ObjectiveTo determine the characters of symptomatic pancreatic pseudocyst due to acute pancreatitis and effects of surgical treatment with two kinds of procedure （internal drainage or external drainage）. MethodsOne hundred and fifteen cases hospitalized during recent ten years were retrospectively analyzed.ResultsWe found that necrotic tissue existed in the pseudocyst in most cases and infection might occur in these pseudocyst. Although effect of two kinds of surgery was similar, the clinical course was different. The complications after surgery were fewer in patients underwent internal drainage than that with procedure of external drainage, and average hospital day was 7d in cases with internal drainage and 11d in cases with external one respectively. Surgery of internal drainage used in treatment was not only successful in noninfectious and single pseudocyst, but in infectious or multiple seudocyst.ConclusionInternal drainage should be used in most cases and considered as the first selection in surgery of pseudocyst due to acute pancreatitis.
Objective To discuss the methods and results of the surgical treatment of apical muscular ventricular septal defects （VSD） , in order to improve the surgical outcome of this disease. Methods The clinical data of 29 patients with apical muscular VSD of Fuwai hospital through Jan. 1999 to July 2004 were analyzed retrospectively. The apical VSDwere repaired via 4 different approaches： right atrium, apical right ventriculotomy, apical left ventriculotomy and the incision of the outflow tract of right ventricle combined with apical left ventriculotomy. The operative outcomes between different approaches were analyzed and compared. Results There were 2 perioperative deaths （6. 9%）. One patient repaired via apical left ventriculotomy died of low cardiac output syndrome, the other died intraoperatively from endocardial fibroelastosis, which was confirmed by myocardial biopsy. There were residual VSD in 4 （13. 8%） patients, who were repaired via the right atrium, which did not necessitate reoperation. Other patients were discharged uneventfully. Follow up was completed {n 11 patients and extended 2 to 34 months, none of the 6 survivors had apical ventricular aneurysms. Conclusions The operative outcome of patients with apical VSD is satisfactory although the incidence of residual VSD is higher. The intraoperative transesophageal echocardiography （TEE） should be performed routinely. Surgical approach should be chosen on the actual site of the VSD at operation. Try to repair the VSD via the right atrium as possible, via the apical right ventrieulotomy if needed and try to avoid left ventriculotomy.
The ulcer resulting from snake-bite injury was characterized by deep and wide tissue necrosis and secondary infection. The patient was at high risk of loss of function of his extremity. From 1989 to 1996, 16 cases with deep ulcer of the upper extremity resulting from snake-bite injury were treated with different types of axial thoraco-abdominal skin flaps, depending on the location of the ulcer. Thoraco-umbilical skin flap was used in 2 cases, lateral thoracoabdominal skin flap in 1 case, iliolumbar skin flaps in 5 cases, lower abdominal skin flaps in 6 cases, lower abdominal divided foliated skin flap in 1 case and Y-shaped hypogastric skin flap in 1 case. Reparative operation was carried out within 3 weeks after injury and primary repair were undertaken in 6 of them. The pedicles were divided in 17 to 24 days after operation. Twelve flaps survived. Three of the 6 flaps had mild signs of inflammation which disappeared after administration of antibiotics. One had necrosis of the distal part of the flap, and was healed with split skin graft. This type of skin flap was an ideal method for the treatment of snake-bite injury of the upper extremity.
ObjectiveTo analyze the influence of different surgical methods on survival and relapse-free survival in colorectal liver metastases.
MethodsClinical data of 71 cases of colorectal liver metastases who treated in PLA General Hospital from January 2002 to may 2013 were collected retrospectively, to analyzed the effect of different surgical methods on survival and relapse-free survival of this kind of cases.
ResultsAll of primary lesions underwent radical resection. And for the liver metastases, 20 cases didn't received any intervention (non-intervention group), 20 cases underwent resection of liver metastases, 20 cases underwent radiofrequency ablation, and 11 cases underwent radiofrequency ablation and resection of liver metastases (all 61 cases who received intervention were classified to intervention group). Results of Cox proportional hazards model showed that, in the condition of controlling other confounding factors, intervention can improve the survival (HR=1.724, P=0.043) and relapse-free survival (HR=0.701, P=0.048) of cases of colorectal liver metastases, cases who received intervention had better survival situation and the relapse-free survival situation.
ConclusionFor cases of colorectal liver metastases, in condition of radical operation for colorectal cancer, the intervention for liver metastases can prolong the survival time and relapse-free survival time.
An experimental study was designed on the treatment of 8 superficial burn wounds and 5 wounds after removing the split-thickness skin grafts with 200GS permanent magnetic flat dressings, and some of the wounds were chosen at random which did not received any treatment and would be served as control. It was noted that the volume of exudate in the treatment group was 11.9 50.7％ less than that of the control group, and the total protein, the albumin and globulin contents in the treatment cases were far less in exudate than those of the control cases. It was concluded that the magnetic therapy not only decresed the exudate, but also diminished the amount of total protein, albumin and globulin in the exudating fluid and it was of benefit to wound recovery.
OBJECTIVE: To investigate a treatment method for overtime avulsion of scalp. METHODS: Form October 1992 to July 2001, we treated 7 cases of avulsed scalp, which had been wounded more than 12 hours and accompanied with shock and head wound, with split thickness scalp skin grafting. RESULTS: Except for partial necrosis of scalp in center of bare area of skull, more than 90% of grafting split thickness scalp skin survived in 4 cases and more than 80% in 3 cases, and presented satisfactory appearance during following up. The bare area had no periosteum above 4 cm in diameter needed to graft split thickness skin after skull was covered granulation tissue. CONCLUSION: The limits of time of scalp skin grafting will be prolonged as long as the processes are settled properly to maintain the skin of body.
Objective To evaluate the results of operative treatment of acetabular fractures and to investigate its influence factors. Methods The cl inical data were analyzed retrospectively from 82 patients with acetabular fractures treated between September 2004 and June 2009. Of 82 patients, 65 were male and 17 were female, aged 26-72 years (mean, 38 years).Fractures were caused by traffic accident in 62 cases, by crush in 13 cases, and by fall ing from height in 7 cases. The time from injury to admission was 30 minutes to 12 days (median, 7.6 hours) in 70 cases, 12 cases were transferred because poor result after 34-67 days of conservative treatment. According to Judet classification, there were 24 cases of posterior wall fracture, 3 cases of posterior column fracture, 1 case of anterior wall fracture, 2 cases of anterior column fracture, 6 cases of transverse fracture, 16 cases of transverse and posterior wall fracture, 4 cases of posterior column and posterior wall fracture, 5 cases of T-type fracture, 3 cases of anterior and posterior hemitransverse fracture, and 18 cases of complete both-column fracture; 24 cases combined with dislocation of the hip. During operation, Kocher-Langenbeck approach was used in 49 cases, anterior il ioinguinal approach in 19 cases, and the combination of anterior and posterior approaches in 14 cases. Reconstructive plate (74 cases) and hollow lag screw (8 cases) internal fixation were used. The function of the hip was evaluated according to the modified Merled’Aubigne- Postel hip score system postoperatively. According to fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hi p dislocation and time of reduction, operative approach, deep vein thrombosis (DVT), and heterotopic ossification (HO), the patients were divided into the groups and the results were compared. Results Accordancewith the Matta X-ray evaluation criteria, anatomic reduction was achieved in 21 cases, good reduction in 37 cases, fair reduction in 16 cases, and poor reduction in 8 cases, and the excellent and good rate was 71%. All the cases were followed up 12-52 months mean, 34 months). Iatrogenic sciatic nerve injury occurred in 8 cases, infection in 3 cases, HO in 16 cases, DVT in 3 cases, hip posttraumatic arthritis in 12 cases, and avascular necrosis of the femoral head in 9 cases. X-ray examination showed that 80 cases achieved fracture union at 10-24 weeks after operation (mean, 14 weeks) and 2 cases had fracture delayed union at 10 months and 12 months after operation. According to the modified Merled’Aubigne-Postel hip score system, the function of the hip was rated as excellent in 26 cases, good in 32, fair in 20, and poor in 4 at 6 months after operation; the excellent and good rate was 71%. The affecting factors of cl inical results of acetabular fractures were fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hip dislocation and time of reduction (P lt; 0.05). However the operative approach, DVT, and HO were not affecting factor of the acetabular fractures (P gt; 0.05). Conclusion Operative treatment of acetabular fractures has a satisfying therapeutic effect. Fracture type, age, lower extremity fracture before operation, qual ity of reduction, timing of surgery, hip dislocation, and time of reduction are risk factors affecting postoperative results.
Objective To study the advances in clinical application of hernioplasty by high molecular material. Methods The literature in the recent years on the advances of hernioplasty by high molecular material was reviewed. Results At present time many operative techniques of hernioplasty by high molecular material have been developed. The representative techniques were ①Rives-Stoppa′s mesh inlay hernioplasty; ②Lichtenstein′s tesion-free herniorrhaphy; ③mesh plug hernioplasty; ④Gilbert′s sutureless hernioplasty; ⑤laparoscopic inguinal hernioplasty. The reparing high molecular material was divided into absorbable and unabsorbable material, the former included polyglycolic-acid and polyglaction, the later consists of polypropylene polyester and expanded polytetrafluoroethylene.Conclusion The clinical application of henioplasty by high molecular material is increasing. According to the hernia type and patient condition, excellent outcome will be achieved by the application of proper repairing method and repair material.
Objective
To discuss the treatment of retinal detachment(RD) after posterior chamber intraocular lents(PCIOL) implantation.
Methods
Twenty eyes with RD after PCIOL inplantation which were treated with vitrectomy combined with scleral buckling and intraocular tamponade from March 1993 to June 1997 in this institute were analysed retrospctively.
Results
The retinas reattached completely in 16 eyes and partly in 2 eyes after RD operation.The postoperative visual acuity improved in 17 eyes,not improved in 2 eyes,and decreasde in 1 eyes.The PCIOL was taken off during RD operative in 6 eyes.Postoperative complications including displacement of the PCIOL in 2 eyes,hyphema and vitreous hemorrhage were found in this series of RD operation in 1 eyes.
Conclusion
Vitrectomy combined with scleral buckling and intraocular tamponade is one of the effective methods to treat the eyes with RD with PCIOL.
(Chin J Ocul Fundus Dis,1998,14:165-166)
