ObjectiveTo systematically review the correlation between HDL-C level and lung cancer. MethodsSuch databases as PubMed, EBSCO, ISI Web of Science, The Cochrane Library (Issue 8, 2015), VIP, and CNKI Data were electronically searched from inception to September 23th, 2015 to collect studies about the correlation between HDL level and lung cancer. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then meta-analysis was performed using Stata 12.0 software. ResultsFifteen studies involving 2 015 lung cancer patients and 15 505 controls were finally included. The results of meta-analysis showed that the total HDL-C level in the lung cancer group was lower than that in the control group (SMD=-0.68, 95%CI-0.97 to -0.40, P=0.000). Further subgroup analysis showed that the incidence of lung cancer of different clinical classification (SMDⅠ~Ⅱ=-0.65, 95%CI -1.07 to -0.23, P=0.002; SMDⅢ~Ⅳ=-0.61, 95%CI -0.73 to -0.50, P=0.000), different pathological types (the small cell lung cancer excluded) (SMDAC=-0.76, 95%CI -1.13 to -0.38, P=0.000; SMDSC=-1.51, 95%CI -2.47 to -0.56, P=0.010; SMDSCLC=-1.19, 95%CI -1.42 to -0.95, P=0.000), different quality scores (SMD≥6 score=-0.60, 95%CI -0.89 to -0.29, P=0.000; SMD< 6 score=-0.77, 95%CI -1.48 to -0.0, P=0.015), the number of different studies (SMD≥100 cases=-0.48, 95%CI -0.80 to -0.15, P=0.004; SMD< 100 cases=-0.80, 95%CI -1.33 to -0.27, P=0.003), smoking (SMD=-1.47, 95%CI -2.51 to -0.43, P=0.006) and Asia (SMD=-0.92, 95%CI -1.21 to -0.63, P=0.000) was correlated with the level of HDL-C. ConclusionThe level of HDL-C is related to the incidence of lung cancer, and low HDL-C level may increase the risk of lung cancer. In view of the limitations of the studies, the above conclusions need a great many large samples and adjust the smoking status of the prospective cohort study at home and abroad to verify.
ObjectiveTo summarize the clinical characteristics of traumatic pancreatitis (TP) after pancreatic trauma and illustrate the experience of specialized treatment. MethodsClinical data of 73 patients with TP treated in our hospital from January 2008 to June 2014 were collected. The pancreatic injury location, grade, and TP pathogenic factors were analyzed, summarized the common problem and the regularity in TP course, and summarized the treatment strategy, methods of surgical intervention, operation key points and difficulties of TP. ResultsThe grade of pancreatic trauma in the all of patients was mainly to levels of 2, 3, and 4, the head of the pancreas injury accounted for 31.5% (23/73), cervical pancreatic body and tail injuries accounted for 68.5% (50/73). Fifty-nine patients were from other hospitals referral. The occurrence of TP peak period was 4-7 days after pancreatic trauma. Pancreatic fistula and uncontrolled peritoneal infection were the treatment difficulty of TP. It's the effective minimally invasive treatment methods for TP that percutaneous catheter drainage, pancreatic duct stent placement, and endoscopic abscess debridement. Forty-two patients with TP needed reoperations, and 19 cases underwent more than 2 times operation. ConclusionsBecause of the condition of TP is complex and changeable, and difficulty to treat, so the early definitive diagnosis and appropriate surgical strategy play a crucial role in the treatment of TP. Besides, professional team of pancreatic surgery has advantages in estimating patients' conditions, selecting and performing surgical interventions.
ObjectiveTo investigate diagnosis and treatment of rupture of pancreatic cystic disease. MethodThe clinical data of 20 patients who were diagnosed as pancreatic cystic disease combined with rupture in the First Affiliated Hospital of Harbin Medical University from June 2011 to December 2015 were analyzed retrospectively. Results① For the 5 patients with pancreatic cystic tumor, 3 patients of them received distal pancreatectomy and 2 patients of them received Whipple procedure. For the 15 patients with pancreatic pseudocyst, 2 patients received ultrasound-guided cyst puncture and drainage, 2 patients received endoscopic retrograde pancreatic drainage (ERPD), 2 patients received ERPD plus ultrasound-guided cyst puncture and drainage, 1 patient received pancreatic external drainage, 3 patients received pancreatic cyst-gastric anastomosis, 5 patients received pancreatic cyst-jejunal Roux-en-Y anastomosis. ② Pancreatic fistula occurred in 3 patients (Grade A 2 cases, Grade B 1 case), delayed gastric emptying was found in 1 patient, peritoneal effusion occurred in 1 patient. ③ Eighteen of them were followed up from 3 to 60 months with an average 25.6 months, 2 patients recurred and non-surgical treatments were taken. ConclusionsHow to correctly identify pancreatic cystic tumor with pancreatic pseudocyst is premise of treatment. Pancreatic cystic disease combined with rupture requires urgent therapy. Based on clinical manifestations, optimal selection might achieve a better prognosis.
ObjectiveTo explore early clinical effects of Centerpiece-based unilateral open-door cervical expansive laminoplasty plus centerpiece titanium minitype plate fixation, to research the data of the best slotting in the CT-based open-door cervical operation and to provide the reference for accurate operation. MethodsA retrospective analysis of the patients who had received Centerpiece-based unilateral open-door cervical expansive laminoplasty plus centerpiece titanium plate fixation from West China Hospital of Sichuan University from February 2013 to November 2013 were performed. The neurological function assessment results (JOA score), cervical curvature indexhave, Pavlov value, spinal canal cross-sectional area and different position, angle and depth of C7 lamina slotting data of all patients before and after the operation were all analyzed and compared. ResultsA total of 58 patients were included. The postoperative JOA score was significantly higher than that of the preoperative (9.4±2.9 vs. 14.7±2.6, t=11.417, P=0.000). The sagittal diameter of vertebral canal (21.3±2.1 mm vs. 9.7±2.1 mm, t=27.737, P=0.000), Pavlov value (0.92±0.13 vs. 0.44±0.12, t=30.621, P=0.000), and spinal canal cross-sectional area (276±37 mm2 vs. 129±25 mm2, t=32.104, P=0.000) at the end of the last follow-up were significantly greater than those of preoperative. When comparing the last follow-up with preoperative, cervical curvature index showed significant difference (11.2±11.5 vs. 9.3±11.7, t=-1.713, P=0.000). Significant differences were found in the comparison of the ideal position and angle of the open door of the C7 lamina and the angle and position of the operation (all P values >0.05); when comparing the position and angle of the ideal position and angle of the C7 lamina hinge with that of the actual operation, no significant differences were found (all P values >0.05); but when comparing the ideal depth with the actual depth of the operation, a significant difference was found (P<0.05). ConclusionCenterpiece micro plate used in posterior cervical expansive open-door laminoplasty forming operation of laminectomy fixed screw loosening and plate breakage, can effectively maintain the lamina in the open state, and prevent it to be closed. The patients have good recovery of nerve function after operation and the clinical efficacy is good.
ObjectiveTo evaluate the advantage of single posterolateral approach for exposing the fragments of lateral malleolus and posterior malleolus in treating bimalleolar and trimalleolar fractures. MethodsBetween January 2013 and June 2015, 47 patients with ankle fractures were treated. Of 47 cases, 16 were male and 31 were female with an average age of 47.7 years (range, 25-65 years); the locations were the left side in 21 cases and the right side in 26 cases. According to types system of Lauge-Hansen, 11 cases were rated as pronation-external rotation and 36 cases as supination-external rotation. There were 9 cases of bimalleolar fractures and 38 cases trimalleolar fractures. CT examination showed that posterior malleolus fracture involved more than 35% of the joint surface in 11 cases, and 9 cases had comminuted posterior malleolus fracture. Of 47 cases, 44 had fresh fractures with a mean disease course of 4 days (range, 8 hours to 7 days), and 3 had old fracture with the disease course of 43, 58, and 62 days respectively. Posterior malleolus fractures were fixed with T-type plates in 12 cases, one-third tubular plates in 10 cases, and cannulated screws in 25 cases. ResultsThe operation time was 60-100 minutes (mean, 80 minutes); the bleeding volume was 50-100 mL (mean, 72 mL). Primary healing of incision was obtained in all patients, and no postoperative complications of infection, cutaneous necrosis, deep venous thrombosis, and sural nerve injury occurred. The CT examinations after operation showed anatomical reduction of fractures. All patients were followed up from 12 to 20 months (mean, 16 months). No fixation failure or reduction loss was found at last follow-up. All patients could walk normally. The active dorsiflexion of the affected ankles was within 5° less than normal side in 43 cases (91.5%) and 5-10° less than normal side in 4 cases (8.5%). The passive dorsiflexion of the affected ankles was within 5° less than normal side in 44 cases (93.6%) and 5-10° less than normal side in 3 cases (6.4%). According to the Olerud-Molander scoring system, the results were excellent in 40 cases, good in 5 cases, and fair in 2 cases; and the excellent and good rate was 95.7% at last follow-up. ConclusionThe single posterolateral approach could simultaneously expose the fragments of lateral malleolus and posterior malleolus, with less complication of the incision, short operation time, and clear exposure of posterior malleolus. The surgery could be performed under direct vision. It especially is suitable for bimalleolar and trimalleolar fractures with lateral malleolus and posterior malleolus.
Objective To compare the surgical outcome of surgical treatment for chronic pancreatic head mass pancreatitis combined with pancreatic duct stones. Methods Clinical data of 19 patients diagnosed as chronic pancreatic head mass pancreatitis combined with pancreatic duct stones by pathology in our hospital were analyzed retrospectively and patients were divided into Beger group (n=9) and Frey group (n=10) according to operation type. Results The duration of operation, blood loss, morbidity, ratio of postoperative pancreatic fistula of grade B, ratio of abdominal cavity infection, ratio of gastric emptying dysfunction, total length of hospital stay, and total hospitalization cost in Frey group were less or lower than those in Beger group significantly (P ＜0.05). None of death or pancreatic fistula of grade C happened in both 2 groups, and abdominal pain and jaundice were subsided in all patients. There were 18 patients (94.7%) were followed up for (8.6±2.5) years ( 5-12 years), and just 1 patient of Frey group was not available for followup. The ratios of 5-year pain subsided of 2 groups were both 7/9, there was no significant difference between the 2 groups (P>0.05). During the follow-up period, there was no dead, relapsed, cancerate or reoperation, but 2 patients suffered from diabetes (1 patient of Frey group and 1 patient of Beger group), 2 patients suffered from steatorrhea (1 patient of Frey group and 1 patient of Beger group), and there was no significant difference between the 2 groups in the ratios of diabetes and steatorrhea (P>0.05). Conclusion The effect is equal for Frey surgery and Beger surgery in treatment of chronic pancreatic head mass pancreatitis combined with pancreatic duct stones, but recover of patient who receives Frey surgery is better than that of Beger surgery.
ObjectiveTo evaluate the effectiveness of channel-assisted minimally invasive repair (CAMIR) for acute closed Achilles tendon ruptures. MethodsBetween January 2011 and June 2012, 30 patients (30 sides)with acute closed Achilles tendon ruptures were treated with CAMIR technique. Among 30 patients, 18 were male and 12 were female with an average age of 30.4 years (range, 22-50 years); the locations were left side in 10 cases and right side in 20 cases. All the causes were sports injury. B-ultrasound was used to confirm the diagnosis, with the average distance from the rupture site to the Achilles tendon insertion of 4.4 cm (range, 2-8 cm). The time from injury to operation was 3 hours to 9 days (median, 4 days). All injuries were repaired by CAMIR technique. ResultsThe average operation time was 17.0 minutes (range, 10-25 minutes), and the mean incision length was 2.0 cm (range, 1.5-2.5 cm). All the incisions healed by first intention. There was no complication of wound problem, deep vein thrombosis, re-rupture, or sural nerve injury. All cases were followed up 12-24 months with an average of 16 months. At last follow-up, the patients could walk normally with powerful raising heels and restored to normal activity level. MRI imaging suggested the continuity and healing of ruptured tendon. The circumference difference between affected leg and normal leg was less than 1 cm, and the ankle dorsi-extension was 20-30°, plantar flexion was 20-30°. Arner Lindholm score showed that the surgical results were excellent in 28 cases and good in 2 cases, with an excellent and good rate of 100%. ConclusionCAMIR is a safe and reliable method to repair acute closed Achilles tendon rupture, with many advantages of minimal injury, low re-rupture and infection. Sural nerve injury can be minimized using CAMIR by carefully placing the suture channel with a stab incision and special trocar based on a modified Bunnel suture technique.
ObjectiveTo explore the efficacy of da Vinci robotic surgical system-assisted radical resection of rectal cancer. MethodsThe clinical data of 456 patients who received radical resection of rectal cancer by the da Vinci robotic surgical system at the Southwest Hospital from March 2010 to March 2016 were retrospectively analyzed. Operative time, operative blood loss, number of harvested lymph nodes, hospital stay, and morbidity were evaluated. Resultsda Vinci robotic surgical system-assisted radical resection of rectal cancer were successfully carried out in 445 patients, and other 11 patients were converted to open surgery (2.4%). Of 456 patients, 322 patients underwent anterior resection of rectum procedure (70.6%), 126 patients underwent abdominoperineal excision procedure (27.6%), 8 patients underwent Hartmann procedure (1.8%). The mean operative time was (192±60) min, the mean operative blood loss was (110±93) mL, the mean number of harvested lymph nodes were 19±6, the mean length between distal resection margin and tumor were (3.5±1.8) cm, the mean time for patients taking normal activity was (2.9±1.5) d, the mean time of passage of the first flatus was (2.7±1.7) d, the mean hospital stay was (7.1±1.6) d. Surgical complications occurred in 40 patients (8.8%), and all the patients were recovery before leaving hospital. The mean follow-up time was 29.1-month (3-75 months). There were 70 patients suffered from occurrence or metastasis (16.2%), and 60 patients died (13.9%). Conclusionda Vinci robotic surgical system-assisted radical resection for rectal cancer is a feasible and safe surgical procedure with the minimal trauma, fast recovery, and satisfactory clinical efficacy.