Objective To discuss the pathogenesis,clinical manifestations,diagnoses and preventive methods on subsequent Wernicke encephalopathy cases of old gastric cancer patients during perioperation.Methods Collected the data of 237 old gastric cancer patients in perioperation from October 1990 to December 2009 hospitalized in the Department of General Surgery,Lanzhou General Hospital Attached to Military Region,PLA.And then retrospectively analysed 7 patents of them who complicated with Wernicke encephalopathy to summarize the clinical manifestation, accessory examination,diagnosis,prevention, and therapy of the Wernicke encephalopathy,and associated factors with its incidence.Results The clinical manifestations of 7 patients included nystagmus （7 cases）,ataxia（4 cases）,brain disorder（6 cases）.Auxiliary examination：4 cases with anemia,7 cases with unusual blood biochemical examination, 5 cases with urinary ketone bodies positive,2 cases with decreasing blood vitamin B1,1 case with unusual skull MRI examination.Five patients were diagnosed before treatment and 2 case were diagnosed by experimental treatment.Finally，4 patents were cured,1 case obviously improved,1 case improved, and 1 case died.And The patients complicated with preoperative hypoproteinemia or pyloric obstruction and postoperative fistula of intestine or gastroplegia syndrome had statistical higher incidence rates of the Wernicke encephalopathy than those without these complications （P＜0.05）.Conclusions The clinical manifestation of the Wernicke encephalopathy have no specificity, it is hard to diagnose,so clinicians should pay attention to it，and combine different ways to diagnose.Improving or preventing complications during perioperative period,and supplementing enough vitamin B are important preventive and therapeutic measures.
Objective To explore clinical application values of thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure for esophageal cancer. Methods Clinical data of 196 patients with esophageal cancer （EC） who underwent thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure in West China Hospital of Sichuan University from February 2008 to August 2012 were analyzed retrospectively. There were 145 male and 51 female patients with their age of 40-76 （58.8±6.6） years. There were 43 patients with EC in the upper segment of the esophagus, 115 patients with EC in the middle segment of the esophagus and 38 patients with EC in the lower segment of the esophagus.Results Total operation time was 215-780 （305.0±40.7） minutes，including thoracoscopic operation time of 50-580 （105.0±38.4） minutes and laparoscopic operation time of 28-105 （54.0±8.6） minutes. Intraoperative blood loss was 20-440 （285.4±38.5） ml. The number of dissected lymph nodes was 6-39 （20.4±1.6） for each patient. Postoperative hospital stay was 7-93 （12.8±5.2） days. Sixty patients （30.6%） had postoperative complications，including 28 patients （14.3%） with pulmonary comp-lications，5 patients （2.5%） with chylothorax，5 patients （2.5%） with arrhythmias，15 patients （7.6%） with anastomotic fistula，10 patients （5.0%） with recurrent laryngeal nerve injury，and other complications in 2 patients. Conclusion Thoracoscopic and laparoscopic-assisted minimally invasive McKeown procedure is a safe and feasible operation for esophageal cancer.
Abstract： Objective To explore the feasibility and safety of concealing incision video-assisted thoracoscopic surgery （VATS）. Methods We retrospectively analyzed the clinical data of 11 patients who underwent concealing incision VATS in West China Hospital of Sichuan University between September and November 2011. There were 2 male patients and 9 female patients with their mean age of 34.0 years （ranging from 16 to 59 years）. There were 4 patients with myasthenia gravis, 4 patients with thymoma, 2 patients with thymus cyst, and 1 patient with hyperhidrosis. Extended thoracoscopic thymectomy was performed in 10 patients, and endoscopic thoracic sympathectomy was performed in 1 patient. Results All the VATS procedures were performed successfully, and there was no intraoperative and postoperative complication. The operation time ranged from 30 to 105 minutes with an average time of 70.5 minutes. All the intraoperative blood loss was less than 5 ml. The time of postoperative thoracic drainage was less than 48 hours, and the drainage volume ranged from 30 to 80 ml with a mean volume of 55.5 ml. The mean postoperative hospital stay was 3.5 （2-4）days. The incision was small with a concealed and esthetic appearance. For 10 patients with extended thoracopscopic thymectomy, histopathology test aftre operation showed 4 patients with thymic hyperplasia, 4 with thymoma, and 2 with cystofthymus. Conclusion Concealing incision VATS is a safe and feasible technique, and it can meet the esthetic requirement of patients.
Objective To summarize the clinical application of esophagogastrostomy with layered anastomosis and to observe the healing quality of anastomotic stoma in animal experiments. Methods One thousand and twenty-four patients suffered from carcinoma of esophagus or carcinoma of gastric cardia had undergone esophagogastrostomy by layered anastomosis with absorbable suture. Twenty-four experimental dogs (adult male healthy hybrid dogs) were divided into two groups: the experimental group and the control group. The former (experimental group) underwent the layered anastomosis, the diameter of esophagogastric stoma and the length and depth of stomal scar were measured under anesthesia in both groups on 5th,8th,14th,and 42th postoperative day, respectively. So were done the histological measurement, such as the count infiltrating inflammatory cells, the proliferation of blood capillary and other cells. And the cytokines related to wound healing (LsAB technique) such as epidermal growth factor(EGF), transforming growth factor-beta 1 (TGF-beta 1) were detected, either. Results One thousand and twenty-four patients had no anastomotic leakage. There were only 6 patients suffered from mild anastomotic stricture, and they got well after one dilatation. The results of the measurement of 24 experimental dogs revealed that, in the experimental group, the mucosa was in good connecting condition, had a soften anastomotic stoma and a thin scar. The counts of inflammatory cells and fibroblast showed more in number at the early time after operation (Plt;0.05), while showed less in number at the advanced time of operation (Plt;0.05). In the control group, however, the mucosa were in a bad connecting condition, the scar was thicker, and the muscle layer was frequently exposed. The counts of inflammatory cells and fibroblast were fewer at the early time after operation, however, they had a clearly tendency of increasing at the anaphase after the operation. On the cytokines related to the healing of wound in the experimental group, there was a high expression and activity at the early period. There were a little expression up to postoperative 42 d. Whereas, in the control group, there had a low expression level,increased clearly on postoperative 8 d, and still a higher expression up to postoperative 42 d. Conclusions The esophagogastrostomy by layered anastomosis has a high healing quality with a thin scar. The proliferation of cells and the expression of growth factors benefits the normal healing of wound by first intention.
Objective To study prospectively the morphological relations among hemorrhage of optic disc, defect of retinal nerve fiber layer, and peripapillary atrophy in normal-tension glaucoma (NTG). Methods Qualitative and quantitative methods were applied to evaluate the relations among hemorrhage of optic disc, defect of retinal nerve fiber layer, and peripapillary atrophy by using stereo ocular fundus photography and computer analyzer systems. Results In 37 patients (42 eyes) in NTG hemorrhage group, 50 hemorrhagic spots at optic disc was found, including coloboma of retinal nerve fiber layer in 35 eyes (83.3%)(35/42). In 35 patients (40 eyes) in non-hemorrahge group, partial coloboma of retinal nerve fiber layer was found in 21 eyes (52.5%)(21/40). The difference of incidence of coloboma of retinal nerve fiber layer between the two groups was not significant (chi;2=1.403, P=0.236). The incidence of atrophic arc in hemorrhage group differed much from which in non-hemorrhage group (chi;2=7.008, P=0.008). The area of atrophic arc at beta;section in hemorrhage group ［(2.05plusmn;0.88)mm2］ was significantly different from which in non-hemorrhage group［(1.42plusmn;0.53)mm2］(t=-2.618, P=0.012). In the follow-up period, the difference of incidence of disc-rim loss between hemorrhage and non-hemorrhage group was significant, (chi;2=5.802, P=0.016); while the difference of the incidence of visual field defect between the two groups was not. Conclusion In eyes with NTG, hemorrhage of optic disc, coloboma of retinal nerve fiber layer and atrophic arc are closely related. More disc-rim loss and changes of atrophic-arc area in hemorrhage group in the follow-up period suggests that hemorrhage of optic disc is the risk factor of development of NTG. (Chin J Ocul Fundus Dis, 2006, 22: 232-235)
Objective To study the clinical significance of total gastrectomy in treatment for gastric cardia cancer.Methods The clinical data of 118 patients with gastric cardia cancer underwent operation from May 1997 to October 2012 in the Department of General Surgery of Baiyin Hospital， Affiliated to Lanzhou University were analyzed retrospe-ctively. Among these 118 patients， there were 65 patients treated by total gastrectomy （total gastrectomy group） and 53patients treated by proximal gastrectomy （proximal gastrectomy group）. The postoperative complications， survival rate，quality of life， and nutrition indexes were compared after operation between the total gastrectomy group and the prox-imal gastrectomy group. Results ① The incidence of postoperative complications was 7.7% （5/65） and 13.2% （7/53） in the total gastrectomy group and the proximal gastrectomy group， respectively， the difference was not statistically signi-ficant （χ2=0.972， P=0.248）. ② 1-， 3-， and 5-year survival rate after operation were 63.1%， 46.2%， and 30.8% in thetotal gastrectomy group；which were 66.0%， 36.9%， and 18.5% in the proximal gastrectomy group. The difference of 1-year survival rate after operation was not statistically significant in two groups （χ2=0.193， P=0.402）， the 3- and the 5-year survival rates of the total gastrectong group were significantly higher than those of the proximal gastrectony group （χ2=4.508， P=0.022；χ2=30.271， P=0.000）. ③ The Spitzer quality of life score had no difference at the different timeafter operation in two groups （P＞0.05）. Compared with the proximal gastrectomy group， the points of heartburn， swallo-wing problem， appetite， and food intake on 12 months after operation in the total gastrectomy group were higher （P＜0.05）， the points of the other indexes had no significant differences （P＞0.05）. ④ The nutrition indexes after operationhad no differences at the different time after operation in two groups （P＞0.05）. Conclusions Total gastrectomy in treatment for gastric cardia cancer would not increase complications， also can improve 5-year survival for patients withⅠ-Ⅲ stage， and survival condition after operation is also much better than that of proximal gastrectomy.
Objective To systematically review the treatment outcomes of multidrug-resistant tuberculosis (MDR-TB) patients, and to provide evidence for treatment. Methods Databases including PubMed, Web of Science, ScienceDirect, CNKI, WanFang Data and VIP were electronically searched to collect literature related to MDR-TB from inception to April 28th, 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using R 4.0.5 software, subgroup and meta-regression analyses were performed based on sample size, survey time, etc. Results A total of 36 studies involving 7 981 patients were included. The results of meta-analysis showed that the overall treatment success rate of MDR-TB patients was 60% (95%CI 56% to 63%). The subgroup analysis showed that the treatment success rates of MDR-TB were 49% (95%CI 41% to 58%) from 1992 to 2010, 62% (95%CI 58% to 65%) from 2011 to 2015, and 62% (95%CI 55% to 68%) from 2016 to 2020; those with sample size above 100 and less than 100 were 60% (95%CI 55% to 65%) and 59% (95%CI 54% to 63%), respectively; those with average age above 45 and less than 45 were 58% (95%CI 51% to 65%) and 56% (95%CI 53% to 59%); those of MDR-TB were 63% (95%CI 57% to 68%) in central China, 63% (95%CI 52% to 73%) in the Northwest, 60% (95%CI 55% to 65%) in the Southeast, and 53% (95%CI 48% to 58%) in the Northeast. Conclusions The overall success rate of treatment for MDR-TB patients in China is low. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusions.
ObjectiveTo systematically review the status of 3 types of delay (patient delay, diagnostic delay and treatment delay) among tuberculosis (TB) patients in China, to determine their associations with economic factors, and to provide guidance for policies regarding TB control. MethodsThe CNKI, WanFang Data, VIP, PubMed, ScienceDirect and Web of Science databases were searched from January 1st, 2001, to December 31st, 2021, for cross-sectional studies related to the 3 types of delay among TB patients in China. Two reviewers independently screened the literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using R 4.1.3 software. ResultsA total of 22 cross-sectional studies involving 9 498 patients were included. The results of the meta-analysis showed that the pooled rates of patient delay, diagnostic delay and treatment delay were 41% (95% CI 34% to 48%), 36% (95% CI 28% to 45%) and 18% (95% CI 10% to 32%), respectively. Family economic status was significantly associated with patient delay (OR=1.32, 95% CI 1.06 to 1.64, P=0.01), diagnostic delay (OR=1.55, 95% CI 1.21 to 1.97, P<0.01) and treatment delay (OR=1.60, 95% CI 0.98 to 2.60, P=0.05). Conclusion The rates of the 3 types of delay in Chinese TB patients are high, and all 3 types of delay are significantly associated with poor family economic status among the patients. Measures should be taken to reduce the incidence of the various types of delays due to the financial burden that is imposed on TB patients.
ObjectiveBy establishing a set of evaluation system for thoracoscopic clinical function and applicability, to evaluate and compare the advantages and disadvantages of different brands of thoracoscopes, and to provide some suggestions for the innovation and upgrade of thoracoscopes, especially for the domestic thoracoscopes.MethodsThe project coordination team initially formulated the evaluation index system for the clinical function and applicability of thoracoscope by querying literature and brainstorming. The Delphi expert consultation method was used to distribute questionnaires to the selected experts. Experts provided scores which were based on the importance of each indicator, and clarified the basis of their judgment and the familiarity with the evaluation indicators. After two rounds of screening by Delphi method, a thoracoscopic clinical function and applicability satisfactory questionnaire was formed. The appropriate sample for pre-investigation was selected, and the reliability and validity were tested. The index composition was adjusted based on the results of the test to form a final evaluation scale.ResultsThe project coordination team initially formulated 24 thoracoscope-related evaluation indicators. After two rounds of experts consultation, the item "brightness adjustment" was deleted without any additional entries. The positive coefficients of the experts in the first round and the second round were 100.0% and 80.0%, respectively. The two rounds of authoritative coefficients were 0.86 and 0.90, and the coordination coefficients were 0.272 (P<0.001) and 0.523 (P<0.001), respectively. A total of 140 questionnaires were issued in this pre-investigation. The recovery rate was 100.0% and the effective rate was 90.0%. The Cronbach's α value of the scale was 0.936, and the Spearman-Brown split-half reliability coefficient was 0.972. The factor analysis finally extracted 3 common factors. The total variance of the cumulative interpretation was 70.9%. The three common factors were named "operation related", "image related" and "device related".ConclusionThe evaluation index system developed in this study has good reliability and validity, and can be used as a tool to evaluate the clinical function and applicability of thoracoscopes.
Objective To compare the differences in the application of ultrasound scalpel and coagulation hook in thoracoscopic anterior mediastinal tumor surgery and to analyze the respective advantages and indications of the two commonly used energy instruments. Methods The clinical data of 85 patients undergoing thoracoscopic anterior mediastinal tumor surgery in West China Hospital of Sichuan University between June and November in 2017 were prospectively analyzed. There were 45 males and 40 females at age of 50.45 (18–75) years. The patients were divided into three groups including a ultrasound scalpel group (59 patients), a coagulation hook group (17 patients) and a mixed group (9 patients) according to the using time of energy devices. The clinical effect among the three groups were compared. Results No significant difference was found among the three groups in operation time, blood loss, average duration of chest tube drainage or volume of drainage (P>0.05). No significant complications occurred in all groups during operation or after operation. The proportion of subxiphoid approach in the ultrasound scalpel group was higher than that in the other two groups (49/59vs. 7/17 vs. 5/9, P<0.01). The maximum diameter of the tumor (4.58±2.19 cmvs. 4.05±1.07 cm vs. 3.00±1.45 cm, P<0.05) and the resected tissue weight (103.67±74.78 gvs. 61.17±31.97 g vs. 61.86±34.13 g, P<0.05) were also significantly greater than that in the coagulation hook group or the mixed group. Conclusion Ultrasound scalpel has good safety and reliability in the thoracoscopic anterior mediastinal tumor surgery, and is more suitable for operation in a narrow space.