Objective To observe the therapeutic effect of poly tetrahydrofurfuryl co-lactic acid(copolymer C4) as the biodegradable vitreous substitutes on rhegmatogenous retinal detachment.Methods Vitreoretinal surgery with copolymer C4 tamponades was performed on 32 pigmented rabbits (64eyes) with rhegmatogenous retinal detachment. The rate of reattached retina and the post operative cornplications were observed.Results Three months after the operation, reattached retina was found in 96. 4%, glaucoma in 5.5%, cataract in 10.9%, and copolymer emulsion in 10.2% of all the eyes.Conclusion copolymer C4 may withstand the retinal tear effectively for 3 months, and can be a valuable vitreous substitutes. (Chin J Ocul Fundus Dis，2004，20：27-28)
Objective To approach the clinical characters and therapeutic methods of retinal detachment(RD) after extracapsular catarat extraction(ECCE)with posterior chamber intraocular lens(PCIOL). Methods Sixty eight cases(68 eyes) of RD after ECCE with PCIOL were treated with sclerel buckling,microvitreo retinal surgery and intraocular gas,silicone oil injection and were reviewed. Results The retinas were totally reattached in 65 eyes(95.59%) which dropped to 94.12% in 6-60 months postoperatively.The resultant rate of visual acuity of the eyes with 0.1 or better was 79.41%,with 0.3 or better was 26.47%. Conclusion The main causes of RD after ECCE with PCIOL are similar to those of general RD,and most cases of RD after ECCE with PCIOL can be cured by surgical treatment. (Chin J Ocul Fundus Dis,1998,14:167-169)
ObjectiveTo evaluate the effects of multi-disciplinary diagnosis and treatment model based on doctor-patient shared decision making on treatment outcomes, quality of life and postoperative complications of breast cancer patients. MethodsA total of 100 breast cancer patients were included in this study through a prospective randomized controlled design, and were randomly divided into control group and intervention group, with 50 patients in each group. The control group received traditional treatment mode, while the intervention group implemented a multidisciplinary treatment mode based on doctor-patient sharing decision making. The results of treatment, quality of life and postoperative complication rate were compared between the two groups. ResultsThe completion rate of adjuvant radiotherapy and chemotherapy in the intervention group was 94.0%, which was higher than that in the control group (80.0%), and the difference was statistically significant (P=0.037). The satisfaction rate of postoperative breast appearance in the intervention group was 90.0%, which was higher than that in the control group (60.0%), with statistical significance (P<0.001). There was no significant difference in grade Ⅲ/Ⅳ toxicity between the two groups (P>0.05). After treatment, the scores of patients’ quality of life in the intervention group were higher than those in the control group, and the difference was statistically significant (P<0.05). The incidence of postoperative complications in the intervention group was 6.0%, which was lower than that in the control group (22.0%), and the difference was statistically (P=0.021). ConclusionsThe application of multidisciplinary diagnosis and treatment model based on doctor-patient sharing decision-making in the treatment of breast cancer patients has significantly improved the treatment effect and quality of life, and effectively reduced the rate of postoperative complications. This model provides a new approach to the treatment of breast cancer that is more personalized, comprehensive and efficient.
Objective To evaluate glaucoma and anterior chamber angle changes after intravitreal silicone oil injection(SOI). Methods The intraocular pressure(IOP) and anterior chamber angles of 34 e yes(33 patients)undergone pars plana vitrectomy and SOI were observed. Results Glaucoma occurred in 9 eyes(26%),in which silicone oil glaucoma(SOG) accounted for 77%(7/9).The changes of the superior part of anterior chamber angle were peripheral anterior synechiae in 11 eye(32%) and SO emulsification droplets in 22 eyes(64%) in 1～4.5 months after surgeries.Glaucoma occurred in 6 eyes of 7 eyes undergone peripheral iridectomy at the inferio r part of the iris after the closure of iridectomy holes (plt;0.05). Conclusion High incidence of glaucoma was found in this series of patients after intravitreal silicone oil injection,and the main causes of SOG were closure of the inferior iridecomy hole and silicone emulsification. (Chin J Ocul Fundus Dis, 2001,17:105-107)
ObjectiveTo systematically evaluate the influence of posterior mediastinal and retrosternal route on the incidence of complications in patients with esophageal carcinoma after esophagectomy. MethodsA systematic literature search for studies which were published on PubMed, EMbase, CBM, VIP was performed from database establishment to April 2014. We included randomized controlled trials and case control studies related to the influence of two routes on the incidence of complications of patients with esophagectomy. We assessed the methodology quality of included researches, and extracted data. RevMan 5.2 was used for meta-analysis. ResultsA total of 23 studies including 7 randomized controlled trials and 16 case control studies were included in this study. Meta-analysis showed that there was statistically significant difference in case control studies related to anastomotic leakage between two groups[OR=0.39, 95%CI (0.30, 0.50), P < 0.01]. However, no statistical difference in anastomotic stricture was observed between the two groups[randomized controlled trials:RR=0.80, 95%CI (0.49, 1.30), P=0.36; case control studies:OR=0.64, 95%CI (0.40, 1.03), P=0.07]. And there was no statistical difference in cardiac complications[randomized controlled trials:RR=0.70, 95%CI (0.46, 1.06), P=0.09; case control studies:OR=1.13, 95%CI (0.70, 1.81), P=0.62]. There was also no statistical difference in pulmonary complications[randomized controlled trials:RR=1.27, 95%CI(0.92, 1.75), P=0.14; case control studies:OR=0.91, 95%CI (0.66, 1.27), P=0.59]. Besides, there was also no statistical difference in postoperative mortality[randomized controlled trials:RR=0.47, 95%CI (0.19, 1.16), P=0.10; case control studies:OR=0.18, 95%CI (0.03, 1.01), P=0.05]. ConclusionFor patients with esophageal carcinoma undergoing esophagectomy and reconstruction, the incidence of anastomotic leakage was significantly lower with posterior mediastinal route than that of retrosternal route.
Objective To compare the effect of intravenous and epidural analgesia on postoperative complications after abdominal and thoracic surgery. Methods A literature search was conducted by using computerized database on PubMed, EBSCO, Springer, Ovid, and CNKI from 1985 to Jan 2009. Further searches for articles were conducted by checking all references describing postoperative complications with intravenous and epidural anesthesia after abdominal and thoracic surgery. All included randomized controlled trials (RCTs) were assessed and data were extracted by the standard of Cochrane systematic review. The homogeneous studies were pooled using RevMan 4.2.10 software. Results Thirteen RCTs involving 3 055 patients met the inclusion criteria. The results of meta-analyses showed that, a) pulmonary complications and lung function: patient-controlled epidural analgesia can significantly decrease the incidence of pneumonia (RR=0.66, 95%CI 0.53 to 0.83) and improve the FEV1 (WMD=0.17, 95%CI 0.05 to 0.29) and FVC (WMD=0.21, 95%CI 0.1 to 0.32) of lung function after abdominal and thoracic surgery, but no differences in decreasing postoperative respiratory failure (RR=0.77, 95%CI 0.58 to 1.02) and prolonged ventilation (RR=0.75, 95%CI 0.51 to 1.13) compared with intravenous analgesia; b) cardiovascular event: epidural analgesia could significantly decrease the incidence of myocardial infarction (RR=0.58, 95%CI 0.35 to 0.95) and arrhythmia (RR=0.64, 95%CI 0.47 to 0.88) than the control group, but could not better reduce the risk of heart failure (RR=0.79, 95%CI 0.47 to 1.34) and hypotension (RR=1.21, 95%CI 0.63 to 2.29); and c) Other complications: epidural and intravenous analgesia had no difference in decreasing the risk of postoperative renal insufficient (RR=0.78, 95%CI 0.53 to 1.14), gastrointestinal hemorrhage (RR=0.78, 95%CI 0.49 to 1.23), infection (RR=0.89, 95%CI 0.70 to 1.12) and nausea (RR=1.03, 95%CI 0.38 to 2.81). Conclusions Epidural analgesia can obviously decrease the risk of pneumonia, myocardial infarction and severe arrhythmia, and can improve the lung function after abdominal or thoracic surgery.
【Abstract】ObjectiveTo investigate the causes of biliary tract complications after liver transplantation, and to put forward effective measures of prevention, diagnosis and treatment. MethodsThe literatures of recent years were reviewed and summarized. Results The causes of biliary tract complications after liver transplantation are very complex, and there are no standard preventive measures. Treatment differs according to causes. ConclusionOne of the most important causes leading to biliary complications is preservative and ischemic injury. Poorly operative techniques and blood supply to biliary tract are also disastrous. Improving T tube placement can reduce the incidence of biliary complications related with T tube. To prevent biliary complications, it is crucial to completely wash the biliary tract， avoid damaging the blood supply to donor biliary tract and manage perfect biliary mucosatomucosa anastomosis without tension. T tube cholangiography combined with noninvasive MRCP enables accurate depiction of the biliary tree and diagnosis of biliary complications. Doppler ultrosonography should be routinely applied postoperatively. Timely application of interventional radiological technique is a valuable nonoperative procedure for treatment of biliary complications. Meanwhile, biliary sludge or cholestasis and mixed infections of biliary tract should be handled actively and properly.
ObjectiveTo study the prevention and treatment of restenosis after the stent placement in the latest progress. MethodsThere were four methods including drug-eluting stents, intracavitary illuminate, drug therapy, and mesenchymal stem cells, which prevented or treatment restenosis after stent placement. ResultsAll the four methods could reduce the postoperative restenosis rate after interventional treatment. Many experimental study of prevention and treatment of restenosis had obvious effect, but clinical curative effect was not very satisfactory, because of a series of problems such as safety, animal models, experiment method, and so on. ConclusionThe multiple factors and links caused restenosis should be considered fully, and interrupting the links or factors as far as possible could control the occurrence or development effectively.
ObjectiveTo compare the safety, effectiveness, and stability of 3D Max lightweight patch and standard patch in laparoscopic transabdominal preperitoneal (TAPP) herniorrhaphy. MethodsThe clinical data of 147 patients who underwent laparoscopic TAPP herniorrhaphy with 3D Max from May 2013 to May 2014 in this hospital were collected. Of all the patients, the lightweight patches were used in 75 patients (observation group), the standard patches were used in 72 patients (control group). The mean operative time, mean early postoperative ambulation time, mean bleeding volume, postoperative pain, postoperative foreign body sensation, complications, average hospital stay, and average costs were compared between these two groups. The postoperative pain point was determined by using visual analogue scale (VAS). The foreign body sensation of postoperative groin area was determined basing on the pain point. ResultsThere were no significant differences in the terms of the mean operation time, the mean early postoperative ambulation time, the mean bleeding volume, the average costs, and the average hospital stay between the observation group and the control group (P > 0.05). On postoperative 2 d, the pain point of the observation group was slightly lower than that of the control group, but there was no statistically significant difference between these two groups (P=0.132); On postoperative 1 month and 6 months, the postoperative pain points of the observation group were significantly lower than those of the control group, the differences were statistically significant (P=0.031, P=0.018). There was no recurrence of hernia and complications in the two groups. ConclusionsThe cost of 3D Max lightweight patch in laparoscopic TAPP herniorrhaphy application is slightly higher than that in standard patch, but it could alleviate postoperative pain, reduce postoperative foreign body sensation, and make patients feel more comfortable. It is safe, effective, and stable in clinical application of laparoscopic TAPP herniorrhaphy.
Objective To evaluate the analgesic effect of intra-articular ropivacaine with lidocaine. Methods A double-blind randomized controlled trial was conducted. Ninety patients receiving selective knee arthroscopy were randomized into three groups of 30 patients. At the end of the operation, before the release of the tourniquet, an intra-articular injection was administered to each patient through arthroscope, in accordance with their random allocation: 0.9% normal saline (normal saline group); 100 mg ropivacaine (ropivacaine alone group) and 100 mg ropivacaine and 100 mg 2% lidocaine (ropivacaine with lidocaine group). Pain intensity was assessed after the operation using the 100-mm visual-analog scale (VAS), and the amount of supplemental analgesics used within the following 24 hours were recorded. Results The VAS scores of 2 hours postoperatively at rest, and 1, 2, 4, and 8 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine alone group (Plt;0.05). The VAS scores 0.5, 1 and 2 hours postoperatively at rest, and at the awaking moment, 0.5, 1, 4, 8, and 24 hours postoperatively at motion, were significantly higher in the normal saline group than in ropivacaine with lidocaine group (Plt;0.05). Conclusion Intra-articular ropivacaine can reduce a patient’s pain after operation. The combination of lidocaine with intra-articular ropivacaine can reduce the patient’s pain severity immediately after the operation and achieve an early analgesic effect.