthesis, and the position and function were good. NDI was decreased to 7, indicating that the l imitation was mild. The VAS of the neck and the upper l imb was 0.5 and 0.6, respectively. SF-36 physical and psychological score was 48 and 53, respectively. The result of operation was graded as excellent according to Odom’s criterion. The patient went back to her job. Conclusion Three-level PRESTIGE® LP artificial disc replacement for cervical disc degenerative disease has satisfactory prel iminary cl inical results. However, more cl inical case studies and longer cl inical followup are needed to confirm its therapeutic effect on multi-level disc disease.
Objective To discuss whether age has an influence on short-term effect of intersphincteric resection (ISR) for elderly (≥75 years old) patients with ultra-low rectal or canal cancer or not. Methods From February 2016 to February 2017, 196 patients with ultra-low rectal or canal cancer received ISR in the Gastrointestinal Surgery Center of West China Hospital were eligible to include in this study, then they were divided into ≥75 years old group and <75 years old group according to the patients’ age. The intraoperative index, postoperative index, and complications rate were compared between these two groups. Results There were 113 cases in the ≥75 years old group, 83 cases in the <75 years old group, the baselines such as the gender composition, body mass index, tumor histology type, differentiation degree, tumor size, and distance from the anal margin had no significant differences ( P>0.05), but the preoperative anaesthetized ASA grade, proportions of pulmonary insufficiency, hypoproteinemia, anemia, hypertension, diabetes, and cardiac insufficiency of the ≥75 years old group were significantly higher than those of the <75 years old group (P<0.05). The operative time, intraoperative bleeding, and total complications rate had no differences between these two groups (P>0.05), the first exhaust time, the first eating time, the first defecation time, the first ambulation time, and hospitalization time of the ≥75 years old group were significantly longer than those of the <75 years old group (P=0.023, 0.037, 0.019, 0.020, and 0.012, respectively). There were no significant differences in the incidences of the anastomotic leakage, perianal infection, intestinal obstruction, and wound infection between these two groups (P>0.05). All the 196 patients were followed-up with an average follow-up of 7 months, there were 4 cases of recurrent patients, of which 3 were in the ≥75 years old group and 1 in the <75 years old group; there were 3 cases of death, of which 2 were in the ≥75 years old group and 1 in the <75 years old group. Conclusions Short-term recovery of elderly patients with ultra-low rectal or canal cancer is slower than younger patients because of poor preoperative conditions. ISR surgery is still safe and effective for elderly patients with ultra-low rectal or canal cancer and postoperative complications rate has no obvious increase, but it needs a surgeon’s skilled operation technology and multi-disciplinary team cooperation.
Objective To investigate short-term effectiveness of robot-assisted fracture reduction and fixation combined with arthroscopic exploration for posterolateral depressed tibial plateau fractures. Methods Between January 2022 and January 2024, 8 patients with posterolateral depressed tibial plateau fractures (Schatzker type Ⅲ) were treated using robot-assisted fracture reduction and fixation combined with arthroscopic exploration, with simultaneous treatment of concomitant ligament or meniscus tears. There were 3 males and 5 females with an average age of 54.1 years (range, 42-68 years). Injury mechanisms included traffic accidents (3 cases) and falls (5 cases). The time from injury to operation ranged from 2 to 4 days (mean, 3.1 days). Operation time, intraoperative blood loss, hospital stay duration, visual analogue scale (VAS) score for pain, and complications were recorded. Fracture healing and knee Rasmussen scores were assessed radiographically, while knee function was evaluated using range of motion and Hospital for Special Surgery (HSS) scores. Results All operations were successfully completed. The operation time was 108-129 minutes (mean, 120.1 minutes). The intraoperative blood loss was 10-100 mL (mean, 41.3 mL). The hospital stay duration was 4-7 days (mean, 5.6 days). All incisions healed by first intention without complication such as peroneal nerve injury, vascular damage, or infection. All patients were followed up 32-48 weeks (mean, 40 weeks). Radiographic follow-up confirmed that the knee Rasmussen scores rated as excellent in 8 patients and all fractures healed with the healing time of 12-16 weeks (mean, 13.5 weeks). The VAS score for pain was 2-4 (mean, 2.8) at discharge and improved to 0 at 1 month after operation. The knee range of motion was 80°-110° (mean, 96.1°) at discharge and increased to 135°-140° (mean, 137.9°) at 1 month after operation. At 3 months after operation, the HSS score was 91-94 (mean, 92.8), all graded as excellent. No severe complication, including implant failure, occurred during follow-up. Conclusion For posterolateral depressed tibial plateau fractures, the minimally invasive approach combining robot-assisted fracture reduction and fixation with arthroscopic exploration demonstrates multiple advantages, including shorter operation time, reduced intraoperative blood loss, excellent wound healing, fewer complications, and rapid recovery of knee function. This technique achieves satisfactory short-term effectiveness, while its long-term effectiveness requires further evaluation.