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Objective:To explore the application effect of laparoscopic surgery skills training course in the standardized residency training of surgery.Methods:A total of 40 standardized trainees of surgical residents rotating in general surgery were selected as the research objects, and randomly divided into the experimental group and the control group. The experimental group was offered laparoscopic surgery skills training course. The course content includes theoretical teaching module, simulated teaching module, virtual teaching module and clinical surgery practice teaching module. The control group was taught by traditional theory teaching and clinical surgery practice teaching. At the end of the courses, the two groups of students were assessed for their skills in laparoscopic grasping and pass, suture and knotting. At the same time, a questionnaire survey was conducted among the students and teachers. The t-test was performed using SPSS 22.0 statistical software. Results:The theoretical scores of the experimental and control groups were (67.90±13.24) and (69.70±13.46), respectively, with no statistically significant difference ( P > 0.05). After the courses, the performance of grasping and pass, suture and knotting of the experimental group (15.25±3.24 and 5.45±2.14) was higher than that of the control group (11.25±2.12 and 2.75±1.16), and the difference was statistically significant ( P < 0.01).The questionnaire survey showed that the proportion of "better" feedback from students and teachers on laparoscopic skills training courses was significantly higher than that of "general" and "poor". Conclusion:The laparoscopic surgery skills training course can improve the laparoscopic surgery skills of the trainees in the standardized residency training of surgery, shorten the learning curve, and make the training standardized and homogeneous. It is worthy of wide promotion and application in the standardized training base.
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Objective:To investigate the clinical efficacy of modified biliary-intestinal anasto-mosis by pancreaticoduodenectomy and influencing factors of postoperative biliary leakage.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopatholo-gical data of 165 patients with benign and malignant diseases around the ampullary who underwent pancreaticoduodenectomy in the Affiliated Hospital of Inner Mongolia Medical University from June 2014 to October 2020 were collected. There were 92 males and 73 females, aged (59±10)years. Of the 165 patients, 44 patients undergoing modified biliary-intestinal anastomosis within pancreatico-duodenectomy were divided into the modified group, and 121 patients undergoing traditional biliary-intestinal anastomosis within pancreaticoduodenectomy were divided into the traditional group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and postoperative situations; (3) analysis of influencing factors of biliary leakage after pancreaticoduodenectomy. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.05. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Univariate analysis was conducted using the corresponding statistical methods based on data type. All indicators in univariate analysis were included in multivariate analysis. Multivariate analysis was conducted using the Logistic regression model. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 165 patients, 72 cases were successfully matched, including 36 cases in the modified group and 36 cases in the traditional group, respectively. The elimination of jaundice, preoperative reduction of jaundice and hypertension confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. All patients in the two groups underwent surgery successfully. The operation time, postoperative pathological type (lower bile duct cancer, pancreatic head cancer, pancreatic cystic tumor, chronic pancreatitis, duodenal cancer), time of no drainage fluid in the drainage tube around biliary-intestinal anastomosis were 371(270,545)minutes, 6, 12, 1, 2, 15, (12±7)days in patients of the modified group, versus 314(182,483) minutes, 13, 14, 1, 4, 4, (16±8)days in patients of the traditional group, showing significant differences in the above indicators between the two groups ( Z=-3.54, χ2=10.01, t=-2.34, P<0.05). Cases with postoperative grade A biliary leakage was 0 in patients of the modified group, versus 6 in patients of the traditional group, showing a significant difference between the two groups ( P<0.05). Cases with postoperative grade B biliary leakage, cases with postoperative grade B pancreatic fistula, cases with postoperative bleeding, cases with abdominal infection, cases with incision infection, cases with delayed gastric emptying, cases undergoing unplanned readmission were 1, 0, 1, 4, 1, 5, 1 in patients of the modified group, versus 0, 1, 2, 5, 2, 5, 2 in patients of the traditional group, showing no significant difference in the above indicators between the two groups ( P>0.05). Cases with postoperative grade A pancreatic fistula, cases with overall complications, cases with Clavien-Dindo grade Ⅰ-Ⅱ complications, cases with Clavien-Dindo grade Ⅲ-Ⅳ complications were 6, 12, 6, 6 in patients of the modified group, versus 7, 14, 8, 6 in patients of the traditional group, showing no significant difference in the above indicators between the two groups ( χ2=0.09, 0.24, 0.36, 0.00, P>0.05). None of patient in the two groups had postoperative grade C biliary leakage and postoperative grade C pancreatic fistula. (3) Analysis of influencing factors of biliary leakage after pancreaticoduodenectomy. Results of multivariate analysis showed that preoperative reduction of jaundice and traditional biliary-intestinal anastomosis were independent risk factors for biliary leakage after pancreaticoduodenectomy ( odds ratio=11.37, 12.27, 95% confidence interval as 1.76-73.35, 1.14-131.23, P<0.05). Conclusions:Compared with traditional biliary-intestinal anastomosis, modified biliary-intestinal anastomosis within pancreaticoduodenectomy is safe and feasible. Preoperative reduction of jaundice and traditional biliary-intestinal anastomosis are independent risk factors for biliary leakage after pancreaticoduodenectomy.
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Objective To study the characteristics and follow-up results of 94 people with indeterminate Western blot (WB) results of HIV antibody. Methods A retrospective analysis was conducted on the characteristics and outcome of 94 patients with indeterminate WB results of HIV antibody from AIDS confirmation laboratories in Jiading District from 2016 to 2019. Results The 94 subjects came mainly from clinical diagnostic tests, accounting for 68.09% of the total, followed by counseling tests and maternal examinations, accounting for 12.77% and 10.64%，respectively. Follow-up testing was performed on 48 patients with indeterminate HIV antibodies, with a follow-up detection rate of 51.06%. Among them, 25.00% turned positive during the follow-up, and 39.58% turned negative. There was no significant difference in the follow-up rate between different population groups and WB band-types. The positive conversion rate of counseling test samples was the highest, accounting for 55.56% of all positive conversion cases. There was a total of 14 WB band types, mainly in p24, gpl60 and p24pl60, accounting for 54.26%, 17.02% and 9.57%, respectively. There was a significant difference in the positive conversion rate of antibodies with different patterns of WB bands. The positive conversion rate of WB band type gp160gp41p24 was 100%, while the positive rate of gp160p24, gp160, and p24 was 66.67%, 37.5% and 11.54%, respectively. Conclusion The samples with indeterminate WB results of HIV antibody were mainly from medical institutions, and the follow-up retest rate was low. Follow-up tests of specific populations and samples with specific patterns of WB bands should be strengthened to confirm HIV infection status as soon as possible.
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Objective:To summarize the computed tomography (CT) and magnetic resonance imaging (MRI) features of acinar cell carcinoma of the pancreas (ACCP).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 21 patients with ACCP who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2015 to December 2019 were collected. There were 5 males and 16 females, aged (57±9)years, with a range from 41 to 74 years. Patients underwent CT and MRI examinations. Observation indicators: (1) imaging examination; (2) imaging features on CT; (3) imaging features on MRI; (4) pathological examination and immunohistochemistry staining; (5) treatment and follow-up. Follow-up using outpatient examination and telephone interview was conducted at 1, 3, 6 months after discharge and once every 6 months thereafter to detect survival of patients up to December 2019. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers. Results:(1) Imaging examination. Of the 21 patients, 7 underwent single CT examination, 11 underwent MRI examination, and 3 underwent both CT and MRI examinations. ① Tumor shape: all the 21 patients had single tumor, including 17 showing round or quasi-round shape, and 4 showing irregular clumps. ② Tumor location: of the 21 patients, 6 had tumor located at pancreatic head, 2 had tumor located at pancreatic head and body, 2 had tumor located at pancreatic body, 4 had tumor located at pancreatic body and tail, 4 had tumor located at pancreatic tail, and 3 had had tumor located at ampulla. ③ The maximum tumor diameter was (43±29)mm, with a range from 11 to 129 mm. ④ Adjacent organ invasion: 10 of the 21 patients had invasion of adjacent organ, including 2 with invasion of stomach, spleen and left adrenal gland invasion, 4 with invasion of duodenum, 3 with invasion of duodenum and common bile duct, 1 with invasion of spleen. ⑤ Vascular invasion: 12 patients had invasion of splenic artery or splenic vein, including 1 combined with invasion of both common hepatic artery and superior mesenteric vein, 1 combined with invasion of celiac root. ⑥ Pancreatic and bile duct invasion: 8 patients had pancreatic and bile duct dilation, including 4 with bile duct and upper pancreatic duct dilation, and 4 with pancreatic duct dilation. ⑦ Lymph node metastasis: 2 patients had perineoplastic lymph node enlargement. ⑧ Other conditions: 7 patients had tumor center with cystic necrosis. Four patients had atrophy pancreatic parenchyma. Two patients had splenic vein tumor thrombosis. Two patients had cysts. One patient had multiple liver metastases. (2) Imaging features on CT. ① The solid part was dominant in the main body of the 10 patients undergoing CT examination, demostrating equal density, of which 3 cases had clear boundaries, 2 cases had pseudocapsule around the lesion, and 5 cases had low-density necrotic area in the center of lesion. ② In arterial phase of CT examination, the solid part of tumor had a lower enhancement compared with the normal pancreatic tissues in 7 patients, while the solid part of tumor had a high enhancement compared with the normal pancreatic tissues in 3 patients. ③ In delayed phase of CT examination, the tumor density was slightly lower than or equal to density of normal pancreatic parenchyma in 7 patients, showing slightly progressive enhancement, while the tumor density was slightly higher than or equal to density of normal pancreatic parenchyma in 3 patients. (3) Imaging features on MRI. ① MRI plain scan of 14 patients showed that 8 patients demostrated slightly longer T2 and slightly longer T1 signals in lesions, while 6 patients demostrated mixed signals dominated by long T2 and equal T1 signals. The area of cystic necrosis was observed in lesions of 4 patients and was not observed in 10 patients. No antiphase signal reduction was observed in the 14 patients. ② MRI dynamic enhanced scan of 12 patients showed that 11 patients presented mild progressive enhancement in lesions and 1 patient presented obvious confounding enhancement and clearance in the delayed phase. Compared with adjacent normal pancreatic parenchyma, diffused weighted imaging showed high signals in 6 cases, slightly high signals in 6 cases, and high signal halo in 2 cases. The apparent diffusion coefficient in 14 lesions was (1.22±0.14)×10 -3 mm 2/s. (4) Pathological examination and immunohistochemistry staining. Results of pathological examination in the 21 patients: acinic cell carcinoma, mixed ductal-acinic cell carcinoma, acinar-endocrine carcinoma, and atypical hyperplasia inacinus were detected in 14, 5, 1, and 1 patients, respectively. Of the 21 patients, 10 had invasion of adjacent organ, 3 had invasion of bile duct, 2 had invasion of lymph node. Results of immunohistochemistry staining in 17 patients: 17 patients had proliferation index of Ki-67 as 1%-80%; 10 out of 16 patients were positive for synaptophysin; 6 out of 16 patients were positive for CD56 protein; 2 out of 14 patients were positive for Chromogranin A; 12 out of 13 patients were positive for α-antitrypsin; 9 out of 11 patients were positive for cytokeratin; 8 patients were positive for β-catenin; 2 patients were positive for B lymphoma-10 protein. (5) Treatment and follow-up. Of the 21 patients, 10 cases underwent pancreatico-duodenectomy, 6 cases underwent pancreatic body and tail pancreatectomy combined with splenectomy, 2 cases underwent pancreatic body and tail pancreatectomy, 1 case underwent pancreatic tail tumor enucleation, 1 case underwent liver metastasis resection, and 1 case underwent ultrasound-guided pancreatic lesion puncture biopsy. All the 21 patients were followed up for (30±16)years, with a range from 2 to 52 months. There were 13 patient surviving and 8 cases of death. They had survived for (19±13)months, with a range from 2 to 35 months. Conclusions:The CT and MRI enhanced scan of ACCP showed slightly progressive enhancement, with cystic necrosis seen in the center and high signals in diffused weighted imaging. Dilation of bile duct and pancreatic duct is common in patients with pancreatic head tumors, and invasion of splenic artery and vein is common in pancreatic body and tail tumors. Calcification and cyst are rare and lesions of pancreatic head and body cause atrophy in pancreatic tail.
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Objective:To investigate the clinical efficacy of transanal minimally invasive surgery (TAMIS) with glove method and transanal endoscopic microsurgery (TEM) in the treatment of rectal neoplasms.Methods:The retrospective cohort study was conducted. The clinicopathological data of 60 patients with rectal neoplasms who were admitted to the First Affiliated Hospital of Fujian Medical University from March 2015 to May 2017 were collected. There were 34 males and 26 females, aged from 49 to 74 years, with an average age of 62 years. Of the 60 patients, 30 undergoing TAMIS with glove method and 30 undergoing TEM were allocated into TAMIS group and TEM group, respectively. Observation indicators: (1) surgical situations and postoperative recovery; (2) postoperative short-term complications; (3) follow-up. Follow-up using outpatient examination and telephone interview was performed to detect tumor recurrence and metastasis up to August 2018. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher exact propability. Comparison of ordinal data between groups was analyzed by the Mann-Whitney U test. Results:(1) Surgical situations and postoperative recovery: patients in the two groups underwent surgery successfully. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, time to postoperative semi-fluid diet intake, postoperative anal pain score, duration of postoperative hospital stay and cases with Kirwan classification Ⅰ, Ⅱ, Ⅲ, Ⅳ, Ⅴ of anus function at 3 months after surgery were respectively (35±7)minutes, (9±5)mL, (2.7±0.9)days, (2.9±0.6)days, 2.1±0.9, (3.6±1.9)days, 29, 1, 0, 0, 0 in the TAMIS groups and (38±7)minutes, (9±6)mL, (2.5±0.8)days, (2.7±0.7)days, 1.8±0.9, (4.0±2.3)days, 28, 1, 1, 0, 0 in the TEM group, showing no significant difference in the above indicators between the two groups ( t=-1.377, -0.099, 0.931, 0.770, 1.418, -0.789, Z=-0.607, P>0.05). Total operation time and treatment expenses were (38±7)minutes and (8 507±1 471)yuan in the TAMIS group, versus (46±7)minutes and (9 551±1 747)yuan in the TEM group, showing significant differences between the two groups ( t=-4.628, -2.506, P<0.05). Results of postoperative pathological examination showed negative margin in the two groups. (2) Postoperative short-term complications: of 2 patients with postoperative short-term complications in the TAMIS group, 1 had postoperative urine retention due to preoperative prostatic hyperplasia and was improved after 3 days of bladder training, 1 was diagnosed as sepsis due to postoperative cold and fever at 2 days after operation with escherichia coli detected in blood culture, and the patient was cured after anti-infection treatment. Of 3 patients with postoperative short-term complications in the TEM group, 1 had anal incontinence at 2 days after operation and was improved after 4 days of anus function exercise, 1 had hematochezia and was improved after hemostatic therapy under colonoscopy, 1 had perineal infection and was improved after anti-inflammation. There was no significant difference in the short-term complications between the two groups ( P>0.05). (3) Follow-up: patients in the TAMIS group and TEM group were respectively followed up for (17±4)months and (16±3)months, with no significant difference between the two groups ( t=0.200, P>0.05). During the follow-up, 1 case of rectal tubular adenoma in the TAMIS group had local tumor recurrence at 1 year after surgery, with a diameter of about 0.5 cm and a distance of about 12 cm from the anal margin. The patient had no recurrence after endoscopic retreatment and was confirmed tubular adenoma by postoperative pathological examination. One patient with poorly differentiated adenocarcinoma in the TEM group was detected mesorectal lymph node metastasis at 6 months after surgery by magnetic resonance imaging examination and underwent laparoscopic radical resection of rectal cancer. The postoperative pathological examination showed no residual cancer cells in the rectum specimen and there was 1 positive in 15 lymph nodes for pathological examination. No tumor recurrence or metastasis occurred by the end of follow-up. There was no significant difference in postoperative tumor recurrence and metastasis between the two groups ( P>0.05). Conclusions:The clinical efficacy of TAMIS with glove method in the treatment of upper-middle rectal neoplasms is comparable to TEM, which is safe and feasible. In addition, the TAMIS with glove method has shorter time and lower treatment expenses.
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Objective To explore the clinical application value of modified invagination for pancreaticojejunostomy in pancreaticoduodenectomy (PD).Methods The retrospective cohort study was conducted.The clinicopathological data of 39 patients who underwent PD in the Affiliated Hospital of Inner Mongolia Medical University from January 2014 to December 2017 were collected.There were 26 males and 13 females,aged (60±7)years,with a range of 41-75 years.All the 39 patients underwent PD,using Child method to reconstruct digestive tract.Of 39 patients,19 undergoing modified invagination for pancreaticojejunostomy and 20 undergoing mucosa-to-mucosa end-to-side pancreaticojejunostomy were allocated to innovative group and traditional group,respectively.Observation indicators:(1)surgical situations;(2) postoperative complications;(3) follow-up.Follow-up was performed by outpatient examination and telephone interview to detect postoperative tumor recurrence,main pancreatic duct dilatation,survival,and discomfort (abdominal pain,bloating,indigestion,etc.) of patients up to October 2018.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was analyzed by t test.Measurement data with skewed distribution were represented as M (P25,P75) or M (range),and comparison between groups was analyzed by Mann Whitney U test.Count data were expressed as absolute numbers,and comparison between groups was analyzed by chi-square test or Fisher exact probability.Results (1) Surgical situations:operation time,volume of intraoperative blood loss,cases with soft pancreas or hard pancreas (pancreatic texture),pancreatic duct diameter,time of pancreatic duct removal,cases using somatostatin,and duration of postoperative hospital stay of the innovative group were (342±47) minutes,400 mL (300 mL,400 mL),10,9,3.1 cm (2.9 cm,3.4 cm),37 days (32 days,63 days),17,18 days (15 days,22 days),respectively,versus (392±95)minutes,400 mL (300 mL,525 mL),6,14,3.6 cm (2.6 cm,4.2 cm),43 days (34 days,49 days),18,and 24 days (15 days,27days) of the traditional group;there was no significant difference in the volume of intraoperative blood loss,cases with soft pancreas or hard pancreas (pancreatic texture),pancreatic duct diameter,time of pancreatic duct removal,cases using somatostatin,and duration of postoperative hospital stay between the two groups (Z=-0.775,x2 =2.063,Z=-1.155,Z=-0.295,x2 =0.003,Z=-1.286,P＞0.05);but a significant difference in operation time between the two groups (t =-2.114,P＜0.05).(2) Postoperative complications:6 patients in the innovative group had complications,including 1 of delayed gastric emptying,1 of wound infection,1 of pulmonary infection,1 of acute respiratory failure,1 of perihepatic effusion,and 3 of grade A pancreatic leakage;11 patients in the traditional group had postoperative complications,including 1 of bile leakage,2 of delayed gastric emptying,4 of abdominal infection,4 of wound infection,2 of pulmonary infection,1 of ascites,1 of abdominal hemorrhage,1 of pleural effusion,2 of grade A pancreatic leakage,5 of grade B and C pancreatic leakage;the same patient had multiple complications.There was no significant difference in postoperative complications between the two groups (x2=2.174,P＞0.05),but there was a significant difference in postoperative grade B and C pancreatic leakage between the two groups (P＜O.05).Patients with postoperative complications were improved after symptomatic support treatment,and no patient died during the perioperative period.(3) Follow-up:of the 39 patients,33 (18 in the innovation group and 15 in the traditional group) were followed up for 3-57 months,with a median follow-up time of 17 months.Of the 18 patients receiving follow-up in the innovative group,5 died of tumor recurrence and metastasis,with a survival time of 5-24 months,1 had tumor recurrence at 34 months after operation,1 had main pancreatic duct dilatation and intermittent abdominal pain and abdominal distension,5 had indigestion,1 had back pain,and 5 had good recovery.Of 15 patients receiving follow-up in the traditional group,10 died of tumor recurrence and metastasis,with a survival time of 3-57 months,2 had main pancreatic duct dilatation and intermittent abdominal pain and abdominal distension,2 had indigestion,1 had good recovery.Conclusion Compared with the traditional mucosa-to-mucosa end-to-side pancreaticojejunostomy,modified invagination for pancreaticojejunostomy in the PD is safe and feasible,which can simplify the operation,reduce the requirements for the operator's operation skills,shorten the operation time,and reduce incidence of postoperative grade B and C pancreatic leakage.
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Objective Toanalyzetheclinicalefficiencyofendovascularinterventionaltherapyinthetreatmentofsolitarykidney withrenalaneurysm.Methods FromJune2014toDecember2017,7casesofsolitarykidneypatientscombinedwithrenalaneurysm werecollected,including4casesofrenalaneurysmlocatedinthemainrenalartery,1caseinrenalsegmentalarteryand2casesinthe renalparenchyma.4casesofmainrenalarteryaneurysmsweretreatedwithstentimplantation;1caseofrenalsegmentalarteryaneurysm was treatedwithstent-assistedcoilembolization;2casesofrenalparenchymaaneurysm wererespectivelytreatedwithpolyvinylalcohol (PVA)embolizationandPVA withcoilembolization.After1month,3months,6monthsandevery6months,therenaldopplerexamination,blood routine,urineroutine,renalfunctionandotherbiochemicalexaminationswerereviewed,andrenalarterialCTAorrenalangiographywereperformed whennecessary.Results Thesuccessrateofoperationwas100%in7solitarykidneypatientswithrenalaneurysm,andtheaneurysmswere graduallyreducedafteroperationwithoutseriousadversereactionsandcomplications.Norecanalizationorrecurrenceofrenalaneurysmwasfound duringthefollow-up,andtherenalfunctionwasbetterthanbefore.Conclusion Endovascularinterventionaltherapyinthetreatment ofsolitarykidneywithrenalaneurysmisminimallyinvasiveandlessrisky.Anditismoretargetedandflexibleforthetreatmentof solitarykidneywithdifferenttypesofrenalaneurysm.
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Objective To investigate the application value of different digestive tract reconstruction methods in laparoscopic distal gastrectomy (LDG).Methods The retrospective cohort study was conducted.The clinicopathological data of 164 with early gastric cancer (GC) who were admitted to the First Affiliated Hospital of Fujian Medical University between June 2010 and April 2015 were collected.Of 164 patients undergoing LDG,45 receiving Billroth Ⅰ (B Ⅰ) anastomosis,39 receiving Billroth Ⅱ (B Ⅱ) anastomosis,44 receiving Roux-en-Y anastomosis and 36 receiving uncut Roux-en-Y anastomosis were allocated into the B Ⅰ group,B Ⅱ group,RY group and uncut RY group,respectively.Observation indicators:(1) surgical and postoperative recovery situations;(2) postoperative short-term complications situations;(3) follow-up situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative nutriology and long-term complications up to May 2017.Measurement data with normal distribution were represented as x±s.Comparison among groups was analyzed using the ANOVA,and pairwise comparisons were done by the Tukey hsd test.Count data were described as the frequency and percentage,and comparisons among groups were analyzed the chi-square test or Fisher exact probability.Ordinal data were analyzed by the Kruskal Wallis test.Results (1) Surgical and postoperative recovery situations:patients in 4 groups underwent successfully LDG.Cases undergoing total LDG and assisted LDG and digestive tract reconstruction time in the B Ⅰ,B Ⅱ,RY and uncut RRY groups were respectively 0,29,13,15 and 45,10,31,21 and (42±7)minutes,(55±8)minutes,(64±8)minutes,(51±6) minutes,with statistically significant differences among 4 groups (x2 =21.628,F=74.441,P＜0.05).(2)Postoperative short-term complications situations:2,2,3 and 1 patients in the B Ⅰ,B Ⅱ,Roux-en-Y and uncut Roux-en-Y groups had respectively postoperative short-term complications,showing no statistically significant difference among 4 groups (x2 =0.840,P＞0.05).(3) Follow-up situations:all patients were followed up,and follow-up time in the B Ⅰ,B Ⅱ,RY and uncut RY groups were respectively (10.8 ± 3.5) months,(10.9 ±3.4)months,(11.3±3.2) months and (11.2±2.2) months,with no statistically significant difference among 4 groups (F=0.200,P＞0.05).① Comparisons of postoperative 1-year nutritional indexes:rates of changes in body mass index (BMI),hemoglobin (Hb),total protein (TP) and albumin were respectively 93％±7％,91％±7％,90％±7％,90％±9％ and 94％±9％,97％±11％,95％±9％,97％±9％ and 101％±9％,99％±7％,98％±7％,99％±7％ and 101％±10％,103％±7％,100％±10％,103％±9％ in the B Ⅰ,B Ⅱ1,RY and uncut RY groups,showing no statistically significant difference among 4 groups (F=1.182,0.724,1.050,0.971,P＞0.05).②)Of 164 patients within 1 year postoperatively,47 were complicated with gastric retention (27,12,6 and 2 with severity in grade 1,2,3 and 4),87 with residual gastritis (53,24,10 and 0 with severity in grade 1,2,3 and 4),and 38 with bile reflux (severity in grade 1).Of 38 patients with bile reflux,33 were combined with residual gastritis,showing a correlation between residual gastritis and bile reflux (r=0.396,P＜0.05).Cases with gastric retention,residual gastritis and bile reflux within 1 year postoperatively were respectively 16,9,21,1and 35,30,13,9 and 16,18,3,1 in the B Ⅰ,B Ⅱ],RY and uncut RY groups,showing statistically significant differences among 4 groups (x2 =21.261,41.103,30.469,P＜ 0.05).There were statistically significant differences in gastric retention occurrence between uncut RY group and B Ⅰ group or B Ⅱ group or RY group (x2 =12.958,6.675,20.065,P＜0.05),and in residual gastritis occurrence between RY group and B Ⅰ group or B Ⅱ group (x2 =20.831,18.587,P＜0.05) and between uncut RY group and B Ⅰ group or B Ⅱ group (x2 =22.452,20.220,P＜0.05).There were statistically significant differences in bile reflux occurrence between RY group and B Ⅰ group or B Ⅱ group (x2 =10.942,16.926,P＜0.05),and between uncut RY group and B Ⅰ group or B Ⅱ group (x2 =12.958,18.620,P＜0.05).Conclusion Roux-en-Y and uncut Roux-en-Y anastomoses are superior to B Ⅰ and B Ⅱ anastomoses in improving residual gastritis and bile reflux in the postoperative digestive tract reconstruction of LDG,and uncut Roux-en-Y anastomosis can effectively reduce occurrence of postoperative gastric retention.
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Objective To evaluate the effects on nutritional intakes and clinical outcomes of severe brain injury patients receiving percutaneous gastrojejunostomy (PEG-J) feedings. Methods The severe brain injury patients treated in ICU of Changshu No.1 Hospital from Jan 2013 to Dec 2016 were enrolled in the study. Patients were randomized into: control group, patients received nasoduodenal feedings and treatment group, patients received PEG-J feedings. The feeding speed was adjusted according to the amount of gastric residual or reflux vomiting. The daily dose of enteral nutrition in the first week, endocrine function, immune function, nutritional states and clinical outcomes were recorded. Results Totally 87 patients were enrolled in this study, 45 patients in the control group and 42 patients in the treatment group. The daily dose of enteral nutrition of the treatment group were significantly more than the control group from the fourth to the seventh days (P= 0.001, <0.01, 0.024), the CD4+T-lymphocyte percentage and CD4+/CD8+ ratio were significantly higher in the treatment group on day 7 (P=0.03, 0.01), levels of thyroidstimulating hormone, free triiodothyronine and free thyroxine of the treatment group were higher (P=0.036, 0.013, 0.025), and the level of hormonal was lower in the treatment group (P=0.004).The levels of albumin, prealbumin and insulin dosage were not significantly different between the two groups, neither did mortality, rates of organ failures. But the treatment group has a higher Barthel index scores (P=0.049), shorter length of mechanical ventilation and stay ICU (P=0.044, 0.048), and the lower incidence of vomiting and ventilator associated pneumonia (P=0.013, 0.037). Conclusions PEG-J could increase energy intake, improve immunity and endocrine function, promote the recovery of life ability, reduce the incidence of VAP, shorten mechanical ventilation time and ICU stay in severe brain injury patients.
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Objective To explore the influence of percutaneous gastrostomy-jejunostomy ( PEG-J) on the nutritional status and prognosis of critically ill patients in ICU .Methods Totally 58 patients who received me-chanical ventilation in the ICU of Changshu No .1 People's Hospital from January 2013 to December 2015 were di-vided into two groups according to random number table:treatment group ( n=28, enteral nutrition by establis-hing PEG-J tube in 120 hours after excluding contraindications );and control group ( n=30, nasogastric tube as the way of giving enteral nutrition and if delayed gastric emptying happened , nasogastric tube would be replaced by nasointestinal tube).The incidence of ventilation-associated pneumonia (VAP) within 28 days, duration of ICU stay, and duration of mechanical ventilation were compared between these two groups .Results The inci-dence of 28-day VAP (7.14%vs.26.67%, P=0.049), duration of ICU stay [ (13.6 ±5.9) d vs.(16.8 ± 4.4) d, P=0.024], duration of mechanical ventilation [ (8.1 ±5.0) d vs.(10.7 ±4.5) d, P=0.041] were significantly lower or shorter in treatment group than in control group .Conclusions The use of PEG-J tube for enteral nutrition in critically ill patients is reliable and safe .It also helps to reduce VAP .
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Objective To investigate the relationship between pelvic asymmetry and Crowe classification of unilateral developmental dysplasia of the hip in adults. Methods According to the inclusion criteria, 100 cases of unilateral DDH in adults were collected, including 78 females and 22 males, with an average age of 56.3 years old (range, 21-79 years). In terms of Crowe classification, there were 30 cases of Crowe typeⅠ, 24 cases of Crowe typeⅡ, 23 cases of Crowe typeⅢ, and 23 cases of CroweⅣ. The normal?side and affected?side pelvic vertical height (the distance from the highest point of the ischial tuberosity to the iliac crest peak) were measured via the radiogram of anteroposterior pelvis. Furthermore, we compared the affected?side pelvic vertical height with the normal?side and analyzed the relationship between Crowe classification and the difference in pelvic verti?cal height. Results The average pelvic vertical height was 23.38±1.46 cm in the normal?side and 22.41±1.38 cm in the affected?side. The average D?value of pelvic vertical height between two sides is 0.98 ± 0.76 cm. From Crowe typeⅠto Ⅳ, the average heights of the normal?side were 22.89±1.09 cm, 23.23±2.07 cm, 23.75±1.16 cm, 23.79±1.22 cm, while those of the affected?side were 22.70 ± 0.98 cm, 22.41 ± 1.98 cm, 22.47 ± 1.12 cm and 21.92 ± 1.32 cm. The average D?values in each group were 0.19 ± 0.37 cm, 0.82±0.43 cm, 1.28±0.32 cm, 1.87±0.59 cm. The differences between the normal?side and the affected?side in each type were statistically significant. The average D?value increased significantly with Crowe type increased, and there was a positive correla?tion between the D?value of bilateral pelvic vertical height and the degree of hip dislocation. Conclusion The pelvic asymmetry does exist in adult patients with unilateral developmental dysplasia of the hip. Moreover, the asymmetry has positive correlation with the degree of hip dislocation.
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Objective To investigate the impact of splenectomy on the prognosis and immune function of patients with end stage carcinoma of the esophagogastric.Methods The clinical data of 61 patients with end stage carcinoma of the esophagogastric junction who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2007 to December 2010 were retrospectively analyzed.All the patients were divided into splenectomy group (22 patients) and spleen preservation group (39 patients).The immune function before operation,on the 10th day and the 6th month after operation was detected.The intra-and postoperative conditions of the patients of the 2 groups were compared.All data were analyzed using the independent sample t test or chisquare test.Results The levels of IgA,IgG,IgM,CD3 and CD4 in the splenectomy group at the 10th day after operation were significantly higher than those before operation (t =2.55,3.33,3.40,2.92,2.10,P ＜ 0.05).The levels of IgA,IgG,IgM,CD3,CD4,the ratio of CD4/CD8 of the spleen preservation group at the 10th day after operation were significantly higher than those before operation (t =3.35,5.29,3.33,2.60,3.53,3.12,P ＜0.05).The levels of IgA,IgG,IgM,CD3,CD4 and the ratio of CD4/CD8 in the splenectomy group at postoperative month 6 were significantly lower than those at postoperative day 10 (t ＝2.75,4.40,3.06,2.51,2.24,2.29,P ＜ 0.05).The levels of IgA,IgG,IgM,CD4,CD8 and the ratio of CD4/CD8 of the spleen preservation group were significantly higher than those of the splenectomy group,while the level of CD8 in the spleen preservation group was significantly lower than that in the splenectomy group (t =1.70,2.10,2.70,2.16,2.13,2.83,P ＜ 0.05).The operation time of the splenectomy group was (152 ± 26) minutes,which was significantly longer than (130 ± 24) minutes of the spleen preservation group (t ＝ 3.42,P ＜ 0.05).There were no significant differences in the operative blood loss,incidence of postoperative infection,median survival time,1-year survival rate between the 2 groups (t =1.38,x2 =0.78,1.22,2.51,P ＞ 0.05).Conclusion Palliative gastrectomy could reverse the immune function of spleen by decreasing tumor burden for patients with end stage carcinoma of the esophagogastric junction who can not be treated by radical resection.Spleen preservation may have positive significance for the immune function and prognosis of patients with end stage carcinoma of the esophagogastric junction.
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Objective To investigate the feasibility and safety of colorectal anastomosis using nickel titanium compression anastomosis ring (CAR).MethodsThe clinical data of 83 patients who received colorectal anastomosis at the First Affiliated Hospital of Fujian Medical University from May to December,2010 were prospectively analyzed.All patients were divided into CAR group (41 patients) and stapler group (42 patients) according to the random number table.The operation time,time to postoperative flatus and bowel movement,duration of hospital stay and the incidence of anastomosis-related complications of the 2 groups were observed.The time of extrusion of the rings and anastomotic healing of the CAR group were recorded.All data were analyzed by the t test or chi-square test.ResultsThe mean operation time of the CAR group and the stapler group were ( 122 ± 25) minutes and (128 ±30)minutes,respectively.The incidences of postoperative anastomotic fistula of the CAR group and the stapler group were 5％ (2/41) and 7％ (3/42),and the anastomotic fistula was cured by operation or conservative treatment.There were no significant differences in the mean operation time,time to postoperative flatus and bowel movement,duration of hospital stay and incidence of anastomotic fistula between the 2 groups (t =1.299,0.756,1.636,0.974,x2 =0.165,P ＞ 0.05 ).The rings were expelled within 9-14 days.The incidences of anastomotic stenosis of the CAR group and stapler group were 0 (0/41) and 2％ (1/42),with no significant difference between the 2 groups (x2 =0.988,P ＞ 0.05).The anastomotic stoma was smooth and well bealed in the CAR group,while nail residues and inflammatory polyp (1 patient) were found at the anastomosis stoma in the stapler group.ConclusionNickel titanium CAR is safe and effective in colorectal anastomosis.
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Polystyrene microspheres (PS) were successfully prepared by suspension polymerization processes. Chloroacetylated polystyrene has been prepared by Friedel-Crafts acetylation of PS with chloroacetyl chloride. In this report, carcinogenic compound (chloromethylether etc.) was avoided. The effects of solvent, catalyst, acylating agent and reaction time were studied. Novel adsorption resins were obtained by synthesis of chloroacetylated polystyrene with amine. The influences of solvent, amine reagent and reaction time on ion exchange capacity were investigated. Under the optimized reaction condition, the ion exchange capacity of the prepared resins was 4.1587 mmol/g. The maximum amount of adsorbed bilirubin was 30.85 mg/g, the adsorption percentage was 80%.