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Objective:To study the clinical results of robot-assisted laparoscopic resection for choledochal cysts.Methods:From October 2020 to June 2022, clinical data on 20 patients who underwent choledochal da Vinci robot-assisted laparoscopic choledochal cyst resection at Fujian Provincial Hospital were retrospectively analyzed. Forty-two children with choledochal cysts were included in this study. There were 16 males and 26 females, aged 25 (range 15.0 to 45.0) months. The operations were carried out by the same team of surgeons. These patients were divided into two groups based on the surgical methods: children who underwent da Vinci robot-assisted laparoscopic surgery were in the robotic group ( n=20) and children who underwent single-port (transumbilical) laparoscopic surgery were in the laparoscopic group ( n=22). The general clinical data, operation time, intraoperative blood loss, fasting time, hospital stay, total medical costs and complications were collectd and analysed. Follow-up was performed in outpatient visits. Results:Both the 2 groups underwent surgery successfully, and no patient was converted to laparotomy. When compared with the laparoscopic group, intraoperative blood loss [(10.65±3.75) vs. (14.86±3.75) ml], indwelling time of abdominal drainage tube [(5.45±2.21) vs. (7.05±1.94) d] and fasting time [(4.00±1.49) vs. (6.05±1.43) d] in the robotic group were significantly less, while the operation time [394(299, 422) vs. 351(269, 380) min] and hospitalization cost [(79 200±4 000) vs. (31 100±3 000) yuan] were significantly increased (all P<0.05). The differences in postoperative complication rates and pain score between the two groups showed no significant differences (all P>0.05). On follow-up, no patients developed complications such as cholangitis, jaundice, intestinal obstruction and cholangiocarcinoma, except for one patient in the laparoscopic group who developed cholangitis after surgery. Conclusion:Robot-assisted laparoscopic choledochal cystectomy was effective and safe in treatment of children with choledochal cysts.
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Objective:To explore the application and value of metagenomic next-generation sequencing (mNGS) in refractory infection after organ transplantation.Methods:A case report discussed about a patient with lumbar spine infection after kidney transplantation and the relevant literature was reviewed. The recipient was a 63-year-old man with low back pain after kidney transplantation. Lumbar spine magnetic resonance imaging showed lumbar spine infection. Multiple operations plus antibacterial and antituberculosis treatments were ineffective. Before and after treatment, numerous tests of traditional pathogenic microorganisms failed to detect any positive bacteria.Results:The detection of lumbar secretion by mNGS suggested aspergillus infection. The symptoms improved after dosing of voriconazole.Conclusions:The incidence of fungal infection of lumbar spine is low. The imaging manifestations are non-typical so that it is easy to misdiagnose. mNGS helps to timely diagnose and guide treatment. With a review of the literature, mNGS has some application value for some difficult and rare infectious diseases.
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Objective:To summarize the clinical experiences of 9 ABO-incompatible kidney transplantation at our center and explore its clinical application value.Methods:Methods From April 2016 to December 2019, there were 9 living kidney transplants of ABO incompatible relatives, including type A to type B (n=3), type B to type O (n=3), type B to type A (n=1) and type AB to type B (n=2). Immunosuppressant plus single membrane plasmapheresis (PE) and/or double filtration plasmapheresis (DFPP) and rituximab were employed for pretreating recipients. Adverse reactions of recipients were observed during and after pretreatment. Blood group antibody titer, complications and other related parameters were recorded before and after transplantation before and after monitoring pretreatment.Results:After pretreatment, IgM, IgG and total titer of blood group antibodies were ≤1: 4 on the day of transplantation and the titer of non-blood group antibodies rebounded within 2 weeks (≤1: 8). During preconditioning, 2 patients experienced oral numbness and involuntary dithering during plasmapheresis and there was 1 case of infusion reaction after rituximab dosing. The early recovery of renal function was all excellent. Renal biopsy was performed in 4 patients with slow elevation of serum creatinine and 1 case developed acute antibody-mediated rejection. The survival rate of all recipients at the last follow-up was 100%.Conclusions:Live kidney transplantation of ABO-incompatible relatives is both safe and feasible so that it may help alleviate some shortage of donor kidney.
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Synchronous multifocal osteosarcoma (SMOS) was analyzed for its predisposing age, sex, location, oncology characteristics, and survival time with different treatment. The key words about "multifocal osteosarcoma" had been used to search articles which includ Synchronous multifocal osteosarcoma patients databases from 1949 to 2020. The articles have been filtratedby title, abstract and full text. There were 80 articles used for thisstudy. All the patients were objects of thisstudy. Butthe same patients' data in different articles had not been used repeatedly. The patients' data had been collected as much aspossible, including age, location, treatment, survival timeand so on. All the patients' data had been used forsystematic analysis. All of the 80 articles and 264 patients had been studied. The mean onset age was 16.17 years old and the peak age of onset was 10-20 years old. The gender difference had been uncovered and the sex ratio was 1.76∶1. The incidence site of 188 patients (92.16%) was located in the extremities. Alkaline phosphatase was elevated in 135 patients (95.10%). The pathological type was osteoblastic osteosarcoma in 134 patients (76.14%). There were 3 patients with hypocalcemia and 2 patients with anemia. The mean survival time of 15 patients (15/58) who gave up treatment was 4.51 months. The mean survival time of 23 patients with chemotherapy was 8.97 months. The mean survival time was 16.17 months in 11 patients with preoperative chemotherapy and surgical treatment. Nine patients with neoadjuvant chemotherapy, surgery and postoperative chemotherapy had an average survival time of 23.28 months. Multiple osteosarcoma of the same type was rare, with high degree of malignancy and poor prognosis. The age of high incidence was 10-20 years old. Currently, the most effective treatment was neoadjuvant chemotherapy, surgery and postoperative chemotherapy.
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Objective:To investigate the effects, complications and survival of patients tumor-type artificial knee prosthesis replacement for treatment of malignant bone tumors around the knee.Methods:The data of 47 patients undergoing tumor-type knee prosthesis replacement in Shanxi Medical University from January 2010 to April 2018 was retrospectively analyzed. There were 21 males and 26 females, with a median age of 21 years (7-70 years). There were 39 cases of osteosarcomas, 3 cases of chondrosarcomas, 2 cases of malignant fibrous histiocytomas, 2 cases of giant cell bone tumors, and 1 case of fibrosarcoma. The involved locations were the distal femur in 35 cases and proximal tibia in 12 cases. Patients with osteosarcoma and malignant fibrous histiocytomas received chemotherapy for 2 courses before operation and 4-6 courses after operation. The data included the survival time, prosthesis survival time, complications, limb function, tumor recurrence and lung metastasis of patients.Results:Patients were followed up for a median time of 25 months (5-102 months). The 1-year, 3-year and 5-year overall survival rates were 95.74%, 71.29% and 58.06%, respectively. The 1-year, 3-year and 5-year disease-free survival rates were 86.42%, 55.49% and 50.86%, respectively. Local tumor recurrence occurred in 10 patients (21.28%) within 3 years after operation. Of the 10 patients, 8 cases had a recurrence of the soft tissue tumor and then they received the resection surgery; the other 2 patients underwent amputation of the diseased limb. The pulmonary metastasis occurred in 15 patients (31.91%). The 5-year survival rate of prosthesis was 82.33%, and the 5-year survival rate of prosthesis in patients with tumor in the distal femur was higher than that in patients with tumor in the proximal tibia [86.96% vs. 75.00%, P = 0.338]. The periprosthetic infection occurred in 3 patients (6.38%), and 1 case (2.13%) received revision after prosthesis loosening, 1 case (2.13%) received revision after prosthesis breakage. At the patient's last follow-up, the Musculoskeletal Tumor Society (MSTS) score was 21 points (15 points, 24 points), and the excellent rate was 61.70% (29/47). The incidence of extensor lag in patients with tumor in the proximal tibia was higher than that in patients with tumor in the distal femur, and the difference was statistically significant [33.33% (4/12) vs. 2.86% (1/35), P = 0.016]. Conclusions:Tumor-type artificial knee prosthesis replacement can effectively treat malignant bone tumors around the knee and maintain satisfactory limb function and patients' survival rate. However, the postoperative complications may lead to limb salvage failure. It is necessary to reduce the occurrence of complications through standardized chemoradiotherapy, extensive and strict tumor resection and proper rehabilitation exercises.
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Objective:To observe the clinical effects of resection and different reconstruction methods of malignant tumors around the ilium (Ⅰ region, Ⅰ+Ⅱ region and Ⅰ+Ⅳ region).Methods:The clinical data of 23 patients with resection and reconstruction of malignant tumors around the ilium in the Second Hospital of Shanxi Medical University from January 2012 to December 2017 was retrospectively analyzed. All patients received pelvic tumor resection and screw-rod system fixation, and some patients received bone graft or cement reinforcement at the same time. The clinical effect, survival rate, complications and limb function score were statistically analyzed.Results:All cases were followed up for 10-79 months (median 42 months). Eleven patients survived, the 1-year overall survival (OS) rate was 82.6% (19/23), the 3-year OS rate was 65.2% (15/23), and the 5-year OS rate was 52.2% (12/23). The 3-year OS rate was 70.6% for the patients without acetabulum involvement, and 57.1% for those with acetabulum involvement, and the difference between the two groups was statistically significant (χ 2 = 4.182, P = 0.041). Seven cases complicated with wound nonunion, dislocation and other complications. The postoperative functional score of patients with pedicle screw-rod fixation and reconstruction was (23.6±1.3) points, and the postoperative functional score of patients with ordinary semi-pelvis and nail-rod semi-pelvic reconstruction was (18.1±1.4) points, and the difference between the two groups was statistically significant (t = 9.42, P < 0.01). Conclusion:For the bone defect after resection of tumors around the ilium, the clinical effect of pedicle screw-rod fixation is better than that of nail-rod semi-pelvic reconstruction.
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Objective@#To discuss the efficacy of pelvic region Ⅰ-Ⅲ malignant bone tumor resection and function reconstruction.@*Methods@#A retrospective study was performed on 23 patients with pelvic malignant bone tumors who underwent limb salvage surgery in the Second Hospital of Shanxi Medical University from January 2010 to December 2018, including 12 males and 11 females, aged 19-78 years old. There were 22 cases of primary tumors, and 1 case of metastatic carcinoma. The tumor of 13 cases located in region Ⅰ, 2 cases in region Ⅱ, 5 cases in region Ⅲ, 1 case in region Ⅱ+Ⅲ, and 2 cases in region Ⅰ+Ⅱ. The surgical methods included resection + allograft, resection + pedicle screw reconstruction, resection + ipsilateral iliac bone graft reconstruction, and artificial hemipelvic replacement. The complications, outcomes, survival, and function recovery of patients were analyzed.@*Results@#None of the 23 patients died in the perioperative period. Five patients with tumor invasion region Ⅱ underwent hemipelvic replacement, and no serious complications occurred after operation; 15 patients underwent allogeneic bone graft or autologous bone graft after tumor resection, 2 of them had milder wound infection, and no serious complications were found in the others; 3 cases underwent pedicle screw reconstruction after tumor resection, and no obvious complications occurred after operation. By the end of follow-up, 12 patients died of local recurrence or lung metastases after surgery, including 4 patients who underwent hemipelvic replacement. The gait of 23 patients was changed to some extent, most of them were claudication; One patient needed to walk with two crutches.@*Conclusions@#The malignant bone tumors in the pelvic region Ⅰ and Ⅲ can achieve satisfactory postoperative results after extensive resection in the boundary of security. For pelvic region Ⅱ malignant bone tumors, the postoperative curative effect of half pelvic prosthesis reconstruction after resection in the boundary of security is acceptable.
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Objective To investigate the oncological prognosis, prosthesis survival rate and other related factors after limb salvage surgery for distal femoral malignant bone tumors. Methods A total of 42 patients who received the surgery of resection of malignant bone tumor of distal femur and prosthesis replacement of knee joint tumor in the Second Hospital of Shanxi Medical University from January 2008 to December 2013 were retrospectively analyzed. The patient's oncological prognosis, prosthesis survival rate and related influencing factors were analyzed. Results The follow-up period was 18-97 months. Of 42 patients with malignant bone tumors, 21 cases (50％) survived without tumor, 7 cases (16％) survived with tumor, and the 5-year overall survival rate was 66％. The overall survival rate of patients with Enneking stage ⅡB tumor was 55.4％, and that of patients with stage ⅡA tumor was 75.0％, and the difference was statistically significant (χ2= 4.350, P= 0.037). The survival rate of artificial prosthesis was 78.6％ (22/28), the different length of osteotomy affected the survival rate of prosthesis (χ2= 4.248, P= 0.039), but the different types of prosthesis did not affect the survival rate of prosthesis (χ2= 2.177, P= 0.140). Conclusions The distal femoral malignant bone tumor has a good oncological prognosis after limb salvage surgery, Enneking staging is an important factor affecting the oncological prognosis. The different length of osteotomy at the distal femur affects the survival rate of the prosthesis, the longer the prosthesis, the lower the survival rate of the prosthesis.
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Objective To evaluate the efficacy of prosthetic replacement for bone tumors and devitalization and replantation after resection of tumor segment for the treatment of patients with extremity osteosarcoma. Methods A total of 54 patients with Enneking stage Ⅱ extremity osteosarcoma who underwent limb-salvaging surgery in the Second Hospital of Shanxi Medical University from December 2010 to June 2017 were analyzed. Kaplan-Meier survival analysis was performed on the prosthetic replacement for bone tumors group and devitalization and replantation after resection of tumor segment group, the 5-year survival rate and distant metastasis rate between the two groups were compared. The χ 2 test and t test were used to compare the local recurrence rate, occurrence of local infection, and postoperative functional recovery between the two groups. Results Forty-six patients were followed up with the period ranging from 3 to 84 months. The prosthetic replacement for bone tumors group had 35 cases and the devitalization and replantation after resection of tumor segment group had 11 cases. The postoperative 5-year survival rate and 5-year distant metastasis rate were compared between the prosthetic replacement for bone tumors group and devitalization and replantation after resection of tumor segment group by using the Kaplan-Meier method (52.5％ vs. 59.4％, 38.5％ vs. 35.7％), and the differences were not statistically significant (χ 2 values were 0.084 and 0.013, both P > 0.05). For local recurrence rate and the risk of postoperative infection, the patients in devitalization and replantation after resection of tumor segment group showed higher results than those in prostheticreplacement for bone tumors group [36.4％ (4/11) vs. 8.6％ (3/35), 36.4％ (4/11) vs. 11.4％ (4/35)], and the differences were statistically significant (χ 2 values were 4.181 and 5.020, both P < 0.05). For 6 months postoperative functional reconstruction score, the patients in devitalization and replantation after resection of tumor segment group showed worse result than that in prosthetic replacement for bone tumors group [(17.4± 2.5) points vs. (24.3±4.8) points], and the difference was statistically significant (t = -4.911, P < 0.05); but this index tended to show better result at 18 months after surgery as compared with prosthetic replacement for bone tumors group [(27.3±2.7) points vs.(24.8±4.6) points], but the difference was not statistically significant (t= 1.811, P > 0.05). Conclusion The efficacy of prosthetic replacement for bone tumors is considered better than that of devitalization and replantation after resection of tumor segment, and it could be used as the preferred surgical option for limb-salvaging treatment in patients with extremity osteosarcoma at present.
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Objective To evaluate the efficacy and safety of converting traditional triple immunosuppressive regimen into quadruple immunosuppressive regimen of low-dose tacrolimus plus sirolimus plus mycophenolic acid plus hormone in expanded criteria donor (ECD) renal transplant recipients .Methods A retrospective analysis was conducted for 39 patients undergoing extended standard kidney transplantation with conversion therapy from January 2015 to June 2018 .Renal function ,liver function ,blood lipid ,bone marrow suppression ,positive rate of urinary protein ,positive rate of urinary BK virus and other adverse reactions were analyzed .Results A total of 39 recipients fulfilled the inclusion criteria ,including 28 boys and 11 girls with an average age of (37 .69 ± 11 .07) years and a median postoperative conversion time of 6 months .As compared with pre-conversion therapy ,renal function and estimated glomerular filtration rate improved significantly at 1 month ,3 months ,6 months and 1 year (P<0 .05) .No significant difference existed in the level of blood lipid ,whole blood leukocyte or hemoglobin at pre and post-conversion ( P>0 .05) .No significant difference existed between AST and ALT at pre and post-conversion (P< 0 .05) . After conversion , the positive rates of urinary protein and BK virus urine declined . Subacute rejection occurred in 1 case after conversion .Addition of sirolimus was curative .No severe adverse reactions such as infection and diarrhea occurred in the remaining cases .Conclusions T he quadruple immunosuppressive regimen of low-dose tacrolimus plus sirolimus plus mycophenolic acid and hormone is both safe and effective for ECD recipients of renal transplantation .
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To evaluate the clinical effects of Shengmai Injection in treating coronary heart disease (CHD) based on correct syndrome differentiation and incorrect syndrome differentiation.
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1 cm. Postoperative pathological findings showed negative cut surface. No hemorrhage or bile leakage were seen after operation. The abdominal drainage tube was indwelled for 3~4 d. The postoperative hospital stay was 3~5 d. Follow-up checkups for 1~20 months (mean, 12.5 months) revealed no tumor recurrence or incision implantation. All the patients survived. Conclusions Laparoscopic regular hepatic left lateral lobectomy can be carried out safely and effectively in clinically selected patients.
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Objective To evaluate the therapeutic effect and safety of Huangqi Danshen Drop Pill (HDP) for angina pectoris (AP) due to coronary heart disease (CHD) classified as qi- deficiency and blood- stasis syndrome. Methods A multi- center, randomized, double- blind, double- simulation, positive- controlled, parallel group trial was adopted. 209 cases of AP due to CHD classified as qi- deficiency and blood- stasis syndrome were enrolled in this study: 104 in HDP group and 105 in Yangxinshi Tablets group. Results The markedly effective rate was 43.27 % , total effective rate 86.53 % , and total effective rate in improving TCM symptoms 92.31 % in HDP group, which were better than those in Yangxinshi Tablets group(P