ObjectiveTo evaluate clinical efficacy of the modified Sugiura procedure with cardia transection in treatment of recurrent portal hypertension with upper gastrointestinal bleeding.
MethodsFrom January 2007 to January 2015, there were 28 cases of recurrent portal hypertension with upper gastrointestinal bleeding were treated by the modified Sugiura procedure with cardia transection in The Second People's Hospital of Yichang and The Zigui County People's Hospital, collecting the clinical data of them and then summarizing the therapeutic effect.
ResultsAll cases underwent surgery successfully with no operative death. The operative time was 120-300 minutes with an average of 160 minutes. About surgical blood loss was 100-500 mL, with an average of 210 mL. Two cases suffered from postoperative gastrointestinal bleeding, 6 cases suffered from postoperative gastric dysfunction, and no one suffered from anastomotic leakage, anastomotic stenosis, and portal vein thrombosis. Three cases died in reason of liver failure and hepatic coma. There were 24 cases were followed up for 6-60 months, with the median of 33 months. No recurrence of gastrointestinal bleeding happened during the follow-up period. Sixteen cases underwent gastroscopy in 6 months after surgery, according to the results, the clinical effect was fine. For grade of varicose veinsm, there were 14 cases of grade GⅠ and 2 cases of grade GⅡ. For shape of varicose veins, there were 11 cases of grade F1 and 5 cases of grade F2.
ConclusionThe modified Sugiura procedure with cardia transection is a safe and thorough operation for recurrent portal hypertension with bleeding.
ObjectiveTo compare clinical efficacy of totally laparoscopic gastrectomy (TLG) and conventional laparoscopy-assisted gastrectomy (LAG) and to explore safety and feasibility of total laparoscopic anastomosis in laparoscopic gastrectomy.
MethodThe clinical data of 64 patients who received TLG and another 70 patients who received conventional LAG in our department from January 2013 to March 2014 were retrospectively analyzed.
ResultsAll procedures were completed successfully. There were no significant differences in the time of anastomosis〔(73.8±10.3) min versus (72.7±8.9) min, t=0.693, P=0.489〕 and the number of dissected lymph nodes (32.4±9.7 versus 33.6±9.6, t=-0.700, P=0.485) between the patients underwent TLG and the patients underwent LAG. However there were obvious differences in the blood loss〔(275.0±66.3) mL versus (364.3±75.7) mL, t=-7.419, P=0.000〕, the incision length〔(3.0±0.8) cm versus (7.3±1.7) cm, t=-19.354, P=0.000〕, the time to fluid diet〔(4.9±0.8) d versus (6.0±0.7) d, t=-8.750, P=0.000〕 and the time to flatus 〔(2.8±0.8) d versus (3.9±0.8) d, t=-8.388, P=0.000〕, the off-bed time〔(1.3±0.5) d versus (3.4±1.2) d, t=-14.118, P=0.000〕, and the hospital stay〔(9.8±1.2) d versus (13.0±1.5) d, t=-17.471, P=0.000〕 between the patients underwent TLG and the patients underwent LAG. Meanwhile it was found that the postoperative pain score〔On day 1 postoperatively: (3.4±0.8) points versus (6.2±1.3) points, t=-15.509, P=0.000; on day 3 postoperatively: (1.7±0.6) points versus (4.0±0.8) points, t=-18.799, P=0.000〕 and the dosage of pain killers (1.7±0.7 versus 4.0±2.1, t=-8.912, P=0.000) in the patients underwent TLG were significantly lower than those in the patients underwent LAG. One patient developed anastomotic leakage and 3 patients developed anastomotic stenosis in the patients underwent LAG, the complication rate related to the anastomosis was 5.7% (4/70). While there were no complications related to the anastomosis in including anastomotic leakage, stenosis, and bleeding in the patients underwent TLG.
ConclusionsTotal laparoscopic anastomosis is safe and feasible in laparoscopic gastrectomy for gastric cancer. Compared with small incision-assisted anastomosis, totally laparoscopic anastomosis is associated with minimal trauma, less blood, quicker postoperative recovery, shorter time, slighter pain and satisfactory short-term efficacy.
ObjectiveTo observe and study the clinical effect of glucosamine in the treatment of patients with knee articular cartilage injury caused by rheumatoid arthritis.
MethodsForty-six patients with knee articular cartilage injury caused by rheumatoid arthritis treated from January 2013 to June 2015 were selected as the research subjects, and they were randomly divided into control group (conventional treatment group, n=23) and observation group (conventional and glucosamine treatment group, n=23) . Then the Noyes classification and serum articular cartilage injury related indexes [cartilage oligomeric matrix protein (COMP), matrix metalloproteinase (MMP)-1, MMP-3 and mouse tissue inhibitors of metalloproteinase (TIMP)-1], inflammatory indexes [tumor necrosis factor (TNF)-α, interleukin (IL)- 17 and IL-33] of the two groups before and after treatment were compared.
ResultsIn the observation group, after treatment for 4, 8 and 12 weeks, Noyes grade was better than that in the control group, but with no statistical significance (P ＞ 0.05) . In the observation group, after treatment for 4, 8 and 12 weeks, serum inflammatory markers serum COMP, MMP-1, MMP-3 and TIMP-1 and other related indicators of cartilage damage and serum TNF-α, IL-17 and IL-33 were all significantly lower than those in the control group (P ＜ 0.05) .
ConclusionIn the treatment of patients with knee articular cartilage injury caused by rheumatoid arthritis, glucosamine has active role for the improvement of articular cartilage injury and inflammatory stress state of patients.
ObjectiveTo explore the clinical effect of keeping the pancreatic capsule in radical gastrectomy for early stage of gastric cancer.
MethodsTwo hundreds and seven patients with early stage of gastric cancer who were treated in our hospital from Jan 2011 to December 2011 were enrolled prospectively, and were divided into experimental group (n=95) and control group (n=112). Patients in experimental group kept the pancreatic capsule in radical gastrec-tomy, but patients in control group didn't keep the pancreatic capsule. Comparison of the clinical effect between the 2 groups was performed.
ResultsThe blood loss[(134.1±5.3) mL vs. (150.3±3.7) mL] and operation time[(76.4±5.7) min vs. (87.5±9.1) min]of experimental group were all lower or shorter than those of control group (P<0.05), but there were no significant difference between the 2 groups in incidence of total complication[7.37% (7/95) vs. 10.71% (12/112)], stomal leak[3.16% (3/95) vs. 4.46% (5/112)], and anastomotic stenosis[4.21% (4/95) vs. 6.25% (7/112)], P>0.05. All of the 207 patients were followed-up for 1-36 months, with the median time of 17.5 months. During the follow-up period, in experimental group, there were 30 patients suffered from recurrence, 23 patients suffered from metastasis, and 44 patients died, and the 1-and 3-year survival rates was 84.21% (80/95) and 53.68% (51/95) respectively, 1- and 3-year disease free survival rates was 80.00% (76/95) and 48.42% (46/95) respectively; in control group, there were 37 patients suffered from recurrence, 23 patients suffered from metastasis, and 49 patients died, and the 1-and 3-year survival rates was 85.71% (96/112) and 56.25% (63/112) respectively, 1-and 3-year disease free survival rates was 81.25% (91/112) and 49.11% (55/112) respectively. There were no significant difference in the 1-and 3-year survival rate, 1-and 3-year disease free survival rate (P>0.05). In addition, there were no significant difference in the survival and disease free survival situation (P>0.05).
ConclusionsSurvival and disease free survival situation of keeping the pancreatic capsule in radical gastrectomy is similar with traditionally radical gastrectomy, but surgery of keeping the pancreatic capsule in radical gastrectomy has the advantages of less bleeding and shorter operation time, which is worthy of further study.
Objective To discuss shortterm effect of rotating hinge knee prosthesis. Methods From July 2002 to April 2005, 17 cases of severe knee joint deformity and instability received rotating hinge knee prosthesis for total knee arthroplasty. There were 8 males and 9 females, aging from 41 to 79 years. The left joints were involved in 10 cases and right joint in 7 cases. All patients were admitted because of pain. The course of disease was from 1 to 7 years. There were 10 cases of osteoarthritis，5 cases of rheumatoid arthritis，1 case of traumatic arthritis after operation of left femur fracture，and 1 case of traumatic arthritis with injury of anterior cruciate ligament, meniscus medialis and medial collateral ligament after operation of left fracture of tibial plateau. According to HSS(hospital for special surgery) scoring system，the preoperative score was 36 to 58 with an average of 48.6. The preoperative flexed motion range of articulation was 21° to 80° with an average of 57.4°. Results All patients were followed up from 7 months to 3 years with an average of 23.6 months. There were no complications of thrombogenesis of veins of lower extremity, pulmonary embolism, palsy of peroneal nerve, fracture, and breakage of extended knee structure. Infection occurred in 1 case at 3 months postoperatively，the prosthesis was dislodged，antibiotic-impregnated cement was filed with knee joint，twostage arthroplasty was expected. At the last follow-up,the HSS score was 78 to 98 with an average of 91.1 in 16 patients. The flexed motion range of articulation was 75° to 100° with an average of 852° at 2 weeks postoperatively. The flexed motionrange of articular was 85° to 123° with an average of 1083° at the last followup. There were significant differences in HSS score and motion range of articular between preoperation and thelast follow-up (P＜0.05). Conclusion The short-term outcome of rotating hinge knee prosthesis is good and a long term followup is necessary.
ObjectiveTo conduct a Meta-analysis to determine the clinical effect of protocol biopsy (PB)-monitored therapy after renal transplantation.MethodsPubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Standards Database and VIP Database for Chinese Technical Periodicals were searched for trials comparing the efficacy of timely intervention under PB surveillance with the conventional treatment. The quality of included studies was assessed and Meta-analysis was conducted by RevMan 5.3 software.ResultsSix randomized controlled trials met our inclusion criteria, including 698 cases. No significant difference was found between the PB group and the control group in 1-year [relative risk (RR)=0.99, 95% confidence interval (CI) (0.97, 1.01), P=0.39] and 2-year recipient survival rate [RR=1.00, 95%CI (0.97, 1.02), P=0.72]. Graft survival rate after 1 year [RR=1.01, 95%CI (0.99, 1.04), P=0.29] and 2 years [RR=1.02, 95%CI (0.99, 1.06), P=0.19] were also statistically similar. No statistical difference was found in glomerular filtration rate between the two groups [mean difference (MD)=0.45 mL/(min·1.73 m2), 95%CI (–3.77, 4.67) mL/(min·1.73 m2), P=0.83]. Renal function of PB group, monitored by serum creatinine, was superior to the control group [MD=–0.46 mg/dL, 95%CI (–0.63, –0.29) mg/dL, P<0.000 01]. No statistical difference was found in infection between the two groups [RR=1.23, 95%CI (0.69, 2.19), P=0.48].ConclusionsOur study did not suggest PB for every kidney transplantation recipient. However, long-term randomized controlled trials with larger sample size would be necessary to determine whether PB was effective for specific populations.
ObjectiveTo explore the effect of comprehensive nursing service in patients with autoimmune encephalitis (AE).Methods32 patients with AE were selected and treated in our hospital from January 2017 to January 2019. There are 16 patients in the observation group and the control group respectively. The observation group received comprehensive nursing service and the control group received routine nursing intervention. Total satisfaction of clinical nursing was compared between the two groups.ResultsCompared with 10 cases (62.50%) in the control group, 15 cases (93.75%) in the observation group had better overall nursing satisfaction, and the difference between the two groups was significant (P<0.05).ConclusionsFor patients with AE, comprehensive nursing service can significantly improve the quality of life of patients, which has clinical application value.
Objective To analyze the outcomes and complications after total knee replacement(TKR) with posterior stabilized prosthesis(PS) and to investigate the influencing factors relating to outcomes. Methods From January 1998 to August2004, 60 cases (74 knees) of osteoarthritis underwent TKR with PS. The outcomeswere evaluated according to the HSS(hospital for special surgery) scoring. The difference in outcomes between patients with post-operative complications and without complications were compared. Pearson correlation was used to analyze post-operative outcomes and the pre-operative factors relating to patients. Results All 74 knees werefollowed up 42.5months(24 to 94 months). The scores for HSS, pain, function, ROM muscle strength, flexion deformity and stability of knees after operation were 84.2±14.2, 25.7±6.9, 17.9±4.3,13.1±2.0，9.2±0.8，8.1±0.4 and 9.3±0.1 respectively. They were improved to some extents, especially pain alleviation was remarkable. The excellent and good rate for outcome assessment was 90.5%. Among 74 knees, 10 cases suffered from postoperative complications, including 1 case of common peroneal nerve paralysis, two cases of wound faulty union, one case of wound infection, one case of joint infection, one case of stiff knee, two cases of deep vein thrombosis and 2 cases of patellofemoral joint complications. The excellent and good rate of outcome in patients with complications(60%) was much lower than that in patients without complication(95.3％),and there was significant difference betweenthem (P＜0.05). Analysis for correlation showed that postoperative HSS score was positively correlative with the postoperative HSS score, pain and function score of knees. The correlation value was 0.523，0.431 and 0.418 respectively(Plt;0.01). Whereas, postoperative HSS score was not correlative with ROM, muscle strength, flexion deformity, stability of knee, age, weight andbody mass index(P＞0.05). Conclusion TKR with PS is an effective method for severe osteoarthritis. The outcomes after TKR have a positive correlation with the HSS score, pain and function score of knees before surgery. Complicationsassociating with surgery have a negative influence on outcomes.
ObjectiveTo analyze the choice of initial antibiotic treatment for health care-associated pneumonia (HCAP).
MethodA retrospective study was conducted in patients with HCAP hospitalized in the Emergency Department of West China Hospital from January 1st to December 31st, 2014. A total of 156 HCAP patients were divided into anti-multidrug-resistant treatment group (group A, n=72) and quinolone monotherapy group (group B, n=84). The baseline characteristics, comorbidities, severity, pathogen distribution, antibiotics and clinical outcomes were compared between the two groups.
ResultsIn group B, there were 46 males and 38 females with the age of (59.9±10.9) years, and the pneumonia severity index (PSI) score was 89.5±22.7; in group A, there were 44 males and 28 females with the age of (62.2±12.2) years, and the PSI score was 94.4±23.6. The differeces between the two groups were not significant (P>0.05). The duration of using antibiotics in group B was (14.5±3.7) days, which was longer than that in group A[(12.8±3.8) days, P=0.005]. The detection rate of multidrug-resistant bacteria, the proportion of changing antibiotics, the average length of hospitalization, the proportion of using mechanical ventilation, the proportion of patients transferred into Intensive Care Unit and 30 days mortality in group B was 17.9%, 34.5%, (16.9±3.6) days, 11.9%, 9.5%, and 4.8%, respectively; which were similar to those in group A[15.3%, 22.2%, (17.3±3.9) days, 16.8%, 12.5%, and 4.2%, respectively] (P>0.05).
ConclusionsIt is unnecessary for all HCAP patients to receive anti-multidrug-resistant treatment. We should regard the risk factors and the popular local features of microbiology to determine the choice of antibiotic treatment.
ObjectiveTo explore the clinical effect and safety of laparoscopic cytoreductive surgery combined with gestrinone in the treatment of adenomyosis.
MethodsWe retrospectively analyzed the clinical data of 82 patients with adenomyosis who accepted treatment in our hospital from January 2008 to April 2011. According to different treatment method, the patients were divided into three groups. Twenty-seven patients in the treatment group underwent laparoscopic cytoreductive surgery combined with postoperative treatment with gestrinone. For the 25 patients in the surgery group, only laparoscopic cytoreductive surgery was performed, and 30 other patients who only received oral gestrinone were designated as the medicine group. Dysmenorrhea, menstrual volume, uterine size, serum carcinoembryonic antigen 125 (CA125), anemia, and drug side effects were respectively recorded before and after surgery.
ResultsThe dysmenorrhea degree reduced significantly in all the three groups. There was no significant difference in the degree of dysmenorrhea, menstrual volume, and uterine volume between the treatment group and the surgery group (P>0.05); the dysmenorrhea degree was significantly different between the treatment group and the medicine group (P<0.05); the differences in hemoglobin levels and the serum CA125 level between the treatment group and the surgery group 12 months later were significant (P=0.019, P=0.049).
ConclusionThe laparoscopic cytoreductive surgery combined with gestrinone in treating adenomyosis can improve recent curative effect and provide more effective symptom control compared with surgery alone.
