ObjectiveTo explore the feasibility of decompression without gastric tube after minimally invasive esophageal cancer surgery.MethodsSeventy-two patients who underwent minimally invasive esophageal cancer resection at the Department of Thoracic Surgery, The Second Affiliated Hospital of Harbin Medical University from 2016 to 2018 were selected as a trial group including 68 males and 4 females with an average age of 58.5±7.9 years, who did not use gastric tube for gastrointestinal decompression after surgery. Seventy patients who underwent the same operation from 2013 to 2015 were selected as the control group, including 68 males and 2 females, with an average age of 59.1±6.9 years, who were indwelled with gastric tube for decompression after surgery. We observed and compared the intraoperative and postoperative indicators and complications of the two groups.ResultsThere were no significant differences between the two groups in operation time, intraoperative blood loss, postoperative level of serum albumin, postoperative nasal jejunal nutrition, whether to enter the ICU postoperatively, death within 30 days after surgery, anastomotic leakage, lung infection, vomiting, bloating or hoarseness (P>0.05). No gastroparesis occurred in either group. Compared with the control group, the recovery time of the bowel sounds and the first exhaust time after the indwelling in the trial group were significantly shorter, and the total hospitalization cost, the incidence of nausea, sore throat, cough, foreign body sensation and sputum difficulty were significantly lower (P<0.05).ConclusionIt is feasible to remove the gastric tube for gastrointestinal decompression after minimally invasive esophageal cancer surgery, which will not increase the incidence of postoperative complications, instead, accelerate the postoperative recovery of patients.
Objective To review the diagnosis and treatment of tuberculosis infection after total knee arthro-plasty (TKA). Methods The recent literature concerning the diagnosis and treatment of tuberculosis infection after TKA were extensively reviewed and summarized. Results The diagnosis of tuberculosis infection after TKA is difficult. It should be combined with the patient’s medical history, symptoms, signs, blood examinations, and imaging examinations, among which the bacterial culture and histopathological examination are the gold standard of diagnosis. Treatment strategy is combined with the drug treatment and a variety of surgical procedures that depends on the clinical situation. Conclusion At present, there is no guideline for the diagnosis and treatment of tuberculosis infection after TKA, it still needs further study and improvement.
objective To analyze the impact of body mass index (BMI) on medical and surgical complications of colorectal cancer patients served by West China Hospital, based on the current version of Database from Colorectal Cancer (DACCA). Methods The data of DACCA was updated on September 27, 2021. The data included BMI, surgical complications, liver nodules, liver function, renal nodules, renal function, operation history, medical complications, diabetes, hypertension, pneumonia, pulmonary nodules, pulmonary function, heart disease, thrombosis, and cardiac function. Results After scanning, 5 305 data rows were included. BMI was divided by Chinese four classification methods. The analysis results showed that in terms of surgical complications, obese patients were more likely to be complicated with surgical complications of digestive system (χ2= 43.883, P<0.001) and reproductive system (χ2=13.139, P=0.004). Lean patients were more likely to have surgical complications of urinary system (χ2=223.415, P<0.001), and obese patients had liver function (H=61.521, P<0.001) and renal function (H=9.994, P=0.019) might be even worse. In terms of operation history, BMI in colorectal cancer patients had nothing to do with the number of times of operation (H=6.262, P=0.100), and operation history of each system or department (P>0.05). Regarding to medical complications, with the increase of BMI, the risk of colorectal cancer patients with diabetes mellitus (χ2=118.597, P<0.001), or hypertension (χ2= 163.334, P< 0.001) increased. Patients with low BMI were more likely to have pneumonia (H=7.899, P= 0.048) and worse pulmonary function (H=40.673, P<0.001). Conclusions The analysis results of DACCA database show that BMI is not related to the occurrence of any special surgical history included in the research. Because the internal and external complications of patients are closely related to the treatment plan and prognosis, we should pay more attention to the obese patients in the process of clinical treatment, and they are more likely to have multisystemic abnormalities and various abnormal indicators than other patients. For thin patients, we should pay more attention to their lung function and inflammatory lesions, so as to improve the clinical therapeutic effect.
【 Abstract 】 Objective To investigate the features and risk factors of bacterial infection after orthotopic liver transplantation (OLT) and summarize the experiences for prevention and treatment of infection. Methods The clinical materials of 79 patients underwent OLT from December 2004 to January 2007 were reviewed. The incidence and sites of postoperative bacterial infections as well as species of bacteria and the situation of drug resistance were retrospectively analyzed. Results Thirty-two (40.5%) out of 79 patients developed bacterial infections. Infection mainly occurred in lung, abdominal cavity and blood, which were mainly caused by Escherichia coli, staphylococcus aureus, klebsiella pneumoniae, staphylococcus epidermidis and enterococcus bacteria. The main risk factors included delayed restoration of gastrointestinal function (gt;5 d), poorly preoperative liver function (Child C grade), hypoproteinemia and persistent postoperative hyperglycemia (gt;11.0 mmol/L). Perioperative decontamination in digestive tract was a protective factor in the prevention of bacterial infection. Conclusion Bacterial infection is one of the most severe complications after OLT. Therefore, it is very important to remove those risk factors, make early diagnosis and take effective treatment ．
ObjectiveTo investigate the clinical effect and the incidence of postoperative complications of Milligan-Morgan hemorrhoids combined with reducing tension of alary incision in the treatment of annular mixed hemorrhoids.MethodsProspectively collected 120 patients with annular mixed hemorrhoids who received treatment from the Department of Colorectal Surgery of Bazhong Hospital of Traditional Chinese Medicinel during the April, 2016 to October, 2018. All of the 120 patients with annular mixed hemorrhoids were randomly divided into the experimental group and the control group, with 60 patients in each one group. Patients in the experimental group was treated with Milligan-Morgan hemorrhoids combined with reducing tension of alary incision, while patients in the control group with conventional Milligan-Morgan hemorrhoid.ResultsIn the experimental group, 49 cases were cured, 11 cases showed obvious effect; in the control group, 39 cases were cured, 20 cases showed obvious effect, and 1 case was effective. The curative effect in experimental groups was better than that of the control group (Z=–2.090, P=0.037), and the effective rates of these two group were both 100% in total. The mean healing time was (19±3) d (14–21 d) in the experimental group and (21±3) d (14–24 d) in the control group, respectively, which was better in the experimental group (Z=–13.636, P<0.001). Experimental group with lower score of wound pain, hemafecia, and anal margin edema, which were much better than control group on 1 d and 3 d after operation (P<0.05). There was no statistically significant differences on incidence of uroschesis and recurrence rate between the two groups (P>0.05).ConclusionsMilligan-Morgan hemorrhoids combined with reducing tension of alary incision in the treatment of annular mixed hemorrhoids has good clinical effect and deserves clinical application.
ObjectiveTo investigate the operation of transcatheter aortic valve replacement (TAVR), the use of TAVR instruments and the current situation of TAVR-related nursing in our country, to reveal the characteristics of TAVR in various hospitals in our country, and to provide reference data for improving perioperative nursing and industry development of TAVR. MethodsA questionnaire survey was conducted among the head nurses of the cardiac catheterization laboratories of 51 hospitals in China that carried out TAVR operations, with a total of 5 items and 23 questions. The current situation of TAVR operation methods, intraoperative instruments and nursing care in China were analyzed. ResultsThe number of hospitals in China which started conducting TAVR and the beginning year were: 2 in 2010, 1 in 2012, 1 in 2013, 1 in 2015, 11 in 2016, 13 in 2017, 15 in 2018 and 7 in 2019; the number of transfemoral TAVR in 2019: 32 (62.75%) hospitals conducted on less than 20 patients, 7 (13.73%) hospitals 20-<50 patients, 6 (11.76%) hospitals 50-100 patients and 6 (11.76%) hospitals more than 100 patients; TAVR strategies adopted by most hospitals were: general anesthesia (90.20%), the use of vascular sealers (80.39%), backing by cardiac surgeon (74.51%) and using homemade prosthetic valves. Conclusion At present, the number of TAVR carried out in Chinese hospitals is still far behind that of developed countries in Europe and the United States. Our country has adopted the form of multidisciplinary cardiac team cooperation and formed a TAVR nursing model with Chinese characteristics.
Objective To verify the significance of the morphological changes of the macula and its relationship to visual function by using optical coherence tomography (OCT) after scleral buckling procdure. Methods The macula of retinae of 68 patients (70 eyes) with reattached retinae after scleral buckling operation for retinal detachment were examined by OCT to scan the macula through fovea vertically and horizontally. Results Among the 70 eyes, 22 eyes revealed normal macula with thickness of neurosensory retina meant (146.47±20.59)μm. In the other 48 eyes (68.60%) with abnormal macula, 19 eyes showed extensive subretinal interspace, 9 eyes showed local subretinal interspace, 8 eyes showed macula edema, 4 eyes showed thin macula, 4 eyes showed subretinal proliferation and 4 eye showed epiretinal membrane over macula. In the normal macular structure group under the OCT, the visual acuity (VA) of the operated eyes was more than 0.3 in 6 eyes 2 weeks after operation and in 14 eyes 3 mons after operation. In the macula edema group, the VA was more than 0.3 in 1 eye 2 weeks after opoeration and 2 eyes 3 mons after operation. In the subretinal interspace group, the VA was more than 0.3 in 5 eyes 2 weeks after operation and in 23 eyes 3 mons after operation. The proportions of the numbers of operated eyes with the VA more than 0.3 after 3 mons of the operation in macular normal group subretinal interspace group and other macular disease group were significantly different (χ2=18.91, P＜0.01). Conclusion OCT can precisely detect the structural changes of macula after retinal reattachment and assess visual function after surgery of retinal detachment. (Chin J Ocul Fundus Dis, 2002, 18: 266-268)
Objective To detect the color damage in patients with idiopathic optical neuritis (ION) after the treatment.Methods A total of 26 ION patients (44 eyes) with ION whose visual acuity were above 1.0 were collected. All the patients had undergone the treatment of incretion and had the visual acuity more than 1.0 after the treatment.The results of MRI and blood examination were normal. Another 24 healthy persons were selected as the normal control. Total error scores (TES) and each error score of red, green and blue were measured via Farnsworth Munsell100 hue tester. The TES origin scores and their square roots were used for a statistical analysis. The results of the two groups were compared.Results There weresignificant differences in TES and its square roots between ION group and the normal control group (t=3.079，3.133；P=0.0033，0.0026).The differences in the level of error scores of each color between the tow groups were not significant (t=1.91,1.15,1.62; P=0.061,0.26,0.11);but the differences in the square roots of red color between the two groups were statistically(t=2.21,P=0.031).Conclusion After the treatment,the visual acuity of ION patients increases,but the color damage still exist; red color damage happens first.
ObjectiveTo explore the effect of different ventilation modes on pulmonary complications (PCs) after laparoscopic weight loss surgery in obese patients. MethodsThe obese patients who underwent laparoscopic weight loss surgery in the Xiaolan People’s Hospital of Zhongshan from January 2019 to June 2023 were retrospectively collected, then were assigned into pressure-controlled ventilation-volume guaranteed (PCV-VG) group and volume controlled ventilation (VCV) group according to the different ventilation modes during anesthesia. The clinicopathologic data of the patients between the PCV-VG group and VCV group were compared. The occurrence of postoperative PCs was understood and the risk factors affecting the postoperative PCs for the obese patients underwent laparoscopic weight loss surgery were analyzed by multivariate logistic regression analysis. ResultsA total of 294 obese patients who underwent laparoscopic weight loss surgery were enrolled, with 138 males and 156 females; Body mass index (BMI) was 30–55 kg/m2, (42.40±4.87) kg/m2. The postoperative PCs occurred in 63 cases (21.4%). There were 160 cases in the PCV-VG group and 134 cases in the VCV group. The anesthesia time, tidal volume at 5 min after tracheal intubation, peak inspiratory pressure and driving pressure at 5 min after tracheal intubation, 60 min after establishing pneumoperitoneum, and the end of surgery, as well as incidence of postoperative PCs in the PCV-VG group were all less or lower than those in the VCV group (P<0.05). The indicators with statistical significance by univariate analysis in combination with significant clinical indicators were enrolled in the multivariate logistic regression model, such as the smoking history, American Society of Anesthesiologists classification, hypertension, BMI, operation time, forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and intraoperative ventilation mode. It was found that the factors had no collinearity (tolerance>0.1, and variance inflation factor<10). The results of the multivariate logistic regression analysis showed that the patients with higher BMI and intraoperative VCV mode increased the probability of postoperative PCs (P<0.05). ConclusionsFrom the preliminary results of this study, for the obese patients underwent laparoscopic weight loss surgery, the choice of ventilation mode is closely related to the risk of developing postoperative PCs. In clinical practice, it is particularly important to pay attention to the risk of postoperative PCs for the patients with higher degree obesity.
Objective To evaluate the efficacy and safety of the silicone stent for treatment of three common benign central airway stenosis. Methods We retrospectively reviewed 40 patients with benign airway stenosis who were treated with a Dumon silicone stent at Affiliated Hospital of Guizhou Medical University between November 2019 to October 2023, including 14 cases of tracheobronchial tuberculosis (TBTB) stenosis, 14 cases of stenosis after tracheal intubation,and 12 cases of stenosis after tracheotomy. The clinical data and information on bronchoscopic interventional procedures and related complications were collected and analyzed, for evaluating the short-term efficacy, long-term efficacy and stent-related complications. Results The 40 patients were successfully implanted of silicone stents for 48 times totally. The mMRC score, KPS score, blood oxygen saturation and the diameter of the narrowest airway were significantly improved (P<0.05) after the implantation of silicone stents in all patients. Patients in TBTB group achieved inferior efficacy than those in the other two groups (P<0.05), while there was no significant therapeutic effect between tracheal intubation and tracheotomy groups (P>0.05). The main complications after the implantation of silicone stents were granulation hyperplasia, sputum retention and stent displacement. There were higher incidence rates of granulation hyperplasia and sputum retention in the TBTB group compared with the tracheal intubation and tracheotomy groups (P<0.05 ), while there was no statistically significant difference in incidence rates of granulation hyperplasia and sputum retention between the last two groups. Meanwhile, there was no significant difference in the proportion of stent displacement among the three groups.Conclusions The efficacy and safety were satisfied in the treatment of the three common benign central airway stenosis,with a recommendation for the treatment of refractory benign airway stenosis. However, the treatment effect of the TBTB group is inferior to that of the tracheal intubation and tracheotomy groups, with higher rates of obvious granulation hyperplasia and sputum retention simultaneously. More detailed follow-up management was recommended for TBTB patients implanted with silicone stents to avoid the development of stent-related minor complications into serious complications with a worse prognosis.