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Objective Pain is an important factor affecting rapid rehabilitation of the patient after minimally invasive esophagectomy (MIE), and few studies are reported on the analgesic effect of intravenous administration of flurbiprofen (FBP) following MIE. This study was to investigate the role of FBP analgesia in rapid rehabilitation of the patients after MIE. Methods Sixty-four patients with esophageal cancer underwent MIE in the General Hospital of Eastern Theater Command from October 2015 to October 2016. Thirty-two of them received analgesia with a patient-controlled analgesia (PCA) pump (the control group) and the other 32 with FBP plus a PCA pump (the FBP group) postoperatively. We measured the concentrations of serum interleukin 6 (IL-6) and procalcitonin (PCT) at 12, 24, 48 and 72 hours after surgery, recorded the visual analog scale (VAS) pain scores at rest, and compared the parameters obtained between the two groups of patients. Results Compared with the control group, the FBP group showed significantly decreased concentrations of serum IL-6 ([156.53 ± 13.46] vs [120.19±13.52] μg/L, P < 0.05) and PCT ([1.99 ± 0.12] vs [1.89 ± 0.18] μg/L, P < 0.05) at 12 hours after MIE, even more significantly at 24, 48 and 72 hours (P < 0.05). And the VAS scores were markedly lower in the FBP than in the control group at all the four time points (P < 0.05). Conclusion Postoperative intravenous administration of flurbiprofen can significantly reduce inflammatory reaction, relieve pain and contribute to rapid rehabilitation after minimally invasive esophagectomy.
ABSTRACT
Objective Early diagnosis and effective treatment are the key to reduce the mortality and improve the prognosis of anastomotic leakage which involved many disciplines after esophageal cancer surgery. The aim of the study is to investigate the value of multidisciplinary which combined diagnosis and treatments in anastomotic leakage after esophageal cancer operations. Methods A total of 82 patients with anastomotic leakage after esophageal cancer surgery in our hospital from June 2013 to June 2018 . 43 patients from June 2013 to December 2015 were included in the control group. 39 patients with anastomotic leakage from January 2016 to June 2018 were used as the observation group. Patients in the control group were given routine diagnosis and treatment, while the observation group was given a multidisciplinary (thoracic surgery, imaging, general surgery, nutrition,etc.) joint diagnosis and treatment model. Observe general data, prognosis, and fistula healing time. Results The proportion of occultation in the observation group was significantly higher than that in the control group(38.5% vs 18.6%), and the difference was statistically significant (P<0.05). The healing time of anastomotic leakage was lower in the observation group[(17.24±3.62)d] than in the control group[(33.85±4.85)d](P<0.05). Conclusion Multidisciplinary combined diagnosis and treatment can improve the incidence of occult sputum and reduce the healing time of anastomotic leakage. It is worthy of clinical promotion.
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Objective At present, there are few studies about the learning curve of da Vinci robot system for surgical treatment of esophageal cancer. This study aimed to evaluate the surgical outcomes of Da Vinci robotic surgical system for radical surgery in esophageal cancer and explore the learning curve characteristics of thoracic surgeon.Methods Clinical data of 60 consecutive cases who received Da Vinci robot-assisted radical esophagectomy between January 2011 and December 2015 in Nanjing General Hospital were reviewed retrospectively. The cases were divided into 3 groups according to the operation period: group A (operation time: January 2011 to January 2013), group B (operation time: February 2013 to February 2014) and group C (operation time: March 2014 to December 2015). There were 20 cases in each group. The docking time, thoracic cavity anatomical separation time, total operation time and complication were compared. The learning curve of robotic surgery system were analyzedResults The operations of 60 patients were successfully completed without any transfer to thoracotomy or laparotomy. There was no statistically significant difference in the incidence of complications between the 3 groups (P>0.05). With the increase in the number of surgical cases, the total operation time of group A (\[450.7±99.1\]min), group B (\[299.7±57.1\]min) and group C (\[248.5±71.5\]min) was gradually reduced. The difference was statistically significant (P0.05) . There were significant differences in total operation time among the three groups(P<0.05).After 20 cases, the fitting curve appeared turning angle, and then the curve began to slow down. Combined with the total operation time, pleural and abdominal cavity anatomical separation time and robotic docking time, it can be seen that the learning curve of Da Vinci robot-assisted radical robotic surgery in esophageal cancer was 20 cases.Conclusion After 20 cases of study, the thoracic surgeon can master the Da Vinci robotic surgical system for the radical surgery of esophageal cancer.
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To clarify the clinical application of the group standard (T/CACM 1035-2017) of the Chinese Society of Traditional Chinese Medicine (TCM), the clinical practice guideline on traditional chinese medicine therapy alone or combined with community acquired pneumonia, and to understand the clinical applicability of the Guideline. The clinical workers trained in terms of the Guideline in hospitals at all levels in China were selected as the research objects. A total of 494 questionnaires on application evaluation and 511 questionnaires on applicability evaluation were collected to construct the database of the post-effect evaluation of the Guideline. Excel software was used for statistical analysis. The overall evaluation of the Guideline was 92.31%, 91.06%, 87.45% respectively in efficacy, safety and economy. The Guideline was well used in clinical application, and 99.41% of the patients were willing to follow the recommended scheme. The agreed ratio in rationality evaluation was 97.98%, 92.37%, 94.53% and 92.71% in treatment rules, syndrome differentiation and classification, prevention of complications, and rehabilitation method. The effective rate of the prescriptions recommended in the Guideline was all above 65%. More than 80% of the prescriptions were Tanreqing Injection, Yinqiao Powder, Qingjin Huatan Decoction, Maxing Shigan Decoction, Shengmai San and Shashen Maidong Decoction. Adverse reactions, unknown active components and economy of Chinese patent medicines were the important factors affecting drug use and efficacy, providing a clinical basis for updating and revising the standard.
Subject(s)
Humans , Anti-Bacterial Agents , China , Community-Acquired Infections , Drug Therapy , Drugs, Chinese Herbal , Medicine, Chinese Traditional , PneumoniaABSTRACT
Among the literatures of the prevention and treatment of community-acquired pneumonia (CAP) published in recent years, there were 16 kinds of classic prescription, including 52 RCTs about Maxingshigan Decoction, 21Chinese patent medicines. There are eight kinds of indications for the drug specification, among which the literatures of Tan Reqing injection accounted for the most about 136 RCTs; There were literatures about non-drug treatment, including： acupuncture, Chinese medicine paste, enema, Chinese medicine ionization, Chinese medicine fumigation, bamboo cans and so on. In this study, author has analysed the classic prescription, Chinese patent medicine and non-drug therapy referring to advantages and disadvantages of CAP, which could be used to treat virus infection instead of antibiotic therapy. Based on antibiotic therapy, Chinese medicine treatment could increase synergistic interaction while decrease the antibiotic side-effects. In addition, Chinese medicine could perform synergistic interaction in CAP every period, which resulted from classified analysis of basic studies about Chinese medicine treatment in CPA. This study is aimed to provides an important basis for clarifying the direction of scientific research.
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This study is aimed to identify and assess the methodological quality of community-acquired pneumonia (CAP) clinical practice guidelines (CPG) in China by using AGREE Ⅱ tool. CNKI, SinoMed, Wanfang, and VIP Chinese databases from database establishment to March 2017 were searched by manual retrieval to collect all the clinical practice guidelines prepared by various associations or organizations, then AGREE Ⅱtool was used to assess them. Data in each CPG were analyzed in terms of six domains, including scope and purpose, participants, rigor, clarity and readability, applicability and editorial independence. A total of 4 CPGs were included. The results showed that the scope and purpose scored 45.8%; the clarity of expression scored 44.75%; the participants scored 31.9%; the rigor scored 18.98%; the applicability scored 7%; and finally the editorial independence scored 1%. It is concluded that the quality of applicability and the editorial independence should attained paid more attention in future development or updating of the guidelines. In addition to strengthening the compliance with international general principles, we should also pay attention to the characteristics of traditional Chinese medicine treatment, especially the related evidences as complementary and alternative treatment for western intervention measures.
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In order to investigate the safety and efficacy of endoscopic retrograde cholangiopancreatograpy (ERCP) in liver cirrhosis patients with common bile duct stones, we retrospectively analyzed data of 46 common bile duct stones patients with liver cirrhosis who underwent ERCP between 2000 and 2008. There were 12 cases of Child-Pugh A, 26 cases of Child-Pugh B, and 8 cases of Child-Pugh C. 100 common bile duct stones patients without liver cirrhosis were randomly selected. All the patients were subjected to ERCP for biliary stones extraction. The rates of bile duct clearance and complications were compared between cirrhotic and non-cirrhotic patients. The success rate of selective biliary cannulation was 95.6% in liver cirrhotic patients versus 97% in non-cirrhotic patients (P>0.05). The bile duct clearance rate was 87% in cirrhotic patients versus 96% in non-cirrhotic patients, but the difference was not statistically significant. Two liver cirrhotic patients (4.35%, 2/46) who were scored Child-Pugh C had hematemesis and melena 24 h after ERCP. The hemorrhage rate after ERCP in non-cirrhotic patients was 3%. The hemorrhage rate associated with ERCP in Child-Pugh C patients was significantly higher (25%, 2/8) than that (3%, 3/100) in non-cirrhotic patients (P<0.01%). There was no significant difference between these two groups in the rate of post-ERCP pancreatitis (PEP) and cholangitis. ERCP is safe and effective for Child-Pugh A and B cirrhotic patients with common bile duct stones. Hemorrhage risk in ERCP is higher in Child-Pugh C patients.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cholangiopancreatography, Endoscopic Retrograde , Methods , Gallstones , General Surgery , Liver Cirrhosis, Biliary , General Surgery , Postoperative Hemorrhage , Retrospective StudiesABSTRACT
In order to investigate the safety and efficacy of endoscopic retrograde cholangiopancreatograpy (ERCP) in liver cirrhosis patients with common bile duct stones, we retrospectively analyzed data of 46 common bile duct stones patients with liver cirrhosis who underwent ERCP between 2000 and 2008. There were 12 cases of Child-Pugh A, 26 cases of Child-Pugh B, and 8 cases of Child-Pugh C. 100 common bile duct stones patients without liver cirrhosis were randomly selected. All the patients were subjected to ERCP for biliary stones extraction. The rates of bile duct clearance and complications were compared between cirrhotic and non-cirrhotic patients. The success rate of selective biliary cannulation was 95.6% in liver cirrhotic patients versus 97% in non-cirrhotic patients (P>0.05). The bile duct clearance rate was 87% in cirrhotic patients versus 96% in non-cirrhotic patients, but the difference was not statistically significant. Two liver cirrhotic patients (4.35%, 2/46) who were scored Child-Pugh C had hematemesis and melena 24 h after ERCP. The hemorrhage rate after ERCP in non-cirrhotic patients was 3%. The hemorrhage rate associated with ERCP in Child-Pugh C patients was significantly higher (25%, 2/8) than that (3%, 3/100) in non-cirrhotic patients (P<0.01%). There was no significant difference between these two groups in the rate of post-ERCP pancreatitis (PEP) and cholangitis. ERCP is safe and effective for Child-Pugh A and B cirrhotic patients with common bile duct stones. Hemorrhage risk in ERCP is higher in Child-Pugh C patients.