Objective To investigate therapeutic effect of endoscopic sphincterotomy with small incision (SES) combined with endoscopic papillary balloon dilation (EPBD) in treatment of larger common bile duct stones. Methods The clinical data of 80 patients with common bile duct stones treated in our hospital from February 2014 to October 2015 were retrospectively analyzed. These patients were divided into endoscopic sphincterotomy (EST) group (n = 40) and SES+EPBD group (n = 40) according to the therapeutic methods. The diameter of common bile duct stone was 10–20 mm. The operation status, recurrence rate and residual rate of common bile duct stone, and complications rate within 3 months after operation were compared between these two groups. Results The age and gender had no significant differences between these two groups (P>0.05). The operation time was shorter (P<0.05) and the intraoperative bleeding was less (P<0.05) in the SES+EPBD group as compared with the EST group. There were no significant differences in the hospital stay and recovery time of gastrointestinal function between these two groups (P>0.05). The levels of ALT, AST, DBIL, and TBIL in these two groups before treatment had no significant differences (P>0.05); after treatment, the above indicators of liver function in the SES+EPBD group were significantly lower than those in the EST group (P<0.05), and which were significantly decreased more in the same group (P<0.05). The residual stone, stone recurrence, and complications such as acute pancreatitis, acute cholangitis, bile leakage and postoperative hemorrhage were not found in the SES+EPBD group, the rates of these indicators in the SES+EPBD group were significantly lower than those in the EST group (P<0.05). Conclusion SES combined with EPBD has a good therapeutic effect on larger common bile duct stones (diameter of common bile duct stone is 10–20 mm) and recurrence rate is low.
Objective To compare the subaxillary small incision thoracotomy (SSIT) with video-assisted thoracic surgery (VATS) for patients with lung cancer. Methods Retrospective analysis of 142 patients with lung cancer in Department of Thoracic Surgery, The First People's Hospital of Neijiang from January 2014 to April 2016 was conducted. There were 86 males and 56 females, aged 40-77 years. Patients were divided into a VATS group (n=72) and a SSIT group (n=70). The following postoperative data were evaluated: operation time, number of dissected lymph nodes, intraoperative bleeding, postoperative chest drainage volume, drainage duration, postoperative ambulation time, average hospital stay, postoperative complications, hospitalization cost, early postoperative incision pain (visual analogue scale, VAS) and other indicators. Results There were no statistically significant differences between the two groups in the operation time (120.8±20.4 minvs. 126.2±21.6 min,P=0.124), the dissected lymph node (11.1±2.0vs. 11.4±1.9,P=0.333) and the postoperative complications rate (13.9% vs. 15.7%, P=0.759). Laparoscopic intraoperative bleeding and postoperative drainage volume were significantly less in the VATS group than those in the SSIT group (123.2±26.9 mlvs. 156.4±24.0 ml,P<0.001; 227.0±75.5 mlvs. 334.3±89.1 ml,P<0.001). Postoperative drainage duration, postoperative ambulation time and hospital stay were shorter in the VATS group than those in the SSIT group (2.5±0.5 dvs. 3.1±0.6 d, 1.5±0.5 dvs. 2.2±0.6 d, 6.5±0.5 dvs. 7.4±0.6 d, allP<0.001). The average hospitalization cost of the VATS group was significantly higher than that of the SSIT group (42 338.9±8 855.7 yuanvs. 32 043.7±7 178.1 yuan,P<0.001). There was no significant difference in the operation cost and anesthesia cost between the two groups (P>0.05). The early postoperative pain of laparoscopic group was less, but the difference was not statistically significant (P>0.05). Conclusion The hospitalization cost of the SSIT is lower than that of thoracic surgery, which may be beneficial to the appilication in primary hospitals.
ObjectiveTo compare the clinical efficacy of small incision with traditional thoractomy for aortic valve replacement.MethodsWe retrospectively analyzed the clinical data of 78 patients with heart valve replacement in our hospital between May 2014 and June 2016. The patients were divided into a small incision group and an open chest group with 39 patients in each group. In the small incision group, 18 males and 21 females, aged 56.4±10.8 years, underwent cardiac surgery with a small incision. And in the open chest group, 17 males and 22 females, aged 57.1±9.7 years, underwent cardiac surgery by thoracotomy.ResultsThe extracorporeal circulation time, aortic cross clamping time of the small incision group were longer than those of the open chest group (P<0.05). But the amount of intraoperative blood transfusion and postoperative 24 h drainage volume of the small incision group were significantly less than those of the open chest group (P<0.05). Postoperative mechanical ventilation time, and postoperative hospitalization time of the small incision group were significantly shorter than those of the open chest group (P<0.05). Pain score of the small incision group was significantly lower than that of the open chest group significantly (P<0.05). There was no statistical difference in complications rate between the two groups after 6 months (P>0.05).ConclusionCompared with traditional open chest cardiac surgery, small incision cardiac surgery is effective and safe, and is worth popularizing in clinic.
ObjectiveTo investigate the value of small incision approach in the anterior surgery of thoracic and lumbar spinal tuberculosis.MethodsA clinical data of 65 patients with thoracic or lumbar spinal tuberculosis treated with posterior-anterior surgery between January 2015 and January 2018 was retrospectively analyzed. The patients were divided into small incision group (group A, 29 patients) and traditional incision group (group B, 36 patients) according to the length of anterior incision. There was no significant difference in general data such as gender, age, disease duration, segment of lesion, American Spinal Cord Injury Association (ASIA) grading, preoperative pain visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Cobb angle of spinal kyphosis between 2 groups (P>0.05). The length of anterior incision, operation time, intraoperative blood loss, postoperative complications, postoperative hospitalization time, ESR, and CRP were recorded and compared. The VAS score was used to evaluate the pain after operation. The Cobb angles in patients with spinal kyphosis were measured and the loss of angle and correction rate of angle were calculated. The result of bone graft fusion was assessed according to the Bridwell standard.ResultsThe length of anterior incision, operation time, intraoperative blood loss, and hospitalization time of group A were all significantly less than those of group B (P<0.05). All patients in both groups were followed up 12-29 months (mean, 20 months). There were 4 cases (13.8%) and 14 cases (38.9%) of postoperative complications in groups A and B respectively, showing significant difference (χ2=5.050, P=0.025). The ESR and CRP in 2 groups all returned to normal at 6 months after operation, and there was no significant difference in ESR and CRP between 2 groups at 3 months, 6 months, and last follow-up (P>0.05). At last follow-up, the neurological function of patient with neurological symptoms was significantly better than that before operation, and there was no significant difference between 2 groups (Z=0.167, P=0.868). The VAS scores of 2 groups at each time point after operation were significantly lower than those before operation (P<0.05); the VAS score in group A was significantly lower than that in group B (t=−2.317, P=0.024) at 1 day after operation, but there was no significant difference between 2 groups (t=−0.862, P=0.392) at last follow-up. Among the patients with kyphosis, the Cobb angle was significantly decreased at 1 day after operation and last follow-up when compared with preoperative angle (P<0.05); but there was no significant difference between 1 day after operation and last follow-up (P>0.05). There was no significant difference in Cobb angle, loss of angle, and correction rate between 2 groups after operation (P>0.05). The bone graft healed well at last follow-up in 2 groups. There was no significant difference in bone graft fusion rate between 2 groups at 6 months after operation, 1 year after operation, and last follow-up (P>0.05). At last follow-up, all patients cured, and no recurrence occurred.ConclusionIn the anterior surgery of thoracic and lumbar tuberculosis, the application of small incision approach can achieve the similar effectiveness as traditional incision surgery with the advantages of minimally invasive, less complications, and quick recovery.
ObjectiveTo investigate the safety, feasibility, and efficacy of full repair strategy under small incision in the treatment of closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture.MethodsThe clinical data of 57 patients with closed Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture treated by full repair strategy (fracture, ligament, and cartilage repair) under small incision between January 2012 and January 2017 were retrospectively analyzed. There were 31 males and 26 females, with an average age of 41.1 years (range, 21-65 years). The causes of injury included traffic accident injury in 33 cases and falling injury in 24 cases. All of them were closed fractures, including 20 cases of medial malleolus fracture, 37 cases of complete medial malleolus but deep and shallow rupture of deltoid ligament. The average time from injury to admission was 9.6 hours (range, 3-34 hours). The quality of reduction of distal tibial articular surface (based on Ketz-Sanders standard), the reduction of tibiofibular syndesmosis (the anterior and posterior distances of distal tibiofibular syndesmosis and the lateral ankle twist angle measured by CT scan at 10 mm above the ankle joint line), and the fracture healing were evaluated. The medial clear space (MCS), tibiofibular clear space (TFCS), and distal fibular tip to lateral process of talus (DFTL) were measured on the X-ray films of ankle points. Before and after operation, the pain and functional improvement of ankle joint were evaluated by visual analogue scale (VAS) score and American Orthopedic Foot and Ankle Association (AOFAS) score, and the activities of ankle dorsiflexion and plantar flexion were measured.ResultsThree cases with osteochondral lesions of the talus were found during operation and all were treated with microfracture techniques. Tournament paralysis occurred in 2 cases after anesthesia. The surgical incisions healed by first intention in all patients. All the 57 patients were followed up 24-84 months, with an average of 38.6 months. All patients achieved bone healing without bone nonunion and malunion at 12 months after operation. The reduction quality of distal tibial articular surface was excellent in 56 cases and good in 1 case at 3 months after operation, the excellent and good rate was 100%. There was no significant difference in the MCS, TFCS, DFTL, anterior distance of distal tibiofibular syndesmosis, posterior distance of distal tibiofibular syndesmosis, and lateral ankle twist angle between the affected and healthy sides at 12 months after operation (P>0.05). At last follow-up, the VAS score, AOFAS score, ankle dorsiflexion and plantar flexion activities of the affected side were significantly improved when compared with preoperative ones (P<0.05). Compared with the healthy side, there was no significant difference in ankle dorsiflexion and plantar flexion activities (P>0.05).ConclusionFull-repair strategy under small incisions for the treatment of Lauge-Hansen pronation-external rotation type Ⅳ ankle fracture is effective and safe. It can not only reduce wound complications, but also improve the quality of joint reduction of the ankle joint and distal tibiofibular syndesmosis. Full repair of ligaments and cartilage can improve the internal fixation strength and joint stability of the ankle joint.
ObjectiveTo investigate the perioperative results and safety of minimally invasive direct coronary artery bypass grafting (MIDCAB) treatment of anterior descending artery disease through a small left thoracic incision assisted by thoracoscopy. MethodsThe clinical data of 92 patients who received MIDCAB in our hospital from May 2014 to October 2018 were retrospectively analyzed, including 72 (78.26%) males aged 42-78 (61.2±7.48) years, and 20 (21.74%) females aged 30-80 (61.30±12.26) years. The perioperative complications, blood product use, left heart function changes, ventilator use time, ICU stay, hospital stay and other indicators were analyzed. ResultsTwo (2.17%) patients were transferred to thoracotomy, 5 (5.43%) patients received blood products during the operation, 2 (2.17%) were subjected to secondary thoracotomy to stop bleeding, 4 (4.34%) had postoperative hypoxemia and 1 (1.08%) was reintubated. The ventilator use time was 3-227 (22.35±35.39) hours, the ICU stay was 16-777 (78.85±108.62) hours, and the postoperative hospital stay was 2-36 (8.86±6.05) days. One (1.08%) patient died in hospital. ConclusionMIDCAB for anterior descending artery disease has good perioperative results, especially for solitary anterior descending artery disease, which can reduce the use of blood products, and shorten the time of ventilator use after operation, ICU stay and hospital stay.
Femtosecond laser small incision lenticule extraction (SMILE) with different residual stromal thicknesses (RST) is set to investigate its effect on corneal biomechanical properties of rabbits in vivo. In this study, 24 healthy adult Japanese rabbits were randomly divided into group A and B. The RST of group A was set 30% of the corneal central thickness (CCT), and the RST of group B was 50% of the CCT. The thickness of the corneal cap in both groups was set one third of CCT. Corneal visualization Scheimpflug technology (Corvis ST) and Pentacam three-dimensional anterior segment analyzer were used to determine corneal biomechanical and morphological parameters before surgery, and 1 week, 1 month and 3 months after surgery. Pearson correlation analysis was used to analyze factors affecting corneal biomechanical parameters after SMILE. The results showed that the corneal stiffness of group A was significantly higher than that of group B at 1 week and 1 month after surgery, and most biomechanical parameters returned to preoperative levels at 3 months postoperatively. The results of correlation analysis showed that postoperative CCT and RST were the main factors affecting corneal biomechanical parameters after SMILE. There was no significant difference in corneal posterior surface height (PE) between 3 months after surgery and before surgery in both two groups. It indicates that although the ability to resist deformation of cornea decreases in SMILE with thicker corneal cap and less RST, there is no tendency to keratoconus, which may be related to the preservation of more anterior stromal layer.
ObjectiveTo analyze the safety and effectiveness of minimally invasive small incision through the right third intercostal and standard aortic valve replacement.MethodsThe clinical data of 123 patients with the first simple aortic valve replacement in our hospital from June 2013 to May 2020 were retrospectively analyzed. The patients receiving aortic valve replacement through the right third intercostal small incision were allocated to a minimally invasive group, and patients receiving aortic valve replacement through the median sternal incision were allocated to a common group. The clinical outcomes of the two groups were compared.ResultsThere were 40 patients in the minimally invasive group, including 11 (27.5%) females and 29 (72.5%) males, aged 54.60±9.98 years with the body mass index (BMI) of 23.16±2.48 kg/m2. There were 83 patients in the common group, including 27 (32.5%) females, 56 (67.5%) males, aged 58.77±9.71 years, with the BMI of 24.13±3.13 kg/m2. Compared with the common group, the aortic cross-clamping time, cardiopulmonary bypass time, and operation time were longer (P<0.05), the ventilator support time was shorter (P<0.05), and the blood loss, postoperative 24 h chest drainage volume and total expense were less (P<0.05) in the minimally invasive group. The ICU stay, postoperative hospital stay, and total hospital stay were not statistically different between the two groups (P>0.05).ConclusionThe aortic valve replacement through the right third intercostal small incision is safe and effective, with less blood loss, 24 h chest drainage volume and invasiveness.
Objective To evaluate the effectiveness and feasibility of a transverse small incision intrathecal “loop” minimally invasive suture for acute Achilles tendon rupture. Methods The clinical data of 30 patients with acute Achilles tendon rupture treated with transverse small incision intrathecal “loop” minimally invasive suture between January 2022 and October 2023 was retrospectively analyzed. The patients were all male, aged from 29 to 51 years, with an average of 39.8 years. The cause of injury was acute sports injury, and the time from injury to operation was 1-14 days, with an average of 3.4 days. The operation time, incision length, intraoperative blood loss, intraoperative complications, wound healing, and hospital stay were recorded. Postoperative appearance and function of ankle were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Vancouver Scar Scale (VSS) score, and Arner-Lindholm score. Results The operation time ranged from 30 to 90 minutes, with an average of 54.2 minutes; the incision length ranged from 1.3 to 3.5 cm, with an average of 2.2 cm; the intraoperative blood loss ranged from 5 to 70 mL, with an average of 22.3 mL; and the hospital stay ranged from 2 to 6 days, with an average of 3.7 days. All incisions healed by first intention, and there was no incision infection, poor healing, and deep venous thrombosis. All patients were followed up 5.3-22.0 months (mean, 14.7 months). During the follow-up, all the 30 patients had returned to exercise, and there was no complication such as Achilles tendon re-rupture, postoperative infection, and gastrocnemius muscle injury. At last follow-up, the AOFAS ankle-hindfoot score was 82-100, with an average of 95.1; the VSS score was 1-4, with an average of 2.1; according to the Arner-Lindholm score, 24 cases were rated as excellent and 6 cases as good. Conclusion Transverse small incision intrathecal “loop” minimally invasive suture for the treatment of acute Achilles tendon rupture has the advantages of simple instrument, convenient operation, small trauma, quick recovery, and satisfactory effectiveness.