The islet transplantation site can be divided into two categories: orthotopic islet transplantation and ectopic islet transplantation. Orthotopic islet transplantation refers to that the insulin secreted and released from the transplanted islet will be metabolized into the liver through the hepatic portal vein system, which does not change the original insulin metabolic pathway, including the portal vein of the liver, the greater omentum. The insulin secreted by the ectopic islet transplantation changes the original metabolic pathway of insulin. The ideal islet transplantation site generally has the following characteristics: high success rate transplantation, high long-term survival rate of graft, simple operation, less trauma, less complications, low risk, easy to repeat detection and so on. This article provides a review of the current research status of each islet transplantation site, in order to provide reference for future related research.
ObjectiveTo systematically review the effect of perioperative supplemental oxygen administration on surgical site infection (SSI) in patients underwent abdominal surgery with general anesthesia.
MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 2,2015), CBM, VIP, WanFang Data and CNKI were searched to collect randomized controlled trials (RCTs) about perioperative supplemental oxygen administration versus normal FiO2 in patients underwent abdominal surgery with general anesthesia from inception to March, 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was conducted using RevMan 5.3 software.
ResultsA total of 13 RCTs involving 3 532 patients were included. The results of meta-analysis indicated that: the incidence of SSI in the perioperative supplemental oxygen administration group was lower than that in the control group (OR=0.68, 95%CI 0.47 to 0.99, P=0.04). There were no significiant differences between both groups in incidence of atelectasis, incidence of infection requiring reoperation and 30-day mortality after surgery (all P values >0.05).
ConclusionPerioperative supplemental oxygen administration could further decrease the risk of SSI in patients underwent abdominal surgery with general anesthesia, and does not increase the risk of other adverse events. Due to the limitations of quality of included studies, more high quality studies are needed to verify the above conclusions.
Laparoscopic hepatectomy is routinely used in the surgical treatment of hepatocellular carcinoma, and has formed a standardized operating procedure. Tumors located in the segments Ⅶ and Ⅷ of liver as well as the paracaval subsegment of caudate lobe are considered to be difficult sites for laparoscopic hepatectomy due to the deep anatomical location, proximity to important vascular structures, difficulty in exposing the visual field under laparoscopy, and limited operating space. Based on the experience of our team and related research reports, the authors analyzed and summarized countermeasures for the difficulties of laparoscopic hepatectomy in the treatment of hepatocellular carcinoma in difficult sites. Adhering to the tumor-centered and margin-based principles, accurate preoperative assessment, selection of the correct surgical approach, designing liver resection plane guided by hepatic vena while taking into account portal vein territory, and giving preference to ananatomical hepatectomy while preserving functional liver parenchyma as much as possible are the prerequisites for ensuring minimally invasive and oncology benefits for patients with hepatocellular carcinoma in difficult sites.
ObjectiveTo explore the risk factors and bleeding points associated with postoperative hemorrhage after thyroidectomy and provide clinical basis for prevention of postoperative bleeding.MethodsThe clinical data of 21 patients with postoperative hemorrhage and 63 patients without postoperative hemorrhage who underwent thyroidectomy from Nov. 2010 to Nov. 2017 in West China Hospital were retrospectively analyzed.ResultsUnivariate analysis showed that hypertension, maximum tumour dimension, lymph node metastasis, recurrent laryngeal nerval infiltration, T stage, N stage, serum triglyceride, and serum high density lipoprotein were significantly associated with postoperative hemorrhage (P<0.05). Multivariate analysis showed that lymph node metastasis (OR=16.219, P=0.002) and low serum high density lipoprotein (OR=0.035, P=0.006) were risk factors for postoperative hemorrhage. Among the patients with postoperative bleeding, the most common five bleeding sites were: ribbon muscle and sternocleidomastoid muscle (both was 19.2%), esophageal tracheal surface blood vessels (11.5%), thyroid bed (7.7%), and larynx recurrent paravascular small vessels (7.7%).ConclusionsLymph node metastasis and serum HDL are independent risk factors of hemorrhage after thyroidectomy. The predilection site for postoperative bleeding is mainly the neck muscle.
Objective To analyze the trend of standardized infection ratio (SIR) of surgical site infection (SSI) in small bowel surgery, objectively evaluate the effect of infection control, and provide evidence-based strategies for SSI prevention. Methods According to Centers for Disease Control and Prevention (CDC) / National Healthcare Safety Network (NHSN) surveillance definitions for specific types of infections and the monitoring methods of SSI events published by NHSN, the SSI and related risk factors of adult inpatients undergoing small bowel surgery in Yichang Central People’s Hospital between January 1, 2016 and December 31, 2022 were prospectively monitored. The inpatients undergoing small bowel surgery that meets the definition of International Classification of Diseases, 10th Revision Clinical Modifications/Procedure Coding System (ICD-10-CM/PCS), a multivariate binary logistic regression model was used to calculate the predicted infections in each year, the model included the risk factors for small bowel surgery in NHSN Complex Admission/Readmission (A/R) SSI Model with 7 years of surveillance data as the baseline. The SIR was calculated by dividing the number of observed SSI by the number of predicted SSI in each year. The Mid-P method was used to test the difference of SIR compared to the previous year, and the linear regression model was used to analyze the trend of SIR. Results A total of 2 436 patients were included, with 48 cases of deep incision infection and 49 cases of organ/cavity infection, and the overall incidence rate of infection was 4.0%. From 2016 to 2022, there were 151, 244, 222, 260, 320, 408, and 831 patients who underwent small bowel surgery, respectively. The Mid-P test showed that there was a significant difference in SIR from 2016 to 2019 (P<0.05), and there was an increase in 2018 compared with 2017. There was no significant difference in SIR compared to the previous year from 2019 to 2022 (P>0.05), and there was no significant difference in the trend of SIR of SSI (P=0.065). Conclusions From January 1, 2017, to December 31, 2022, advances have been made in SSI control practices of small bowel surgery in six consecutive years, except for 2018, but there was no annual downward trend from 2020 to 2022. The use of SIR provides a new approach for evaluating the quality of infection control.
【摘要】 目的 探討子宮部位異位妊娠的臨床特征和處理對策。 方法 回顧分析2002年9月-2009年9月間收治的31例子宮部位異位妊娠患者的臨床資料。 結果 31例患者中，初診確診僅8例，誤診率74.2%。除5例因難以控制的大出血行經腹病灶清除術加子宮修補術或全子宮切除術外，其余26例患者均經氨甲喋呤（MTX）治療加清宮術或宮腔鏡下病灶清除術保守治療成功。 結論 子宮部位異位妊娠容易誤診，超聲檢查是診斷的主要方法。保守治療安全、有效，可保留生育能力。氨甲喋呤治療加清宮術可作為治療子宮部位異位妊娠的主要方法。【Abstract】 Objective To investigate the clinical characteristics and treatment of ectopic pregnancy in the uterus. Methods The clinical data of 31 patients diagnosed as ectopic pregnancy from September 2002 to September 2009 were analyzed retrospectively. Results During preliminary diagnosis, only eight patients were accurately diagnosed.The error rate of first diagnosis was 74.2%. Five patients suffered focal cleaning and uterus neoplasty or total hysterectomy due to uncontrollable bleeding.The other 26 patients were successfully cured by conservation treatment of methotrexate (MTX) combined with dilatation and curettage or clearance of focal lesion under hysteroscopy. Conclusion Misdiagnosis of ectopic pregnancy in the uterus is easy to make.The ultrasonography is the main method for the diagnosis of ectopic pregnancy in the uterus.Conservative treatment is proved to be safe and effective and can preserve the patients’ fertility. Administration of MTX combined with dilatation and curettage is an main therapeutic method in handling ectopic pregnancy in the uterus.
