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1.
Chinese Journal of Gastrointestinal Surgery ; (12): 969-976, 2021.
Article in Chinese | WPRIM | ID: wpr-942996

ABSTRACT

Objective: To investigate the safety of definitive surgery for chronic radiation intestinal injury. Methods: A descriptive case series study was performed. Clinical data of 105 patients who were diagnosed as chronic radiation intestinal injury, had complete data and received definitive surgery (the radiation-induced intestinal segment and digestive tract reconstruction) at Department of Gastrointestinal Surgery of Beijing Tsinghua Changgung Hospital from June 2016 to May 2020 were retrospectively analyzed. There were 30 males (28.6%) and 75 females (71.4%) with the median age of 58 years (P25, P75: 52, 64 years). Patients who had tumor recurrence or refused surgical treatment were excluded. According to the preoperative evaluation and clinical manifestations, to select the resection range. Outcome parameters: (1) preoperative evaluation (nutrition risk assessment and status of obstruction or fistula); (2) clinical manifestations and treatment strategies; (3) details of surgical parameters; (4) postoperative complications, and Clavien-Dindo classification III to V was defined as main moderate-severe complication. Results: (1) Preoperative evaluation: Eighty-eight patients (83.8%) developed symptoms of chronic radiation intestinal injury more than 1 year after the end of radiotherapy. Ninety-eight patients (93.3%) had preoperative NRS-2002 score ≥3, 74 patients (70.5%) received preoperative parenteral nutritional support, and the median time of nutritional support was 10.5 (7.0, 16.0) days. Sixteen patients (15.2%) received small intestinal decompression tube implantation due to severe obstruction. (2) Clinical manifestations and treatment strategies: Among 105 patients, 87 (82.9%) presented with obstruction and received definitive resection of the radiation-induced intestinal segment plus one-stage digestive tract reconstruction; 18 (17.1%) presented with intestinal fistula and all of them received definitive resection of the radiation-induced intestinal segment, intestinal fistula plus one-stage digestive tract reconstruction. Among above 18 patients with fistula, 3 patients with ileorectal stump fistula received pedicled pelvic closure of greater omentum at the same time; 4 patients had ileal vesical fistula, of whom 2 patients received cystectomy and bladder repair due to preoperative nephrostomy decompression, and the other 2 patients received transection of the small intestine proximal and distal to the fistula and anastomosis of the intestinal loop without fistula resection, intestinal fistula or bladder fistula repair. (3) The details of surgical parameters: Median operative time and intraoperative blood loss was 230 (180, 300) minutes and 50 (20, 50) ml respectively. Ninety-two patients (92/105, 87.6%) underwent ileocolonic anastomosis, and anastomosis on the hepatic flexure or splenic flexure colon were performed in 88 (83.8%) and 4 (3.8%) patients respectively. Ileoileal anastomosis was performed in 13 patients (12.4%). The anastomotic site of 92 patients (87.6%) was strictly located in the contralateral quadrant of the radiation field, and the anastomotic site of 13 patients (12.4%) was far from the radiation field. Nine patients (8.6%) had more than one anastomosis, 5 patients (4.8%) had less than 180 cm of residual small intestine, 7 patients (6.7%) underwent retrograde intestinal permutation, 4 patients (3.8%) underwent abdominal wall reconstruction surgery due to abdominal wall defects, and 87 patients (82.9%) had severe abdominal pelvic adhesions (grade 3-4 adhesions). Intraoperative complications occurred in 3 patients (2.9%), which were found in time and handled properly. The median postoperative hospital stay was 13.0 (12.0, 24.5) days, and all the patients had resumed oral feeding upon discharge. (4) Postoperative complications: Fourteen patients (13.3%) had 18 major complications (grade III to V). The incidence of postoperative anastomotic leakage was 5.7% (6/105), and the incidence of anastomotic leakage for ileocolon anastomosis and ileoileal anastomosis was 2.2% (2/92) and 4/13, respectively (χ(2)=17.29, P<0.001). The incidence of postoperative anastomotic leakage of intestinal fistula and intestinal obstruction was 3/18 and 3.4% (3/87), respectively (χ(2)=4.84, P=0.028). The mortality at 30 days after operation was 1.0% (1/105), after abdominal infection and septic shock caused by postoperative anastomotic leakage resulting in multiple organ failure. Conclusion: For chronic radiation intestinal injury patients with obstruction or fistula, definitive surgical treatment is feasible and safe with acceptable major complications.


Subject(s)
Female , Humans , Male , Middle Aged , Anastomosis, Surgical , Anastomotic Leak , Intestines , Postoperative Complications , Radiation Injuries , Retrospective Studies
2.
International Eye Science ; (12): 1464-1468, 2014.
Article in Chinese | WPRIM | ID: wpr-641950

ABSTRACT

AIM: To observe the tear film changes after phacoemulsification combined with intraocular lens implantation in age - related cataract patients and to compare the therapeutic effect of hydroxyl-glucoside and sodium hyaluronate on the postoperative dry eye. METHODS:A total of 49 patients ( 70 eyes ) with age-related cataract suffering from dry eye after phacoemulsification combined with IOL implantation were divided into treatment group 1 ( group A, 23 eyes with conventional therapy and hydroxyl - glucoside at 7d postoperatively) , treatment group 2 ( group B, 22 eyes with conventional therapy and sodium hyaluronate at 7d postoperatively) and control group ( group C, 25 eyes with conventional therapy only ) . Questionnaire score of dry eye symptoms, SchirmerⅠtest ( SⅠt) , tearfilm break up time ( BUT ) and corneal fluoresce in staining ( CFS ) were measured at 2d preoperatively and 7, 14, 30, 90d postoperatively. RESULTS: No statistical differences existed among the three groups of preoperative 2d ( P > 0. 05 ). At 2d preoperatively and 90d postoperatively, the results of questionnaire score of dry eye symptoms, SⅠt, BUT, and CFS displayed no statistical differences in the patients of three groups (P>0. 05). While there was statistical significance among preoperatively and 7, 14, 30d postoperatively of the three groups (PCONCLUSION: At the early stage after phacoemulsification combined with IOL implantation, the tear film stability is decreased, which may promote eyesymptoms. Management with hydroxyl-glucoside or sodium hyaluronate plays a role in relief of the structure and stability of the tear film and improves dry eye symptoms, while sodium hyaluronate eye drops is more effective.

3.
Chinese Pharmaceutical Journal ; (24): 1213-1214, 2013.
Article in Chinese | WPRIM | ID: wpr-860318

ABSTRACT

OBJECTIVE: To compare the efficacies of different target concentrations of propofol combinded with remifentanil for painless induced abortions, thus to explore the best target concentrations. METHODS: One hundred and twenty ASAI-II patients receiving elective painless induced abortions between May 2011 and October 2011 were randomly divided into three groups. The target concentrations of propofol were 2, 3, and 4 μg·mL-1, respectively. The hemodynamic changes and body movements at different time and the time of leaving operating room in the three groups were compared. RESULTS: The patients in the three groups all finished operations. The MAPs and HRs when dilating uterine and aspirating embryo bud were significantly increased, and the incidence of body movements was the highest in the 2 μg·mL-1 group; the number of apnea cases and the time of leaving operation room in the 4 μg·mL-1 group were significantly higher than the other two groups. CONCLUSION: When using propofol at target concentration of 3 μg·mL-1 combined with remifentanil at target concentration of 3 μg·mL-1 for painless induced abortions, the patients had stable perioperative MAP and HR, less apnea cases, and shorter time of leaving operation room. So these are the ideal target plasma concentrations for controlled anesthesia for painless induced abortions.

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