Objective To investigate the clinical effect of retroperitoneal laparoscopic dismembered pyeloplasty on ureteropelvic junction obstruction (UPJO). Methods From November 2010 to September 2015, a total of 28 cases (21 males and 7 females) with ureteropelvic junction obstruction (UPJO) underwent retroperitoneal laparoscopic dismembered pyeloplasty. All the 28 patients had a previous history of different degrees of lumbar pain, which was confirmed as typical UPJO by imaging examination. Operation method: following complete renal pelvis and upper ureter isolation, the renal pelvis was clipped into a trumpet-shaped mouth, 1/3 of the upper renal pelvis was temporarily kept without section. In the inferior margin of renal pelvis, longitudinal cut procedure was operated in the ureter and across the stenotic segment in about 1–2 cm; and then, anastomosis of the ureter and the renal pelvis at the lowest was performed, to maintain the continuity of the renal pelvis and ureter. Subsequently, the stenosed segment of ureter and the dilatant renal pelvis were removed, the posterior ureteropelvic anastomosis was made with an interrupted suture, and antegrade stenting of double J tube was further performed, followed by a continuous suture of the anterior wall. Results The procedure was successfully accomplished in all patients whithout conversion to open surgery. The operating time was 90-240 minutes with the median time of 160 minutes. The estimated blood loss was 20-70 mL with the median of 50 mL. No severe surgical complication occurred in perioperative period. The 3-24 -month follow up showed that symptoms of lumbar pain were relieved or disappeared in all the incorporated patients. Postoperative radiographic examination showed no stomal stenosis at the ureteropelvic junction, and the hydronephrosis was alleviated. Conclusions Retroperitoneal laparoscopic dismembered pyeloplasty for UPJO is an effective, safe, and minimally invasive surgical technique. The key to the success of the operation is to the accurate renal pelvis clipping, tension- and torsion-free anastomosis of the lowest position of the renal pelvis and the ureter, and the reconstruction of a new funnel-shaped ureteropelvic junction.
Objective To know the basic research and the clinical application of cartilage-derived retinoic acid-sensitive protein (CD-RAP) in orthopedic and in other clinical fields. Methods The literature related to CD-RAP in basic research and clinical application were extensively reviewed. Results CD-RAP, as a protein, which is cartilage-specific,could be a marker of the joint diseases. It also can be used to monitor metastsais of melanoma. Conclusion CD-RAP test provides a new way to study repair of cartilage and metastsais of melanoma.
ObjectiveTo explore the clinical efficacy and safety of ligation of intersphincteric fistula tract in the treatment of high simple anal fistula.MethodsA prospective collection of 72 patients diagnosed with high simple anal fistula, who admitted to the department of the author’s hospital between March 2015 and December 2017 was performed, and then the patients were divided into two groups according to the random number table method combined with the patients’ wishes: the ligation of intersphincteric fistula tract group (experimental group, 32 cases) and the low incision and high hanging group (control group, 40 cases). Comparison of indexes on the operative effect and physiological function of the sphincter in six months after operation was performed.ResultsCompared with the control group, the patients in the experimental group had short postoperative pain duration, short postoperative wound healing time, high cure rate, low recurrence rate, low initial sensory threshold, high anal resting pressure, and long anal high pressure band length, with statistically significant differences (P<0.05). However, there was no statistically significant difference between the two groups in the operation time, anal maximal contractive pressure, and rectal resting pressure (P>0.05). The results suggested that the physiological function of anus in the experimental group recovered well.ConclusionThe ligation of intersphincteric fistula tract is a safe and reliable method in the treatment of high simple anal fistula, which can be widely used in the clinic.
Abstract： Objective To evaluate the early and late results of mitral valve replacement with home made C-L pugesturt tilting disc and analyse the factors which impact on the therapeutic effect，so as to elevate the operative effect. Methods A retrospective study was made on the result of clinical data and longterm followup of 259 patients who had undergone the Chinesemade C-L pugesturt tilting disc mechanical valve replacement from October 1991 to November 2006. Results The data showed that there were 12 patients died in the duration of hospital stay.The hospital mortality was 4.63% (12/259).There were no mechanical valverelated complication in the earlier postoperative period.The mortality fell to 2.59% since 1996.Among the 235 patients,12 patients were lost during the followup,the rate of followup was 95.1%(235/247).The time for followup was 9.77±3.09 years. There were 26 late deaths.During the follow-up,death associated with the deterioration of valve structure were not observed. The 5 years, 10 years and l5 years survival rates were 86.80%±2.30%, 78.20%±3.33% and 55.23%±4.34% respectively; the thromboembolic event free rates for 5 years, 10 years and l5 years were 95.95%±0.74%, 92.52%±4.11% and 80.52%±4.11% respectively; the anticoagulant related bleeding free rates for 5 years, 10 years and l5 years were 94.64%±1.75%, 89.55%±3.28% and 79.39%±4.43% respectively.There were 141 patients(67.46%) in New York Heart Association(NYHA) classⅠ, 56 patients(26.79%) in class Ⅱ, 10 patients(4.78%) in class Ⅲ and 2 patients(0.95%) in class Ⅳ. Conclusion The results of follow-up for 15 years suggest that the Chinesemade C-L pugesturt tilting disc medical mechanical valve is a reliable and safe choice for mitral valve replacement.
ObjectiveTo develop a patient satisfaction evaluation scale for day surgery and test its reliability and validity, so as to provide a scientific and effective tool for day surgery patient satisfaction assessment.MethodsThe literature review method was used to form an entry pool, and the initial version of the scale was formed in conjunction with the expert review method. And then a preliminary survey was conducted to obtain the tentative version of the scale. Finally, 290 day surgery patients discharged between June 15th and July 15th, 2019 were selected to accomplish a survey to check the reliability and validity of the scale.ResultsFinally, a day surgery patient satisfaction evaluation scale was formed, containing 3 stages (pre-hospital, hospitalization, and postdischarge follow-up), 3 dimensions (medical staff evaluation, medical service evaluation, and environment and process evaluation), and 40 items. After the formal survey, the overall Cronbach’s α coefficient of the scale was 0.980, the Spearman-Brown coefficient was 0.933, the Guttman’s half-coefficient was 0.932, and the content validity was 0.87-1.00.ConclusionThe day surgery patient satisfaction evaluation scale was proven good reliability and validity, which can be used as a measurement tool for day surgery patients and applied to clinical practice.
Objective To explore the reoperative techniques of differentiated thyroid carcinoma. Methods Clinical data of 56 patients who treated in The First Affiliated Hospital of General Hospital of PLA and General Hospital of PLA from Feb. 2011 to Feb. 2013 were analyzed retrospectively. Results All performed surgeries were successful. Surgeries took 90-150 minutes with an average of 120 minutes. Bleeding during surgeries was 70-200 mL with an average of 120 mL. Postoperative drainage was 90-210 mL with an average of 100 mL. The pathological diagnosis of the second surgery in 44 cases were as the same as the first， but there were no malignant tumor tissues of dissected glands in 12 cases. All patients had no postoperative bleeding and bucking， but 8 patients experienced hand and foot numbness， and 5 patientsexperienced transient hoarseness. Fifty patients were followed-up for 6-30 months （average 10.8 months） from the reoper-taion and 18-66 months （average 45.2 months） from the first operation， and rate of postoperative followed-up was 89.3%（50/56）. During the followed-up， 1 patient with papillary thyroid carcinoma and 1 patient with follicular thyroid carcinoma died in 44 months and 38 months respectively， 3 patients suffered lymph node metastasis at non-Ⅵ region ofaffected side， no one suffered recurrence. Conclusions For differentiated thyroid carcinoma patients who are undergoingthe second surgery， thorough whole body condition analysis should be performed and appropriate type of surgery should be chosen. By using recurrent laryngeal nerve monitoring， carbon nanoparticles for lymph node clearance， and protecting parathyroid gland to lower the possibility of postoperative complication， to improve survival rate and life quality.
ObjectiveTo explore the effect of body mass index (BMI) on the outcomes of laparoscopic surgery for esophageal hiatal hernia.MethodsWe divided the patients who underwent hiatal hernioraphy and fundoplication surgery in our hospital between July 2013 and June 2018 into two groups according to the BMI: a group A, BMI ≥24 kg/m2, 77 patients, 41 males, 36 females, with an average age of 42 years; a group B: BMI<24 kg/m2, 63 patients, 38 males, 25 females, with an average age of 67 years, and the age, gender, type of hiatal hernia, score of subjective feeling of symptoms, level of reflux esophagitis were analyzed with the propensity score matching method. Fifty one patients were successfully matched in each group, and the curative effect of surgery was compared between the two groups.ResultsThere was no statistical difference in the type of surgery, intraoperative complications, postoperative complications, and hospital stay between the two groups (P>0.05). The operative time of the group A was significantly longer than that of the group B (P=0.023). There was no statistical difference between the two groups in postoperative recurrence (P=0.741).ConclusionThe operative time in overweight patients is significantly longer than that in the non-overweight patients, but it has no effect on the surgical outcomes and complications.
ObjectiveTo understand the related application and future development trend of enteral nutrition (EN) support in the treatment of patients with malignant obstructive jaundice (MOJ), and provide a reference for clinical decision-making. MethodThe relevant literatures on EN support in the treatment of MOJ at home and abroad in recent years were reviewed. ResultsIn the treatment of patients with MOJ, EN support treatment could maintain the integrity of intestinal mucosal barrier function, reduce intestinal permeability, and reduce bacterial ectopic. At the same time, it could effectively improve the immune function of patients, promote the recovery of liver function, reduce the stress response of patients, reduce the incidence of complications, accelerate the postoperative recovery of patients and shorten the hospitalization time of patients. ConclusionEN support is an important measure in treatment of MOJ, which can obviously promote recovery of patients.
Objective This study aims to conduct a multi-dimensional quantitative evaluation of three rapid-acting insulin analogues, aspart (Novolog), lispro (Humalog), and glulisine (Apidra) to provide references for the selection of these drugs in medical institutions. Methods The recommended methods from the "Quick guideline for drug evaluation and selection in Chinese medical institutions (the second edition)" were employed to evaluate the pharmaceutical characteristics, effectiveness, safety, cost-effectiveness, and other attributes of the three rapid-acting insulin analogues. Results The total scores of insulins aspart (Novolog), lispro (Humalog), and glulisine (Apidra) were 73.5, 80.4, and 70.9, respectively. Insulin lispro (Humalog) had the highest score, demonstrating a prominent advantage in both effectiveness and cost-effectiveness dimensions. Conversely, insulin glulisine (Apidra) had the lowest score, with ratings in effectiveness and safety dimensions lower than those of the other two rapid-acting insulin analogs. Conclusion When selecting rapid-acting insulin analogs, healthcare institutions can choose one or more insulins, aspart (Novolog), lispro (Humalog), or glulisine (Apidra), all of which are strongly recommended, with priority given to insulin lispro (Humalog), which has the highest total score.
Objective To explore and evaluate the accuracy and feasibil ity of individual rapid prototype (RP) drill templates for atlantoaxial pedicle screw implantation. Methods Volumetric CT scanning was performed in 8 adult cadaveric atlas and axis to collect Dicom format datas. Then three-dimensional (3D) images of atlas and axis were reconstructed and the parameters of pedicles of 3D model were measured by using software Mimics 10.01. The 3D model was saved by STLformat in Mimics. The scattered point cloud data of 3D model were processed and the 3D coordinate system was located in software Imageware 12.1. The curves and surfaces of 3D model were processed in software Geomagic Studio 10. The optimal trajectory of pedicle screw was designed and a template was constructed which accorded with the anatomical morphology of posterior arch of atlas and lamina of axis by using software Pro/Engineer 4.0. The optimal trajectory of pedicle screw and the template were integrated into a drill template finally. The drill template and physical models of atlas and axis were manufactured by RP (3D print technology). The accuracy of pilot holes of drill templates was assessed by visually inspecting and CT scanning. Results The individual drill template was used conveniently and each template could closely fit the anatomical morphology of posterior arch of atlas and lamina of axis. Template loosening and shifting were not found in the process of screw implantation. Thirty-two pedicle screws were inserted. Imaging and visual inspection revealed that the majority of trajectories did not penetrate the pedicle cortex, only 1 cortical penetration was judged as noncritical and did not injury the adjacent spinal cord, nerve roots, and vertebral arteries. The accuracy of atlas pedicle screw was grade 0 in 15 screws and grade I in 1 screw, and the accuracy of axis pedicle screw was grade 0 in 16 screws. Conclusion The potential of individual drill templates to aid implantation of atlantoaxial pedicle screw is promising because of its high accuracy.