Objective To discuss the technical keypoints of the second-phase diaplasis treatment after Hartmann operation. Methods Twenty-one cases of the second-phase diaplasis operation of Hartmann operation in this hospital from January 2003 to December 2007 were analysed retrospectively. Results In this group, stapler technique was used in 15 cases, anastomotic ring was used in 3 cases, and one-layer suture was used in 3 cases. The time of these operations was between 118 min and 240 min (mean 164 min). Neither stomal leak nor stomal stenosis occurred, acute ileus occurred in 2 cases, and both recovered after the treatments of gastrointestinal decompression, inhibition of secretion digestive juice and reoperation. Acute retension of urine occurred in 1 case after urine catheter removed. The symptoms disappeared after excises of bladder function. These cases were followed up for 3-36 months (mean 20 months). All the patients recovered to normal function of defecation. Conclusion The technical keypoints of the second-phase diaplasis treatment after Hartmann operation are how to find and liberate the end of the distal colon. It will affect the prognosis and the occurrence of complications after this operation.
Objective To investigate the clinical significance of routine application of choledochoscope during operation of biliary duct. Methods The clinical data of 136 patients with the routine application of intraoperative choledochoscope dealing with bile duct diseases in this hospital from October 2003 to July 2009 were analyzed and summarized. Results Intraoperative choledochoscope inspection, taking stones and targeted surgery were performed in 116 cases with extrahepatic and (or) intrahepatic bile duct stones. The taking out rate of extrahepatic bile duct stones was 100% (85/85), the residual stone rates of extrahepatic and intrahepatic bile duct were 0 (0/85) and 22.6% (7/31), respectively, with the total residual stone rate was 6.0% (7/116). By using intraoperative choledochoscope, benign intrahepatic bile duct stricture was found in 13 cases, malignant extrahepatic and intrahepatic bile duct stricture in 8 cases. Four cases of hilar cholangiocarcinoma and 4 cases of common bile duct cancer, 2 cases of lower segment of common bile duct polyp, 3 cases of hepatolithiasis with the left hepatic bile duct carcinoma were diagnosed by biopsy via choledochoscope. Causes were confirmed by applying choledochoscope in 16 patients with obstructive jaundice. The use of choledochoscope with surgical treatment enabled benign and malignant bile duct stricture to achieve good results, without serious complications such as bile duct dilaceration, subphrenic abscess or acute cholangitis. Conclusions Using choledochoscope can tremendously reduce the residual rate of stone in biliary duct surgery, increase the definite diagnosis rate of biliary duct diseases and play a role of reasonable instruction in its treatment options. It has unique advantages in identifying causes of jaundice. It is remarkable that the role of applying choledochoscope to diagnose and cure biliary duct diseases. It should be widely used.
Objective To retrospectively analyze the clinical and imaging features of multi-segmental lumbar intervertebral disc protrusion and its treatment with the limited recessive decompression operation. Methods Twenty two patients (14 males and 8 females, aged 49-68 years) were admitted to hospital from March 1999 to March 2004. They suffered from multisegmental lumbar intervertebral disc protrusion that involved L1S1 and were treated with the limited recessive decompression operation. Results The follow-up for 4-21 months showed that 16 of the patients had an excellent outcome, 5 had a good outcome, and 1 had fair outcome. There were nosuch operative complications as nerve root lesions and putamen lesions. Conclusion The limited recessive decompression operation is one of the available good treatments for multi-segmental lumbar intervertebral disc protrusion. It solves problems of herniation and stenosis and maintains stability ofthe spine.
Objective
To explore the feasibility and effectiveness of spinal pedicle screw internal fixation through endoscope-assisted posterior approach for the treatment of traumatic atlantoaxial instability.
Methods
Between September 2008 and September 2010, 44 patients with traumatic atlantoaxial instability received spinal pedicle screw internal fixation through endoscope-assisted posterior operation (micro-invasive surgical therapy group, n=22) or traditional surgical therapy (control group, n=22). There was no significant difference in gender, age, type of injury, disease duration, and preoperative Japanese Orthopedic Association (JOA) score between 2 groups (P gt; 0.05). The blood loss, operation time, length of the incision, improvement rate of JOA, and graft fusion rates were compared between 2 groups to assess the clinical outcomes.
Results
The blood loss, operation time, and length of the incision in the micro-invasive surgical therapy group were better than those in control group (P lt; 0.05). All incisions were primary healing. Of 88 pedicle screws, 7 pedicle screws penetrated into the interior walls of cervical transverse foramen in the micro-invasive surgical therapy group and 8 in the control group, but there was no syndrome of vertebral artery injury. All patients of the 2 groups were followed up 12 to 37 months (mean, 26 months). Bony fusion was achieved in all cases within 3 to 12 months (mean, 5.3 months). No loosening or breakage of screw occurred. At 6 months to 1 year after operation, the internal fixator was removed in 6 cases and the function of head and neck rotary movement were almost renewed. The JOA score was significantly improved at last follow-up when compared with preoperative score (P lt; 0.05), and no significant difference in JOA score and improvement rate between the 2 groups at last follow-up (P gt; 0.05).
Conclusion
The micro-invasive surgical therapy can acquire the same effectiveness to the traditional surgical therapy in immediate recovery of stability, high graft fusion rate, and less complication. Moreover, it can significantly reduce the operation time, blood loss, and soft tissue injury, so this approach may be an ideal way of internal fixation to treat traumatic atlantoaxial instability.
ObjectiveTo evaluate the effect of postoperative no indwelling urethral catheters in lung operation.
MethodsIn this prospective cohort study, we recruited 100 patients who were scheduled for pulmonary lobectomy under general anesthesia in a single institution of Thoracic Surgery Department in West China Hospital between April and December 2014. These patients were divided into two groups including a no indwelled urethral catheter group (NIUC, 50 patients) and an indwelled urethral catheter group (IUC, 50 patients). The clinical effect was compared between the two groups.
ResultsThere was no statistical difference in incidence of postoperative urinary retention or urinary tract infection between the two groups (P=0.433, 0.050). However, the comfort degrees(0 degree) of patients in the NICU group was significantly higher than that of the ICU group with a statistical difference (P=0.002). While postoperative hospitalization time in the NICU group (P=0.023) was shorter than that in the ICU group (P=0.004). Prostatic hyperplasia was the high risk factor for the lung postoperative urinary retention (P=0.056).
ConclusionPostoperative no indwelling urethral catheters in lung operation has the benefit of improving the comfort degrees of inpatients and increasing the postoperation urinary retention.
Objective To study a new method of treatment for upper limb lymphedema after radical mastectomy. Methods From Jun. 2001 to Sep. 2003, 11 cases(2with complication of erysipelas ) of upper limb lymphedema being treated with radical mastectomy for more than 2 years were used as model. All the edema of limbs was sucked from hypodermis with liposuction technique and compressed with compression garment. Three months after operation, elasticity stress was conducted every night. Results The reduction of the edema of upper limbswas remarkable. The average decrease of circumference was 4 cm. No erysipelas was observed. Conclusion The liposuction technique and elasticity stress is a new and effective approach to the treatment of upper limb lymphedema.
Objective
To investigate the clinical effects and safety differences of open surgery and laparoscopy primary lesion resection combined with D2 lymph node dissection in the treatment of elderly patients with advanced gastric cancer.
Methods
One hundred and forty elderly patients with advanced gastric cancer were chosen and randomly divided into two group including open operative group (70 patients) with primary lesion resection combined with D2 lymph node dissection by open operation and laparoscopic surgery group (70 patients) with primary lesion resection combined with D2 lymph node dissection by laparoscopy; and the operative time, intraoperative bleeding amount, the levels of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of haemoglobin (Hb) after operation, the hospitalization time, the number of lymph node dissection, the survival rate with followed-up and postoperative complication incidence of both groups were compared.
Results
There was no significant difference in the operative time between 2 groups (P>0.05). The intraoperative bleeding amount, the level of PaCO2 in operation, liquid diet eating time, postoperative anal exhaust time, postoperative gastric tube indwelling time, postoperative ambulation time, the level of Hb after operation and the hospitalization time of laparoscopic surgery group were significantly better than open operative group (P<0.05). The level of PaCO2 in operation of laparoscopic surgery group was significantly higher than open operative group (P<0.05). There were no significant difference in the gastric lymph node dissection number and the peripheral lymph node dissection number of gastric artery between 2 groups (P>0.05). There were no significant difference in the survival rates between the 2 groups after 3-year followed-up (P>0.05). The complication incidence after operation of laparoscopic surgery group was significantly lower than open operative group (P<0.05). The quality of life scores of patients in laparoscopic surgery group were significantly higher than those in open operative group on 7 days and in 3 months after operation, and the difference were statistically significant (P<0.05).
Conclusion
Compared with open operation, primary lesion resection combined with D2 lymph node dissection by laparoscopy in the treatment of elderly patients with advanced gastric cancer can efficiently possess the advantages including minimally invasive, shorter recovery time and less postoperative complications.
Objective To investigate surgical indications，techniques，safety and clinical outcomes of minimallyinvasive sternal lowering operation for the treatment of pectus carinatum （PC）. Methods Clinical data of 40 PC patientswho underwent minimal invasive sternal lowering operation in Xinhua Hospital，School of Medicine，Shanghai Jiao Tong University from July 2009 to August 2012 were retrospectively analyzed. There were 39 male patients and 1 female patientwith their average age of 14.5 （12-22）years. All the patients underwent their surgical correction for the first time，and their chest deformity were characterized by a significant protrusion of the sternum and ribs including 21 symmetric and 19 asymmetric protrusions. Preoperative evaluation included electrocardiogram，CT scan of the chest，echocardiogram and pulmonary function test. Preoperative mean Haller index was 1.91±0.23. Sixteen patients had mild restrictive ventilatory disorder. Allthe patients received minimally invasive sternal lowering operation with a curved Nuss steel bar. Aggravating activities wererestricted within 3 months postoperatively，and the steel bar was removed 2 years later. Results All the operations were completed successfully，and thoracic appearance was significantly improved after correction. All the patients and their relativeswere very satisfied with the corrective outcomes. The operation time was 65-115 （82.0±15.6）minutes and average intraop-erative blood loss was less than 10 ml. Postoperative hospital stay was 3-5 （3.5±0.8） days. Postoperative Haller index was2.39±0.17，which was significantly higher than preoperative Haller index （P＜0.01） . Postoperative complications included wound infection in 2 patients，pneumothorax in 1 patient （cured by closed thoracostomy），subcutaneous effusion in 3 patients，and persistent pain （longer than 14 days） in 2 patients. There was no other serious postoperative complication. All the 40 patients were followed up for 3-36 months after discharge. A steel bars was removed ahead of schedule because of wound infection in one patient. Other steel bars were in normal position in 39 patients and there was no displacement of the steel bars or the stabilizers. Eight patients received removal of the steel bars without PC recurrence. Conclusion Juveniles with PC who have good chest wall compliance are the best candidates for minimally invasive sternal lowering operation which is an easy，safe，reliable，minimally invasive and esthetic procedure with satisfactory corrective outcomes.
Objective To compare the long-term outcomes between laparoscopic and open sphinter preservation operation for low rectal cancer. Method The literatures about the long-term outcomes between laparoscopic and open sphinter preservation operation for low rectal cancer were reviewed. Result Compared with open sphinter preservation operation, laparoscopic sphincter preservation operation for low rectal cancer did not increase locoreginonal recurrence rate and metasatasis rate. Conclusion The safety, efficacy, and long-term outcomes remain to be determined by more randomized clinical tirals and evidence-based medical results.
In the evaluation of tear film stability based on corneal topography, a pretreatment algorithm for tear film video was proposed for eye movement, eyelash reflection and background interference. First, Sobel operator was used to detect the blur image. Next, the target image with highlighted ring pattern was obtained by the morphological open operation performed on the grayscale image. Then the ring pattern frequency of the target image was extracted through the Hough circle detection and fast Fourier transform, and a band-pass filter was applied to the target image according to the ring pattern frequency. Finally, binarization and morphological closed operation were used for the localization of the ring pattern. Ten tear film videos were randomly selected from the database and processed frame by frame through the above algorithm. The experimental results showed that the proposed algorithm was effective in removing the invalid images in the video sequence and positioning the ring pattern, which laid a foundation for the subsequent evaluation of tear film stability.
