摘要:目的:探討床旁超聲檢查在肝移植術后下腔靜脈(IVC)并發癥診斷中的應用價值。方法:對424例肝移植術后患者進行床旁超聲檢查,對下腔靜脈并發癥,包括狹窄及栓塞的資料進行回顧性分析和總結。結果:床旁超聲檢查發現下腔靜脈并發癥患者18例,其中狹窄6例,栓塞12例。結論:床旁超聲檢查在肝移植術后,尤其是對術后早期發生的下腔靜脈并發癥的診斷及監測具有重要的作用,為臨床診斷和治療提供及時、有價值的影像學依據。Abstract: Objective: To evaluate the value of bedside ultrasound in diagnosis and monitoring of inferior vena cava (IVC) complications after liver transplantation. Methods: 424 cases with liver transplantation were examined by bedside ultrasound after the operations. The results of IVC complications,including thrombosis and stenosis, were analyzed and summarized. Results: 18 cases with IVC complications were detected by bedside ultrasound, including 6 cases of stenosis and 12 cases of thrombosis. Conclusion: Bedside ultrasound is important for diagnosing and monitoring IVC thrombosis and stenosis after liver transplantation, especially in the earlier period. It could provide valuable imaging for clinical diagnosis and treatment promptly.
ObjectivesTo systematically review the safety and effectiveness of uterine artery embolization (UAE), surgery and high intensity focused ultrasound (HIFU) in the treatment of uterine fibroids.MethodsPubMed, EMbase, The Cochrane Library, Web of Science, WanFang Data and CNKI databases were electronically searched to collect relevant studies on comparing the safety and effectiveness of UAE, surgery and HIFU in the treatment of uterine fibroids from January 2000 to August 2019. Two reviewers independently screened the literature, extracted the data and evaluated the risk of bias of included studies, network meta-analysis was performed by ADDIS 1.16.8 software and Stata 14.0 software.ResultsA total of 11 trials (22 references) involving 3469 patients were included. Compared with surgery, UAE and HIFU patients had higher quality of life (1-year follow-up) improvement, and UAE was higher than HIFU. Network meta-analysis showed that patients treated with HIFU had the lowest incidence of major complications within 1 year, followed by UAE, and surgery. Patients treated with HIFU and UAE had shorter hospitalization and quicker recovery time than surgery. The rate of further intervention after surgery treatment might be lower than that of UAE and HIFU.ConclusionsUAE has the highest quality of life improvement (1-year follow-up) for uterine fibroids. HIFU and UAE are safer with shorter hospital stays and quicker recovery time compared with surgery. However, both UAE and HIFU have the risk of re-treatment. However, limited by the number and quality of included studies, the above conclusions are needed to be verified by more high-quality studies.
ObjectiveTo systematically evaluate the efficiency and safety of interventional embolization versus laparoscopic surgery in the treatment of varicocele.
MethodsWe searched the Chinese Journal Full-text Database, Wanfang Medical Journal Database, and VIP Chinese Science and Technology Journal Full-text Database with such keywords as interventional therapy, embolization, laparoscope, and varicocele. For PubMed and Cochrane Library, MESH terms or keywords were interventional embolization, interventional therapy, embolization, laparoscope, laparoscopic surgery, and varicocele. All database were searched up to March 2015. Then we selected trials comparing interventional embolization versus laparoscopic surgery in the treatment of varicocele according to the including criteria. We assessed the quality of the included studies with the Newcastle-Ottawa Scale and conducted meta-analysis with revman 5.2 for the primary outcomes sperm improvement rate, recurrence rate, complication rate, pregnant rate, etc.
ResultsWe included 7 trials comparing interventional embolization with laparoscopic surgery, including 1 prospective study and 6 retrospective studies, with a total of 349 patients receiving interventional therapy and 400 patients receiving laparoscopic surgery. Meta analysis of the included studies showed that there were no significant differences for sperm improvement rate[OR=1.17, 95%CI (0.70, 1.96), P=0.54], pregnant rate[OR=0.58, 95%CI (0.29, 1.13), P=0.11], recurrence rate[OR=0.84, 95CI% (0.40, 1.78), P=0.66] or complication rate[OR=0.68, 95%CI (0.34, 1.32), P=0.25] between the two groups.
ConclusionPresent evidence shows that there is no significant difference between interventional embolization and laparoscopic surgery for varicocele.
ObjectiveTo summarize the treatment measures and experience for one patient with acute pulmonary thromboembolism after modified radical mastectomy for breast cancer. MethodsThe discussion on MDT (multi-disciplinary team) of a breast cancer patient admitted to The First Hospital of Lanzhou University in March 2018 and the results of the discussion on acute pulmonary thromboembolism after operation were summarized. ResultsThis patient had many high risk factors for deep venous thrombosis of the lower extremities, such as obesity, advanced age, hypertension, malignant tumor, and surgical stress. The operative time was about 90 min and the blood loss was 30 mL, without nerve and vascular injuries. Acute pulmonary thromboembolism occurred suddenly on 10 days after operation, which led to heart failure. Eventually, the patient died of the peripheral circulatory insufficiency caused by respiratory failure and heart failure. ConclusionSurgeons should pay great attention to the perioperative management of the patients with many high-risk factors, who may occur acute pulmonary thromboembolism caused by deep venous thrombosis of lower limbs after radical mastectomy.
To discuss the effect of dexamethasone in preventing fat embol ism syndrome (FES) in cemented hi p arthroplasty patients. Methods Forty patients scheduled for unilateral cemented hi p arthroplasty between January 2008 and December 2009 were randomly divided into trial group (n=20) and control group (n=20). In trial group, there were 6 males and 14 females with an average age of 73.2 years (range, 54-95 years), including 4 cases of osteoarthritis, 3 cases ofavascular necrosis of femoral head, and 13 cases of femoral neck fracture; the disease duration was 4 days to 6 years (median, 0.8 year). In control group, there were 10 males and 10 females with an average age of 71.9 years (range, 59-91 years), including 2 cases of osteoarthritis, 3 cases of avascular necrosis of femoral head, and 15 cases of femoral neck fracture; the disease duration was 3 days to 5 years (median, 0.6 year). There was no significant difference in gender, age, or disease duration (P gt; 0.05) between 2 groups. Cemented total or bipolar hip arthroplasty (with the same brand of cement and prosthesis) in 2 groups were performed by a group of surgeons. The patients were given intravenously injected with dexamethasone (20 mg) in trial group before 1 hour of cement injection and intravenously injected with normal sal ine (2 mL) in control group. Amount of 5 mL vein blood were withdrawn before surgery, after 4, 8, and 24 hours of cement injection to test the number and average diameter of fat droplets. According to Gurd diagnosis standard, related FES symptoms and signs were inspected. Results Primary heal ing of incision was achieved in all cases of 2 groups. According to Gurd standard of diagnosis, no FES occurred in each group at 2 weeks postoperatively; deep venous thrombosis occurred in 2 cases (10%) of trial group and in 5 cases (25%) of control group, showing significant difference (P lt; 0.05). The number and diameter of fat droplets in trial group were significantly lower than those in control group at 4, 8, and 24 hours of cement injection (P lt; 0.01). All cases were followed up 7.4 months on average (range, 3-13 months). The postoperative Harris score was 89.5 ± 6.1 in trial group and 87.9 ± 8.3 in control group, showing no significant difference (P gt; 0.05). No loosening occurred during follow-up period. Conclusion Intravenous injection withdexamethasone can effectively reduce the number and diameter of venous fat droplets in cemented hip arthroplasty, which can decrease the risk of postoperative FES.
