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Diagnosis and treatment of gastrointestinal bleeding after aortic dissection
WEI Song, WANG Min, XU Gaoxin, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 444-446.   DOI: 10.3969/j.issn.1005-6483.2023.05.012
Abstract411)      PDF(pc) (812KB)(231)       Save
Objective To explore diagnostic strategies and treatment options for gastrointestinal bleeding after aortic dissection surgery.Methods The clinical data and diagnosis and treatment results of patients with gastrointestinal bleeding after aortic dissection surgery admitted from January 2020 to June 2022 in the Affiliated Nanjing Hospital of Nanjing Medical University were analyzed retrospectively.Results A total of 10 cases of 14 patients with gastrointestinal bleeding after aortic dissection surgery were cured,7 cases were mainly based on basic support and drug therapy,1 case was treated with endoscopic therapy,and 2 cases were treated with surgical operations;In the untreated group,3 cases were basic support and medication,and 1 case died due to poor surgical treatment.Conclusion The diagnosis and treatment strategy of gastrointestinal bleeding after aortic dissection surgery should be comprehensively evaluated according to the amount,location and complications of bleeding,and the individualized treatment of patients should be strengthened.Timely surgical treatment is helpful to improve the prognosis and outcome of patients with gastrointestinal bleeding after aortic dissection surgery.
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Applications of single pig-tail biliary stents placement via choledochoscopy in laparoscopic common bile duct exploration and primary duct closure
LI Jin, XU Meng, WANG Bing, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 364-367.   DOI: 10.3969/j.issn.1005-6483.2023.04.018
Abstract269)      PDF(pc) (865KB)(85)       Save
Objective   To compare the efficacy and safety of single pig-tail biliary stent placement under choledochoscopy followed by primary common bile duct closure with traditional T-tube drainage after laparoscopic common bile duct exploration.   Method  A total of 98 cases who underwent laparoscopic common bile duct exploration in our hospital from June 2019 to June 2022 were included retrospectively.They were divided into bile duct stents group (BD-stent group,40 cases) and the T-tube drainage group (TTD group,58 cases) according to the surgery type.The general conditions,intraoperative indicators,postoperative recovery and complications in two groups were statistically compared.   Result   In terms of surgery,the BD-stent group had significantly less surgery time,bile-duct-operation time,bleeding volume,postoperative VAS index and Caprini score than the TTD group (P<0.05).Both groups had no mortality or reoperation.There were no significant differences in first-day serum total bilirubin,γ-GT and total analgesia usage between two groups(P>0.05).But the first-day serum albumin,anal ventilation time,antibiotic usage,leukocyte recovery days,drain-tube removal days,bile duct drainage days,postoperative hospital stay and total costs in BD-stent group were significantly better than those in TTD group (P<0.05).As for postoperative complications,the rate in BD-stent group and TTD group were respectively 5.0% and 6.9%,without significant differences (P>0.05).  Conclusion   Single pig-tail biliary stent placement under choledochoscopy followed by primary common bile duct closure has unique advantages in safety and rapid recovery.It avoids long-term drainage.
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Effect of inverted L approach combined with lateral approach with double plate fixation on knee range of motion in patients with three column fracture of tibial plateau
XIAO Ben, LI Xuejun
JOURNAL OF CLINICAL SURGERY    2023, 31 (7): 666-669.   DOI: 10.3969/j.issn.1005-6483.2023.07.017
Abstract226)      PDF(pc) (805KB)(66)       Save
Objective   To study the effect of double plate fixation through inverted L approach combined with lateral approach on the range of motion of knee joint in patients with three column fracture of tibial plateau. Methods   Retrospectively,88 patients with tibial plateau triple column fractures admitted in the orthopedic department of Beijing Tongren Hospital affiliated to Capital Medical University from November 2017 to December 2,2020 were selected as the study subjects and divided into control group and study group according to the treatment methods.The control group,44 patients had lateral approach double plate fixation,and 44 patients had lateral approach double plate fixation combined with inverted L approach.Compare the surgical efficacy and postoperative recovery between the two groups;compare the preoperative and postoperative knee function scores and quality of life scores between the two groups. Results   After operation,the operation time of the study group was (90.12±11.30) min,the intraoperative bleeding volume was (463.20±70.10) ml,and the hospital stay was (3.08±1.12) d,the time of knee joint exercise was (3.08±1.12) days,the time of complete fracture healing was (14.58±2.64) weeks and the time of complete weight-bearing was (16.27±3.65) weeks,which were shorter than those in the control group [(98.42±12.18) min,(502.41±77.10) ml,(20.36±3.12) d,(5.54±1.69) d,(16.06±3.27) weeks,(18.67±4.21) weeks] (P<0.05).In study group,the scores of the American Special Surgery Hospital (HSS)  were (87.06±10.06) points,the scores of the health survey summary (SF36)  was (82.69±10.30) points,the rate of excellent and good healing (93.18%),and the range of motion of the knee joint [knee extension (9.54±2.36),flexion (135.28±28.48)],which were higher than those of the control group [(80.26±9.20),(74.12±9.20),(77.27%),(8.06±2.06) and (121.64±22.61)] (P<0.05).There was no significant difference in the total incidence of postoperative complications between the two groups (P>0.05).  Conclusion   The treatment of patients with three column fracture of tibial plateau with lateral approach double plate fixation combined with inverted L approach can improve the range of motion of knee joint,promote fracture healing and improve the quality of life.
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Short and long term efficacy of sentinel lymph node biopsy combined with breast conserving surgery and modified radical mastectomy in the treatment of stage Ⅰ-Ⅱ breast cancer and its impact on post-traumatic stress disorder
SHI Xueliang, HUANG Qinjie, CHEN Weici, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 432-435.   DOI: 10.3969/j.issn.1005-6483.2023.05.009
Abstract216)      PDF(pc) (762KB)(28)       Save
Objective To explore the short-term and long-term efficacy of sentinel lymph node biopsy combined with breast conserving surgery and modified radical mastectomy in the treatment of stage Ⅰ-Ⅱ breast cancer and its impact on post-traumatic stress disorder(PTSD).Methods Between January 2016 and may 2019,220 breast cancer patients admitted to Qidong people's hospital were divided into two groups according to the treatment scheme,of which 135 patients in the radical cure group received modified radical surgery and 85 patients in the breast conservation group received sentinel lymph node biopsy combined with breast conservation surgery.The surgical indexes,breast aesthetic effect,PTSD level,serum tumor marker level,postoperative complications,3year overall survival rate and recurrence rate were compared between the two groups.Results The operation time,intraoperative bleeding volume,postoperative drainage volume and hospital stay in the breast conserving group were less than those in the radical group(P<0.05).The cosmetic effect of breast conserving group was better than that of radical mastectomy group(P<0.05).One week after operation,the levels of serum carcinoembryonic antigen(CEA) and carbohydrate antigen 153(CA153) in both groups were lower than those before operation(P<0.05).The scores of PTSD checklist version(PCL-C) in breast conserving group and radical therapy group were [(33.67±7.89) points and [(46.82±6.15) points],respectively,the PCL-C of the breastconserving group were lower than those of the radical treatment group in a week after operation,and both groups were higher than those before operation(P<0.05).There were no serious complications such as severe infection and flap necrosis in both groups.The incidence of postoperative complications in radical group was higher than that in breast conserving group(P<0.05).The 3-year survival rates of breast conserving group and radical operation group were 98.78% and 100.00% respectively,and the recurrence rates were 6.10% and 3.10% respectively,there was no significant difference in the 3-year survival rate and recurrence rate between the two groups(P>0.05).Conclusion The application of sentinel lymph node biopsy combined with breast conserving surgery in the treatment of stage Ⅰ-Ⅱ breast cancer patients is more helpful to shorten the operation time,hospital stay and other operation indicators,improve the postoperative breast aesthetic effect,reduce the incidence of postoperative complications and PTSD level,and the adjustment level of short-term tumor markers,long-term survival rate and recurrence rate after operation are equivalent to that of modified radical mastectomy.
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Nine cases of Petersen’s hernia after gastrectomy and review of the literature
LIU Guangshuai, LI Zhongmin, PEI Lunqing, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 357-359.   DOI: 10.3969/j.issn.1005-6483.2023.04.016
Abstract205)      PDF(pc) (812KB)(125)       Save
Objective   To summarize the etiology,clinical features,treatment and prevention of internal abdominal hernia after gastric surgery(Petersen hernia) and improve the understanding of Petersen hernia.  Methods   A retrospective analysis in January 2018 to December 2021 jilin university fellowship between China and Japan hospital for treatment of 9 cases after gastrectomy Petersen hernia patients,7 cases underwent open Bie-ⅱ anastomosis and 2 cases underwent Roux-en-Y anastomosis due to the primary disease.The median duration of onset was 2 days.The percentage of neutrophils in blood routine was increased to varying degrees.Preoperative abdominal CT showed anastomotic wall thickening,proximal small bowel obstruction sign 4 cases,small intestine torsion signs in 2 cases,no special signs only 3 cases of small intestinal obstruction,has not been in patients with preoperative diagnosis for Petersen hernia,all patients underwent surgical treatment,intraoperative see output section of the small intestine to shift into the Petersen clearance and hernia in 5 cases,There were 3 cases without torsional herniation into Petersen space in the output segment and 1 case with torsional herniation into Petersen space in the input segment.Among them,4 patients underwent intestinal resection and anastomosis due to intestinal necrosis.  Results   One patient developed pleural and abdominal effusion after operation,and all patients were cured and discharged after treatment.  Conclusions   Petersen’s hernia is a relatively rare complication after gastrectomy.Preoperative abdominal CT can help to determine the criticality of the patient’s condition and can be the first choice of examination.A small number of patients with acute pancreatitis should pay attention to preoperative and postoperative amylase changes,and once the diagnosis is confirmed,surgery should be performed as soon as possible.
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Study on the effect and safety of “cross” suture in reconstruction of perineal incision and closure of enterostomy for rectal cancer
LI Xiaohe, YANG Shengfu, SU YeNeng, XU Shaoqiang, FENG Guangge
JOURNAL OF CLINICAL SURGERY    2023, 31 (6): 528-532.   DOI: 10.3969/j.issn.1005-6483.2023.06.008
Abstract198)      PDF(pc) (1065KB)(60)       Save
Objective To analyze the effect and safety of “cross” suture in the reconstruction of perineal incision and closure of enterostomy for rectal cancer. Methods A total of 107 patients with perineal incision reconstruction during combined abdominal perineal resection and abdominal incision reconstruction during enterostomy closure treated in our hospital from January 2019 to January 2022 were selected.They were divided into traditional stoma group (12 cases),stoma “cross” group (14 cases),traditional reconstruction group (37 cases) and reconstruction “cross” group (44 cases).Follow up for 30 days after operation to compare the effects of each group. Results The operation time,incision healing time,postoperative extubation time,and postoperative hospital stay in the ostomy “cross” group and the reconstruction “cross” group were shorter than those in the traditional ostomy group and the reconstruction traditional group,and the intraoperative blood loss was less than that in the traditional ostomy group and the reconstruction traditional group (P<0.05).The NRS score of the “cross group” and the  reconstruction“cross group” 1,2 and 3 days after surgery was lower than that of the traditional group and the traditional reconstruction group (P<0.05).The color,thickness,blood vessels,softness and total score of postoperative incision in the “cross group” and the reconstruction“cross group” were lower than those in the traditional group and the traditional reconstruction group (P<0.05).The incidence of postoperative complications in the reconstruction “cross” group was 6.82%,significantly lower than that in the traditional reconstruction group (24.32%) (P<0.05).There was no difference in the total incidence of complications between the traditional stoma group and the stoma “cross” group (P>0.05). Conclusion “Cross” suture can be used for incision reconstruction during combined abdominal perineal resection and enterostomy closure.It has the characteristics of “unobstructed drainage” and “reduced tension suture”,and can reduce the incidence of postoperative complications.
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Progress in endoscopic diagnosis and treatment of common bile duct stones and dilation in children
LI Wenhai, WANG Xin, YANG Hu, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 490-493.   DOI: 10.3969/j.issn.1005-6483.2023.05.023
Abstract184)      PDF(pc) (469KB)(151)       Save
Common Bile Ducts(CBDS),also called choledocholithiasis,is more common in adults than in children.The incidence of children increased with the change of life style and the improvement of diagnostic techniques.Choledocholithiasis is often associated with common bile duct dilatation.Adult treatment includes laparotomy,laparoscopic and endoscopic retrograde cholangiopancreatography(ERCP).In order to avoid repeated inflammation and canceration of dilated bile duct,it is considered that choledocholithiasis and dilatation to a certain extent in children need radical operation.In recent years,with the development of ERCP in children,choledocholithiasis and dilatation have been relieved by ERCP treatment.In order to provide some reference for selecting appropriate treatment methods and exploring individualized treatment,this paper reviews the diagnosis and treatment of choledocholithiasis complicated with choledochal dilatation in children.
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Clinical features of incidental prostate cancer (report of 9 cases)
YAO Xuan, Liu Bo, WANG Li, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 380-382.   DOI: 10.3969/j.issn.1005-6483.2023.04.022
Abstract183)      PDF(pc) (741KB)(95)       Save
Objective   To summarize the clinical and pathological features of incidental prostate cancer.  Methods   The clinical data of  9 cases admitted from Jan 2018 to Dec 2021 were retrospectively analyzed.All patients underwent surgical treatment, and postoperative pathological examination confirmed prostate adenocarcinoma. Summarize the clinical and pathological features of the patients.  Results   All patients were discharged after operation.Prostate adenocarcinoma was detected in 6 cases in cystectomy specimens.Adenocarcinoma of prostate was detected pathologically in 3 patients with hyperplasia of prostate.Gleason score was 6 in 7 and 7 in 2 of the 9 patients.During follow-up, 1 patient received robot-assisted laparoscopic radical prostatectomy with continuous PSA increase.  Conclusion   Outcome of incidental prostate cancer has limited relationship with incidental prostate cancer itself.Occasional prostate cancer usually requires no surgery, but active surveillance is required.A few of incidental prostate cancer.patients may undergo prostatectomy if necessary.
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The research on clinical use of platelet-rich fibrin in treatment of chronic wounds
SHI Jingyuan, CUI Zhenjie, ZHAO Hong
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 387-390.   DOI: 10.3969/j.issn.1005-6483.2023.04.024
Abstract182)      PDF(pc) (754KB)(101)       Save
Objective   To observe more cases and indexs of platelet rich fibrin (PRF) application on chronic wounds,which provide solid basis for the application of PRF on the treatment of chronic wounds.  Methods   86 patients with chronic wounds treated in our hospital from January 2014 to January 2022 were selected.The odd and even number grouping was used to guide the patients to draw numbers by themselves.The patients with odd numbers were classified as the control group (routine treatment),and the patients with even numbers were classified as the observation group (PRF treatment).The number of patients in each group was 43.The infection control,wound area change,VAS score,push score,quality of life score,cost and time after treatment were observed before and after treatment,and the therapeutic effect of PRF was summarized.   Results   Before treatment in the observation group and the control group TNF-α Level,IL-2,IL-8,granulation tissue score,wound area,VAS score,push score,negative emotion score and quality of life score were not statistically significant (P>0.05).There was significant difference between the two groups after treatment and before treatment (P<0.05).There was significant statistical significance between the two groups after treatment (P<0.05).There was significant difference in treatment cost and time between the two groups (P<0.05).The therapeutic effect of the two groups was statistically significant (P<0.05).  Conclusion   The application of PRF on the treatment of chronic wounds can effectively reduce the level of inflammatory factors in patients,control the degree of infection,reduce the wound area,alleviate the pain degree of patients and improve the quality of life.At the same time,it can effectively reduce the treatment cost and wound healing time.
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Comparison of efficacy and safety of DEB-TACE and cTACE combined with sorafenib in the treatment of advanced hepatocellular carcinoma
XU Renliang, SHEN Songbai, YU Longwu, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 383-386.   DOI: 10.3969/j.issn.1005-6483.2023.04.023
Abstract176)      PDF(pc) (840KB)(91)       Save
Objective   To explore the efficacy and safety of drug-loaded microspheres transarterial chemoembolization(DEB-TACE) and conventional hepatic arterial chemoembolization(cTACE) combined with sorafenib in the treatment of advanced hepatocellular carcinoma.   Methods   From March 2019 to March 2021,106 patients with advanced hepatocellular carcinoma were included in the study and were randomly divided into two groups according to the random number table method.The control group was treated with cTACE combined with sorafenib,and the study group was treated with DEB-TACE combined with sorafenib.The clinical efficacy,serum hypoxia-inducible factor 1α(HIF-1α),alpha-fetoprotein(AFP),total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST) levels,and adverse reactions and living conditions were compared in both groups.   Results   The objective remission rate in the study group was 64.15%, higher than that in the control group (43.40%)(P<0.05).After 3 months of treatment,serum HIF-1α and AFP levels in both groups were decreased,and the research group was lower(P<0.05).After 3 months of treatment,the levels of serum TBIL,ALT and AST in both groups were increased(P<0.05),and serum levels of TBIL,ALT and AST in the study group were lower than the control group(P<0.05).The difference in the incidence of adverse reactions was not significant in both groups(P>0.05).The median progression-free survival time of study group and control group was 12.11 months(95%CI 7.78-16.22) and 10.09 months(95%CI 7.67-12.33),respectively.There was no significant difference in the median progression-free survival curve between the two groups(χ2=2.293,P=0.130).  Conclusion   DEB-TACE combined with sorafenib in the treatment of patients with advanced hepatocellular carcinoma can improve the therapeutic effect,regulate the level of serum tumor markers,improve reduce liver damage.
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Investigation and influencing factors of complications after TAPP for inguinal hernia in elderly men
LIU Weiguang, PAN Zhulou
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 372-375.   DOI: 10.3969/j.issn.1005-6483.2023.04.020
Abstract176)      PDF(pc) (923KB)(68)       Save
Objective   To investigate the postoperative complications of laparoscopic transabdominal preperitoneal hernia repair(TAPP) for inguinal hernia in elderly men,and to analyze the related influencing factors.  Methods   A total of 86 elderly male patients with inguinal hernia who underwent laparoscopic TAPP treatment in the hospital from March 2020 to November 2021 were selected,Complications were counted 6 months after the operation,and the patients were divided into a complication group and an uncomplicated group accordingly.The baseline data of the two groups were collected,and the univariate and Logistic multivariate regression analysis of the influencing factors of complications after laparoscopic TAPP for inguinal hernia in elderly men was performed,and a prediction model was established based on the selected independent risk factors.The receiver operating characteristic(ROC) curve was used to observe the predictive value of independent risk factors and predictive models for postoperative complications in patients,and cross-validation was used to test the predictive performance of the predictive models.  Results   Of the 86 patients in this group,76 had no complications,10 had complications,and the complication rate was 11.63%.Univariate analysis showed that the age,body mass index(BMI),the proportion of chronic obstructive pulmonary disease(COPD),and the proportion of hernia sac diameter ≥ 5cm in the complication group were higher than those in the uncomplicated group(P<0.05).Logistic multivariate regression analysis showed that age,BMI,COPD,and diameter of hernia sac were independent risk factors for postoperative complications(P<0.05).Drawing the ROC curve showed that age,BMI,COPD,and hernia sac diameter had good predictive value for postoperative complications,and the areas under the curve(AUC) were 0.757,0.689,0.688,and 0.732,respectively.A prediction model was established based on independent risk factors,The ROC curve showed that the AUC of the prediction model was 0.887,the SE was 0.045,and the 95%CI was 0.799-0.974,P<0.001.Using cross-validation test,it was found that the classification accuracy of the prediction model was 80.23%(69/86).  Conclusion   Elderly men have a higher risk of complications after TAPP for inguinal hernia,and the risk factors include age,BMI,COPD,diameter of hernia sac,The predictive model established on this basis has a good predictive effect on the occurrence of complications,and clinical preventive measures can be taken accordingly.
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Diagnosis and treatment of simultaneous multiple primary colorectal cancer(clinical analysis of 6 cases)
HU Jun, LUO Junfeng, ZHOU Wenbin, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 360-363.   DOI: 10.3969/j.issn.1005-6483.2023.04.017
Abstract174)      PDF(pc) (1121KB)(87)       Save
Objective   To explore the diagnosis and treatment of synchronous colorectal carcinoma(SCC).  Methods   The clinical data of 6 cases of SCC treated with surgery in our hospital from March 2021 to July 2021 were retrospectively analyzed.  Results   All 6 patients with SCC underwent one-stage surgical resection and anastomosis successfully.The patients recovered smoothly without serious complications such as anastomotic leakage.  Conclusion   The treatment effect is satisfactory for patients with SCC by choosing the appropriate surgical method according to the tumor location.
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Clinical significance of monitoring blood calcium,serum parathyroid hormone and central drainage fluid parathyroid hormone in evaluating parathyroid function after thyroidectomy
WANG Xinsheng, WU Shile, HE Beibei, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 428-431.   DOI: 10.3969/j.issn.1005-6483.2023.05.008
Abstract168)      PDF(pc) (335KB)(31)       Save
Objective To explore the dynamic variation rule of serum calcium levels,serum parathyroid hormone levels and central drainage fluid parathyroid hormone levels after total thyroidectomy,To investigate the clinical significance of monitoring the above indexes in evaluating parathyroid function.Methods From January 2018 to January 2021,112 patients who received total thyroidectomy and bilateral central lymph node dissection in general Surgery Department of Qinghai provincial People's Hospital were chosen as the research objectve,According to the number of parathyroid glands(0, 1, 2) retained in situ,patients were divided into group A0,group A1 and group A2,Serum calcium,blood PTH and central drainage fluid PTH levels were detected before surgery and 1 to 4 days after surgery,Then we did a statistical analysis.Results There were 23 cases of hypocalcemia in 112 patients,including 15 cases in group A0,6 cases in group A1 and 2 cases in group A2.The level of postoperative serum calcium were lower than those before operative,And the most obvious decrease was  group A0,There was no significant increase in postoperative 1~4 days,However,group A1 and A2 showed a trend of gradual increase,and group A2 showed a faster increase.The level of postoperative serum PTH were lower than those before operative,And the most obvious decrease was group A0,There was no significant increase in postoperative 1~4 days,The level of serum PTH in group A1 and group A2 showed an upward trend,But the level of serum PTH in the two groups did not increase to the preoperative level within 4 days after operation.The level of postoperative drainage fluid PTH was significantly different among all groups,With group A2 having the highest mean value,Group A1 followed by group A0 having the lowest.With the passage of time,there was no significant change in group A0,And the PTH level of drainage fluid in group A1 and group A2 showed a general downward trend,As well,The decrease of group 1 was faster than that of group A2.Conclusion By monitoring serum calcium,serum PTH and drainage fluid PTH,the functional recovery of orthotopic parathyroid gland can be effectively evaluated after thyroidectomy,The central drainage fluid PTH can directly reflect the activity of the in-situ retained parathyroid gland,The maintenance of a high level of postoperative drainage is direct evidence of orthotopic parathyroid survival.
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The effect of obesity on perioperative complications in patients with acute Stanford A aortic dissection
ZHANG Jie, ZHENG Zhi, PAN Youmin
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 344-347.   DOI: 10.3969/j.issn.1005-6483.2023.04.013
Abstract166)      PDF(pc) (756KB)(91)       Save
Objective  To investigate the effect of obesity on perioperative complications in patients with acute Stanford A aortic dissection(TAAD).  Methods   According to BMI,the patients were divided into obese group (BMI ≥28kg/m2) and non-obese group (BMI < 28kg/m2) .The obese group included 55 cases,the non-obese group included 78 cases,133 cases in total.The differences of postoperative hypoxemia, ventilator assistance time, pulmonary infection, nervous system complications, acute kidney injury, poor wound healing, blood transfusion volume, hospital mortality and length of stay were compared between the two groups.  Results   The proportion of hypoxemia,extubation time ≥96 hours,poor wound healing,CSICU(Cardiac Surgery Intensive Care Unit) ≥7 days and total hospital stay ≥20 days in obese group were significantly higher than those in non-obese group (P<0.05),there was no significant difference in postoperative acute renal injury,pulmonary infection,neurological complications and in-hospital mortality between the two groups(P>0.05).BMI≥28km2,extubation time ≥96h,and pulmonary infection were the main independent risk factors for hospital stay ≥7 days in CSICU after Type A aortic dissection.Patients with BMI ≥28kg/m2 had 2.45 times more CSICU hospital days (≥7 days) than non-obese patients.  Conclusion   Obesity increases the incidence of perioperative complications in patients with acute Stanford A aortic dissection and is an independent risk factor for hospital stay of ≥7 days in CSICU,but there is no significant difference in in-hospital mortality.

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Observation of curative effect of CT three-dimensional reconstruction technique in the treatment of unstable pelvic fractures with anterior sacroiliac joint plate
LU Shunli, LV Bao, ZHANG Ning
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 317-320.   DOI: 10.3969/j.issn.1005-6483.2023.04.006
Abstract163)      PDF(pc) (874KB)(90)       Save
Objective  To observe the effect of CT three-dimensional reconstruction technique in the treatment of unstable pelvic fractures with anterior sacroiliac joint plate. Methods  From January 2020 to January 2022, Eighty patients with unstable pelvic fracture(treated in our hospital) were selected and divided into control group(40 cases) and combined group(40 cases) according to the random number table method.The control group was given anterior sacroiliac joint plate treatment,combined with CT three-dimensional reconstruction technology on the basis of the control group.Intraoperative and postoperative related indicators,pain degree,fracture reduction,fracture functional recovery and complications were compared.Results  There was no obvious difference in the amount of bleeding,fracture healing time,and preoperative VAS score between the two groups(P>0.05).Compared between the control group with the combined group,the time of getting out of bed [(4.52±0.57)w vs(5.14±0.63)w],weight bearing time [(9.75±1.12)w vs(11.53±1.26)w],hospital stay [(10.35±1.26)d vs(12.78±1.31)d] and operation time [(65.78±6.62)min vs(85.49±8.67)min],1 week [(4.72±0.64) vs(5.11±0.78)],2 weeks [(4.01±0.57) vs(4.65±0.64)],4 weeks [(2.31±0.27) vs(3.45±0.36)]VAS scores were lower than those of the control group(P<0.05).The excellent and good rate of fracture reduction(97.50%) and the excellent and good rate of fracture function recovery(95.00%) in the combined group were greatly higher than those in the control group(80.00%,75.00%)(P<0.05); the incidence of complications such as osteonecrosis in the combined group(7.50%) was greatly lower than that in the control group(27.50%)(P<0.05). Conclusion   CT three-dimensional reconstruction technology applied to the treatment of unstable pelvic fracture injury with anterior sacroiliac joint plate can effectively shorten the operation time,reduce the pain of patients,and promote postoperative recovery,which is safe and effective.
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Recent advances in targeted therapy for cholangiocarcinoma
FAN Feimu, DONG Hanhua
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 394-397.   DOI: 10.3969/j.issn.1005-6483.2023.04.026
Abstract163)      PDF(pc) (769KB)(94)       Save
Cholangiocarcinoma is a malignant tumor originating from the epithelium of the bile ducts,and its incidence is increasing year by year,especially intrahepatic bile duct carcinoma that originates from the bile duct branches above the second level in the liver.Due to the insidious early symptoms and the lack of effective screening methods,most patients have lost the opportunity for radical surgery by the time they present.Over the past few years,several drugs have been developed that target genetic alterations with the detection of the cholangiocarcinoma genome.The molecular targets with clinical significance mainly include fibroblast growth factor receptor(FGFR),isocitric acid dehydrogenase(IDH),RAS-RAF-MEK-ERK,ERBB,VEGF and NTRK.Drugs targeting their targets show encouraging response rates and survival data as second-line therapies,and are characterized by high specificity and low toxicity.Therefore,targeted therapy is gradually emerging in the treatment of cholangiocarcinoma.In this review,we discuss the latest advances in targeted therapies for cholangiocarcinoma.
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Comparison of clinical features and surgical outcomes in trigeminal neuralgia caused by arterial/venous compression:a single-center follow-up analysis of 335 cases
XU Yu, MA Yixuan, ZHAO Kai, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 423-427.   DOI: 10.3969/j.issn.1005-6483.2023.05.007
Abstract162)      PDF(pc) (1059KB)(227)       Save
Objective To summarize the clinical features and surgical outcomes of idiopathic trigeminal neuralgia (TN) caused by sole arterial and venous compression.Methods Between Jan 2010 and Dec 2016,335 TN patients caused by sole arterial and venous compression were applied to microvascular decompression (MVD) treatment in our department.The patient data were retrospectively analyzed.Results Compared to arterial compression,V3 branch of the trigeminal nerve was more frequently involved,while V1 was rarely affected in venous compression (P<0.05).The most frequently offending vessel was the superior cerebellar artery (SCA,87.8%) in arterial compression and the transverse pontine vein (TPV,80.6%) in venous compression.The most common compression site was the root entry zone (REZ,78.6%) for arterial compression and cisternal (74.2%) for venous compression.Compared to arterial compression,the neuro-vascular compression grade was significantly lower in venous compression (P<0.05); the short-term outcomes were relatively worse in the venous compression group (P<0.05); however,the long-term outcomes were similar (P>0.05).No statistical differences were established regarding the rate of postoperative complications and recurrence between both groups(P>0.05).Conclusions Our results suggest that venous compression is more prone to involve V3 distribution of the trigeminal nerve.3D-TOF-MRA is preferred in identifying venous compression.MVD is still effective and safe for TN caused by venous compression and only small intraneural veins could be sacrificed.A relative long-term follow-up (1 year) is mandatory to monitor delayed pain relief and recurrence.
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Clinical observation on treatment of proximal humeral fracture with shoulder abduction brace and Trigen interlocking intramedullary nail
YAN Fengxiang
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 330-333.   DOI: 10.3969/j.issn.1005-6483.2023.04.009
Abstract158)      PDF(pc) (889KB)(72)       Save
Objective  To observe the clinical effect of shoulder abduction brace combined with trigen interlocking intramedullary nail in the treatment of proximal humeral fractures.  Methods  55 patients with proximal humeral fractures treated in our hospital from January 2020 to January 2021 were divided into two groups according to different treatment schemes.The control group:26 patients were treated with trigen interlocking intramedullary nail.Study Group:29 cases were treated with shoulder abduction brace combined with trigen interlocking intramedullary nail.The results of reduction evaluation,clinical healing time of fracture,bone healing time of fracture,constant Murley shoulder function score and shoulder range of motion were compared.  Results  The reduction assessment of the study group were significantly better than those of the control group.The clinical healing time of fracture in the study group was shorter than that in the control group,and the bone healing time of fracture was shorter than that in the control group(P<0.05).One year after operation,the constant Murley shoulder function score of the control group and the study group were were higher than 1 month after surgery(P<0.05).One year after operation,the constant Murley shoulder function score of the study group was not significantly different from that of the control group(P>0.05).Following up for 1 year,there was no significant difference between the two groups in the activities of flexion and lifting,external rotation and abduction(P>0.05).  Conclusion  The shoulder abduction brace combined with trigen interlocking intramedullary nail is conducive to the reduction of proximal humeral fractures,shorten the clinical healing time and bone healing time of fractures,and it is conducive to improving the early shoulder joint function and range of motion.
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Application of single-port robotic technology in urological surgery of infants
HUANG Guangbin, LI Geng, GAO Heyun, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 419-422.   DOI: 10.3969/j.issn.1005-6483.2023.05.006
Abstract156)      PDF(pc) (832KB)(69)       Save
Objective To explore the application value of single-port robotic surgery in infant urological surgery by using the Da Vinci Xi system.Methods From August 2020 to October 2022,18 infants who underwent single-port robotic surgery in our center with at least 6 months’ follow-up were selected.11 cases completed pyeloplasty,including 1 case of bilateral pyeloplasty;3 cases underwent uretero-ureteral anastomosis;1 case followed Lich-Gregoir technique;2 cases underwent nephrectomy of renal hypoplasia;1 case underwent capsulectomy of the prostate;9 in 18 cases were combined with patent processus vaginalis,including 3 cases with bilateral patent processus vaginalis;The operating experience and follow-up treatment effect were analyzed.Results All 18 children successfully completed the operation without converting to laparotomy through a single incision under the umbilicus;the postoperative hospital stay was (7.9±3.8 )days,and the postoperative follow-up was (16.3±8.6 )months.1 case occurred anastomotic leakage after the operation,and it was cured after the drainage tube was used for 9 days;1 case developed urinary tract infection 2 weeks after the operation,and was cured after taking antibiotics without recrudescence;there was no mid-and-long-term complications;the surgical incision healed well,and there were no complications such as infection,scar proliferation or incisional hernia.Postoperative appearance satisfaction was great.Conclusion It is feasible to perform urological surgery on infants through single-port robotic technology using the Da Vinci Xi system.Although it exists certain technical difficulties in application,it can bring better minimally invasive experience and cosmetic effect for infants.
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JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 368-371.   DOI: 10.3969/j.issn.1005-6483.2023.04.019
Abstract153)      PDF(pc) (747KB)(59)    PDF(mobile) (747KB)(3)    Save
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Expression and diagnostic value of miR-144,MALAT1 and SPOCK1 in bladder cancer tissue
LIANG Bo, HE Yue, LIU Hongjian, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 440-443.   DOI: 10.3969/j.issn.1005-6483.2023.05.011
Abstract152)      PDF(pc) (914KB)(55)       Save
Objective To analyze the expression of miR-144,lung cancer metastasis-associated transcript 1 (MALA T1) and testis proteoglycan (SPOCK1) in bladder cancer tissues and their diagnostic efficacy.Methods A total of 96 bladder cancer patients who were treated in our hospital from January 2018 to January 2021 were selected.Fresh tumor tissue from bladder cancer patients (tumor group) and normal tissue adjacent to the tumor > 2 cm away from the tumor edge (paracancerous group) were collected during surgery.5 mg each.The relative expression levels of miR-144,MALAT1 and SPOCK1 in different tissues were detected by polymerase chain reaction (PCR),and the expressions of miR-144,MALAT1 and SPOCK1 in different pathological features of bladder cancer were analyzed.The ROC curve was drawn to test the diagnostic effect of miR-144,MALAT1 and SPOCK1 on bladder cancer.96 patients underwent surgery + postoperative adjuvant chemotherapy in our hospital,and the patients were followed up by telephone and outpatient followup.Followup ended on January 30,2022,and the expressions of miR-144,MALAT1 and SPOCK1 were compared in patients with different prognosis.Results The relative expressions of MALAT1 and SPOCK1 in the tumor group were significantly higher than those in the paracancerous group,while the relative expression of miR-144 was significantly lower than that in the control group (P<0.05).The expression of miR-144 in stage Ⅲ-Ⅳ patients with lymph node metastasis was significantly lower than that in stage Ⅰ-Ⅱ patients without lymph node metastasis(P<0.05).MALAT1 and SPOCK levels in stage Ⅲ-Ⅳ,poorly differentiated,and lymph node metastasis were significantly higher than those in stage Ⅰ-Ⅱ,moderately and well differentiated,and no lymph node metastasis (P<0.05).The ROC curve was drawn,and the AUC value was calculated.The AUC values of miR-144,MALAT1 and SPOCK1 for the diagnosis of bladder cancer were 0.643 and 0.557,respectively,and the AUC value for the diagnosis of SPOCK1 was 0.717 (95%Cl:0.688-0.845).the highest AUC value was diagnosed with SPOCK1 (P<0.05).Follow-up data showed that 85 of 96 patients had good prognosis and 11 had poor prognosis.The miR-144 in the poor prognosis group was significantly lower than that in the good prognosis group,and MALAT1 and SPOCK1 were significantly higher than those in the good prognosis group (P<0.05).Conclusion The abnormal expression of miR-144,MALAT1 and SPOCK1 in bladder cancer tissue has a certain relationship with the pathological characteristics of patients,and may be used as potential diagnostic markers for bladder cancer.
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Correlation analysis between serum inflammatory factors and osteoporosis in elderly patients with chronic obstructive pulmonary disease
WANG Yang, ZHU Yiliang, XI Jintao, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 466-469.   DOI: 10.3969/j.issn.1005-6483.2023.05.017
Abstract148)      PDF(pc) (768KB)(32)       Save
Objective To investigate the relationship between serum interleukin-6 (IL-6),interleukin-17 (IL-17),tumor necrosis factor-α (TNF-α),C-reactive protein (CRP),matrix metalloproteinase-9 (MMP-9) and osteoporosis (OP) in elderly patients with chronic obstructive pulmonary disease (COPD).Methods 135 elderly patients with COPD admitted to our hospital from April 2017 to January 2022 were retrospectively selected as the study object,according to whether the elderly COPD patients were complicated with OP,they were divided into OP group (75 cases) and non OP group (60 cases).The general data,25-hydroxyvitamin D [25 (OH) D] and other clinical biochemical indexes of the two groups were compared.The serum LEVELS of IL-6,IL-17,TNF-α,CRP and MMP-9 were compared between the two groups.Multivariate Logistic regression analysis was used to evaluate whether the above serum inflammatory factors were independent risk factors for OP in elderly COPD patients.Results The age of OP group was (73.87±9.70) years,which was higher than that of non-OP group (70.00±7.70) years,the difference was statistically significant (P<0.05); The proportion of women in OP group was 32.00%,higher than 16.67% in non OP group,the difference was statistically significant (P<0.05); The BMI of OP group was (21.05±3.21) kg/m2,which was lower than that of non OP group (24.95±2.93) kg/m2,the difference was statistically significant (P<0.05); The proportion of type 2 diabetes mellitus in the OP group was 17.33%,which was lower than 35.00% in the non-OP group,and the difference was statistically significant (P<0.05).Blood calcium and 25 (OH) D in OP group were (2.10±0.16) mmol/L and (15.83±4.02) ng/ml,respectively,lower than those in non-OP group (2.18±0.13) mmol/L and (17.96±5.00) ng/ml,and the difference was statistically significant (P<0.05).In OP group,IL-6,IL-17,TNF-α,CRP and MMP-9 were (76.85±9.26) ng/L,(27.18±4.52) pg/ml,(41.20±4.40) μg/L,(6.25±1.12) mg/L,(84.60±6.25) μg/L,respectively.It was higher than that in non-OP group [(52.91±7.07) ng/L,(10.50±3.50) pg/ml,(30.54±3.73) μg/L,(3.62±1.10) mg/L,(33.74±7.12) μg/L],and the difference was statistically significant (P<0.05).Multivariate Logistic regression analysis showed that age ,sex,IL-6 ,IL-17 ,TNF-α,CRP,MMP-9  were independent risk factors for OP in elderly patients with COPD (P<0.05),BMI,blood calcium,25 (OH) D were independent protective factors affecting OP in elderly patients with COPD (P<0.05).Conclusion IL-6,IL-17,TNF-α,CRP and MMP-9 are all abnormally high expression in serum of elderly patients with COPD complicated with OP,which are independent risk factors affecting elderly patients with COPD complicated with OP.
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Innovative innovation of modified complete retention of deng’s fascia effect of total mesorectal excision in rectal cancer
DENG Tao, HE Jie
JOURNAL OF CLINICAL SURGERY    2023, 31 (6): 533-536.   DOI: 10.3969/j.issn.1005-6483.2023.06.009
Abstract145)      PDF(pc) (700KB)(70)    PDF(mobile) (700KB)(2)    Save
Objective To explore the application effect of improved total mesorectal excision (TME) with complete preservation of Deng’s fascia in rectal cancer. Methods Ninety-five patients with rectal cancer who were treated in our hospital from June 2019 to May 2021 were selected as the study subjects,and they were divided into iTME group(50 cases) and TME group(45 cases) according to different surgical methods.Among them,patients in iTME group received TME surgery with complete preservation of Deng’s fascia,and patients in TME group received general TME surgery.The patients were followed up for 12 months,and their data were collected to compare the recent surgical efficacy,urinary function and erectile function of the two groups. Results There was no significant difference between the two groups in sex ratio,age,BMI,preoperative radio and chemotherapy ratio,distance between tumor and anal margin,whether diabetes mellitus was combined,intraoperative bleeding volume and postoperative recovery time (P>0.05),while the operation time in iTME group was longer than that in TME group (P<0.05).Comparing the postoperative urinary function of patients in the two groups,it was found that there were no severe symptoms in the iTME group,2 patients with moderate symptoms (4.00%).2 patients with severe symptoms (4.44%) and 9 patients with moderate symptoms (20.00%) in the TME group.There was a significant difference between the two groups in urinary function (P<0.05).After comparing the erectile function of male patients in the two groups,it was found that in the iTME group,1 patient with severe erectile dysfunction (3.45%),1 patient with moderate erectile dysfunction (3.45%),12 patients with mild erectile dysfunction (41.38%).2 patients with severe erectile dysfunction (8.00%),3 patients with moderate erectile dysfunction (12.00%),and 11 patients with mild erectile dysfunction (44.00%) were found in the TME group,but there was no significant difference between the two groups in erectile function (P>0.05). Conclusion The improved innovative TME with complete preservation of Deng’s fascia can bring better curative effect to patients on the basis of ensuring safety,and at the same time,reduce the damage to patients’ urinary function and male erectile function
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Efficacy analysis of silverhawk plaque rotary cutting combined with domestic paclitaxel DCB and bare metal stent in the treatment of patients with lower extremity arterial occlusion
FENG Bo, SUN Xianfei, LIU Wenju, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 479-481.   DOI: 10.3969/j.issn.1005-6483.2023.05.020
Abstract144)      PDF(pc) (751KB)(36)       Save
Objective This article analyzes the clinical efficacy of silverhawk plaque cyclotomy,Drug-coated balloon(DCB)and bare metal stent in the treatment of patients with lower extremity arterial occlusion.Method A total of 101 patients with lower extremity arterial occlusion admitted to our hospital from January 2019 to December 2021 were prospectively selected and divided into group A for silverhawk plaque rotary cutting treatment by randomized controlled method.Group B was treated with domestic paclitaxel DCB + bare metal stent on the basis of group A,and then its clinical indicators,clinical target lesion revascularization rate,ET-1,NO and plasma P-selectin levels were compared.Results The clinical indexes of group B were significantly better than those of group A(P<0.05).The levels of plasma P-selectin and ET-1 in the two groups were significantly decreased at 12 h after treatment(P<0.05).The levels of NO in the two groups were significantly increased at 12 h after treatment(P<0.05),and the levels of plasma P-selectin,ET-1 and NO in group B were significantly better than those in group A(P<0.05).The revascularization rates at 6 months and 12 months after operation in group B were significantly lower than those in group A(P<0.05).Conclusion Application of silverhawk plaque rotary cutting + domestic paclitaxel DCB + bare metal stent combined treatment of lower extremity arterial occlusion of clinical curative effect is remarkable,improve the patient ’s vascular patency rate,ET-1,NO and plasma P-selectin level,improve the ankle brachial index,reduce the target lesion blood flow reconstruction rate,is worth promoting.
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Single-center experience of robotic-assisted laparoscopic pediatric hiatal hernia surgery
LIU Haijin, HUANG Haijin, YU Keyang, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 415-418.   DOI: 10.3969/j.issn.1005-6483.2023.05.005
Abstract144)      PDF(pc) (758KB)(109)       Save
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Continuous lumbar plexus block for postoperative analgesia in patients with hip arthroplasty and its effect on inflammatory factors
ZHUANG Haibin, XU Fusheng, ZHUANG Meiping, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 391-394.   DOI: 10.3969/j.issn.1005-6483.2023.04.025
Abstract143)      PDF(pc) (765KB)(65)       Save
Objective   To investigate the effect of continuous lumbar plexus block in postoperative analgesia in patients with hip arthroplasty and its effect on inflammatory factors.  Methods   A retrospective analysis of 114 patients who underwent hip arthroplasty from November 2018 to December 2019 was used as the object,and they were divided into the control group and the observation group according to the postoperative analgesia,there were 57 patients in each group.The control group received patient-controlled intravenous analgesia after operation,and the observation group received continuous lumbar plexus block.The effect of the patients was evaluated 3 days after operation,and the visual analog pain (VAS) scores,postoperative inflammatory factor levels,and cognitive function levels were compared between the two groups.and safety.  Results   The VAS scores of the observation group were lower than those of the control group on the 1st,2nd and 3rd days after operation.The levels of inflammatory factors TNF-ɑ and IL-6 in the observation group[(3.26±0.19)ng/L,(1.55±0.12)ng/L] were lower than the control group patients[(5.49±0.23)ng/L,(2.63±0.14)ng/L](P<0.05).In the observation group,the IL-10 level of the patients was (4.79±0.23) ng/L,which was higher than that of the control group [(2.48±0.19) ng/L,P<0.05].The MMSE scores of the observation group at 1d and 2d before surgery were (20.30±2.32) score and (21.35±2.33) score,which were higher than the MMSE score of the control group; the incidences of lower limb numbness,urinary retention,nausea and vomiting and respiratory depression in the observation group after analgesia were lower than those in the control group (P<0.05).  Conclusion   Continuous lumbar plexus block can reduce pain and reduce inflammatory factor levels in patients undergoing hip arthroplasty after analgesia.It has less effect on patients’ cognitive function and can reduce complications
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Expression of hypoxia-induced lipid droplet-associated protein in hepatocellular carcinoma and clinical significance
LIU Jinwei, BA Linchao, ZHANG Jingfu, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 447-452.   DOI: 10.3969/j.issn.1005-6483.2023.05.013
Abstract140)      PDF(pc) (1961KB)(44)       Save
Objective To investigate the expression and prognostic value of HILPDA gene in hepatocellular carcinoma,and further explore the potential clinical application value of HILPDA. Methods The bioinformatics method was used to download the mRNA sequencing data of hepatocellular carcinoma and the clinical data of patients from the TCGA database.The differences of HILPDA expression in hepatocellular carcinoma and adjacent tissues were analyzed.Univariate Cox regression and multivariate Cox regression were used to analyze the relationship between HILPDA expression level and prognosis of patients.The possible mechanism of HILPDA was investigated by GESA enrichment method.TIMER database was used to analyze the relationship between HILPDA gene expression and immune cell infiltration.Results The expression level of HILPDA gene in hepatocellular carcinoma tissues was higher than that in corresponding paracancer tissues.The expression level of HILPDA was correlated with tumor size(P<0.001),lymph node metastasis(P<0.01),pathological grade(P<0.05) and serum AFP level(P<0.01).Univariate and multivariate Cox regression analysis showed that HILPDA expression level was an independent prognostic factor in hepatocellular carcinoma patients,and patients with high expression level had a poor prognosis.Using TIMER database,the expression level of HILPDA is correlated with immune invasion of Th1 and Macrophage cells(P<0.001).Conclusion HILPDA may be a prognostic factor and a potential molecular therapeutic target for hepatocellular carcinoma.
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Influence of sodium bicarbonate ringer’s solution on internal environment and recovery in patients undergoing controlled low central pressure venous hepatectomy
LIU Xiaorong, LI Xinyi, ZHENG Yongping, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 475-478.   DOI: 10.3969/j.issn.1005-6483.2023.05.019
Abstract139)      PDF(pc) (765KB)(46)       Save
Objective To analyze the clinical effects of sodium bicarbonate ringer’s solution in patients undergoing controlled low central venous pressure hepatectomy.Methods 80 Patients undergoing hepatectomy in our hospital from October 2021 to May 2022 were randomly divided into lactate ringer’s group (LR group) and sodium bicarbonate ringer’s group (BR group) according to the different types of intraoperative infusion.All patients with partial liver resection were treated with controlled low central venous pressure.The operation time,hilar block time,bleeding volume,infusion volume,urine volume,application of vasoactive drugs,postoperative eye opening time,extubation time,PACU residence time and the number of delayed recovery cases were compared between the two groups.The arterial blood gas and lactate values between the two groups were compared at the time before the induction of anesthesia (T-1),hepatectomy completed immediately (T-2) and the end of surgery (T-3).Results Lactate values  were significantly lower(P<0.05) while PH,HCO-3 and BE were significantly higher in the BR group than those in the LR group (P<0.05) at T-2 and T-3.Urine volume in the BR group was significantly excess in the LR group (P<0.05).Postoperative eye opening time,extubation time,PACU residence time and the number of delayed recovery cases in the BR group were significantly less than those in the LR group (P<0.05).Conclusion Sodium bicarbonate ringer’s solution can effectively maintain the acid-base balance stability of the body,reduce the lactate value,reduce the burden of the liver,increase the urine volume,and shorten the time of awakening and extubation in patiens undergoing controlled low central venous pressure hepatectomy.
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The experiences of laparoscopic cholecystectomy with the “A-C-P”: lines as anatomical markers
YU Linlin, LI Chuntao, LU Changyou, PU Bangming, GUO Yong, GAO Yuan
JOURNAL OF CLINICAL SURGERY    2023, 31 (6): 581-583.   DOI: 10.3969/j.issn.1005-6483.2023.06.023
Abstract138)      PDF(pc) (739KB)(55)       Save
Objective To explore the clinical value of laparoscopic cholecystectomy with the “A-C-P” lines as anatomic markers. Methods We found out the patients who treated by laparoscopic cholecystectomy with the “A-C-P” lines as anatomical markers  in The Affiliated Hospital of Traditional Chinese Medicine Southwest Medical University from January 2018 to December 2021,and we analyzed the clinic date of the 1364 patients retrospectively to investigate the safety and efficacy of the“A-C-P” lines approach laparoscopic cholecystectomy procedure.Results The 1364 patients were successfully treated by laparoscopic cholecystectomy with the “A-C-P” lines as anatomic markers.The mean operation time was (35.20±11.30) min,the mean amount of intraoperatively bleeding was (10.62±5.51) ml,and the mean postoperative hospitalization time was (5.33±1.47) d.Seven cases had postoperative complications,including 3 cases of umbilical incision infection which were cured by clinic dressing change,and 4 cases of secondary common bile duct stones which were cured by endoscopic retrograde cholangiopancreatography or laparoscopic common bile duct exploration,without biliary tract injury and perioperative death. Conclusion We can finish a laparoscopic cholecystectomy with the “A-C-P” lines as Anatomical markers,our clinical practice preliminarily confirmed the safety of the procedure.
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Experience study of 32 cases of implantable venous-access ports via cephalic vein venotomy
DONG Hong, KUSH, LI Ning, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 436-439.   DOI: 10.3969/j.issn.1005-6483.2023.05.010
Abstract134)      PDF(pc) (614KB)(78)       Save
Objective To introduce a new method of totally implantable venous access ports(TIVAP)  via cephalic vein venotomy.(CVV-Port).Methods The clinical and follow-up data of 32 patients who received TIVAP from October 2019 to December 2020 were summarized and analyzed. During the same period, the 47 patients who underwent CVV-Port were compared and analyzed in terms of operation time and complications.Results 28 patients received TIVAP successfully , the average operation time was (25.93±4.77)min, while the CCV-port group was (28.73±5.16)min, with no statistical difference (p<0.05). There was no thrombosis in the TIVAP group, and thrombosis in the CCV-port group in 13 cases, the difference was significant (p<0.05). Catheterization related adverse events were 1 case in TIVAP group and 3 cases in CCV-port group. There were statistically significant differences in the increase of treatment time and treatment cost between the two groups [0 vs.(16.7±2.1)d; 0 vs.(1233±166.7)yuan, both p<0.05].Conclusion TIVAP via cephalic vein section does not increase the operation time and has fewer complications.
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A nomogram model of systemic immune inflammation index for predicting the occurrence of urosepsis after upper urinary calculi surgery
GU Jie, LI Dujian, LI Quan, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 470-474.   DOI: 10.3969/j.issn.1005-6483.2023.05.018
Abstract133)      PDF(pc) (915KB)(166)       Save
Objective To investigate the value of preoperative systemic immune-inflammation index (SII) in predicting postoperative urosepsis after flexible ureteroscopic lithotripsy,and establish a preoperative nomogram prediction model.Methods The clinical data of 329 patients who underwent flexible ureteroscopic lithotripsy in Shanghai Fourth People’s Hospital affiliated to Tongji University from August 2020 to October 2021 were retrospectively analyzed.According to the occurrence of urinary sepsis, the patients were divided into sepsis group and non-sepsis group.The independent risk factors of postoperative urosepsis for upper urinary calculi were evaluated by univariate and multivariate Logistic regression analysis.We drew receiver operating characteristic (ROC) to find the cut-off value of risk factors and calculated the area under curve (AUC) to evaluate its diagnostic power.The R software was used to establish a nomogram model for predicting the occurrence of postoperative urosepsis and calculate the c-index.And its accuracy was evaluated by the calibration curve.
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The value of preoperative plasma fibrinogen as a prognostic index in patients with non metastatic gastric cancer:a Meta-analysis
XU Hui, LI Hao, QIN Jingjing, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 348-352.   DOI: 10.3969/j.issn.1005-6483.2023.04.014
Abstract132)      PDF(pc) (1162KB)(97)       Save
Objective   To explore the value of preoperative fibrinogen and the prognosis of non metastatic gastric cancer.  Methods   From the start of the library to May 31, 2022,by searching PubMed、EMBASE、Web of Science、Cochrane Library to determine the studies to evaluate the prognostic role of Fib in GC.Revman software(version 5.4) was used for data analysis.The hazard ratio(HR) with 95% confidence interval(CI) was used to evaluate the correlation between Fib and overall survival(OS) and recurrence free survival(RFS) in GC patients.  Results   This study included 8 retrospective studies,including 3999 patients.Meta analysis showed that the higher Fib value was associated with the shorter OS and RFS(HR=1.73,95%CI:1.32-2.26,P<0.001;HR=2.12,95%CI:1.50-2.99,P<0.001).Subgroup analysis according to the country,sample size,Fib critical value and NOS score showed that the higher level of Fib before operation was related to the shortening of OS in gastric cancer(all P<0.05).  Conclusion   The increase of preoperative Fib can be used as a prognostic index for patients with non metastatic gastric cancer.A higher level of Fib indicates that the prognosis of patients with gastric cancer is poor.
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JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 333-334.   DOI: 10.3969/j.issn.1005-6483.2023.04.010
Abstract128)      PDF(pc) (1027KB)(64)       Save
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Follow up study with three-dimensional gait on postoperative of anterior cruciate ligament reconstruction
LIU Cheng, ZHAO Lingcai, WANG Hao, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 321-325.   DOI: 10.3969/j.issn.1005-6483.2023.04.007
Abstract128)      PDF(pc) (616KB)(141)       Save
Objective  To investigate the characteristics of the three-dimensional gait changes of the knee joint after the single bundle anatomical reconstruction of autologous hamstring tendons after the rupture of the anterior cruciate ligament (ACL) of the knee. Methods  From August 2018 to June 2020,twenty five patients with ACL rupture of the lateral knee joint were selected as the injury group.During the operation,ACL rupture was confirmed by arthroscopy and the autologous hamstring tendon anatomical reconstruction was performed.Then 25 healthy people were selected as the control group.The three-dimensional gait data of normal knee joints were recorded with the three-dimensional motion capture system and compared with the injury group.In addition,the injury group was followed up before and after surgery and Lysholm knee joint function score was performed. Results  In the control group,the flexion and extension angle was - 2 °~66 °,the internal and external rotation angle was - 5 °~9 °,and the internal and external rotation angle was - 4 °~8 °.After ACL injury,the flexion and extension angle is - 5 °~52 °,the internal and external rotation angle is - 3 °~24 °,and the internal and external rotation angle is - 13 °~14 °.Three months after ACL autologous hamstring tendon reconstruction,the flexion and extension angle was - 2 °~47 °,the internal and external rotation angle was - 5 °~9 °,and the internal and external rotation angle was - 6 °~10 °.Six months after ACL reconstruction,the flexion and extension angle was - 2 °~59 °,the internal and external rotation angle was - 4 °~8 °,and the internal and external rotation angle was - 5 °~8 °.Nine months after ACL reconstruction,the flexion and extension angle was - 2 °~64 °,the internal and external rotation angle was - 2 °~9 °,and the internal and external rotation angle was - 2 °~8 °.12 months after ACL reconstruction,the flexion and extension angle was - 2 °~65 °,the internal and external rotation angle was - 1 °~9 °,and the internal and external rotation angle was - 1 °~8 °.After ACL rupture,the variation range of knee joint from flexion to extension,internal and external rotation,and internal and external turnover angle became larger than that of the control group,and there was significant difference in statistics(P<0.05).The angle range of each motion direction of knee joint after reconstruction was significantly improved compared with that before surgery(P<0.05),the difference at each time point after reconstruction was statistically significant compared with that before reconstruction(P<0.05).The gait at 9 and 12 months after reconstruction was significantly improved compared with that at 3 months after reconstruction (P<0.05).The Lysholm score increased from (62.35±3.45) before operation to (93.62±3.51) at 12 months after operation,and the difference was significant (P<0.05).  Conclusion  ACL reconstruction surgery has played a role in stabilizing the knee joint and improved the Lysholm knee joint function score,and with the passage of time after the operation,the Lysholm knee joint function score gradually improved,and basically returned to normal 9 months after the operation.
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JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 493-494.   DOI: 10.3969/j.issn.1005-6483.2023.05.024
Abstract124)      PDF(pc) (878KB)(77)       Save
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Combined approach in the treatment of complex hyperextension tibial plateau fractures
GUAN Guoyi, LIU Chen , CHEN Jialin, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 326-329.   DOI: 10.3969/j.issn.1005-6483.2023.04.008
Abstract119)      PDF(pc) (828KB)(64)       Save
Objective  To analyze the safety and effectiveness of combined anterior and posterior knee approach in the treatment of complex hyperextension tibial plateau fractures. Methods  92 patients with complex hyperextension tibial plateau fractures treated in the department of trauma and orthopedics of our hospital from February 2015 to February 2020 were analyzed retrospectively.The patients in the combined group received combined anterior and posterior knee approach (48 cases),and the patients in the central group received traditional anterior and median knee approach (44 cases).The perioperative conditions,follow-up indexes and imaging evaluation in 2 groups were recorded and compared.Results  The perioperative indicators such as intraoperative blood loss,radiation exposure time,postoperative drainage volume and hospital stay in the combined group were significantly lower than those in the median group (P<0.05).At the last follow-up,the incidence of adverse reactions in the combined group was significantly lower than that in the median group (6.82% vs.13.16%,P<0.05).At 3 months after operation and at the last follow-up,the hospital for special surgery (HSS) score of the knee joint [(64.57±0.47) vs.(56.39±0.46)] and Rasmussen score[(16.42±0.46) vs.(12.39±0.41)] in the combined group was safe than the median group(both P<0.05).At the last follow-up,the improvement of tibial plateau imaging indexes such as varus angle[(84.16±4.89)° vs.(89.14±6.78)°],femoral tibial angle[(176.64±4.21)° vs.(167.65±3.83)°] and posterior dip angle[(11.54±0.79)° vs.(9.65±0.83)°] in the combination group was significantly lower than that in the median group (P<0.05). Conclusion The combined approach in the treatment of complex hyperextension tibial plateau fractures has satisfactory curative effect in restoring knee function,alleviating pain symptoms,promoting fracture healing,reducing perioperative indicators and avoiding the impact of surgical trauma on rehabilitation as much as possible.
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Evaluation of curative effect of three methods for treating common bile duct stones after cholecystectomy based on propensity score matching method
LU Jianli, HE Wei, LIU Jinheng
JOURNAL OF CLINICAL SURGERY    2023, 31 (7): 635-639.   DOI: 10.3969/j.issn.1005-6483.2023.07.011
Abstract119)      PDF(pc) (709KB)(97)       Save
Objective   To compare the efficacy of three different surgical methods in the treatment of common bile duct stones after cholecystectomy:open common bile duct exploration (OCBDE),endoscopic retrograde cholangiopancreatography and papillary sphincterotomy (ERCP/EST),and laparoscopic common bile duct exploration (LCBDE). Methods   The clinical data of 109 cases of recurrent choledocholithiasis after cholecystectomy treated in our hospital from July 2016 to July 2020 were analyzed retrospectively.Among them,33 cases were ERCP,40 cases were OCBDE group,and 36 cases were LCBDE.The influence of confounding factors among the groups was balanced by the tendentious score matching method (PSM),and the clinical efficacy and complications of the three groups after matching were compared.  Results   28 patients were included in each group by PSM method,and the baseline data of the three groups were not statistically significant(P>0.05).No statistical difference was found in the success rate of operation and stone clearance rate among three groups (P>0.05).The specific amount of bleeding,specific duration of operation,specific duration of anal exhaust and specific duration of hospitalization after operation in ERCP group were lower/shorter than those in OCBSE group and LCBDE group,with obvious difference (P<0.05),while the specific amount of bleeding,specific duration of operation,specific duration of anal exhaust and specific duration of hospitalization after operation in LCBDE group were lower/shorter than those in OCBSE group,with obvious difference (P<0.05).The incidence rate of perioperative complications of ERCP group showed no obvious difference with that of other 2 groups (P>0.05),while the incidence rate of postoperative complications in LCBDE group was lower than that in OCBDE group,with statistical difference (P<0.05).Postoperative follow-up showed that the recurrence rate of common bile duct stones in ERCP group was higher than OCBDE and LCBDE groups,with statistical difference (P<0.05),while the recurrence rate yielded no statistical difference between OCBDE group and LCBDE group (P>0.05). Conclusion   ERCP,OCBDE and LCBDE can effectively remove common bile duct stones after gallbladder surgery.ERCP surgery is less traumatic,but it is prone to severe complications such as acute pancreatitis and hyperamylasemia after surgery,and the residual rate of stones after surgery is high.LCBDE has the advantage of micro-invasive surgery than OCBDE,but it is not suitable for patients with severe abdominal adhesion.It is recommended that the operator select an appropriate surgical method according to the specific situation of the patient.
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Effect of gamma knife in treating residual tumors after surgery for invasive pituitary adenoma
LI Zhen, WANG Yiquan, SONG Shuyue, et al
JOURNAL OF CLINICAL SURGERY    2023, 31 (4): 398-399.   DOI: 10.3969/j.issn.1005-6483.2023.04.027
Abstract115)      PDF(pc) (805KB)(129)       Save
Complete surgical removal of invasive pituitary tumors(APT) is extremely difficult,and forced complete removal may pose significant risks.In order to preserve neural function,ensure the safety of surgery,and reduce complications,tumor residues often occur after APT.Residual tumors can be treated with stereotactic radiosurgery(SRS),especially gamma knife stereotactic radiosurgery(GKRS).This article reviews the necessity,effectiveness,safety,and application prospects of GKRS as an important method for treating residual tumors after APT.
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Clinical effect evaluation and analysis of the posterior orbital septal fascia-levator muscle complex and orbicularis oculi muscle fixation in double eyelid surgery
TIAN Tian, LIU Qiannan, YANG Zhi
JOURNAL OF CLINICAL SURGERY    2023, 31 (5): 482-485.   DOI: 10.3969/j.issn.1005-6483.2023.05.021
Abstract115)      PDF(pc) (1132KB)(47)       Save
Objective To analyze the clinical effect of internal fixation of posterior orbital septum-levator muscle complex and orbicularis oculi in double eyelid surgery.Methods A total of 100 patients who received double blepharoplasty in the Third Affiliated Hospital of Chongqing Medical University from April 2020 to October 2021.They were randomly divided into experimental group(n=50) and control group(n=50) according to difffferent treatment methods.Surgery was performed by the same surgeon with two different surgical methods,the experimental group was treated with modified double eyelid surgery,and the control group was treated with traditional surgery.And the degree of postoperative swelling,eyelid scar,eye aesthetics and complications of the two surgical methods were analyzed and compared.Results The swelling score was 5.42±0.76 in the experimental group and 6.10±0.93 in the control group on the third day after operation.The swelling score was 3.40±0.75 in the experimental group and 4.00±0.99 in the control group one week after operation.The swelling score was 1.72±0.64 in the experimental group and 2.08±0.78 in the control group one month after operation.The differences were statistically significant(P<0.05).The scar score was 2.58±0.70 in the experimental group and 3.20±0.67 in the control group one month after operation.The scar score was 1.14±0.40 in the experimental group and 1.50±0.58 in the control group 6 months after operation,with statistical significance(P<0.05).Six months after operation,the double eyelid aesthetics score and self-satisfaction score of the experimental group respectively were 4.00±0.45,4.00±0.49.The results of the control group were 3.84±0.42,3.72±0.57,the differences were statistically significant(P<0.05).The incidence of complications such as the “stripped” or “stepped” appearance was 2%,lower than that in the control group 14%,and the difference was statistically significant(P<0.05).Symptoms of the two patients with mild ptosis was improved after surgery,and the effect was satisfactory.
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Early influencing factors analysis of myocardial microcirculatory perfusion after off-pump coronary artery bypass graft
LIU Wei, GAO Feng, SHI Zepeng, GAO Yang, SHI Lei, WANG Wenjun, ZHANG Bo, ZHANG Lin, CUI Mingjing, ZHUANG Xijing, HE Xuezhi
JOURNAL OF CLINICAL SURGERY    2023, 31 (7): 617-621.   DOI: 10.3969/j.issn.1005-6483.2023.07.006
Abstract114)      PDF(pc) (1018KB)(82)       Save
Objective  Exploring the factors associated with the recovery of early myocardial microcirculatory perfusion after OPCABG.Methods  Retrospective analysis of 100 patients treated with OPCABG in the department of cardiovascular surgery from June 2019 to February 2021.Patients were divided into two groups according to the recovery of myocardial perfusion in each segment in the early postoperative period.Group A:76 patients with improved perfusion in all segments and Group B:24 patients with poor perfusion improvement left in some segments.We compared the pre-procedure gender composition,age,BMI,hypertension,diabetes,dyslipidaemia,smoking,alcohol consumption,metabolic disease,history of PCI,cTnI-T,BNP and cardiac echocardiography results between the two groups.Results  Age[(71.63±5.09)y vs.(64.74±9.45)y],BMI[(29.27±3.56)kg/m2 vs.(26.09±3.08)kg/m2],prevalence of diabetes(87.5% vs.21.1%) and incidence of dyslipidemia(70.8% vs.9.2%) were significantly higher in Group B than in Group A,and the difference was statistically significant(P<0.05).No statistically significant differences were seen in the gender composition,prevalence of hypertension,smoking,alcohol consumption,prevalence of metabolic disease,history of PCI,cTnI-T,BNP and cardiac structure between the two groups(P>0.05).Logistic regression modelling showed that age(OR:1.240,95%CI:1.080-1.486),prevalence of diabetes(OR:0.086,95%CI:0.014-0.391) and the occurrence of dyslipidaemia(OR:0.047,95%CI:0.007-0.220) were risk factors for poor improvement of the residual segment in the early postoperative period after OPCABG,and that they were good predictors(AUC=0.934,P<0.001).No significant coefficients were seen between age,dyslipidemia,history of diabetes and BMI(P>0.05). Conclusion  Age,history of diabetes and dyslipidaemia as risk factors for predicting improvement in myocardial microcirculatory perfusion after OPCABG.They can predict the improvement of microcirculation in the early postoperative period in OPCABG patients with high sensitivity and specificity.  
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