ObjectiveTo analyze risk factors of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery.
MethodData were collected retrospectively for consecutive patients undergoing defunctioning ileostomy following sphincter preservation surgery for rectal cancer, from January 2014 to December 2014.
ResultsOne hundred and thirty patients were included (median time to reversal 132 d, range 39-692 d), of whom 35 patients (26.92%) had postoperative complications after stoma reversal. The main complications included 23 cases of diarrhea, 6 cases of bowel obstruction, 9 cases of incision infection, and 4 cases of perianal eczema. The results of univariate analysis showed that the distant of tumor from anal verge <5 cm (P=0.010), postoperative adjuvant chemotherapy (P=0.002), and time to reversal (P=0.025) were related to the postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. The result of multivariate analysis by using a logistic regression model showed that the time to reversal (OR=1.006, P=0.021) was a significant independent risk factor for it.
ConclusionDelay reversal of defunctiong ileostomy might increase risk of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery.
Objective To summarize the application of different types of perineal and vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body for patients with primary or recurrent advanced rectal cancer with distal vagina or perineal body invasion， and to review the advantages and shortages and the application range of common reconstructive surgical procedures. Method The clinical data of 10 rectal cancer patients underwent extended surgery with distal vagina and perineal body resection accompanied with or without hysterectomy from October 2009 to September 2013 were summarized. Results There was no perioperative mortality. Omental flaps were used for obliteration of pelvic defect in 4 patients. The uterus was pushed backward to fill the pelvic defect after severing the round ligament in 2 patients. A reversed pedicled sigmoid flap was employed for reconstruction of the vagina in 2 patients. The reversed flap of anterior vaginal wall was used for vaginal and perineal reconstruction in 3 patients. Three cases had postoperative complications， in which included 1 patient with pelvic sepsis who underwent reoperation for drainage， 2 patients with perineal wound infection. All other patients had an uneventful healing postoperatively. Conclusions Some types of one-stage pelvic and perineal-vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body could produce an expedited wound healing with acceptable morbidity. Despite the well documented pedicled musculocutaneous flap for reconstruction， omental flap， pedicled sigmoid flap， overturn of anterior vaginal wall for reconstruction and pushing-back of the uterus for filling pelvic cavity might also result in reduced pelvic and perineal associated complications. Pedicled musculocutaneous flap is better reserved for huge pelvic and perineal defect and should be recommended among Chinese surgeons.
Objective
To analyze the pathogeny of vitreous re-hemorrhage in proliferative diabetic retinopathy (PDR)
after vitrectomy, and to evaluate the treatment effects.
Methods
The clinical data of 315 eyes of 302 patients with PDR who had undergone vitrectomy were retrospectively analyzed. Thirty-two eyes with vitreous re-hemorrhage after the treatment had undergone vitrectomy again. The follow-up duration was 3-48 months (average 12 months).
Results
The occurrence of vitreous hemorrhage after vitrectomy was 10%. The reasons included fibrovascular ingrowth at the sclera incision (28%), residual neovascularization membrane or inappropriately treated vascular stump on the surface of optic nerve (19%), insufficient photocoagulation on retina (22%), residual epiretinal neovascularization membrane (9%), retinal vein occlusion (6%), and ocular trauma (16%). Re-hemorrhage occurred 1-210 days (average 51 days) after vitrectomy. The patients with re-hemorrhage underwent cryotherapy for fibrovascular at the incision site, removal of residual neovascularization membrane on the optic nerve and retina, electrocoagulation of the vascular stump, complementary retinal photocoagulation and binding up of two eyes. After the re-treatment, the visual acuity increased in 91% and decreased in 9%. The postoperative complications mainly included vitreous re-hemorrhage, posterior synechia of the iris, lens sclerosis, and delayed healing of corneal epithelium.
Conclusion
The main reasons of vitreous re-hemorrhage after vitrectomy in patients with PDR include fibrovascular ingrowth at sclera incision, residual neovascularization membrane or inappropriately treated vascular stump on the surface of optic nerve, insufficient photocoagulation on retina, residual epiretinal neovascularization membrane, retinal vein occlusion, and ocular trauma. The efficient methods in preventing and treating re-hemorrhage after vitrectomy are appropriate management of insection sites, completely removal of residual neovascularization membrane on the optic nerve and retina, electrocoagulation of the vessel stump and sufficient retinal photocoagulation.
(Chin J Ocul Fundus Dis,238-240)
ObjectiveTo analyze the related risk factors of influencing on postoperative severe complications (PSC) in elderly patients with gastric cancer. MethodsAltogether 202 cases of elderly patients with gastric cancer who received surgical treatment between January 2003 and December 2008 in this hospital were analyzed. On the basis of the degree of complications, the patients were divided into the group with PSC and the group without PSC. The relevant clinical and laboratory data were evaluated, and compared with statistical analysis. ResultsClinically the preoperative comorbidity, total gastrectomy, more than 800 ml intraoperative blood loss, intraoperative transfusion, and combined organ resection were significantly correlated with PSC (Plt;0.05). In laboratory data, the lower preoperative serum albumin and the blood glucose level on the first day after operation were significantly correlated with PSC (Plt;0.05). ConclusionThe preoperative comorbidity, lower serum albumin, and extended radical resection are the danger factors leading to PSC.
ObjectiveTo systematically evaluate the influence of posterior mediastinal and retrosternal route on the incidence of complications in patients with esophageal carcinoma after esophagectomy.
MethodsA systematic literature search for studies which were published on PubMed, EMbase, CBM, VIP was performed from database establishment to April 2014. We included randomized controlled trials and case control studies related to the influence of two routes on the incidence of complications of patients with esophagectomy. We assessed the methodology quality of included researches, and extracted data. RevMan 5.2 was used for meta-analysis.
ResultsA total of 23 studies including 7 randomized controlled trials and 16 case control studies were included in this study. Meta-analysis showed that there was statistically significant difference in case control studies related to anastomotic leakage between two groups[OR=0.39, 95%CI (0.30, 0.50), P < 0.01]. However, no statistical difference in anastomotic stricture was observed between the two groups[randomized controlled trials:RR=0.80, 95%CI (0.49, 1.30), P=0.36; case control studies:OR=0.64, 95%CI (0.40, 1.03), P=0.07]. And there was no statistical difference in cardiac complications[randomized controlled trials:RR=0.70, 95%CI (0.46, 1.06), P=0.09; case control studies:OR=1.13, 95%CI (0.70, 1.81), P=0.62]. There was also no statistical difference in pulmonary complications[randomized controlled trials:RR=1.27, 95%CI(0.92, 1.75), P=0.14; case control studies:OR=0.91, 95%CI (0.66, 1.27), P=0.59]. Besides, there was also no statistical difference in postoperative mortality[randomized controlled trials:RR=0.47, 95%CI (0.19, 1.16), P=0.10; case control studies:OR=0.18, 95%CI (0.03, 1.01), P=0.05].
ConclusionFor patients with esophageal carcinoma undergoing esophagectomy and reconstruction, the incidence of anastomotic leakage was significantly lower with posterior mediastinal route than that of retrosternal route.
【 Abstract 】 Objective To investigate the features and risk factors of bacterial infection after orthotopic liver transplantation (OLT) and summarize the experiences for prevention and treatment of infection. Methods The clinical materials of 79 patients underwent OLT from December 2004 to January 2007 were reviewed. The incidence and sites of postoperative bacterial infections as well as species of bacteria and the situation of drug resistance were retrospectively analyzed. Results Thirty-two (40.5%) out of 79 patients developed bacterial infections. Infection mainly occurred in lung, abdominal cavity and blood, which were mainly caused by Escherichia coli, staphylococcus aureus, klebsiella pneumoniae, staphylococcus epidermidis and enterococcus bacteria. The main risk factors included delayed restoration of gastrointestinal function (gt;5 d), poorly preoperative liver function (Child C grade), hypoproteinemia and persistent postoperative hyperglycemia (gt;11.0 mmol/L). Perioperative decontamination in digestive tract was a protective factor in the prevention of bacterial infection. Conclusion Bacterial infection is one of the most severe complications after OLT. Therefore, it is very important to remove those risk factors, make early diagnosis and take effective treatment ．
ObjectiveTo comparatively analyze the effect of one-stage nonstented tubularized incised plate urethroplasty (TIP) on operative pain and compl ication by comparing with urethral catheter and urethral stent drainages.
MethodsBetween March 2010 and June 2013, 214 cases of distal and mid-shaft hypospadias underwent TIP, and the cl inical data were analyzed retrospectively. The patients were divided into 3 groups based on different urinary drainage techniques: indwell ing urethral catheter was used in 68 cases (group A), indwell ing urethral stent in 70 cases (group B), and nonstented drainage in 76 cases (group C). There was no significant difference in age, hypospadias type, and accompany malformation among 3 groups (P>0.05). At 2 days after operation, Wong-Banker facial scale (WBS) and Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) were used for pain and praxiology assessment. The complications after operation also were observed and compared among 3 groups.
ResultsAll patients were followed up 6-25 months (median, 11.8 months). At 2 days after operation, the median WBS scores were 4.0 (0-10), 3.5 (0-10), and 3.0 (0-10) in groups A, B, and C, respectively; median CHEOPS pain scores were 6.0 (1-13), 6.0 (1-13), and 4.0 (1-11), respectively. The WBS pain score and CHEOPS pain score in group C were significantly lower than those in groups A and B (P<0.05), but there was no significant difference between group A and group B (P>0.05). The postoperative complication occurred in 27 cases (39.7%) of group A, 29 cases (41.4%) of group B, and 13 cases (17.1%) of group C; two or more than two complications occurred in 14, 15, and 9 cases, respectively. There was significant difference in total incidence of postoperative complication among 3 groups (P<0.05). The incidences of postoperative overactive bladder, bladder spasms, urinary tract infection, and fistula in group C were significantly lower than those in groups A and B (P<0.05). There was no significant difference in incision infection, acute urinary retention, urinary extravasation, meatal stenosis, and urethral stricture among 3 groups (P>0.05).
ConclusionOne-stage nonstented TIP is suitable for distal and mid-shaft hypospadias and could reduce postoperative pain and complications compared with the traditional postoperative indwell ing urethral catheter and indwell ing urethral stent.
【Abstract】 Objective To multifactorially analyze the risk factors related to the post-pancreaticoduodenectomy (PD) complications and death. Methods Two hundred and thirty-three PD cases were analyzed, average age 56, of those cases, 210 malignant with 72 pancreatic head and 138 periampullary involvement, 23 benign. Fifty-nine cases suffered coexisting vital organ disorders. Results Sixty-three cases (27.0%) experienced postoperative complications, among those 58 cases (24.9%) early complications, 28(12.0%) infection, 15(6.4%) organ systemic disorder, 14(6.0%) bleeding, 12(5.2%) pancreatic fistula, 15(6.4%) reoperations, 16 postoperative death during hospitalization. The independent risk factors related to the postoperative complications included coexisting vital organ disorders, operation methods, main pancreatic duct (MPD) diameter and surgeon’s experiences, those related to the death during hospitalization included preoperative serum creatinine, coexisting vital organ disorders, surgeon’s experiences; those related to the reoperation included preoperative CA19-9, surgeon’s experiences, tumor diameters, lymph nodes metastasis; and those related to the pancreatic fistula included operation methods, MPD diameters and surgeon’s experiences. Conclusion Coexisting vital organ disorders and surgeon’s experiences are the independent risk factors related to postoperative complications and death during hospitalization, operation methods, MPD diameter and surgeon’s experiences are the independent risk factors related to the pancreatic fistula. Thus, it is very important to choose the appropriate PD candidates, select the right operation method and to familiarize the operation.
Objective To evaluate the clinical treatment methods of deep infection after total knee arthroplasty (TKA) and its effectiveness. Methods Between January 2004 and January 2010, 32 cases (32 knees) of deep infection after TKA were treated, including 13 males and 19 females with an average age of 64.6 years (range, 52-79 years). The time from primary TKA to infection was 3 weeks to 10 years. The preoperative knee society score (KSS) was 104.6 ± 9.1, and the visual analogue scale (VAS) score was 7.8 ± 1.4. Open debridement and continuous irrigation were perfomed in 3 cases of acute infection, arthroscopic debridement and irrigation in 3 cases of acute haematogenous infection; in 26 cases of chronic deep infection, 9 cases underwent open debridement, 4 cases underwent antibiotics impregnated bone cement spacer, 12 cases received two-stage revision, and 1 case underwent conservative treatment by intravenous antibiotics. Results All cases of acute infection failed to control deep infection; 1 case of acute haematogenous infection failed to treat; 7 cases of chronic infection undergoing debridement and 1 case of conservative treatment failed to treat; and all the failure cases were cured after symptomatic treatment. Thirty-two cases were followed up 2-8 years (mean, 4.6 years). At last follow-up, the KSS score and VAS score were 158.4 ± 8.3 and 4.1 ± 0.8, respectively, all showing significant differences when compared with preoperative scores (P lt; 0.05). Re-infection occurred in 3 patients who received two-stage revision during follow-up. Conclusion In patients with acute infection of methicillin-resistant Staphylococcus aureus after TKA, open debridement and liner change have low success rate; arthroscopic debridement can be performed to control acute haematogenous infection; and two-stage revision is an effective method to control chronic infection and restore the knee function, but two-stage revision has a potential risk of re-infection.
Objective
To analyze the clinical risk factors of the occurrence of severe proliferative vitreoretinopathy (PVR) after scleral reattachment surgery.
Methods
A total of 4031 eyes of 4031 consecutive patients with reghmatogenous retinal detachment (RRD) and PVR (grade C1 or less), on whom the scleral buckling was performed, were retrospectively studied. Twenty-two clinical charac teristics of the patients (including the ocular tension, condition of lens and vitreous, characte ristics of retinal detachment, whether or not with choroidal detachment, et al) were recorded.In 4031 patients, 2660 were followed up for more than 3 months, and 72 (in PVR group) of the 2660 patients underwent the second surgery (vitre oretinal surgery) because of the occurrence of postoperative seve re PVR; in the other 2588 patients, 72 (72 eyes) with retinal reattachment for more than 3 months were selected randomly as the control. The data were analyzed in SPSS (10.0) software.
Results
Logistic regression analysis revealed that the significant risk factors for PVR were incomplete posterior vitreous detachment ( P＜0.001), intraocular pressure lt;7 mm Hg（1 mm Hg=0.133 kPa, P＜0.002）, and large retinal tear (gt;2 DD,P＜0.005).
Conclusion
Incomplete posterior vitreous detachment, intraocular pressure lt;7 mm Hg and large retinal tear of the patient with RRD may be the major risk factors for PVR.
(Chin J Ocul Fundus Dis，2003，19：141-143)
