Objective To evaluate the effectiveness and safety of implanted sustained-release fluorouracil in gastric cancer surgery. Methods Literature search was conducted in the following databases: PubMed, EMbase, The Cochrane Library (Issue 6, 2012), CNKI, VIP and WanFang Data from inception to June, 2012. Randomized controlled trials (RCTs) or quasi-randomized controlled trials on implanted sustained-release fluorouracil for gastric cancer were included. Two reviewers independently identified the literature according to the inclusion and exclusion criteria, and then extracted the data and assessed the quality of the included studies. Then, meta-analysis was conducted using RevMan 5.1 software. Results A total of 7 studies involving 742 patients were included. The results of meta-analysis showed no significant difference in the rate of postoperative complications between the two groups (OR=0.93, 95%CI 0.54 to 1.59, P=0.79), while a significant reduction was found in the recurrence rate in the sustained-release fluorouracil group during 1 to 3 year follow-up (1 year after surgery: OR=0.32, 95%CI 0.22 to 0.46, P=0.02; 2 years after surgery: OR=0.19, 95%CI 0.08 to 0.42, Plt;0.001; 3 years after surgery: OR=0.40, 95%CI 0.24 to 0.67, P=0.004). As for the survival rate, no significant difference was found between the two groups 1 year after surgery (OR=1.98, 95%CI 0.92 to 4.25, P=0.08), while it was significantly higher in the sustained-release fluorouracil group than in the control group 2 to 3 years after surgery (2 years after surgery: OR=2.63, 95%CI 1.17 to 5.91, P=0.02; 3 years after surgery: OR=2.42, 95%CI 1.53 to 3.83, P=0.002). Adverse reaction rates in the sustained-release fluorouracil group were lower than those in the control group, but without significantly differences between the two groups (OR=1.22, 95%CI 0.49 to 3.07, P=0.67). Conclusion Compared with the control group, implanted sustained-release fluorouracil for gastric cancer can significantly reduce the recurrence rate 1 to 2 years after surgery and improve the overall survival rate 2 to 3 years after surgery without increasing the incidences of the postoperative complications and adverse reaction. However, due to the limitation of quantity and quality of the included studies, this conclusion should be further confirmed by more high quality, larger sample and multi-center RCTs.
【Abstract】ObjectiveTo study the application of ultrasonically activated scalpel in laparoscopic intestinal adhesion release.MethodsIntestinal adhesion release with ultrasonically activated scalpel under laparoscope was performed in 29 patients suffered from intestinal adhesive obstruction after gynecological operation. ResultsAll operations were successfully performed, and none of them converted into open surgery. Intestinal disruption occurred durring operation in 2 patients with extensive intestinal denseadhesion which were mended successfully under laparoscope. The operative duration was 30-150 min (mean 45 min). Postoperative complications such as bowel leakage, bleeding, abdominal infection were not experienced. Postoperative hospital stay was 3-7 days (mean 4 days). No case had relapse symptom such as abdominal distention or pain after 1-24 months of followup. ConclusionCompared with electric scalpel, ultrasonically activated scalpel can improve the operative safety, lessen tissue damage, shorten operative time, and reduce the chance of relapse in laparoscopic operation in gynecology.
Objective To investigate the effects of sustained-release basic fibroblast growth factor (bFGF) on healing of bile duct defect. Methods A model of bile duct wall defect (2 cm in length and 1/3-2/3 of the bile duct circumference in width) was made in 24 pigs (male or female, weighing 15-30 kg), and then defect was repaired with sustained-release bFGF collagen membrane (2.0 cm × 1.0 cm × 0.5 cm in size) in the experimental group (n=12) or with collagen membrane (2.0 cm × 1.0 cm × 0.5 cm in size) alone in the blank control group (n=12). Another 4 healthy pigs were used to obtain normal bile duct as normal control group. The survival condition of pigs was observed after operation; at 1, 2, and 3 months after operation, the blood sampling was collected to test the changes of liver function, and the bile duct specimens were harvested to count the microvessel density (MVD) and submucosal gland by HE staining and immunohistochemistry staining; and at 3 months after operation, cholangiography examination was done. Results All the animals survived to completion of the experiment. Intra-abdominal adhesion was serious in the experimental and blank control groups at 1 week after operation, but the adhesion was markedly improved in the experimental group when compared with the blank control group with time passing. The liver function test showed that alkaline phosphatase in the experimental group was significantly lower than that in the blank control group at 2 and 3 months (P lt; 0.05), but no significant difference in aspartate aminortransferase, total bilirubin, and albumin was found among 3 groups (P gt; 0.05). The histology and immunohistochemistry staining observations showed that the regeneration rates of submucosal glands and epithelium in the experimental group were faster than those in the blank control group; defect was covered with the epithelium at 2 months, and the structure was similar to that of normal control group at 3 months; and the edema and inflammation infiltration were reduced when compared with the blank control group. The counts of MVD and submucosal gland were significantly higher than those in blank control group and normal control group at 1 month after operation (P lt; 0.05), and then decreased and remained at normal levels at 2 months after operation. There was a positive correlation between submucosal gland counting and MVD counting in 3 groups after operation (P lt; 0.01). The cholangiography examination showed no biliary dilatation or cholelithiasis after 3 months in experimental group and blank control group. Conclusion Sustained-release bFGF can promote healing of bile duct defect by accelerating the vascularization, gland regeneration, and epithelialization.
【Abstract】 Objective To evaluate the surgical management of rigid post-traumatic thoracolumbar kyphosis (RPTK) by simultaneous posterio-anterior circumferential releasing, correction and anterior corpectomy with preserved posterior vertebral wall. Methods Twenty patients with RPTK were treated between October 2004 and October 2010 by posterior releasing, anterior subtotal corpectomy with preserved posterior vertebral wall, correction, strut graft, and short segmental fixation. There were 14 males and 6 females with an average age of 43.2 years (range, 23-63 years). The time between injury and operation was 4 months to 23 years (mean, 1.4 years). The affected locations were T11 in 1 case, T12 in 8 cases, L1 in 10 cases, and L2 in 1 case. The Cobb angle and the intervertebral height of the fractured vertebra body were measured before and after operations. The degrees of low back pain were assessed by Japanese Orthopaedic Association (JOA) scores. Results No incision infection, nerve injury, or cerebral spinal fluid leakage occurred. Seventeen patients were followed up 1-5 years with an average of 2.8 years. The JOA score at last follow-up (26.2 ± 3.9) was significantly improved when compared with the pre-operative score (14.0 ± 5.7) (t=4.536, P=0.001). One patient had aggravation of kyphosis at 3 months postoperatively, who was in stabilized condition after prolonging immobilizated time. The Cobb angle was corrected from (43.2 ± 11.5)° preoperatively to (9.8 ± 5.7)° at last follow-up, showing significant difference (P lt; 0.01). There was significant difference in the intervertebral height of the fractured vertebra body between preoperation and last follow-up (P lt; 0.05). The intervertebral height of fractured vertebra was restored to 87.0% ± 11.2% of adjacent disc height. Conclusion Posterio-anterior circumferential releasing and anterior corpectomy with preserved posterior vertebral wall can achieve satifactory clinical results, not only in pain relieving, kyphosis correction, vertebral height restoration, and spinal stability restoration, but also in the risk reduce of bleeding and spinal cord disturbance.
Objective To review the progress in the treatment method of carpal tunnel syndrome (CTS). Methods Recent l iterature concerning the treatment method of CTS was extensively reviewed, analyzed, and summarized. Results Wrist spl inting and local steroid injection are effective in patients with mild to moderate CTS in the short-term. however, patients with recurrent CTS have to accept surgical treatment. The main operative patterns include open carpal tunnel release (OCTR), mini-OCTR, and endoscopic carpal tunnel release. Conclusion The final conclusion of the most effective method to treat CTS needs more cl inical researches, and surgical treatment is one method recommended by some scholars.
Objective To evaluate the primary cl inical effectiveness of Austin metatarsal osteotomy combined with transection of adductor muscle and transverse metatarsal l igament for treating mild or moderate hallux valgus through a single medial incision. Methods Between May 2006 and January 2009, 41 patients (45 feet) with mild or moderate hallux valgus were treated. There were 9 males (10 feet) and 32 females (35 feet) with an average age of 45.3 years (range, 23-71 years). The hallux valgus angle (HVA) was (33.1 ± 1.4)°, and the first and second inter-metatarsal angle was (20.4 ±1.1)°. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score of the affected foot’s function was 47.2 ± 3.7. A longitudinal medial incision was made at the first metatarsophalangeal joint. By the incision, Austin metatarsal osteotomy and lateral soft tissue release (including transection of adductor muscle and the transverse metatarsal l igament) were performed at the same time. Results During operation, 1 case had superficial peroneal nerve branch injury and suture repair was done microsurgically. All incisions healed by first intention postoperatively. All patients were followed up 16-36 months (mean, 26 months). Medial forefoot numbness occurred in 2 feet at 3 days after operation and rel ieved within 6 weeks. The X-ray films showed bone heal ing at osteotomy site within 8 weeks after operation. At last follow-up, the HVA was (10.7 ± 1.7)°, showing significant difference when compared with preoperative value (t=22.32, P=0.00), and the first and second inter-metatarsal angle was (12.1 ± 1.7)°, also showing significant difference when compared with preoperative value (t=21.17, P=0.03). The postoperative AOFAS ankle and hindfoot score of the affected foot’s function was 84.9 ± 4.5, showing significant difference when compared with preoperative score (t=20.75, P=0.01). No foot hallux varus, hallux valgus, or metatarsal necrosis occurred during follow-up. Conclusion The Austin metatarsal osteotomy combined with transection of adductor muscle, transverse metatarsal l igament through a single medial incision can effectively correct the mild or moderate hallux valgus, and avoid the scar and injury of deep peroneal nerve branches by traditional lateral incision.
Objective To investigate the procedure and effectiveness of medial patellofemoral l igament (MPFL) reconstruction for the treatment of recurrent patellar dislocation. Methods Between June 2005 and September 2007, 29 patients with recurrent patellar dislocation underwent MPFL reconstruction with allograft semitendinosus or allograft anterior tibial is tendon. There were 6 males and 23 females with an average age of 20.3 years (range, 13-45 years). The patients sufferedfrom 2-10 times patellar dislocation preoperatively. The average time between last dislocation and surgery was 43.9 months (range, 1-144 months). CT scan was performed to measure the tibial tuberosity-trochlear groove distance (TT-TG). The femoral tunnel was made at the origin of MPFL insertion, just inferior to the medial epicondyle. The double L-shape patellar tunnels were made on the medial rim of patella with 4.5 mm in diameter. The loop side of the graft was fixed with a bioabsorbable interference screw in the femoral tunnel both ends of the graft. For the TT-TG was more than 20 mm, a modified Elmsl ie-Trillat osteotomy was performed to correct the distal al ignment of patella. The arthroscopic examination was also performed for loosebody and lateral retinacular release. Results Twenty-seven patients were followed up 45.5 months on average (range, 40-67 months). No recurrent dislocation or subdislocation occurred. All the patients showed negative apprehension test at 0° and 30° flexions of knee. The range of motion of knee restored normal 1 year after operation. The Kujala score was improved from 72.03 ± 17.38 preoperatively to 94.10 ± 7.59 postoperatively, and Lysholm score was improved from 72.65 ± 14.70 to 95.44 ± 6.25, both showing significant differences (P lt; 0.05). The Tegner score was decreased from 5.25 ± 1.83 preoperatively to 4.33 ± 1.00 postoperatively, showing no significant difference (t=1.302, P=0.213). In patients whose TT-TG was more than 20 mm, TTTG was decreased from (23.38 ± 3.70) mm to (16.88 ± 5.92) mm at last follow-up, showing significant difference (t=2.822,P=0.026). Conclusion The technique of MPFL reconstruction is an effective surgical procedure for the treatment of recurrent patellar dislocation, which can improve the patella stabil ity and knee function.
Objective To evaluate pulmonary function changes in patients with severe scol iosis undergoing anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib. Methods FromJanuary 2006 to July 2007, 16 patients with severe scol iosis were treated with anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib. There were 6 males and 10 females with an average age of 16.9 years (range, 10-24 years). There were 1 case of Lenke 1 curve, 9 cases of Lenke 2 curve, and 6 cases of Lenke 4 curve. The preoperative Cobb angle was (104.8 ± 10.9)° and the preoperative thoracic kyphotic angle was (30.0 ± 4.2)°. The preoperative height of “razor back” deformity was (5.9 ± 1.2) cm. Before operation, the actual value of forced vital capacity (FVC) was (2.04 ± 0.63) L and that of forced expiratory volume in 1 second (FEV1.0) was (1.72 ± 0.62) L. The percentage of actual values to expected ones in FVC was 70% ± 16%, and that in FEV1.0 was 67% ± 15%. All patients had pulmonary function tests before operation and 3, 6, 12, 24 months after operation. Results All wounds healed by first intention. The Cobb angle at 24-month follow-up was (53.4 ± 18.6)° and the correction rate was 49.0% ± 15.3%. The thoracic kyphotic angle at 24-month follow-up was (34.0 ± 2.4)° and the correction rate was 13.3% ± 2.2%. The height of “razor back” deformity at 24-month follow-up was (2.2 ± 0.8) cm. Compared with preoperative level, all these data showed significant differences (P lt; 0.05). At 3 and 6 months, the actual values of FVC and FEV1.0 decl ined, but no significant difference was found (P gt; 0.05). At 12 and 24 months, the actual values of FVC andFEV1.0 were close to the preoperative level (P gt; 0.05). The percentages of actual values to expected ones in FVC and FEV1.0 indicate continued improvement in pulmonary function from the postoperative 3 to 24 months follow-up. Compared with preoperative level, the percentages of actual values in FVC decl ined 19% 3 months postoperatively (P lt; 0.05) and 12% 6 months postoperatively (P lt; 0.05). The percentages of actual values to expected ones in FEV1.0 decl ined 16% 3 months postoperatively (P lt; 0.05), and 10% 6 months postoperatively (P lt; 0.05). The percentages of actual values to expected ones in FVC and FEV1.0 were close to the preoperative level 12 and 24 months after operation (P gt; 0.05). Conclusion In severe scol iosis patients who are treated with anterior release, posterior segmental fixation and fusion, and convex thoracoplasty by resecting a short length of rib, pulmonary function decreases obviously 3-6 months after operation. And it returns to the operative baseline 12-24 months after operation.
Objective To study the effect of surgical treatment of carpal tunnel syndrome (CTS) by endoscope through a transparent combined with dilation conductor to cut the transverse carpal l igament. Methods Between April 2003 and April 2008, 56 patients with CTS were treated with endoscopic carpal tunnel release through a transparent combined with dilation conductor. There were 8 males and 48 females with an average age of 50 years (range, 38-65 years). CTS was caused bywrist injury in 5 cases, by forearm fracture in 12 cases, and by wrist strain in 39 cases. The locations were left hand in 14 cases and right hand in 42 cases with a disease duration range of 2-7 years (4 years on average). According to Hamada classification of CTS, 38 cases were classified as stage I, 12 cases as stage II, and 6 cases as stage III. Results All cases achieved the primary heal ing of incision. All patients were followed up 14-68 months (40 months on average). According to Kelly’ s evaluation, the results were excellent in 25 cases, good in 22 cases, fair in 4 cases, and poor in 5 cases with an excellent and good rate of 83.93%. The distal motor latency of median nerve was (4.48 ± 0.50) ms at 1 months, (4.06 ± 0.35) ms at 3 months, (3.79 ± 0.25) ms at 6 months, and (3.42 ± 0.24) ms at 12 months after operation, showing significant differences when compared with the preoperative one [(5.09 ± 0.61) ms, P lt; 0.05]. There were significant differences among different time points after operation (P lt; 0.05). Conclusion The method of endoscope through a transparent combined with dilation conductor to cut the transverse carpal l igament is a simple and effective surgical procedure for treament of CTS, which can precisely cut the transverse carpal l igament and completely release the pressure of carpal tunnel.
Objective To explore the effect of controlled release of nerve growth factor (NGF) on peripheral nerve defect repaire by acellular nerve graft. Methods The microspheres of NGF were prepared with drug microsphere technologyand fixed with the fibrin glue to make the compl icated controlled release NGF. Twenty healthy male SD rats weighing 280-300 g were adopted to prepare acellular xenogenous nerve, 52 male Wistar rats weighing 250-300 g were adopted to prepare the 10 mm defect model of left sciatic nerve. and thereafter were randomly divided into 4 groups: autograft group(group A), acellular nerve allograft combined with the double controlled release NGF (group B), acellular nerve allograft (group C) and acellular nerve allograft combined with fibrin glue (group D). Without any operation, the right sciatic nerve was regarded as control group. General observation was conducted after operation. The nerve axon regeneration length was measured 2 weeks after operation. The effects of peripheral nerve regeneration were evaluated by neural electrophysiology, the recovery rate of triceps surae muscular tension and weight and histological assessment 16 weeks after operation. Results All the animals survived till the end of experiment. The length of nerve regeneration was measured at 2 weeks after transplantation. The regeneration nerve of group A was longer than that of other groups (P lt; 0.05), group B longer than groups C and D (P lt; 0.05), and there were no difference between group C and group D (P gt; 0.05). At 16 weeks after operation, the recovery rates of nerve conduction velocity of groups A and B (73.37% ± 7.82% and 70.39% ± 8.45%) were larger than that of groups C and D (53.51% ± 6.31% and 55.28% ± 5.37%) (P lt; 0.05). The recovery rates of the triceps surae muscular tension in group A (85.33% ± 5.59%) were larger than that in groups B, C and D (69.79% ± 5.31%, 64.46% ± 8.49％ and 63.35% ± 6.40%) (P lt; 0.05). There were no significant differences among groups B, C and D (P gt; 0.05). The recovery rates of the triceps surae weight in group A (62.54% ± 8.25%) werelarger than that in groups B, C and D (53.73% ± 4.56%, 46.37% ± 5.68% and 45.78% ± 7.14%, P lt; 0.05). There was significant difference between group B and groups C, D (P lt; 0.05) and no significant differences between group C and group D (P gt; 0.05). The histological observation indicated that axon number and myel in thickness in group B were larger than those in group C and group D (P lt; 0.05). The axonal diameter in group B was significantly less than that in group A (P lt; 0.05). Conclusion Acellular nerve graft combined with the controlled release NGF is a satisfactory alternative to repair the peripheral nerve defect.