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20 July 2020, Volume 28 Issue 7
Robotic surgery in lung cancer treatment: current status and prospects
YUAN Ye, JIN Runsen, LI Hecheng
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  601-604.  DOI: 10.3969/j.issn.1005-6483.2020.07.001
Abstract ( 149 )   PDF (386KB) ( 202 )   PDF(mobile) (386KB) ( 3 )  
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The research progress of machine learning in lung cancer surgery
LI Zongyuan, CHEN Xiaoye, LIU Lunxu
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  605-607.  DOI: 10.3969/j.issn.1005-6483.2020.07.002
Abstract ( 175 )   PDF (394KB) ( 500 )   PDF(mobile) (394KB) ( 4 )  
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Prospect of neoadjuvant immunotherapy for non-small cell lung cancer
TENG Xiao, HU Jian
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  608-610.  DOI: 10.3969/j.issn.1005-6483.2020.07.003
Abstract ( 158 )   PDF (342KB) ( 488 )   PDF(mobile) (342KB) ( 12 )  
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Current status of immune checkpoint inhibitors in neoadjuvant treatment of non small cell lung cancer
ZHANG Fan, TAN Fengwei, XUE Qi, et al
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  611-614.  DOI: 10.3969/j.issn.1005-6483.2020.07.004
Abstract ( 197 )   PDF (398KB) ( 377 )   PDF(mobile) (398KB) ( 10 )  
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The Status of Surgery in Multi-Disciplinary Treatment of Stage Ⅲ Non-Small Cell Lung cancer
FU Rui, ZHONG Wenzhao
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  615-617.  DOI: 10.3969/j.issn.1005-6483.2020.07.005
Abstract ( 177 )   PDF (357KB) ( 332 )   PDF(mobile) (357KB) ( 3 )  
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Progress and prospect of the combined surgery in patients with concomitant lung cancer and coronary heart disease
GUO Fan, SUN Daqiang
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  618-621.  DOI: 10.3969/j.issn.1005-6483.2020.07.006
Abstract ( 133 )   PDF (426KB) ( 214 )   PDF(mobile) (426KB) ( 4 )  
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Progress and challenge of minimally invasive radical surgery for lung cancer
ZHOU Yuming, ZHENG Hui
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  621-623.  DOI: 10.3969/j.issn.1005-6483.2020.07.007
Abstract ( 163 )   PDF (396KB) ( 224 )   PDF(mobile) (396KB) ( 12 )  
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Tubeless VATS for lung cancer surgery
ZHONG Yunpeng, HE Jianxing, LI Shuben
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  624-626.  DOI: 10.3969/j.issn.1005-6483.2020.07.008
Abstract ( 150 )   PDF (367KB) ( 235 )   PDF(mobile) (367KB) ( 6 )  
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Prognostic value of the preoperative neutrophil-to-lymphocyte ratio in thoracic esophageal squamous cell carcinoma patients with lymph node metastasis
YUAN Jun, LI Yin, PENG Yinjie, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  627-630.  DOI: 10.3969/j.issn.1005-6483.2020.07.009
Abstract ( 214 )   PDF (387KB) ( 140 )   PDF(mobile) (387KB) ( 2 )  
Objective To evaluate the prognostic value of neutrophil to lymphocyte ratio(NLR)in thoracic esophageal squamous cell carcinoma(TESCC)patients with lymph node metastasis.
Methods Clinical data of 313 TESCC patients treated with standard curative esophagectomy in the Affiliated Cancer Hospital of Zhengzhou University between April 2014 and April 2016 were collected.According to the median NLR value 3.2 of all patients,all patients were divided into high NLR group(≥3.2)and low NLR group(<3.2).The general clinicopathological features of the two groups were compared,and the survival curves of  Overall survival(OS)and Disease-free survival(DFS)in the two groups were drawn and compared.Multivariate analysis was performed using Cox proportional risk model to determine prognostic factors.
Results 1-year and 3-year OS rates in high NLR group and low NLR group were 86.5%,56.2% and 88.9%,61.0%(P>0.05),1-year and 3-year DFS rates in high NLR group and low NLR group were 71.1%,35.3% and 83.1%,47.1%(P<0.05),respectively.Multivariate analysis showed that only pathological stage was an independent prognostic factor for OS(P< 0.05),while surgical approach,tumor differentiation degree,pathological stage and NLR(P<0.05)were independent prognostic factors for DFS.
Conclusion NLR is valuable for predicting recurrence in TESCC patients with lymph node metastasis,but it can not be used as a predictive index for the overall survival time.
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Surgical treatment of gastric cancer after esophagectomy
JIANG Wanli, ZENG Wenhui, WANG Xin, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  631-633.  DOI: 10.3969/j.issn.1005-6483.2020.07.010
Abstract ( 235 )   PDF (311KB) ( 135 )   PDF(mobile) (311KB) ( 1 )  
Objective To investigate the clinical efficacy of resection for Thoracic Gastric Cancer(TGC)after esophagectomy.
Methods Between June 2013 and December 2018,7 individuals with gastric cancer in the reconstructed gastric tube after esophagectomy in Renmin Hospital of Wuhan University were studied.
Results A total of 7 patients with TGCs were selected for this study.There were 6 male patients,the average age at diagnosis was 63.2 years(range:53~73)and that the interval between esophagectomy and cancer onset in the reconstructed gastric tube ranged from 2.8 to 15 years.There were no operative or in-hospital mortalities.The operative time ranged from 170min to 580min and the blood loss ranged from 350 to 1100ml.Postoperative pulmonary infection occurred in 2 cases and arrhythmia in 1 case.Neck anastomotic fistula occurred in 1 case,which was cured two weeks after dressing change through incision.The postoperative follow-up was made for 12 months in the whole patients and all of them were alive with eating normally.
Conclusion The development of TGC should be taken into consideration during the extended follow-up of patients undergoing esophagectomy for cancer.Gastrectomy should be considered the preferred treatment modality in operable patients with locally invasive tumor.
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The relationship between MTHFR gene polymorphism and the incidence of esophageal cancer
XU Wendong, ZHANG Peng(Xiao), LV Peng, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  634-638.  DOI: 10.3969/j.issn.1005-6483.2020.07.011
Abstract ( 150 )   PDF (587KB) ( 150 )   PDF(mobile) (587KB) ( 4 )  
Objective To investigate the relationship between methyltetrahydrofolate reductase gene C677T and A1298C polymorphism and susceptibility to esophageal cancer.
Methods PMedline(PubMed),Embase,web of Science,Cochrane,wanted,CNKI,VIP were retrieved by computer,and the relevant articles published from the database establishment to September 2019 were retrieved by hand.Odds ratio and corresponding 95% confidence interval were used to assess the relationship between mutations in two folic acid metabolic genes,MTHFR C677T(rs1801394)and MTHFR A1298C(rs1801131),and the risk of esophageal cancer.
Results This study found that MTHFR A1298C(rs1801131)variant genotype was associated with an increased incidence of esophageal cancer(CA vs.AA:OR=1.22,P<0.05;CA+CC vs.AA:OR=1.18,P<0.05).The MTHFR C677T(rs 1801133)variant genotype was not associated with an increased risk of esophageal cancer.
Conclusion Methyltetrahydrofolic acid reductase(MTHFR)genes 1298AC and CC genotypes are associated with esophageal cancer.
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Short-term curative effect of thoracoscopic-laparoscopic Ivor-Lewis and McKeown on thoracic middle-lower segment esophageal cancer and their influences on postoperative complications and quality of life
LI Jian, TONG Xiwen, WANG Kun, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  639-642.  DOI: 10.3969/j.issn.1005-6483.2020.07.012
Abstract ( 274 )   PDF (333KB) ( 139 )   PDF(mobile) (333KB) ( 4 )  
Objective To explore short-term curative effect of thoracoscopic-laparoscopic intrathoracic anastomosis(Ivor-Lewis)and neck anastomosis(McKeown)on thoracic middle-lower segment esophageal cancer.
Methods A total of 110 patients with thoracic middle-lower segment esophageal cancer who were admitted to the hospital from February 2016 to April 2018 were enrolled.According to different surgical methods,they were divided into two groups.Fifty-two patients in Ivor-Lewis group were treated with thoracoscopic-laparoscopic Ivor-Lewis,while fifty-eight patients in McKeown group were treated with thoracoscopic-laparoscopic McKeown.The perioperative surgical related indexes and complications were compared between the two groups.The lung function in both groups was evaluated before surgery and after 10d of surgery.Quality of Life Questionnaire-Oesophagus 18(QLQ -OES18)was applied to assess quality of life in both groups before surgery and after 4 weeks of surgery.
Results There were no significant differences in perioperative indexes such as operation time and hospitalization time between the two groups(P>0.05).After 6 months of surgery,there were no significant differences in lymph node metastasis and tumor recurrence between the two groups(P>0.05).After 10d after surgery,FEV1/FVC,FEV1 predicted value,PaO2 and SaO2 in both groups were significantly higher than those before surgery(P<0.05).After 4 weeks of surgery,scores of difficulty eating,coughing and speech in Ivor-Lewis group significantly lower than those in McKeown group(P<0.05).After 4 months of surgery,difficulty eating scores in both groups were significantly lower than those before surgery(P<0.05),while scores of reflux,cough and speech were significantly higher than those before surgery(P<0.05).
Conclusion The tumor clearance effects of thoracoscopic-laparoscopic Ivor-Lewis and McKeown are similar in treatment of thoracic middle-lower segment esophageal cancer.However,incidence of complications is lower in patients treated with the former,lung function recovery is better,and quality of life is higher,whose short-term curative effect is more advantageous.
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Application study of individualized three-dimensional reconstruction of pulmonary nodules in thoracoscopic segmentectomy
CHEN Gang, WANG Fangqing, RUAN Weimin, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  643-646.  DOI: 10.3969/j.issn.1005-6483.2020.07.013
Abstract ( 335 )   PDF (335KB) ( 442 )   PDF(mobile) (335KB) ( 3 )  
Objective To explore the application value of individualized 3D reconstruction of lung nodules in thoracoscopic segmentectomy.
Methods Sixty patients with pulmonary nodules who underwent surgical treatment were randomly divided into three-dimensional reconstructionsimulated surgery group and non-three-dimensional reconstruction simulated surgery group in our hospital from December 2018 to December 2019,and 30 cases each group.A comparative analysis of the differences in the perioperative indicators of the two groups of patients.
Results Both groups of patients successfully completed thoracoscopic lung segmentectomy.Preoperative and intraoperative anastomosis rates of the three-dimensional reconstruction simulated surgery group were 100% of the nodule site,96.67% of the target segment blood vessel,and 96.42% of the target segment bronchus respectively.The operation time,intraoperative blood loss,drainage tube retention time,postoperative total drainage volume and postoperative hospital stay were significantly lower in the simulated surgery group than in the non-three-dimensional reconstruction simulated surgery group,the difference was statistically significant(P<0.05).There was no statistically significant difference in the number of intermediate dissection lymph nodes and the incidence of postoperative complications between the two groups(P>0.05).
Conclusion Individualized thoracoscopic anatomical segmentectomy of lung nodules based on three-dimensional reconstruction is safe and effective,and has more clinical value than conventional surgery.
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Clinical analysis of 52 patients with lung cancer complicated with pulmonary tuberculosis
WANG Xunhao, SHEN Lei, DAI Xiyong.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  647-649.  DOI: 10.3969/j.issn.1005-6483.2020.07.014
Abstract ( 266 )   PDF (310KB) ( 227 )   PDF(mobile) (310KB) ( 5 )  
Objective To investigate the clinical characteristics and surgical treatment of pulmonary tuberculosis complicated with lung cancer.
Methods The clinical data,surgical methods,pathological types,tumor stages,postoperative treatment strategies and related complications of 52 patients with lung cancer complicated with pulmonary tuberculosis admitted to our department from January 2015 to December 2017 were retrospectively analyzed.
Results There were 40 cases of stable tuberculosis and 12 cases of active tuberculosis.There were 40 cases of lobectomy,4 cases of compound lobectomy and 8 cases of total pulmonary resection.Twelve patients received anti-tuberculosis treatment before operation,and 25 patients received anti-tuberculosis and chemoradiotherapy simultaneously after operation.Perioperative complications occurred in 7 cases,and there were no perioperative deaths.
Conclusion Surgical resection is the first choice for lung cancer patients with pulmonary tuberculosis.Patients with lung cancer combined with active pulmonary tuberculosis should be anti-tuberculous for at least 2 weeks before surgery.Patients with lung cancer complicated with stable pulmonary tuberculosis should receive anti-tuberculosis treatment at the same time after radiotherapy and chemotherapy,both of which can be carried out at the same time.
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Influenceofabdominal body shape parameters onperioperative complications and postoperative recovery in patients with laparoscopy-assisteddistal D2 resectionfor gastric cancer
YANG Xiuwei, WANG Gang, LU Feng, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  650-653.  DOI: 10.3969/j.issn.1005-6483.2020.07.015
Abstract ( 188 )   PDF (325KB) ( 116 )   PDF(mobile) (325KB) ( 2 )  
Objective To investigate the influenceof abdominal body shape parameters on perioperative complications and postoperative recovery in patients with laparoscopy-assisted distal D2 resection for gastric cancer(LADG).
Methods 168 gastric cancer patients who underwent LADG were enrolled.The body mass index(BMI)and waist-to-hip ratio(WHR)were measured 4days before surgery,the abdominal body parameters[average umbilical abdominal wall thickness(NMT)and abdominal visceral fat thickness(VFT)]was measured by CT.The intraoperative and postoperative rehabilitation indicators and complications were counted.
Results Of the 168 patients,32 cases had perioperative complications,the complication rate was 19.05%.The Pearson correlation analysis showed that NMT was significantly positively correlated with postoperative anal exhaust time,eating time and hospital stay(P<0.05),VFT was negatively correlated with lymph node dissection(P<0.05),and VFT was positively correlated with operation time(P<0.05).Multivariate logistic regression analysis showed that preoperative complications were independent risk factors for perioperative complications(P<0.05).
Conclusion Abdominal body parameters have certain influence on the intraoperative and postoperative rehabilitation condition of LADG patients,but the effect on perioperative complications is not obvious.
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Establishment and preliminary validation of a predictive scoring system for risk of PPOI after radical gastrectomy for gastric cancer
MAO Xingbo, WEI Yiru, ZHUANG Liping, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  654-657.  DOI: 10.3969/j.issn.1005-6483.2020.07.016
Abstract ( 232 )   PDF (351KB) ( 154 )   PDF(mobile) (351KB) ( 3 )  
Objective To construct a simple scoring system for predicting the risk of PPOI,and to preliminarily validate its predictive effectiveness.
Methods A total of 296 patients with gastric cancer were collected.Patients were divided into PPOI group and non PPOI group and the possible risk factors were analyzed.According to the weight of related risk factors,a risk scoring system was constructed and verified.
Results Of the 296 patients,92 cases developed PPOI,the incidence was 31.1%.Multivariable analysis showed that age more than 65 years old,operation duration more than 4h,operation mode of laparotomy,TNM staging=Ⅲ and TOP>0.3mg/Kg were independent risk factors of PPOI(P<0.05).Assigning values with regression coefficients=1.5 and 2.5,each risk factor was assigned 1.5 points,1.0 points,1.5 points,1.5 points and 2.5 points,respectively.The total score of the scoring system was 8.According to different scores,they were divided into low risk group(0~3 points),medium risk group(4~6 points)and high risk group(7~8 points).Taking the patient data into the established scoring system,the incidence of PPOI in the low,middle and high risk group were 10.4%,26.8% and 72.5%,respectively.The area under the ROC curve is 0.731,the sensitivity and specificity were 0.74 and 0.62,χ2=1.526,P=0.93.The model has good fitting validity and high prediction value.
Conclusion A variety of risk factors are involved in the occurrence of PPOI.The prediction model has a good evaluation efficiency and has certain clinical application value.
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Clinical application of laparoscopic colorectal tumor surgery through natural orifice specimen extraction
QIN Chuanhui, ZHAO Qisheng, YANG Guiyi, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  658-661.  DOI: 10.3969/j.issn.1005-6483.2020.07.017
Abstract ( 184 )   PDF (472KB) ( 182 )   PDF(mobile) (472KB) ( 3 )  
Objective To investigate the feasibility,and safety of laparoscopic resection for colorectal tumor by natural orifice specimen extraction surgery(NOSES)for lcolorectal tumor.
Methods The Clinical data of 68 patients with colorectal tumor Accord with NOSE were retrospectively analyzed,including30 cases of NOSES and 38 cases of traditional laparoscopic.The operation time,intraoperative blood loss,postoperative intestinal function recovery,hospitalization time,postoperative pathological indexes and postoperative complications were observed and recorded in the two groups.
Results There were no significant difference  in age,gender,tumor stage,Tumor diameter,time of operation,biood loss,and postoperative complications between the two groups(P>0.05).The recovery of intestinal function and hospitalization time in NOSES operation group were significantly better than those in traditional operation group(P<0.05).
Conclusions NOSES is safe and feasible for the patients with laparoscopic resection for colorectal tumor,the patients can recover early and incision is showed more cosmetic,and without increasing complication incidence.
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Application of single resorbable suture interactive inversion suture in full manual anastomosis
Ren Yingkun, Huo Mingke, Han Guangsen.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  663-665.  DOI: 10.3969/j.issn.1005-6483.2020.07.019
Abstract ( 148 )   PDF (341KB) ( 150 )   PDF(mobile) (341KB) ( 2 )  
Objective To introduce the specific operation method and application value of applying a single absorbable suture for manual bowel anastomosis.
Methods From July 2017 to June 2018, a total of 224 patients underwent manual bowel anastomosis due to abdominal and pelvic neoplastic diseases; they were divided into two groups according to different methods of anastomosis, 98 cases in the manual group, with a single absorbable suture. 126 patients in the instrument group, with silk thread reinforcement additionally. The anastomosis time, anastomotic hemorrhage, anastomotic stenosis, and anastomotic cost were compared between the two groups, and the application value of single absorbable suture interactive inversion suture in manual bowel anastomosis was statistically analyzed.
Results All 224 patients were successfully completed the operation. The postoperative anastomotic leakage in the manual group and the instrument group were 3 and 15 respectively, the anastomotic bleeding was 1 and 19, and the anastomotic stenosis was 0 and 13 cases. The operation time was (3.2±1.1) min and (5.5±2.1) min, and the cost of anastomosis was (53±13.2) yuan and (2753±899.2) yuan respectively. The difference between the two groups was statistically significant.
ConclusionUsing  a single absorbable suture in interactive inversion suture is a safe and reliable method in manual bowel anastomosis, with fewer complications associated with anastomosis, which is beneficial to reduce the operation time and reduce the cost of hospitalization.
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Laparoscopic total extraperitoneal hernia repair for adult inguinal hernia:a report of 1021 cases in a single center
LV Zhiqiang, SHEN Genhai, DAI Wei, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  666-668.  DOI: 10.3969/j.issn.1005-6483.2020.07.020
Abstract ( 226 )   PDF (325KB) ( 164 )   PDF(mobile) (325KB) ( 8 )  
Objective To investigate the diagnosis and treatment of adult inguinal hernia by totally extraperitoneal  prosthesis(TEP)under laparoscopy.
MethodsA retrospective analysis was performed on 1021 cases of TEP in our hospital from May 2014 to May 2019,and the correlation between operation time,the incidence of seroma and general clinical data was compared and analyzed to summarize clinical experience.
ResultsIn this group,1021 patients underwent TEP,and no patients were transferred to open surgery.The average operative time(37.93±16.14)min,the average intraoperative blood loss(3.55±3.02)ml,the average postoperative drainage volume(75.44±53.11)ml,the average postoperative hospital stay(4.25±0.86)days.There were 12 cases of seroma,3 cases of testicular pain,2 cases of umbilical incision infection,and no patch infection,hernia recurrence,testicular atrophy or chronic pain.The operation time of bilateral hernia was longer than that of unilateral hernia,and the difference was statistically significant(P<0.05).The operation time of indirect hernia was longer than that of direct hernia,and the difference was statistically significant(P<0.05).The operation time of scrotal hernia was longer than that of non-scrotal hernia,and the difference was statistically significant(P<0.05).The incidence of seroma after scrotal hernia was higher than that of non-scrotal hernia,and the difference was statistically significant(P<0.05).
Conclusion Scrotal hernia is an important factor that increases the difficulty of TEP operation and is an independent risk factor for seroma after TEP operation.
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The influence of fast tract surgery on postoperative recovery and stress reaction for laparoscopic common bile duct exploration and primary suture
ZHANG Tao, ZHENG Mingyou, HUANG Shuming, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  669-672.  DOI: 10.3969/j.issn.1005-6483.2020.07.021
Abstract ( 162 )   PDF (374KB) ( 102 )   PDF(mobile) (374KB) ( 2 )  
Objective To analyze the effect of enhanced recovery after surgery(ERAS)procedures on recovery and stress response in patients undergoing laparoscopic common bile duct exploration and primary suture(LBEPS).
Methods Retrospective analysis of 60 patients with the LBEPS in Chongqing People’s Hospital from May 2016 to April 2019.According to the rehabilitation method,it was divided into intervention group(n=30)and control group(n=30).The intervention group adopted the concept of ERAS for perioperative management,and the control group was managed according to the routine method.The time to get out of bed,anal exhaust time,eating time,length of stay,hospital costs,postoperative complications,and interleukin-6(IL-6),C-reactive protein(CRP),and white blood cell count(WBC)on day 1st,3rd,and 5th before and after surgery were compared between the two groups.
Results Both groups completed the operation successfully.There was no significant difference in general data between the two groups(P>0.05).In the intervention group,the time of getting out of bed,exhaust and eating were earlier,the time of hospitalization was shorter and the cost of hospitalization was lower.The incidence of postoperative complications(26.7% vs.50%)was lower than that of the control group,and the analgesic effect was better,with statistically significant differences(P<0.05).On the first,third and fifth days after surgery,IL-6 and CRP in the intervention group were lower than those in the control group,respectively(80.05±27.84)μg/L vs.(191.47±118.26)μg/L,(52.78±33.28)μg/L vs.(112.98±63.89)μg/L,(18.11±8.20)μg/L vs.(55.80±38.62)μg/L,(30.46±16.37)mg/L vs.(56.38±38.12)mg/L,(80.05±27.84)mg/L vs.(113.88±68.44)mg/L,(43.60±22.49)mg/L vs.(66.59±〖LM〗35.72)mg/L,the difference were statistically significant(P<0.05).
Conclusion The  concept of the ERAS to patients with the LBEPS can reduce postoperative stress response,reduce postoperative complications,and accelerate rehabilitation of patients.
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Comparison of clinical value of dynamic fixation system and short segment decompression fusion and internal fixation in the treatment of degenerative scoliosis
PAN Xiaofeng, LV Renfa, SUN Qi, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  674-677.  DOI: 10.3969/j.issn.1005-6483.2020.07.023
Abstract ( 152 )   PDF (482KB) ( 136 )   PDF(mobile) (482KB) ( 1 )  
Objective To evaluate the clinical value of dynamic fixation system and short segment decompression fusion and internal fixation in the treatment of degenerative scoliosis.
Methods The clinical data of 96 patients with degenerative scoliosis who underwent orthopaedic surgery in our hospital from March 2016 to July 2019 were analyzed retrospectively.48 patients in the control group were treated with short segment decompression fusion and internal fixation.48 patients in the observation group were treated with dynamic fixation system.The operation related situation,clinical symptom improvement,orthopedic effect,clinical curative effect and complications were observed and compared between the two groups.
Results Compared with the control group,the intraoperative blood loss,operation time,postoperative drainage volume and hospital stays in the observation group were significantly lower than those in the control group(P<0.05).The incidence of perioperative complications decreased in the observation group(P<0.05).Compared with that before operation,the VAS score and ODI index of the two groups were improved,and the observation group was significantly better than the control group at the last follow-up(P<0.05).Compared with before operation,the Cobb angle of lumbar scoliosis in the two groups was significantly improved,and at the last follow-up,the observation group was significantly better than the control group(P<0.05).Compared with the control group,the patients in the observation group had better range of motion of adjacent joints after operation and the total effective rate was significantly increased(P<0.05).
Conclusion Compared with short segment decompression,fusion and internal fixation,dynamic fixation system has the advantages of less bleeding,shorter operation time and less postoperative drainage in the treatment of degenerative scoliosis,and has more advantages in the improvement of clinical symptoms and orthopedic effect.The clinical curative effect is remarkable,at the same time can significantly reduce the risk of complications.
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Efficacy and prognosis of flexible cystoscopy combined with percutaneous nephrolithotomy in complicated renal calculi
XIONG Bobo, ZHANG Jinsong, LI Ning, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  678-681.  DOI: 10.3969/j.issn.1005-6483.2020.07.024
Abstract ( 171 )   PDF (363KB) ( 146 )   PDF(mobile) (363KB) ( 1 )  
Objective The efficacy of percutaneous nephrolithotomy combined with flexible cystoscopy in complicated renal calculi was explored.
Methods We collected 78 patients with complicated stones in our department from June 2018 to June 2019,including 36 patients in the combined group and 42 patients in the percutaneous nephrolithotomy group.All patients were anesthetized by general anesthesia.The intraoperative operative time,hospital stay,intraoperative bleeding,and number of percutaneous nephroscopic channels were compared between the two groups.The stone clearance rate at 5 days and 1 month after surgery,the incidence of stage Ⅱ lithotripsy,and the incidence of perioperative complications were evaluated.
Results The operation was successful in both groups.The average operation time of the combined group was 136.32±12.54min,the average hospitalization time was 7.02±0.84 d,the average intraoperative blood loss was 74.29±7.17 ml,and the incidence of stage Ⅱ lithotripsy was 2.7%(1/36).The average operation time of percutaneous nephrolithotomy was 120.28±14.62 min,the average hospitalization time was 7.10±0.96 d,the average intraoperative blood loss was 75.23±6.18ml,and the incidence of stage Ⅱlithotripsy was 23.80%(10/42).The operation time of the combined group was often longer than that of the percutaneous nephrolithotomy group.The incidence of stage Ⅱ lithotripsy was lower than that of the percutaneous nephrolithotomy group,the difference was statistically significant(P<0.05).There was no difference in hospitalization time,number of percutaneous nephroscopic channels and intraoperative bleeding between the two groups.Statistical significance(P>0.05),The 5d stone clearance rate was 91.7%(33/36)in the combined group,97.2%(35/36)in the postoperative month,and 69.0% in the percutaneous nephrolithotomy./42),the stone clearance rate was 76.2%(32/42)in January,and the difference was statistically significant(P<0.05).The total complication of the combined group was 16.66%(6/36),and the total complication of the percutaneous nephrolithotomy group was 38.09%(16/42).The difference between the two groups was statistically significant(P<0.05).The degree was higher than that in the percutaneous nephrolithotomy group,and the difference was statistically significant(P<0.05).
Conclusion In the treatment of complex kidney stones,percutaneous nephrolithotomy combined with flexible cystoscopy surgery has good effect and safety,and it is worthy of clinical application.
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The clinical effect of soft ureteroscopy at the same time on bilateral 2~3cm upper ureteral stones
ZOU Jin, LIANG Bo, WANG Lihong, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  683-686.  DOI: 10.3969/j.issn.1005-6483.2020.07.026
Abstract ( 175 )   PDF (390KB) ( 125 )   PDF(mobile) (390KB) ( 2 )  
Objective In order to investigate the clinical effect of simultaneous ureteral soft-scopy surgery on bilateral 2~3 cm upper ureteral stones,and to provide a reference for clinical treatment options,this study retrospectively analyzed 84 cases with bilateral 2-3 cm upper ureteral stones in our hospital from January 2016 to December 2018.The study subjects were divided into observation group(40 cases)and control group(44 cases)according to the surgical method.The observation group was treated with simultaneous ureteral soft endoscopic surgery,and the control group was treated with staged ureteral soft endoscopic surgery.The operation indexes,stone removal rate,medical expenses,level of inflammatory factors,urine routine,blood routine and complications of the two groups were compared.The total operation time,intraoperative hemorrhage,hospitalization time and medical expenses of the observation group were less than those of the control group(P<0.05).The stone clearance rate of the observation group and the control group was 100.00% and 93.18%,respectively,with no significant difference(P>0.05).The levels of TNF - α,IL-6,hs CRP,WBC and uroleukocyte in the two groups were significantly higher than those before operation(P<0.05),but there was no significant difference in the levels of TNF - α,IL-6,hs CRP,WBC and uroleukocyte between the two groups(P>0.05).The total postoperative complication rate in the observation group(7.50%)was significantly lower than that in the control group(25.00%),and the difference was statistically significant(P<0.05).
Conclusions indicate that simultaneous ureteral soft-scopy surgery has a significant effect on bilateral 2~3 cm upper ureteral stones.It can improve the clearance rate of primary stones and eliminate the need for secondary surgery.The length of hospital stay reduces the risk of complications.
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Analysis of the effect of preoperative application of magnesium sulfate combined with local lumbar square muscle block on patients undergoing general anesthesia and its influence on postoperative cognitive function
LI Lu, ZHAO Xin, WU Li, et al.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  687-689.  DOI: 10.3969/j.issn.1005-6483.2020.07.027
Abstract ( 149 )   PDF (324KB) ( 112 )   PDF(mobile) (324KB) ( 2 )  
Objective To investigate the effect of preoperative application of magnesium sulfate combined with quadratus lumborum block(QLB)on patients undergoing general anesthesia and its influence on postoperative cognitive function.
Methods 80 patients who underwent laparoscopic inguinal hernia surgery were selected and divided into study group and control group,40 cases in each group.Patients in study group were given routine general anesthesia plus magnesium sulfate combined with quadratus lumborum block,and patients in control group were given routine general anesthesia,then the two groups were compared the differences in terms of clinical efficacy,Tau protein and Aβ42 protein.
Results The analgesia satisfaction of the study group(90.0%)were better than the control group(72.5%)after operation(P<0.05).The FLACC score(3.7±1.2)and PAED score(3.5±0.5)of T1,the FLACC score(3.3±1.5)and PAED score(2.7±0.8)of T2 in the study group were significantly improved than the control group,which were(2.4±1.5),(2.3±0.8),(2.0±1.0)and (1.7±0.5),respectively(P<0.05).One week after surgery,the Tau protein and Aβ42 protein of study group were(46.3±12.0)ng/L and(93.6±20.1)ng/L,respectively,which were significantly improved compared with the control group[(55.2±18.1)ng/L and(86.1±18.5)ng/L],respectively(P<0.05).After anesthesia,the heart rate[(95.8±7.5)beats / min] and blood pressure[(106.6 ± 8.3)mmHg] of the study group were better than those of the control group,which were(106.8±8.5)beats/min and (115.3±11.5)mmHg,respectively(P<0.05).
Conclusion Preoperative application of magnesium sulfate combined with QLB has better analgesic effect on patients undergoing laparoscopic inguinal hernia surgery is significant,And it can improve patients' postoperative cognitive function and help maintain the hemodynamic stability of the body.
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Application of dexmedetomidine in mixed hemorrhoidectomy under intravenous anesthesia in lateral decubitus position
ZHANG Jiangchuan, ZHANG Chunmei.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  690-692.  DOI: 10.3969/j.issn.1005-6483.2020.07.028
Abstract ( 235 )   PDF (317KB) ( 96 )   PDF(mobile) (317KB) ( 2 )  
Objective To analyze the application effect of dexmedetomidine in mixed hemorrhoidectomy under intravenous anesthesia in lateral position.
 Methods 60 patients undergoing mixed hemorrhoidectomy were divided into control group and research group according to random number table method,with 30 cases in each group,and were divided into control group and research group according to random number table method,with 30 cases in each group.Both groups were induced by propofol anesthesia,the control group was maintained by remifentanil and propofol anesthesia,and the study group was maintained by remifentanil and dexmedetomidine anesthesia.The dosage of remifentanil and propofol,anesthesia recovery quality,heart rate(HR),mean arterial pressure(MAP),bispectral index(BIS),visual analogue scale(VAS),and adverse reactions were compared between the two groups.
ResultsThe dosage of propofol and remifentanil in the research group was lesser than that in the control group(P<0.05).There was no significant difference in respiratory recovery time and awake time between the two groups(P>0.05).Before anesthesia induction,there was no significant difference in HR,MAP and BIS between the two groups(P>0.05).HR and MAP in both groups increased 10min after the operation,while BIS in the research group was lower than that in the control group and decreased 10min after the operation,and the research group was lower than that in the control group(P<0.05).The VAS score of the research group was lower than that of the control group 1 hour and 4 hours after operation(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).
Conclusion Dexmedetomidine on the basis of intravenous anesthesia for mixed hemorrhoid resection does not delay the recovery time of patients and reduces the dosage of narcotic drugs,which can maintain stable hemodynamics and relieve pain,and has high safety.
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Current status and prospect of treatment for small cell lung cancer
DENG Yu, HAO Bo, GENG Qing.
JOURNAL OF CLINICAL SURGERY. 2020, 28 (7):  696-699.  DOI: 10.3969/j.issn.1005-6483.2020.07.030
Abstract ( 392 )   PDF (335KB) ( 235 )   PDF(mobile) (335KB) ( 42 )  
Small cell lung cancer(SCLC)is an aggressive cancer of neuroendocrine origin,which accounts for 15% of all primary lung cancers.Besides the conventional chemotherapy and radiotherapy,accumulating evidence suggested that surgery achieved a favorable outcome in parts of limited stage of SCLC patients,and some progress has also been made in immunotherapy and targeted therapy.The present study intends to review the latest research on the treatment of SCLC.
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