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Objective@#To evaluate the diagnostic value of three-dimensional multi-slice spiral computed tomography (CT) imaging in Crohn's disease(CD) of small intestine and its active and remission stages.@*Methods@#The clinical and CT data of 34 patients with Crohn's disease confirmed by digestive endoscopy were retrospectively analyzed. According to whether the lesions were active, the patients were divided into active group (25 cases) and remission group (9 cases). The difference of CT signs between the two groups was compared. Chi square test was used to evaluate the diagnostic efficiency of CT three-dimensional imaging for polyps and their activity evaluation of Crohn's disease.@*Results@#The incidences of intestinal wall stratification, moderate enhancement, severe enhancement, ulcer, cellulitis, lymph node enlargement and wood comb sign in active group were higher than those in remission group (χ2=20.193, 9.018, 4.986, 3.947, 9.551, 4.986, 6.766, 4.986 respectively, P<0.05). The incidence of intestinal wall monolayer thickening, non-enhancement, mild enhancement and abdominal abscess in remission group was higher than that in active group, with significant difference (χ2=15.092, 13.768, 25.336, 16.996, P<0.05). while there were no significant difference between the two groups in the incidence of pneumoperitoneum, intestinal stenosis and enlargement (P>0.05).@*Conclusions@#Spiral CT three-dimensional reconstruction imaging can show the intestinal wall thickening, intestinal lesions and parenteral complications of Crohn's disease comprehensively, carefully and intuitively, and play an important role in guiding clinical treatment by evaluating the active and remission stages of CD.
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Objective To evaluate the diagnostic value of three-dimensional multi-slice spiral computed tomography (CT) imaging in Crohn's disease(CD) of small intestine and its active and remission stages.Methods The clinical and CT data of 34 patients with Crohn's disease confirmed by digestive endoscopy were retrospectively analyzed.According to whether the lesions were active,the patients were divided into active group (25 cases) and remission group (9 cases).The difference of CT signs between the two groups was compared.Chi square test was used to evaluate the diagnostic efficiency of CT three-dimensional imaging for polyps and their activity evaluation of Crohn's disease.Results The incidences of intestinal wall stratification,moderate enhancement,severe enhancement,ulcer,cellulitis,lymph node enlargement and wood comb sign in active group were higher than those in remission group (x2 =20.193,9.018,4.986,3.947,9.551,4.986,6.766,4.986 respectively,P ＜ 0.05).The incidence of intestinal wall monolayer thickening,non-enhancement,mild enhancement and abdominal abscess in remission group was higher than that in active group,with significant difference (x2 =15.092,13.768,25.336,16.996,P ＜0.05).while there were no significant difference between the two groups in the incidence of pneumoperitoneum,intestinal stenosis and enlargement (P ＞ 0.05).Conclusions Spiral CT three-dimensional reconstruction imaging can show the intestinal wall thickening,intestinal lesions and parenteral complications of Crohn's disease comprehensively,carefully and intuitively,and play an important role in guiding clinical treatment by evaluating the active and remission stages of CD.
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Objective To investigate the application value of biological mesh in the pelvic floor reconstruction of extralevator abdominoperineal excision (ELAPE) for advanced low rectal cancer (RC).Methods The retrospective cohort study was conducted.The clinicopathological data of 228 patients with advanced low RC who underwent ELAPE in the Beijing Chaoyang Hospital of Capital Medical University between August 2008 and December 2016 were collected.Of 228 patients,174 using biological mesh closure and 54 using primary closure were respectively allocated into the biological mesh group and primary closure group.Observation indicators:(1)intra-and post-operative situations;(2) postoperative complications (including short-term and long-term complications);(3) follow-up and survival situations.Follow-up using outpatient examination and telephone interview was performed to detect postoperative long-term complications,tumor recurrence or metastasis and overall survival up to December,2017.Measurement data with normal distribution were represented as（ x） ±s,and comparison between groups was analyzed using the independent-sample t test.Measurement data with skewed distribution were described as M (range),and comparison between groups was analyzed using the nonparametric test.Comparisons of count data were evaluated by the chi-square test or Fisher exact probability.Results (1)Intra-and post-operative situations:all the patients underwent successful ELAPE.The perineal operation time,time of indwelling perineal drainage-tube and hospital expenses were respectively (60 ± 50)minutes,(11.6 ± 2.4) days,(57 781± 11 337) yuan in the biological mesh group and (50±21) minutes,(8.9± 1.7) days,(53 714± 13 395)yuan in the primary closure group,with statistically significant differences between groups (t =3.327,7.691,-2.203,P＜0.05).The total operation time and duration of postoperative hospital stay were respectively (242±53) minutes,(13.0±5.0) days in the biological mesh group and (228±51) minutes,(12.0±5.0) days in the primary closure group,with no statistically significant difference between groups (t =1.701,1.309,P＞0.05).(2) Postoperative complications:26 and 19 patients in the biological mesh group and primary closure group had respectively perineal wound complications (1 patient combined with multiple complications),showing a statistically significant difference between groups (x2 =10.660,P＜0.05).The perineal wound infection,perineal hernia and disruption of perineal wound were respectively detected in 20,6,1 patients in the biological mesh group and 12,7,3 patients in the primary closure group,showing statistically significant differences between groups (x2 =3.931,5.282,P＜0.05).(3) Follow-up and survival situations:174 patients in the biological mesh group were followed up for 64 months (range,13-112 months),and 54 patients in the primary closure group were followed up for 51 months (range,23-76 months).The local recurrence rate,distal metastasis rate and overall survival rate were respectively 5.17％ (9/174),20.11％ (35/174),77.59％ (135/174) in the biological mesh group and 7.41％(4/54),24.07％(13/54),79.63％(43/54) in the primary closure group,with no statistically significant difference between groups (x2 =0.080,0.389,0.101,P＞0.05).Conclusions The biological mesh in the pelvic floor reconstruction of ELAPE for advanced low RC is safe and feasible.Compared with primary closure,biological mesh closure will extend perineal operation time and time of indwelling perineal drainage-tube,and increase hospital expenses,but doesn't affect total operation time and duration of postoperative hospital stay,meanwhile,it can also reduce the overall perineal wound complications,especially in perineal wound infection,perineal hernia and disruption of perineal wound.
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OBJECTIVE: To understand the current situation of psychological resilience of sanitation workers and its impact on their happiness. METHODS: A total of 277 sanitation workers from Dongguan City of Guangdong Province were enrolled as study participants by stratified random sampling method. The psychological resilience and happiness were measured by Connor-Davidson Resilience Scale and Campbell Index of Well-being Scale respectively. RESULTS: The median scores of psycological resilience and happiness of the study subjects were 49. 0 and 7. 8,respectively. Psycological resilience was positively correlated with happiness( P < 0. 01). The multivariate linear regression analysis showed that the types of work,education level,personal monthly income and daily working time were the influencing factors of sanitation workers 'psychological resilience( P < 0. 05). The types of work and psychological resilience can significantly predict happiness(P < 0. 05). After controlling the demographic variables such as age,type of work,education level,personal monthly income,and daily working time,the psychological resilience prediction happiness contribution rate increased by 34. 1%(P < 0. 01). Age has a regulating effect on psychological resilience and happiness. Psychological resilience is easier to predict in the second generation( born after 1978) of sanitation workers in the sense of happiness. CONCLUSION: Psycological resilience of sanitation workers affects their happiness. Enhancing psychological resilience can help improve the happiness of sanitation workers.
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<p><b>OBJECTIVE</b>To evaluate the laparoscopy combined with transperineal extralevator abdominoperineal excision (TP-ELAPE) for locally advanced low rectal caner.</p><p><b>METHODS</b>Clinical data of 12 patients with locally advanced low rectal cancer undergoing laparoscopy combined with TP-ELAPE in our department from May 2013 to March 2015 were retrospectively analyzed. There were 8 male and 4 female patients with median aged of 63 (46 to 72) years. The median distance from tumor lower margin to anal verge was 3.5(2.0 to 4.0) cm. A self-made transanal suit for minimally invasive operation was used to make a sealed lacuna outside the sphincter, thus laparoscope can be applied to perform transperineal operation.</p><p><b>RESULTS</b>All the patients underwent operations successfully without conversion to open abdominal operation. The median operating time was 206 (180 to 280) minutes with perineal operating time 95(80 to 120) minutes. The median intraoperative blood loss was 120(50 to 200) ml. The median postoperative hospital stay was 12(9 to 18 ) days. Postoperative pathology revealed that all circumferential margins (CRM) were negative. The area of sample horizontal section was (2 824±463) mm(2), and of outer muscularis propria was(2 190±476) mm(2). Postoperative complications included chronic sacrococcygeal region pain in 2 cases, urinary retention in 3 cases, perineal wound infection in 1 case. No perineal seroma, perineal hernia, wound dehiscence and sinus tract formation were observed. Among 8 patients with preoperative normal sexual function, sexual dysfunction occurred in 2 patients. There was no local recurrence and metastasis during a median follow-up of 21(12 to 34) months.</p><p><b>CONCLUSION</b>Laparoscopy combined with TP-ELAPE has the potential to simplify the operation procedure for low rectal cancer, can ensure the radical treatment and safety of operation, and may be carried out in experienced centers.</p>
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Aged , Female , Humans , Male , Middle Aged , Abdomen , Anal Canal , Blood Loss, Surgical , Digestive System Surgical Procedures , Methods , Laparoscopy , Length of Stay , Neoplasm Recurrence, Local , Operative Time , Perineum , Postoperative Complications , Postoperative Period , Rectal Neoplasms , General Surgery , Rectum , Retrospective StudiesABSTRACT
Objective To evaluate methods of OP mesh spreading in preperitoneal tension-free repair of inguinal hernia via open anterior approach.Methods The clinical data of 1 528 cases underwent preperitoneal tension-free repair of inguinal hernia via open anterior approach from March 2012 to April 2015 was analyzed retrospectively.The methods of mesh crimp spreading, pectineal ligament suture fixation, pubic tubercle suture fixation and auxiliary support were used.Results The mesh crimp spreading method was used in 1 021 cases, pectineal ligament suture fixation method was used in 64 cases, pubic tubercle suture fixation method was used in 48 cases, auxiliary support method was used in 395 cases.Meshes were all well spreaded.Conclusions The four methods of mesh spreading are effective, simple, convenient and easy to use in preperitoneal tension-free repair of inguinal hernia via open anterior approach.
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BACKGROUND:In elderly patients with unstable intertrochanteric fracture, because of poor general condition and poor bone condition, on one hand, the internal fixation of fracture may lead to nonunion. On the other hand, patients stil need longer time in bed and hip joint fixation, and may result in complications of long-term bed rest. Artificial femoral head replacement is a safe operation mode, can solve the problem of early ambulation of patients. OBJECTIVE:To observe the repair effect of bipolar artificial femoral head replacement on unstable femoral intertrochanteric fracture in elderly patients. METHODS: A total of 39 elderly patients with unstable femoral intertrochanteric fractures, who were treated in the Department of Orthopedics, 101 Hospital of Chinese PLA from 2005 to 2014, were enroled in this study. There were 21 males and 18 females, at the age of 80-96 years old, averagely 85 years old. They al received bipolar artificial femoral head replacement. Harris score was measured to assess hip joint function at 1 year after replacement. The incidence of complications was recorded. RESULTS AND CONCLUSION:A total of 39 cases were folowed up for 1-5 years. The wound of al patients was healed in the primary stage. No cardiovascular or cerebrovascular accident appeared. Al patients passed safely through the perioperative period. No severe complications occurred. Hip joint function was assessed according to Harris score at 1 year after replacement: excelent in 13 cases, good in 20 cases, average in 4 cases, poor in 2 cases, with an excelent and good rate of 85%. No dislocation appeared. The results suggest that bipolar artificial femoral head replacement can be used to treat femoral intertrochanteric fracture in elderly patients. The postoperative recovery time was short; bleeding was less; complications were few. Hip joint function recovered wel. For elderly patients with femoral intertrochanteric fracture, bipolar artificial femoral head replacement is an ideal safe effective repair method.
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BACKGROUND:Posterior hip dislocation combined with femoral head fractures easily induced femoral head necrosis, ectopic ossification, osteoarthritis and deep vein thrombosis. Different therapeutic methods should be utilized according to the type of fracture. OBJECTIVE:To investigate the factors affecting the therapeutic effects and complications fol owing surgery of posterior hip dislocation combined with femoral head fractures. METHODS:Twenty-eight patients, who had been diagnosed as posterior hip dislocation combined with femoral head fractures in the 101 Hospital of Chinese PLA from September 2004 to May 2010, were enrol ed in this study. According to Pipkin typing, operative approach and the time from injury to surgery, therapeutic effects were evaluated using radiographs and the recovery conditions of hip function (Epstein method), and the occurrence of complications was recorded. RESULTS AND CONCLUSION:A total of 28 patients were fol owed up from 1 to 5 years, averagely 2.8 years. Using the Epstein method, there were excellent in 6 cases, good in 12 cases, average in 7 cases, and poor in 3 cases, with an excellent and good rate of 64%. The therapeutic effects in patients with Pipkin I and II were good, with excellent and good rates of 100%and 78%, respectively. Moreover, the complications were less, with a rate of 17%and 22%, respectively. The therapeutic effects of patients with Pipkin III and IV were poor, especial y, Pipkin IV patients, whose excellent and good rate was only 20%and the incidence of complications was 80%. No significant difference in the incidence of complications was detected in patients undergoing Smith-Peterson anterior approach and K-L posterior approach (P>0.05). No significant difference in the incidence of complications was detectable among patients from three groups (the time from fracture to operation48 hours) (P>0.05). Results indicated that the choice of treatment method should be determined by the type of fracture. The prognosis depends on the patient’s age, time of treatment, types of fracture and dislocation, methods of treatment and related measures of prevention of complications.
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BACKGROUND:Currently thoracolumbar fixation techniques have its advantages and disadvantages, it is necessary to explore a new internal fixation to fix the spine effectively and conveniently. OBJECTIVE:To establish thoracolumbar (T12-L2) three-dimensional finite element model and observe the effect of anteroposterior integration fixation by posterolateral nail-stick system on thoracolumbar stability. METHODBased on the CT scan data of normal human T12-L2 segments, we used Geomagic 11.0, Ug 7.0, Hypermesh 10.0, Abaqus 6.9.1 software to establish a three-dimensional finite element model of T12-L2 segments. Subsequently we established nail-stick system posterior fixation, anterior fixation, posterolateral anteroposterior integration fixation model. T12 segment was given 500 N preload and 7.5 N·m torque, to simulate thoracolumbar flexion, extension, lateral bending and rotation. The average rigidity of fixed segments under different conditions were observed. RESULTS AND CONCLUSION:Three fixation models showed a higher average rigidity than normal model under different conditions. The average rigidity in anteroposterior integration fixation by posterolateral nail-stick system was increased by 13%, 28%, 11%, 17%and 9%, compared with simple posterior fixation under the conditions such as anterior flexion, lateral bending and lateral rotation, respectively. Under the posterior extension, the average rigidity was reduced by 6%than the posterior fixation. Compared with the anterior fixation, the average rigidity in anteroposterior integration fixation by posterolateral nail-stick system was reduced by 15%, 10%, and 14%under the conditions of anterior flexion and lateral bending. While the average rigidity was higher than anterior flexion under the posterior extension and lateral rotation, increasing 5%, 12%and 2%. The anteroposterior integration fixation by posterolateral nail-stick system can improve the stability of fixed segments, and the stability is higher than anterior fixation at posterior extension and lateral rotation, while higher than posterior fixation in anterior flexion, lateral bending and lateral rotation. So it is a potential fixation method.
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Objective To explore the value of helical computed tomography (CT) in differential diagnosis of xanthogranulomatous cholecystitis (XGC) and wall-thicked gallbladder cancer (GBC).Methods The CT signs of 18 XGCs and 20 wall-thicked GBCs were retrospectively analyzed.The maximum thickness of gallbladder wall, intramural hypoattenuated nodules, mucosal line of gallbladder inner wall,patterns of enhancement of thickened wall,whether combined with stones,the pericholecystic adjacent liver tissue involvement and biliary tract obstruction were observed.Measurement data were analyzed by independent sample t test and count date were analyzed by Fisher precisely the probability method.Results The mean maximum thickness of the gallbladder wall of XGC and wall-thicked GBC was (22.11±10.19) mm and (20.55±7.94) mm respectively,and there was no statistical significance (t=0.530,P=0.600).Eighteen cases of XGC and five cases of wall- thicked GBC patients were with intramural hypoattenuated nodules (Fisher precisely the probability method,P＜0.01 ),14 cases of XGC and six cases of GBC were with integrated mucosal line (Fisher precisely the probability method,P =0.004 ),three cases of XGC and 12 cases of GBC were with biliary tract obstruction (Fisher precisely the probability method,P=0.009).There was no statistical significance in the CT signs of the range of wall thickness,patterns of enhancement and enhanced degree of thickened wall,adjacent liver tissue involvement, lymphadenopathy, combined with gallbladder or bile duct stone between XGC and wall-thicked GBC patients (Fisher precisely the probability method,all P ＞ 0.05).Conclusions The thickened gallbladder wall with intramural hypoattenuated nodules and integrated gallbladder inner wall mucosal line were characteristic signs for diagnosing XGC.Helical CT scanning can provide evidence for differential diagnosis in XGC and wall- thicked GBC.
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OBJECTIVE:To determine the therapeutic effect of transpedicular instrumentation without fusion on patients with thoracolumbar burst fractures.METHODS:A total of 63 patients with thoracolumbar burst fractures (the inclusion criteria was neurologically intact spine with a kyphotic angle >20° and/or decreased anterior vertebral body height > 50%) who were treated with transpedicular instrumentation without fusion were studied,including 40 cases treated by AF internal fixation,16 cases by Tennor screw-rod fixation system and 7 cases by Diapason screw-rod fixation.All patients underwent a radiological and clinical assessment (including the loss of kyphotic angle,decreased anterior vertebral body height,the midsagital diameter of the canal and the Low Back Outcome Score) preoperatively,postoperatively and after 24 months.The deformity of angulation was measured by Cobb angle.RESULTS:All pstients were followed for a 24 months,with average stay of 13.4 days.There were averaged 3.8 days from admitted to operation,and the internal fixation was removed within 8-12 months in 51 cases,followed a 9.4-day hospital stay.According to low back outcome score,46 patients achieved excellent,9 good,5 fair and 3 poor,with excellent and good rates of 88%.The Cobb's angle was 20.1° preoperatively,6.2° postoperatively,and 11.9° after 24 months.The average lose of anterior vertebral body height was changed from 49.1% preoperatively to 17.4% postoperatively,which was 20.4% after 24 months.The midsagittal diameters was 49.8% (n=63) preoperatively,78.1% (n=28) postoperatively,and 91.7% (n=25) after 24 months.The implant failure occurred in 5 patients.The radiographic parameters had no associativity to the outcome of LBOS.CONCLUSION:Transpedicular instrumentation without fusion is conductive to treating burst fractures of the thoracolumbar spine without nerve injury.The routine posterior or posterolateral fusion is unnecessary in the operative management of these fractures.
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Objective To evaluate the helical CT diagnostic value of primary retroperitoneal neoplasm(PRN). Methods 32 cases of PRN confirmed by operation and pathology were retrospectively analyzed. Plain and enhanced CT scan were perfomed in 28 cases,and only 4 cases underwent plain CT scans. Results Of 32 cases,15 were benign tumor and 17 cases were malignant tumor.Among them ,16 cases were mesenchymal tissue-origin(11 cases were malignant neoplasm), 10 cases were nervous tissue-origin(3 cases were malignant neoplasm),3 cases were rudimental embryonal tissue-origin(all benign), and the source of unknown-origin were 3cases(all malignant neoplasm).To be correctly localized was 28 cases(87.5%) and correctly qualitative diagnosis of the tumor was 20 cases (62.5%) by CT before operation. Conclusion PRNs have many typies, helical CT provides informations in both position and characteristics before operation.