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  • JOURNAL OF CLINICAL SURGERY

    主管单位:湖北省卫生和计划生育委员会
    主办单位:中华医学会湖北分会
    地  址:武汉市武昌区东湖路165号
    邮  编: 430071
    电  话:027-87893476
    电子邮件:whlcwk@126.com
    国际标准刊号:ISSN 1005-6483
    国内统一刊号:CN 42-1334/R
    邮发代号:38-184

Current Issue
20 December 2022, Volume 30 Issue 12
Effect of debridement combined with negative pressure wound therapy on wound healing and infection in patients with deep second-degree burn
ZHANG Xiaohua, LIN Guangming, GUO Peng, et al
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1115-1118.  DOI: 10.3969/j.issn.1005-6483.2022.12.005
Abstract ( 10 )   PDF (752KB) ( 2 )  
[Abstract] Objective To investigate the effect of debridement combined with negative pressure wound therapy on wound healing and infection in patients with deep second-degree burn.Methods Ninety patients with burn treated in the hospital from March 2018 to March 2021 were selected as the research subjects.Among them,49 patients treated with debridement combined with routine dressing change were included in the control group,while 41 patients treated with debridement combined with negative pressure wound therapy were included in the observation group.Wound healing status was compared between the two groups.Results The complete healing time of the observation group was significantly shorter than that of the control group [(23.48±4.27) d vs.(26.57±3.84) d] (P<0.05).The wound healing rates in the observation group at T1,T2 and T3 were higher than those of the control group [(14.64±3.27)% vs.(11.57±3.51)%,(54.38±10.63)% vs.(40.41±9.58)%,(75.26±8.47)% vs.(62.19±9.03)%],and VAS scores were lower than those of the control group [(3.54±1.27) vs.(4.75±1.13),(2.24±0.78) vs.(3.05±0.81),(1.84±0.56) vs.(2.47±0.62)] (P<0.05).At T1,the incidences of wound redness and secretion in the observation group were lower than those in the control group (41.46% vs.63.27%,43.90% vs.63.27%) (P<0.05).The wound infection rates and positive rates of secretion bacterial culture in the observation group at T1 and T2 were lower than those in the control group (2.42% vs.20.41%,0.00% vs.14.29%;4.89% vs.26.53%,2.42% vs.18.37%) (P<0.05).At 6 months after treatment,the incidence of scar and VSS score in the observation group were lower than those in the control group [14.63% vs.36.73%,(5.64±1.53) vs.(8.25±2.17)] (P<0.05).Conclusion Debridement combined with negative pressure wound therapy can effectively improve wound healing rate in patients with deep second-degree burn,shorten wound healing time,and reduce wound infection rate,wound pain and scar formation.
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Analysis of the efficacy of stepwise decompression with intracranial pressure monitoring combined with different timing of skull defect repair in patients with sTBI and the effect on their serum indicators and prognosis
YUAN Baoyu, LU Zheng, WANG Dongliu, et al
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1120-1122.  DOI: 10.3969/j.issn.1005-6483.2022.12.007
Abstract ( 8 )   PDF (656KB) ( 3 )  
[Abstract] Objective To investigate the efficacy of stepwise decompression with intracranial pressure monitoring combined with different timing of skull defect repair in patients with sTBI and the effect on their serum indicators and prognosis. Methods Seventy-three patients with STBI who were admitted to our hospital were selected for the study.They were divided into 2 groups according to the differences in treatment modalities.Among them,40 patients in the study group were treated with intracranial pressure monitoring step decompression combined with ultra-early skull defect repair,while 33 patients in the control group were treated with intracranial pressure monitoring step decompression combined with conventional time skull defect repair,comparing the clinical efficacy and other differences between the two groups. Results After treatment,the rate of good recovery was significantly higher in the study group than in the control patients(P<0.05);All inflammation-related test indexes in the study group improved significantly after treatment compared with the control group(P<0.05);After treatment,the incidence of complications was significantly lower in the study group than in the control group(P<0.05).The mean MCA flow velocity in the study group improved significantly after treatment compared with the control group(P<0.05).After treatment,the prognosis of the study group was significantly better than that of the control patients(P<0.05). Conclusion The efficacy of intracranial pressure monitoring step decompression combined with ultra-early skull defect repair in the treatment of patients with heavy craniocerebral injury is remarkable,and it can reduce the inflammatory state of patients and improve their cerebral perfusion,and reduce the incidence of complications.
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The effects of miR-367-3p regulating CCND2 expression on the proliferation and migration of lung cancer cells
CAO Lei, ZHANG Chengli, HOU Ying
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1123-1127.  DOI: 10.3969/j.issn.1005-6483.2022.12.008
Abstract ( 5 )   PDF (799KB) ( 2 )  
Objective To investigate the effect of miR-367-3p regulating the expression of recombinant cyclin D2 protein(CCND2) on the proliferation and migration of lung cancer cells.Methods Human lung cancer cells Calu,MSTO-211H,NCI-H2347,NCI-H1437,NCI-H1944,NCI-H647,human normal lung cells HLF-a were selected,qRT-PCR method was used to determine the expression level of miR-367-3p in the cells.Calu cells were divided into control group,miR36-7-3p NC group,miR-367-3p mimic group,miR-367-3p mimic+pcCCND2 group,CCK-8 method was used to determine the viability of Calu cells in each group;flow cytometry was used to measure cell apoptosis ability.Transwell test was used to measure cell invasion ability.Scratch test was used to measure the migration ability of Calu cells.WB method was used to determine the relative expression of CCND2,apoptosis and invasion-related proteins in Calu cells.Luciferase assay was used to determine the targeting relationship between miR-367-3p and CCND2.Results miR-367-3p showed low expression in human lung cancer cells;compared with the control group,the Calu cell viability,invasion,migration ability,MMP-2 and MMP-9 protein expression in the miR-367-3p mimic group were significantly reduced(P<0.05),the apoptosis ability,Caspase-3,Bax protein expression were significantly increased(P<0.05),the Bcl-2 protein expression was significantly reduced(P<0.05);CCND2 overexpression reversed the inhibitory effect of miR-367-3p overexpression on Calu cell viability,invasion,and migration;the results of luciferase experiments showed that miR-367-3p and CCND2 had a targeted regulatory relationship.Conclusion miR-367-3p can inhibit the proliferation and migration of human lung cancer cells Calu,which may be achieved by inhibiting CCND2.
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Meta-analysis of the efficacy and safety of TACE combined with apatinib in the treatment of advanced primary liver cancer
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1129-1132.  DOI: 10.3969/j.issn.1005-6483.2022.12.010
Abstract ( 2 )   PDF (1640KB) ( 2 )  
Objective To evaluate the efficacy and safety of TACE combined with apatinib in the treatment of advanced primary progressive hepatic carcinoma by Meta-analysis. Methods The literatures of randomized controlled studies on TACE combined with apatinib in the treatment of advanced liver cancer from January 1,2015 to July 25,2021 were retrieved for Meta-analysis.Results A total of 20 publications were included,all RCTs,with a total of 1373 patients,including the experimental group (n=687) and the control group (n=686).The objective sustained release rate (ORR) of the experimental group was significantly higher than that of the control group (P<0.05).There was no significant difference in the 6 month survival rate between the two groups (P>0.05),but compared with the control group,the 1 year and 2  year survival ratein the experimental group were significantly higher than those in the control group (P<0.05).There was no significant difference in the incidence of nausea and vomiting between the two groups (P>0.05).The symptoms of fever,abdominal pain,myelosuppression,diarrhea,hypertension,proteinuria,and hand-foot syndrome between groups had statistical significance(P<0.05).Conclusion TACE combined with apatinib is more effective in treating of advanced primary hepatic carcinoma,while the prevention and treatment of adverse effects such as proteinuria,hypertension,and hand-foot syndrome should also be considered.
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Application of 3D reconstruction combined with 3D laparoscopy in liver surgery
NI Zhongpeng, ZHANG Xinhui, WANG Xiaochuan, et al.
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1133-1136.  DOI: 10.3969/j.issn.1005-6483.2022.12.011
Abstract ( 9 )   PDF (1030KB) ( 4 )  
Objective To explore the application of 3D reconstruction combined with 3D laparoscopy in liver surgery.Methods The clinical data of 37 patients who met the corresponding conditions in the Hepatobiliary and Pancreatic Center of Xuzhou Central Hospital from June 2020 to December 2021 were retrospectively analyzed.All patients completed the 3D reconstruction before operation to clarify the blood vessel movement of the liver and its relationship with pathological changes,and the operation was performed by 3D laparoscopy,and the operation mode,operation time,intraoperative blood loss,hospital stay after operation and postoperative complications were observed.Results All 37 patients underwent laparoscopic surgery without conversion to open surgery.The operation time was 60420min,with an average of (226±101)min.Intraoperative blood loss ranged from 50 to 1000ml,with an average of (228±195)ml.Postoperative anal exsufflation time was 1~3 days,with an average of (2.2±0.6)days.The removal time of the drainage tube was 3~20 days,with an average of (7.5±3.1)days.Among the 37 patients,the levels of transaminase and bilirubin in 8 patients returned to normal on the 3rd day after surgery.On the 7th day after surgery,transaminase and bilirubin were all within 100U/L and 34μmol/L in all patients who were not discharged.Postoperative hospital stay was 4-23d,with an average of (9.78±4.1)d.A total of 1 case of  biliary leakage and 8 cases of pleural effusion occurred after operation,and they were cured and discharged after conservative treatment.Conclusion 3D reconstruction combined with 3D laparoscopy is safe and reliable in liver surgery,and has certain effects on controlling intraoperative bleeding,shortening operation time and reducing complications.
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Effect of postoperative adjuvant chemotherapy on prognosis of patients with distal cholangiocarcinoma:a propensity score matching analysis based on SEER database
SHI Jianwen, DENG Zhengdong, WANG Jianming
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1137-1141.  DOI: 10.3969/j.issn.1005-6483.2022.12.012
Abstract ( 5 )   PDF (878KB) ( 2 )  
Objective To analyze the effect of postoperative adjuvant chemotherapy on prognosis of patients with distal cholangiocarcinoma(DCC).Methods Clinical data of 455 DCC patients who received radical surgical treatment from 2010 to 2015 were retrospectively analyzed in SEER database.Propensity score matching(PSM) was employed to reduce the bias,Kaplan-Meier test and Log-rank test were used to evaluate prognostic differences and Cox proportional risk model was used to analyze independent prognostic risk factors.Results  After PSM,it is found that TNM stage,postoperative chemotherapy and N stage were correlated with the prognosis of DCC patients,and postoperative adjuvant chemotherapy was an independent risk factor affecting the prognosis of patients.Further subgroup analysis showed that there were no significant difference in 3 year survival rate and  median survival time of DCC patients with stage Ⅰ between the postoperative chemotherapy group and the only surgery group(P>0.05),while the prognosis of patients with stage Ⅱ in the chemotherapy group was significantly better than that in the only surgery group(P<0.05).Postoperative chemotherapy could prolong the 3 year survival rate and median survival time of the moderately differentiated and poorly differentiated/undifferentiated patients(all P<0.05),while there were no significant differences in the 3 year survival rate and median survival time of the highly differentiated patients in the postoperative chemotherapy group and the only surgery group(P>0.05).Adjuvant chemotherapy could benlifit the 3 year survival rate and postoperative median survival time of patients with positive lymph nodes( P<0.05),but did not significantly improve the survival prognosis of patients with negative lymph nodes( P>0.05).Conclusion Postoperative chemotherapy is associated with long-term survival benefit of patients with distal cholangiocarcinoma,and it is an independent risk factor affecting prognosis.DCC patients with TNM stage Ⅱ,moderately differentiated and poorly differentiated/undifferentiated pathologically and lymph node positive status are potential beneficiaries of postoperative chemotherapy.
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Optimization of anesthesia protocol for intestinal obstruction and analysis of the differential effects on intestinal barrier function,oxidative stress,and inflammatory response
YAN Zhaohong, ZHAO Jiankui
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1143-1146.  DOI: 10.3969/j.issn.1005-6483.2022.12.014
Abstract ( 4 )   PDF (725KB) ( 3 )  
Objective To investigate the differential effects of the optimization of anesthesia protocols on intestinal barrier function,oxidative stress,and inflammatory response in patients with intestinal obstruction.Methods Ninety-three patients receiving intestinal obstruction surgery in our hospital from January 2019 to January 2022 were enrolled,and classified into two groups according to different anesthesia methods.Control group(n=53) received routine general anesthesia,while experimental group(n=40) received  general anesthesia combined with transverse abdominal plane(TAP) + rectus sheath block block.Then comparison was conducted on intestinal barrier function [diamine oxidase(DAO) activity and endotoxin(ETX)],oxidative stress [catalase(CAT) and epinephrine],inflammatory response [tumor necrosis factor-α(TNF-α) and interleukin6(IL-6)],along with the postoperative time of first anal exhaust,defecation and out-of-bed activity.Results Compared with control group,experimental group had lower intraoperative sufentanil consumption,and shorter postoperative time of first anal exhaust and defecation(all P<0.05).Compared with baseline data,an increase in DAO activity,ETX,TNF-α,IL-6 and epinephrine levels along with a decrease in CAT were observed in both groups at postoperative 1 d and 3 d(all P<0.05).Compared with control group,experimental group had higher DAO activity,ETX,TNF-α,IL-6 and epinephrine levels,and lower CAT levels at postoperative 1 d and 3 d,with statistical difference(all P<0.05).Conclusion Compared with other anesthesia protocol,general anaesthesia combined with TAP + rectus sheath block is more effective for patients receiving intestinal obstruction surgery,which cause less impact on intestinal barrier function and oxidative stress,and can attenuate the inflammatory response.
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Correlation analysis of tumor location,body mass index and prognosis of patients with colorectal cancer after radical resection
ZHANG Xiaonan, HANG Jiamin, WU Qian, et al
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1147-1151.  DOI: 10.3969/j.issn.1005-6483.2022.12.015
Abstract ( 5 )   PDF (928KB) ( 3 )  
Objective To investigate the correlation between tumor location,body mass index(BMI) and prognosis of colorectal cancer(CRC) patients after radical resection.Methods The clinical data of 102 patients with CRC who underwent radical resection in the hospital from June 2015 to June 2017 were retrospectively analyzed.The 5year survival of the patients was observed,and the patients were divided into a death group and a survival group accordingly.Baseline data,tumor location,and BMI were compared between the two groups.To explore the prognostic factors of CRC patients after radical resection and the relationship between tumor location,BMI and prognosis of patients.The predictive power of tumor location and BMI on the 5year prognosis of patients was analyzed,and the 5year survival of patients with different tumor locations and BMI was observed.Results In this group of 102 CRC patients who underwent radical resection,32 died within 5 years and were classified as the death group;70 patients survived for 5 years and were classified as the survival group.There were significant differences in pathological stage,tumor differentiation,lymph node metastasis,tumor location and BMI between the two groups(P<0.05).COX regression analysis showed that pathological stage,tumor differentiation,lymph node metastasis,tumor location,and BMI were the prognostic factors of death in patients with CRC after radical resection(P<0.05).After further adjusting for confounding factors such as pathological stage,tumor differentiation,lymph node metastasis and other confounding factors through COX regression analysis,it was found that tumor location and BMI were still significantly correlated with the prognosis and death of patients(P<0.05).The receiver operating characteristic(ROC) curve showed that the area under the curve(AUC) of tumor location combined with BMI to predict the 5year death of patients was 0.822,which was higher than tumor location or BMI alone.The sensitivity and the specificity of tumor location combined with BMI was 68.75% and 84.29%,respectively.The Kaplan-Meier curve analysis showed that the 5year survival rate of patients with rectal tumor was higher than that of patients with right and left colon(Log-Rank χ2=7.530,P=0.023),the 5year survival rate of patients with left colon tumor was higher than that of patients with right colon(Log-Rank χ2=5.362,P=0.042),and the 5year survival rate of patients with lower BMI was higher than that of patients with higher BMI patients(Log-Rank χ2=24.043,P<0.001).Conclusion Tumor location and BMI are closely related to the prognosis of patients with CRC after radical resection.The combination of tumor location and BMI has a high efficacy in predicting the prognosis of patients with death,which can provide a certain reference for prognosis evaluation.
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Analysis of the composition of pathogenic bacteria in abdominal pus and drug sensitivity test results in 280 patients with acute appendicitis
HE Jian, WANG Xiaolong, LU Zhuocai
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1152-1154.  DOI: 10.3969/j.issn.1005-6483.2022.12.016
Abstract ( 8 )   PDF (710KB) ( 4 )  
Objective To count and analyze the composition of pathogenic bacteria inabdominal pus and drug sensitivity test results of patients with acute appendicitis.Methods From January 1, 2020 to January 1, 2021, 280 patients with acute appendicitis received laparoscopic appendectomy. Intraoperatively, abdominal fluid was taken from the patients, and bacterial culture and drug sensitivity tests were performed.Bacteria were identified by VTEK-MS mass spectrometer; drug susceptibility tests were performed by VITEK2-Compact automatic microbiological analyzer or disk diffusion.Result In terms of the composition of pathogenic bacteria,Escherichia coli was the main pathogenic bacteria,accounting for 59.7%,followed by pseudomonas aeruginosa (11.2%) and klebsiella pneumoniae (6.6%).In drug susceptibility test,the five antibiotics with the highest sensitivity to Escherichia coli  were:carbapenems(100%),amikacin(98.3%),piperacillin/tazobactam(97.4%),cefoxitin(95.7%),amoxicillin/clavulanate potassium (85.5%).Conclusion The sensitivity rates of piperacillin/tazobactam,cefoxitin,amoxicillin/clavulanate potassium,amikacin and carbapenems to Escherichia coli in patients with acute appendicitis are all above 70% ,which can be preferred according to clinical situation.
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Effect of modified Karl-Storz single-port laparoscopic surgery on acute appendicitis and its effect on immune function and inflammatory response
LIANG Wenjie, LI Ran, FENG Jiangmian, et al
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1155-1158.  DOI: 10.3969/j.issn.1005-6483.2022.12.017
Abstract ( 2 )   PDF (668KB) ( 2 )  
Objective To investigate the clinical efficacy of modified Karl-Storz single-port laparoscopic surgery for acute appendicitis and its effect on immune function and inflammatory response.Methods A total of 78 patients with acute appendicitis admitted to our hospital from August 2019 to January 2020 were selected.According to the different treatment methods,they were divided into the observation group with modified Karl-Storz single-port laparoscopic surgery(n = 40) and the control group with traditional laparoscopic surgery(n=38).The perioperative index,immune function index,pain index and complications were compared in the two groups.Results The operation time and the extubation time in the observation group and the control group were(47.26±6.33)min and(45.87±6.28)min,(2.15±0.84)h and(2.23±0.89)h,respectively.The bed rest time was(16.46±4.37)h and(17.82±4.51)h after operation,respectively.There was no significant difference between the two groups(P>0.05).The amount of intraoperative bleeding in the observation group was(16.24±3.11)ml,the time to recovery of intestinal function was(12.14±1.56) h,and the duration of hospitalization was(4.91±1.43) d,while that in the control group was(20.15±3.26)ml,(13.85±1.67) h and(6.02±1.58) d,respectively(P<0.05).There was no significant difference in the levels of CD3+,CD4+,CD8+ and the ratio of CD4+/CD8+ between the two groups 1d before operation and 7d after operation(P>0.05).On day 1 after surgery,the ratios of CD3+,CD4+,CD8+ and CD4+/CD8+ in the observation group were significantly different from those in the control group(P<0.05).There were no statistical difference in serum levels of inflammatory factors TNF-α,IL-6,IL-8,and CRP at 1d before surgery(P>0.05).Higher serum inflammatory factors in both groups at 3d later than preoperative(P<0.05),and the serum levels in the observed group were significantly lower than the control group(P<0.05).The VAS scores of the observation group at 12 h,24 h,36 h,48 h and 72 h after operation were significantly lower than those of the control group(P<0.05).There was no significant difference in postoperative complications between the two groups(P>0.05).Conclusion Compared with traditional laparoscopic appendectomy,modified Karl-storz single-port laparoscopic surgery is effective in treating acute appendicitis.
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Study of gender differences in breast cancer survival outcomes in relation to tumor subtypes
ZHANG Li, LIAO Mengdi, ZOU Erxia, et al
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1159-1166.  DOI: 10.3969/j.issn.1005-6483.2022.12.018
Abstract ( 2 )   PDF (1427KB) ( 2 )  
Objective Exploring the relationship between gender differences in breast cancer survival outcomes and tumor subtypes by conducting the largest population-based comparative study of men with breast cancer and women with breast cancer.Methods A population-based retrospective cohort study using data from the US disease surveillance,epidemiology and final outcomes(Seer) Project 2010-2012,to investigate differences in tumor subtypes,overall survival(OS),and breast cancer-specific mortality(BCSM) between men and women.〖WTHZ〗Results〓〖WTBZ〗A total of 181814 breast cancer patients(1516 men and 180298 women) met the criteria of this study.The male patients were mostly black people,old,with low histological grade,late stage,large tumor,more lymph node and distant metastasis,and human EGFR 2(HER2) negative tumor(P<0.05).The two year OS of male and female patients was 91.2% and 93.7%,and that of BCSM was 2.2% and 2.5%,respectively.Univariate analysis showed that the OS of male triple negative(TN),hormone receptor(Hor)/HER2 positive and HOR/HER2 negative patients were worse(P<0.01).At the same time,both HOR/HER2 positive and TN subtype were significantly associated with BCSM in male patients(P<0.01).Multivariate analysis showed that OS and BCSM were worse in patients with TN MBC(P<0.05).At the same time,the results showed that male patients in the HR +/HER2 negative subgroup were less likely to die of BC after adjustment for other factors(P<0.05).Conclusion A 2year OS and BCSM analysis of breast cancer subtypes showed significant differences between male and female breast cancer patients with TN subtypes,and these differences deserve further study.
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Application of isthmus extended resection and lymph node dissection in the central area of the affected side in thyroid micro papillary carcinoma with length≤1cm
WAN Jiangyang, FENG Ziyu, ZHEN Linlin.
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1168-1171.  DOI: 10.3969/j.issn.1005-6483.2022.12.020
Abstract ( 0 )   PDF (348KB) ( 2 )  
Objective To explore the application of extended isthmus resection combined with lymph node dissection in the central area of the affected side in the treatment of thyroid micro papillary carcinoma with length ≤1cm.Methods The data of 164 patients with thyroid papillary carcinoma treated in Huai'an First Hospital Affiliated to Nanjing Medical University from January 2015 to January 2017 were analyzed retrospectively.According to the operation method,they were divided into control group(74 cases) and observation group(90 cases).The control group received thyroidectomy + isthmus resection on the affected side,and the observation group received thyroidectomy + isthmus resection + central lymph node dissection on the affected side.The operation situation,pharyngeal reflux symptom index (RSI),voice disturbance index (VHI),complication rate and follow-up of the two groups were counted.Results There was no significant difference in blood loss,length of hospital stay,incidence of temporary recurrent laryngeal nerve injury,incidence of hypocalcemia and incidence of parathyroid gland dysfunction between the two groups (P>0.05).There was no significant difference in RSI scores and VHI scores between the two groups before operation and 1 week after operation (P>0.05).The RSI scores and VHI scores of the two groups after 1 week of operation were lower than those before operation (P<0.05).The operation time of the observation group was longer than that of the control group(P<0.05).The 6 month recurrence rate,1 year recurrence rate and 1 year lymph node metastasis rate of the observation group were lower than those of the control group The 3 year survival rate was higher than that in the control group (P<0.05).Conclusion The implementation of isthmus extended resection + central lymph node dissection on the affected side has no effect on the pharynx and sound of patients with thyroid micro papillary carcinoma with length ≤1cm.It can reduce the incidence of complications and recurrence rate without increasing intraoperative blood loss,and can significantly improve the survival rate of patients.
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Prediction of postoperative survival of triple-negative breast cancer combined with expression of HIF-1α and c-myc
YANG Jianguo, YANG Hongli, WANG Le
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1172-1175.  DOI: 10.3969/j.issn.1005-6483.2022.12.021
Abstract ( 4 )   PDF (475KB) ( 2 )  
Objective To determine the expression of HIF-1α and c-myc in triple-negative breast cancer and establish a predictive model for postoperative survival.Methods Tissue microarray including clinical and follow-up data of 161 triple negative breast cancer patients was selected in this study.Immunohistochemistry was performed to detected the expression of HIF-1α and c-myc protein in breast cancer tissues.We used cox regression analysis to explore the correlation between HIF-1α/c-myc expression and clinical pathological parameters as well as prognosis.ROC curve was generated for cox multivariate analysis.A nomogram was generated based on the cox multivariate analysis.Results The positive expression rates of HIF-1α and c-myc protein in breast cancer tissues were 45.3%(73/161) and 59.0%(95/161),respectively.Cox univariate and multivariate analysis showed that HIF-1α and c-myc protein expression,histological grade,lymph node status,and tumor TNM stage were the independent risk factors for postoperative survival in triple-negative breast cancer patients.The AUC of prediction model was 0.820(0.796-0.854).The nomogram could predict the probability of 3 years disease free survival according to each patient's condition.Conclusion High expression of HIF-1α and c-myc,as well as histological grade Ⅲ,positive lymph node,stage Ⅲ tumors suggest that patients with triple-negative breast cancer have a poor prognosis.The prediction model can be used to predict postoperative survival.
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Comparative study of different methods in reducing edema after total knee arthroplasty
ZHANG Ting, TAO Fengqin, SHEN Duanduan, et al
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1176-1178.  DOI: 10.3969/j.issn.1005-6483.2022.12.022
Abstract ( 4 )   PDF (719KB) ( 3 )  
Objective To compare the effectiveness of multi-layer compression therapy and biological ice pack in alleviating edema after total knee arthroplasty.Methods 100 patients who underwent total knee arthroplasty in our department from January 2020 to January 2022 were selected.They were randomly divided into two groups,50 cases in each group.The observation group was treated with multi-layer compression therapy,while the control group was treated with biological ice pack.The degree of swelling at 1d,2d,3d and 7d after surgery was evaluated,the time of swelling subtraction was recorded,and the pain and comfort at 1d and 3d after surgery were evaluated.Results On postoperative day 1,3,5 and 7,the circumference of lower limb swelling in the control group was (43.51±1.88)cm、(41.97±1.74)cm、(40.60±1.82)cm and (37.93±1.49)cm,respectively.The circumference of lower limb swelling in the observation group was (42.78±1.29)cm,(40.36±1.62)cm,(38.25±1.51)cm and (37.52±1.18)cm,respectively,which were significantly lower than those in the control group P<0.05).Besides,the swelling degree scores were significantly reduced at 1d,2d and 3d (P<0.05)and the swelling regression time was reduced compared to the control group (P<0.05),while the pain scores and comfort scores of observation group were not significantly different at 1d and 3d after operation (P>0.05).Conclusion Multi-layer compression therapy was more effective than ice pack cold compress in alleviating edema after total knee arthroplasty.
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Influencing factors and prevention of proximal femoral shortening(PFS) after intertrochanteric fracture
TANG Yong, ZENG Zhaochi, ZHU Zhiyong, et al
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1179-1182.  DOI: 10.3969/j.issn.1005-6483.2022.12.023
Abstract ( 3 )   PDF (670KB) ( 3 )  
Objective To retrospectively analyze the incidence and influencing factors of proximal femoral shortening after intertrochanteric fracture surgery. Methods The clinical data of 97 patients with intertrochanteric fracture treated from January 2017 to February 2020 were retrospectively analyzed.There were 31 cases with the dynamic hip screw(DHS),41 cases with the proximal femoral nail antirotation(PFNA),25 cases with Intertan.They were divided into normal group(59 cases) and PFS group(38 cases) according to the shortening of proximal femur after operation.The differences of age,gender,body mass index(BMI),bone mineral density,fracture type,internal fixation method,reduction quality,TAD value and complete weight-bearing time between the two groups were observed.Results In this group,the proportion of proximal femoral shortening was 38/97(39.18%).In PFS group,the shortening of femoral neck main screw was (5.43±1.72)mm,including 2 cases(2.06%) with internal fixation penetrating the femoral head and 5 cases(5.14%) with nonunion; The proportion of type Ⅲ and type Ⅳ fractures in the normal group was 40.68%,and that in the PFS group was 76.32%,the difference was statistically significant(P<0.05).The proportion of PFNA /Intertan was 76.27% in the normal group and 65.79% in the PFS group(P<0.05).There were 26 cases of positive reduction,18 cases of neutral support and 15 cases of negative support in the normal group,while there were 8 cases,13 cases and 17 cases in the PFS group,the difference was statistically significant(P<0.05).The complete weight-bearing time of normal group was (8.54±2.37)weeks,which was significantly later than that of PFS group(4.15±1.83)weeks(P<0.001).Conclusions  Internal fixation,reduction quality and complete weight-bearing time were important factors affecting the proximal femoral shortening after intertrochanteric fracture.
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Establishment of risk prediction model for postoperative lung ventilation disorders in patients with multiple rib fractures
YAO Fa, HE Shushuai, YANG Wensheng, et al
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1183-1186.  DOI: 10.3969/j.issn.1005-6483.2022.12.024
Abstract ( 4 )   PDF (925KB) ( 2 )  
Objective To establish a risk prediction model for postoperative pulmonary ventilation disorder in patients with multiple rib fractures.Methods From March 2019 to March 2021,a total of 150 patients with multiple rib fractures admitted to our hospital were selected and divided into a control group(patients without ventilatory disorders,52 cases) and a study group(patients with ventilatory disorders,98 cases) according to whether or not pulmonary ventilation disorders occurred after the operation.The clinical data of patients,such as visit time,diabetes,sputum expectoration,the number of rib fractures,smoking history,underlying lung diseases,age,gender and other clinical data,were collected for univariate analysis,multi-factor Logistic regression analysis was performed according to the results of single factor analysis,and R software was used to construct a risk prediction model for postoperative ventilatory disorder in patients with multiple rib fractures,the ROC curve and H-L fit degree were used to test and evaluate the model.Results Univariate analysis,the results showed that the occurrence of postoperative pulmonary ventilation disorder in patients with multiple rib fractures was related with age,underlying lung diseases,sputum expectoration,visit time,diabetes,smoking history,operation time,number of fractures,and body mass index(P<0.05);the multivariate Logistic regression analysis model,and the results showed that the age older than 60 years old,combined with underlying lung diseases,poor sputum expectoration,smoking history,visit time more than 24 h,combined with diabetes,operation time ≥120min,number of fracture ≥6,and body mass index ≥24kg/m2 were independent risk factors for lung ventilation disorder after multiple rib fracture operation(P<0.05).On this basis,R software was used to construct a risk prediction model for postoperative lung ventilation disorders in patients with multiple rib fractures,the area under the ROC curve and the HL deviation were used to test the model,the area under the ROC curve was 0.908,and the sensitivity and specificity were 80.77,86.73 respectively.The result of H-L deviation degree was  χ2=3.758,P=0.512.Conclusion Age older than 60 years old,combined with underlying lung diseases,poor sputum expectoration,smoking history,visit time more than 24 h,combined with diabetes,operation time ≥120 min,number of fractures ≥6,and body mass index ≥24 kg/m2 are independent risk factors that affect lung ventilation disorder after multiple rib fractures operation,the risk prediction model established on this basis has high discrimination and accuracy,which can provide an effective basis for early clinical identification of the risk of pulmonary ventilation disorder after operation.
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Effect of transurethral plasma ERBT on blood loss and oxidative stress factors in patients with NMIBC
XU Weijie, LI Jinyu, LIN Lianzheng, et al.
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1187-1190.  DOI: 10.3969/j.issn.1005-6483.2022.12.025
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Objective To investigate the effect of transurethral plasma resectoscope retrograde submucosal enucleation of bladder tumor(ERBT) on blood loss and oxidative stress in patients with non myometrial invasive bladder cancer(NMIBC).Methods92 patients with NMIBC who underwent surgery in our hospital from January 2019 to January 2021 were selected as the research object.The data of the patients were analyzed retrospectively.According to the operation method,they were divided into transurethral resection of bladder tumor(TURBT) group(n=53) and erbt group(n=39).The changes of operation related indexes,operation complications,micturition function and blood oxidative stress indexes before and after operation were recorded and compared between the two groups.〖WTHZ〗Results〓〖WTBZ〗There was no significant difference in the operation time and catheter retention time between the two groups(P>0.05).The amount of intraoperative bleeding in erbt group was significantly less than that in TURBT group,and the bladder flushing time and hospital stay were significantly shorter than that in TURBT group(P<0.05).The incidence of obturator nerve reflex in erbt group was significantly lower than that in TURBT group(P<0.05),and the incidence of bladder perforation and urinary tract infection were also lower than that in TURBT group,but there was no significant difference(P>0.05).The maximum urinary flow rate(Qmax) and maximum detrusor pressure(MDP) in erbt group were significantly higher than those in TURBT group,and the residual urine volume(PVR) was significantly lower than that in TURBT group(P<0.05).7 days after operation,serum glutathione peroxidase(GSH PX),superoxide dismutase(SOD) and total antioxidant activity(AOA) in erbt group were significantly higher than those in TURBT group,while serum malondialdehyde(MDA) was significantly lower than that in TURBT group(P<0.05).Conclusion Transurethral plasma erbt can significantly reduce the amount of intraoperative bleeding in patients with NMIBC,shorten the time of intraoperative bladder flushing,effectively alleviate the body's oxidative stress response caused by surgery,and reduce the incidence of obturator nerve reflex,which is conducive to the postoperative prognosis of patients.
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Effect of erector spinal plane block on analgesia and postoperative recovery of lumbar spine decompression and fusion internal fixation operation
XIONG Yunchuan, LI Qian, LIU Chang, et al
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1191-1194.  DOI: 10.3969/j.issn.1005-6483.2022.12.026
Abstract ( 1 )   PDF (681KB) ( 3 )  
Objective To explore the application effect of ultrasound-guided erector spinal muscle plane block(ESPB) in lumbar decompression and fusion internal fixation.Methods Sixty patients with lumbar decompression and fusion internal fixation in this hospital from January to April 2022 were selected and divided into two groups according to the random number table method,thirty cases in each group.The study group implemented the general anesthesia intubation under the ESPB intervention and the control group conducted the general anesthesia intubation.The intraoperative vital signs,total amount of anesthetic drugs use and operation time were recorded.The resting Visual analogue scale(VAS) scores of the incision at different postoperative time periods,and the proportion of remedial analgesic medication use within postoperative 48h and adverse reactions were recorded.Results There was no statistical difference in the vital signs,intraoperative situation,resting VAS scores of the incision at postoperative 36,48h and occurrence rate of adverse reactions at postoperative 48h between the two groups(P>0.05).Compared with the control group,the use amounts of intraoperative remifentanil in the study group were significant decreased(P<0.05).The resting VAS scores of the incision at postoperative 2,6,12,24h were reduced(P<0.05);the proportion of remedial analgesic drugs use at postoperative 48h were reduced(P<0.05).Conclusion Ultrasound-guided ESPB can effectively improve the analgesia efficacy for the patients with lumbar decompression fusion and internal fixation,which is conducive to postoperative earlier recovery.
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The research progress of exosome in the treatment of hypertrophic scar and keloid
TAO Rui, TAN Zhixiang, LI Sicheng, et al
JOURNAL OF CLINICAL SURGERY. 2022, 30 (12):  1196-1199.  DOI: 10.3969/j.issn.1005-6483.2022.12.028
Abstract ( 2 )   PDF (346KB) ( 2 )  
In the terminal stage of the human wound repair process,it is often accompanied by scar formation.Hypertrophic scar and keloid may occur when the orderly repair process of the body is broken and the wound heals abnormally.The emergence of them not only brings physical and mental burden to patients,but also consumes a lot of medical resources.Clinically,scar is mainly treated by surgery,local radiation and drug injection,but there is still a little gap between its curative effect and expectation.Therefore,it is of great significance to explore new treatment methods.Existing studies have shown that exosomes  have a certain therapeutic effect on scar.This review will summarize the mechanism and recent research progress of exosome in the treatment of hypertrophic scar and keloid.
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