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Objective:To explore the risk factors of occurrence of colorectal adenoma after endoscopic polypectomy.Methods:From January 2014 to December 2019, at the Department of Day Surgery Centre in West China Hospital, Sichuan University, 6 430 patients with 20 351 polyps who underwent endoscopic colorectal polypectomy were retrospectively analyzed. Patients were divided into adenomas group (4 573 patients) and non-adenomas group (1 857 patients) according to whether they had at least one adenomatous polyp. According to the results of postoperative histopathology, colorectal polyps were divided into adenomatous polyp group (10 656 polyps) and non-adenomatous polyp group (9 695 polyps). The propensity score matching (PSM) method was applied, with 1∶1 matching, in the patients with adenoma group and the patients with non-adenoma group, as well as in adenomatous polyps group and non-adenomatous polyps group. A total of 1 824 pairs of patients and 7 362 pairs of colorectal polyps were successfully matched. After PSM, patients-related factors as gender (male), age (<40 and 40 to 60 years old), number of polyps (>2), obesity (body mass index ≥28 kg/m 2), melanosis, family history of colorectal cancer in first-degree relatives, polyps-related factors as the maximum diameter (6 to 10 and >10 mm), distribution (distal colon), and morphological classification (sessile and flat polyps) were included in the analysis of risk factors of colorectal adenoma. Univariate analysis and multivariate logistic regression were used for statistical analysis. Results:Among 6 430 patients with colorectal polyps, the detection rate of adenoma was 71.12% (4 573/6 430). After PSM, the results of univariate analysis showed that obesity, family history of colorectal cancer in first-degree relatives, the maximum diameter of polyps >10 mm were all correlated with the occurrence of adenoma (odds ratio ( OR)=1.483, 1.426 and 1.503, 95% confidence interval ( CI)1.063 to 2.067, 1.015 to 2.004, 1.198 to 1.887, all P<0.05). The results of multivariate logistic regression analysis indicated that obesity, family history of colorectal cancer in first-degree relatives, the maximum diameter of polyps >10 mm, sessile or flat polyps in morphological classification were independent risk factors of the occurence of colorectal adenomas ( OR=1.425, 1.411, 1.629, 1.165 and 1.151, 95% CI1.019 to 1.994, 1.001 to 1.988, 1.290 to 2.058, 1.030 to 1.316 and 1.012 to 1.310, all P < 0.05). Conclusions:Obesity, family history of colorectal cancer in first-degree relatives, maximum diameter of polyps >10 mm, sessile polyps or flat polyps were the independent risk factors of the occurrence of colorectal adenomas.
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As a new type of medical service mode, day surgery significantly alleviates the contradiction between supply and demand of medical resources. Since 2009, day surgery center in West China Hospital of Sichuan University has gradually carried out endoscopic gastrointestinal(GI) polypectomy, continuously explored and practiced the centralized management mode of GI polyps. The integrated management process included pre-hospital management, clinical pathway during hospitalization, and extended service after discharge. The overall-management database for day surgery patients was established, guiding the clinical practice and standardizing clinical behavior based on various clinical studies, which help day surgery managers make clinical decisions, and achieve the management objectives of fine management, quality and safety normalization for day surgery.
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BACKGROUND@#The types and number of day surgery are increasing, what is the result of day surgery of selected patients with lung cancer? To explore the operation process and clinical effect of day surgery in patients with lung cancer by fusing the concept of enhanced recovery after surgery (ERAS) and minimally invasive surgical techniques.@*METHODS@#A prospective study was planned with the approval of our institutional review board. 153 lung cancer patients who underwent anatomic resection in a single medical group between June 2019 and Nov 2019 were randomized. 20 patients were applied day surgery and 28 patients by inpatient surgery and the average length of stay, average hospital cost , complications and adverse reactions were analysed.@*RESULTS@#The average hospital day in DSG group (1 d) was significantly shorter than in ISG group (7.7±2.8) d (P=0.000). The average hospital cost in DSG group (38,297.3±3,408.7)¥ was significantly lower than in ISG group (47,831.1±7,376.1)¥ (P=0.000). There was no significant difference in the incidence of postoperative complications between the daytime surgery group (5.0%) and the inpatient surgery group (3.6%) (P=0.812). The postoperation adverse reactions in DSG (10.0%) and ISG (17.9%) is no difference (P=0.72).@*CONCLUSIONS@#Our study showed that the same clinical effect achieved between DSG and ISG, and recover quickly lung cancer patients after day surgery.
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Objective To explore the clinical feasibility of ambulatory surgery for inguinal hernia in 70 years of age or older patients.Methods The retrospective cohort study was adopted.The clinical data of 675 patients undergoing ambulatory surgery for inguinal hernia and 464 patients (age ≥ 70 years) undergoing inpatient surgery for inguinal hernia who were admitted to the West China Hospital of Sichuan University from January 2015 to May 2016 were collected.Of 675 patients undergoing ambulatory surgery,594 patients with age ＜ 70 years and 81 with age≥70 years were respectively allocated into the under 70 years group and 70 years or older group.Four hundred sixty-four patients undergoing inpatient surgery with age ≥ 70 years were allocated into the inpatient surgery group.Observation indicators included:(1) efficacies of patients undergoing ambulatory surgery:① type of anesthesia,surgical procedures and operation time,② cases with delayed discharge and cases with unplanned readmission,③postoperative complications,including wound infection and dehiscence,edema of scrotum,urinary retention,chronic pain and patch infection.(2) Efficacies of patients with inpatient surgery:①type of anesthesia,surgical procedures and operation time,② postoperative complications,including wound infection and dehiscence,edema of scrotum,urinary retention,chronic pain and patch infection,③ duration of postoperative hospital stay.(3) Follow-up.Patients were regularly followed up using telephone interview at postoperative day 1,2,3,and using outpatient examination and telephone interview at postoperative week 2 and month 3,6,12 up to July 2016.Follow-up included the survival of patients,recurrence of hernia and number of readmission.Measurement data with normal distribution were represented as （x） ± s and comparison between groups was evaluated with the t test.Comparison of count data were analyzed using the chi-square or Fisher exact probability.Results (1) Efficacies of patients undergoing ambulatory surgery:① type of anesthesia,surgical procedures and operation time:patients in the under 70 years group and 70 years or older group underwent tensionfree repair under local anesthesia.The operation time in the under 70 years group and 70 years or older group was respectively (29 ± 11) minutes and (28 ± 10) minutes,with no statistically significant difference between 2 groups (t =0.378,P ＞ 0.05).② The cases with delayed discharge and with unplanned readmission:there were 2 patients with delayed discharge and 1 with unplanned readmission in the under 70 years group and no case in the 70 years older group,with no statistically significant difference between the 2 groups (x2=0.601,0.137,P ＞ 0.05).③ The postoperative complications:wound infection and dehiscence,edema of scrotum,urinary retention and chronic pain were detected in 4,2,1,3 patients in the under 70 years group and 1,0,0,1 patients in the70 years or older group,respectively,showing no statistically significant difference between the 2 groups (P ＞ 0.05).No patch infection occurred.(2) Efficacies of patients undergoing inpatient surgery:① type of anesthesia,surgical procedures and operation time:patients in the inpatient surgery group underwent tension-free repair under local anesthesia and operation time was (29 ± 10) minutes.There was no statistically significant difference in operation time between the inpatient surgery group and 70 years or older group (t =0.806,P ＞ 0.05).② The wound infection and dehiscence,edema of scrotum,urinary retention and chronic pain in the inpatient surgery group were respectively detected in 3,1,1,2 patients,showing no statistically significant difference between the inpatient surgery group and 70 years or older group (P ＞ 0.05).No patch infection occurred.③ Duration of postoperative hospital stay was less than 1 day in 439 patients and more than 1 day in 25 patients in the inpatient surgery group,respectively.(3) Follow-up:625 of 675 patients undergoing ambulatory surgery were followed up for a median time of 9 months (range,2-18 months).One patient in the under 70 years group was complicated with recurrence of hernia and then was cured by reoperation.There was no recurrence of hernia in the 70 years or older group.Of 464 patients in the inpatient surgery group,432 were followed up for a median time of 9 months (range,2-18 months),and 1 patient with recurrence of hernia was cured by reoperation.Conclusion Ambulatory surgery for inguinal hernia is feasible in 70 years or older patients.
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Objective To explore the clinical value of combined detection of serum beta human chorionic gonadotropin (β-hCG),estradiol (E2),progesterone (P) and antiphospholipid antibodies (ACA) in predicting the outcomes of early threatened abortion.Methods 80 pregnant women were chosen from six to eight weeks singleton pregnancies,50 cases of threatened abortion and 30 cases of normal pregnancy.The serum levels of β-HCG,estradiol,progesterone and ACA-IgG,ACA-IgM and ACA-IgA were detected.The threatened abortion patients were given intramuscular progesterone 20 mg/day/time for 1 week,then,the pregnancy outcomes were analyzed and the serum levels of β-HCG,estradiol and progesterone were explored.Results The serum β-HCG,estradiol and progesterone of the threatened abortion group [(5 140.77 ± 2 365.47) IU/L,(680.28 ± 306.06) pg/mL,(15.59 ± 3.65) pg/L]were lower than those of the normal pregnant women [(14 520.4 ± 11 016.24) IU/L,(1 142.81 ± 670.57) pg/mL,(27.6 ± 4.78) pg/L] (t =3.224,P =0.003 ; t =2.43,P =0.022 ; t =7.72,P =0.001).According to pregnancy outcome,patients with threatened miscarriages were divided into the two groups,including 45 patients with continuing pregnancies and 5 patients with inevitable miscarriages.The serum levels of β-HCG,estradiol and progesterone in ongoing pregnancies group [(10 829.42 ± 6 926.28) IU/L,(832.9 ± 397.91) pg/mL,(25.62 ± 4.51) pg/L] were higher than those in inevitable miscarriages [(6 310.14 ± 2 593.19) IU/L,(487.14 ± 275.47) pg/mL,(13.6 ±4.84) pg/L] (P ＜ 0.05) ;The serum levels of ACA-IgG,ACA-IgM and ACA-IgA in 80 cases tested,only 2 cases who appeared in the threatened abortion group were detected with the positive of serum ACA-IgG,accounted for 4％ (2/50) (x2 =68.05,P =0.000),occurred spontaneous abortion in the end.Conclusion Combined detection of serum ACA,β-HCG,estradiol and progesterone may be helpful for prognosis of threatened abortion.However,the clinical predictive value of ACA needs further study in the early threatened abortion.
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Objective To review the research advance of intestinal barrier changes and its pathogenesis in stress conditions.Methods The literatures in recent years on the changes of the intestinal barrier,and its pathogenesis in stress conditions were reviewed.Results In some severe stress conditions, such as trauma, severe inflammation and acute severe pancreatitis, etc, a series of pathophysiologic disorders of intestinal barrier, even systemic inflammatory response syndrome and multiple organ dysfunction syndrome or multiple organ failure were induced. The pathogenesis was a result of a series of neurologic, immunologic and endocrine factors making one another. Conclusion Recognizing the changes and pathogenesis have an important clinical significance for treating and preventing the intestinal barrier dysfunction induced by stress.
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OBJECTIVE:To evaluate the biological compatibility and clinical therapeutic effect of the medical sterilized bone wax.METHODS:Embedding test and pathological test as well as hemolytic test were performed by using rabbits as test animal.12531case-times were investigated in respect to the therapeutic effect,prognosis and satisfactory rate.RESULTS:The embedded bone wax was coated by connective tissue and has not been absorbed without surrounding inflammation,edema or necrosis.The bone wax could not be absorbed after stanching bleeding of the bone broken surface.No hemolytic phenomena were observed.The wound healing obtained a satisfactory rate of99.1%.CONCLUSION:The sterilized medical bone wax has good biological compatibility and is safe and effective to stanch bleeding.It is convenient to use due to its singer dose sterilized packaging.
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OBJECTIVE:To prepare the sterilized medical bone wax and to establish the standard of quality control.METHODS:The bone wax was identified with chemical approach and the quality of bone wax was evaluated by saponification value.RESULTS:The bone wax was appropriate in formula,feasible in preparing technique and satisfactory in therapeutic efficacy with a satisfication rate of 98%.CONCLUSION:There are no obvious differences between the bone wax developed by our hospital and imported bone wax in quality,therefore the prepared bone wax can take the place of imported products.