ABSTRACT
Objective To compare the curative effect of tissue-selecting therapy stapler and procedure for prolapse and hemorrhoids in the treatment of patients with stage Ⅲ to Ⅳ hemorrhoids.Methods The patients with stage Ⅲ to Ⅳ hemorrhoids who underwent prolapse and hemorrhoids or tissue-selecting therapy stapler surgery in the department of General Surgery,Shanghai Ninth People's Hospital and Xinhua Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Chongming Branch,from Jan.2013 to Jun.2014 were accepted and allocated to prolapse and hemorrhoids or tissue-selecting therapy stapler group.The peri-operative parameters about operative time,blood loss,postoperative hospital stay and the time required to return to normal activity were compared by t test,The postoperative complications including pain assessment and the incidence of postoperative bleeding,urine retention,faecal urgency,fecal incontinence,anal stenosis,rectovaginal fistula and recurrence rate were compared by t test and chi-square test.Rank sum test was used to compare the recurrence rate and patient's satisfaction between the two groups.Results The operation time,intraoperative bleeding volum,postoperative hospital stay and the time required to return to normal activity in the procedure for prolapse and hemorrhoids group were signifcantly higher than those in the tissue-selecting therapy stapler group (P =0.021,P =0.003,P =0.001,P ＜0.001).The pain score of procedure for prolapse and hemorrhoids group were all higher than those of the tissue-selecting therapy stapler group in the first post-operative defecation and in post-operative 24 hours and 72 hours (all P ＜ 0.001).The incidence of faecal urgency of the procedure for prolapse and hemorrhoids group in post-operative 1 month (18.6％) was higher than that of the tissue-selecting therapy stapler group (6.6％) (P =0.036).There were no statistically significant differences in the incidence of postoperative bleeding,urinary retention,recurrence rate and patient's satisfaction between two group (P ＞ 0.05).Conclusion Tissue-selecting therapy stapler was superior to the procedure for prolapse and hemorrhoids in operation time,intraoperative blood loss,postoperative pain and the incidence of faecal urgency.Long-term results demonstrate that tissue-selecting therapy stapler and prolapse and hemorrhoids have similar effectiveness.
ABSTRACT
Objective To compare the curative effect of tissue-selecting therapy stapler and procedure for prolapse and hemorrhoids in the treatment of patients with stage Ⅲ to Ⅳ hemorrhoids.Methods The patients with stage Ⅲ to Ⅳ hemorrhoids who underwent prolapse and hemorrhoids or tissue-selecting therapy stapler surgery in the department of General Surgery,Shanghai Ninth People's Hospital and Xinhua Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Chongming Branch,from Jan.2013 to Jun.2014 were accepted and allocated to prolapse and hemorrhoids or tissue-selecting therapy stapler group.The peri-operative parameters about operative time,blood loss,postoperative hospital stay and the time required to return to normal activity were compared by t test,The postoperative complications including pain assessment and the incidence of postoperative bleeding,urine retention,faecal urgency,fecal incontinence,anal stenosis,rectovaginal fistula and recurrence rate were compared by t test and chi-square test.Rank sum test was used to compare the recurrence rate and patient's satisfaction between the two groups.Results The operation time,intraoperative bleeding volum,postoperative hospital stay and the time required to return to normal activity in the procedure for prolapse and hemorrhoids group were signifcantly higher than those in the tissue-selecting therapy stapler group (P =0.021,P =0.003,P =0.001,P ＜0.001).The pain score of procedure for prolapse and hemorrhoids group were all higher than those of the tissue-selecting therapy stapler group in the first post-operative defecation and in post-operative 24 hours and 72 hours (all P ＜ 0.001).The incidence of faecal urgency of the procedure for prolapse and hemorrhoids group in post-operative 1 month (18.6％) was higher than that of the tissue-selecting therapy stapler group (6.6％) (P =0.036).There were no statistically significant differences in the incidence of postoperative bleeding,urinary retention,recurrence rate and patient's satisfaction between two group (P ＞ 0.05).Conclusion Tissue-selecting therapy stapler was superior to the procedure for prolapse and hemorrhoids in operation time,intraoperative blood loss,postoperative pain and the incidence of faecal urgency.Long-term results demonstrate that tissue-selecting therapy stapler and prolapse and hemorrhoids have similar effectiveness.
ABSTRACT
Objective To evaluation the efficacy of dexmedetomidine mixed with dezocine and levobupivacaine for patient-controlled epidural analgesia (PCEA) after cesarean section.Methods A total of 300 patients, aged 23-35 yr, with body mass index of 24-28 kg/m2 , of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , undergoing elective cesarean section under epidural anesthesia, were randomly divided into 3 groups (n =100 each) according to the random number table: morphine and levobupivacaine group (ML group), dezocine and levobupivacaine group (DL group), and dexmedetomidine, dezocine and levobupivacaine group (DDL group).In group ML, the loading dose included morphine 2 mg + levobupivacaine 10 mg + 5 ml normal saline, and PCEA solution contained morphine 5 mg + levobupivacaine 150 mg + normal saline 100 ml.In group DL, the loading dose included dezocine 3 mg+ levobupivacaine 10 mg+ normal saline 5 ml, and PCEA solution contained dezocine 15 mg + levobupivacaine 150 mg + normal saline 100 ml.In group DDL, the loading dose included dezocine 2 mg+ levobupivacaine 10 mg + dexmedetomidine 0.5 μg/kg + normal saline 5 ml, and PCEA solution contained dezocine 7.5 mg+ levobupivacaine 150 mg + dexmedetomidine 1.5 μ g/kg + normal saline 100 ml.At 10 min before the end of operation, the loading dose was given via the epidural catheter, and the PCEA pump was connected and set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Analgesia was maintained until 42 h after operation.Visual analog scale score was main-tained ≤ 3, and (or) visual analog scale for fatigue score ≤ 2.When PCEA failed, morphine 2 mg was injected epidurally as rescue analgesic.At 4, 8, 24 and 42 h after operation, the modified Bromage score and Ramsay sedation score were recorded, and patients' satisfaction with analgesia was evaluated.The occurrence of epidural analgesia-related adverse reactions was recorded.Results The consumption of PCEA solution and requirement for rescue analgesics were significantly lower in group ML than in group DL.Compared with group ML, Ramsay sedation score was significantly decreased at 4 and 8 h after operation, the degree of patients' satisfaction with analgesia was increased, and the incidence of nausea, vomiting, dizziness and pruritus was decreased in DL and DDL groups, and the incidence of urinary retention was decreased in group DDL.The degree of patients' satisfaction with analgesia was significantly higher, and the incidence of dizziness and urinary retention was lower in DDL group than in group DL.No patients developed epidural analgesia-relatcd hypotension, bradycardia, or respiratory depression in the three groups.Conclusion The efficacy of dexmedetomidine mixed with dezocine and levobupivacaine is good when used for PCEA after cesarean section, and the adverse reactions are fewer.
ABSTRACT
Objective To remedy the general defects of external fixator such as poor stability,complexed operation,strong stress shielding and bad extension function. Methods A total of 102 patients with limb shaft fracture were treated with the self-made external fixation and the curative effect observed. There were 84 males and 18 females aged at 5-78 years. Of all, 76 cases had tibial and fibular fractures, 10 femoral shaft fractures (children), 4 intertrochanteric or subtrochanteric fractures, 7 ulnar or radial fractures and 5 humeral shaft fractures. Results All patients got good results through a all-course observation, among which 76 cases with tibial and fibular fractures were followed up for 3 months to one year. Furthermore, the mean substantial bone healing time was only 3.5 months. The joint functions of the knee and the ankle recovered synchronously, with an overall excellence rate of 93.4%. No displacement of the fractured part or further fracture occurred. Conclusions The structure and function of the self-made external fixation accord with the demanding of current external fixator in orthopaedics.