ABSTRACT
Objective:To compare the therapeutic effects of percutaneous transhepatic choledochoscopic lithotripsy (PTCSL) and traditional open hepatectomy (OH) on regional hepatolithiasis with biliary cirrhosis.Methods:From January 2020 to August 2022, 110 cases of regional hepatolithiasis complicated with biliary cirrhosis treated in the hepatology department of Hunan Provincial People′s Hospital were retrospectively collected. According to the surgical methods of treating hepatolithiasis, the patients were divided into minimally invasive group and laparotomy group. The minimally invasive group received PTCSL, and the laparotomy group received OH. The clinical data of the two groups were compared and analyzed, and the postoperative exhaust time, gastrointestinal function recovery time, operation time and intraoperative bleeding volume were observed. The levels of alanine aminotransferase (ALT), γ-glutamyltransferase(GGT) and aspartate aminotransferase (AST) before and after operation were compared between the two groups. The incidence of complications and stone removal rate of the two groups were recorded.Results:The postoperative exhaust time (11.12±2.09)h, gastrointestinal function recovery time (25.76±4.28)h, operation time (108.51±16.19)h, intraoperative blood loss (20.16±3.59)ml and postoperative exhaust time (29.35±4.83)h and gastrointestinal function recovery time in the minimally invasive group were less than those in the laparotomy group (36.91±6.35)h, operation time (116.27±21.54)h and intraoperative blood loss (38.03±6.22)ml (all P<0.05). The levels of ALT (77.82±16.25)U/L, GGT (248.16±24.83)U/L and AST (65.42±16.82)U/L in the minimally invasive group after operation were lower than those in the laparotomy group [ALT (102.37±25.64)U/L, GGT (345.45±32.60)U/L and AST (96.30±22.17)U/L] (all P<0.05). The incidence of postoperative complications was 7.27%(4/55) in the minimally invasive group and that in the laparotomy group was 29.09%(16/55), with statistically significant difference ( P<0.05). The stone removal rate was 61.82%(34/55) in the minimally invasive group and 92.73%(51/55) in the laparotomy group, with statistically significant difference ( P<0.05). Conclusions:PTCSL and OH are effective in the treatment of regional hepatolithiasis complicated with biliary cirrhosis. The traditional OH has a high stone removal rate, and PTCSL has little influence on liver function, small complication rate and fast postoperative recovery.
ABSTRACT
@#Objective To compare the perioperative outcomes of atypical segmentectomy between robotic-assisted thoracoscopic surgery (RATS) and conventional video-assisted thoracoscopic surgery (VATS) in early-stage non-small cell lung cancer (NSCLC). Methods The data of patients who underwent minimally invasive anatomic atypical segmentectomy in our hospital from October 2016 to December 2021 were collected. These patients were divided into a RATS group and a VATS group according to the operation method. Propensity score (PS) matching was used to select patients with close clinical baseline characteristics, and the perioperative results of the two groups were compared. Results A total of 1 048 patients were enrolled, including 320 males and 728 females, with a mean age of 53.51±11.13 years. There were 277 patients in the RATS group and 771 patients in the VATS group. After 1∶1 PS matching, 277 pairs were selected. Both groups were well balanced for age, sex, smoking history, body mass index, Charlson comorbidity index, pulmonary function, tumor size, tumor location, and histological type. All patients were R0 resection, and there were no deaths within 30 days after surgery. The RATS group had shorter operative time [85 (75, 105) min vs. 115 (95, 140) min, P<0.001] and less blood loss [50 (30, 100) mL vs. 60 (50, 100) mL, P=0.001]. There were no statistical differences between the two groups in lymph node resection, conversion to thoracotomy, thoracic drainage time, total amount of thoracic drainage or postoperative complications (P>0.05). Conclusion Both RATS and VATS atypical segment-ectomies are safe and feasible for early-stage NSCLC. RATS can effectively shorten the operative time, and reduce blood loss.
ABSTRACT
Objective:To explore the diagnosis, treatment and prevention of biliary hemorrhage after percutaneous transhepatic choledochoscopic lithotomy(PTCSL).Methods:Retrospective summary and analysis were made on 48 cases of PTCSL completed by the hepatobiliary surgery department of Hunan Provincial People′s Hospital (the First Affiliated Hospital of Hunan Normal University) from January 2016 to December 2020.Results:Biliary hemorrhage occurred in 3 cases after operation, of which 1 case was considered to have a small amount of biliary mucosa bleeding, and the bleeding was stopped after blood transfusion, hemostatic agents and appropriate fluid rehydration. In the other case, a small amount of blood oozing around the T-tube sinus canal was accompanied by a small amount of bloody fluid in the T-tube, which was considered to cause arterioles or venules accompanied by bile duct bleeding during sinus expansion during operation, and the bleeding stopped after compression. Another patient underwent a short time drainage of hemorrhagic fluid ≥100 ml in T tube 15 days after operation, and was prepared for interventional therapy while receiving blood transfusion products and conservative treatment. Celiac arteriography was performed, and pseudoaneurysm was found in the right anterior lobe of the liver. Embolization was performed later and the patient discharged 10 days after embolization.Conclusions:Biliary hemorrhage is one of the more common complications after PTCSL. Increasing the understanding of this complication provides a guarantee for the safety of surgery and has clinical significance for patients with accelerated postoperative recovery.
ABSTRACT
OBJECTIVE：To provide referenc e for selectin g antitumor drugs economic evaluation models and improving the quality of evidence for antitumor drugs economics evaluation in China. METHODS ：A systematic search of the antitumor drug health technology evaluation （pCODR）reports were conducted on the official website of the Canadian Agency for Drugs and Technologies in Health （CADTH）. The search time was limited to Jan. 1st，2015 to Sep. 6th，2020. The basic information ，model types and structure ，and key limitations were extracted and summarized. RESULTS & CONCLUSIONS ：A total of 185 pCODR reports were finally retrieved ，involving 114 types of tumor indications and 98 types of antitumor drugs. The number of CADTH antitumor drugs economics evaluations in the past 5 years had shown an increasing trend. Among 137 pCODR reports with final economic guidance report ，98 reports（71.5％）adopted the PartSA model ，21 reports（15.3％）used the Markov model ，and some reports（6 reports，4.3％）used both PartSA and Markov models to explore the uncertainty of the model structure. In terms of model health status setting ，86 reports（62.8％）used three-state models to evaluate the economy of different anti tumor drugs ，and 16 reports（11.7％）used no less than four health states to simulate the outcome of disease state. However ，there were still some problems in CADTH models ，such as the unreasonable choice of research time limit ，the unreasonable extrapolation method or uncertain extrapolation results of efficacy （survival）data，the uncertainty of efficacy data obtained by indirect comparison ，and some assumptions or parameter settings did not conform to the actual diagnosis and treatment environment. In view of the advantages of PartSA model ，it is suggested that PartSA model or Markov model combined with PartSA model should be used first to verify the uncertainty of model structure in the future economic evaluation of antitumor drugs ；reasonable settings of key model parameters should be considered to improve the quality of evidence for antitumor drugs economics evaluation in China.
ABSTRACT
Objective:To study and analyse the results of postoperative hemorrhage after laparoscopic pancreaticoduodenectomy (LPD).Methods:The clinical data of patients who underwent LPD from May 2011 to December 2019 at Hunan Provincial People's Hospital were retrospectively analyzed. The clinical characteristics of patients, onset time of postoperative hemorrhage, location of postoperative hemorrhage, postoperative biliary fistula, pancreatic fistula, infection and other short-term complications, reoperation and mortality rates were analyzed.Results:Of 356 patients who underwent LPD in this study, there were 200 males and 156 females, aged (58.0±10.5) years. The postoperative complication rate was 33.1% (118/356), the reoperation rate was 6.5% (23/356), and the mortality rate was 2.5% (9/356). The most common complications were postoperative hemorrhage [15.2% (54/356)], pancreatic fistula [14.6%(52/356)] and abdominal infection [13.8%(49/356)]. The onset time of postoperative hemorrhage was usually in the 1st - 14th day, and the highest rate of postoperative hemorrhage was 3.9% (14/356) on the first day after surgery. The postoperative hemorrhage rate then showed a downward trend, but increased again on the 7th day. The extraluminal hemorrhage locations were relatively widely distributed, and the incidence of gastrointestinal anastomotic hemorrhage in patients with intraluminal hemorrhage was the highest [67.9%(19/28)]. Of the 9 patients who died, 7 were related to postoperative bleeding.Conclusions:LPD resulted in a high incidence of complications. Postoperative hemorrhage was a complication that had the greatest impact on short-term recovery of patients. It was also an important cause of reoperation and death. In addition to postoperative bleeding caused by pancreatic fistula, gastrointestinal anastomotic bleeding was also clinically important.
ABSTRACT
Objective:To explore the application of ureteroscope combined with holmium laser in patients with hepatolithiasis complicated with biliary cirrhosis.Methods:The clinical data of 89 patients with hepatolithiasis complicated with biliary cirrhosis treated in the hepatobiliary department of Hunan Provincial People's Hospital from February 2014 to December 2019 were collected and divided into two groups: group A was routine operation group and group B was ureteroscopy and holmium laser technology group. The clinical data of the two groups were compared and analyzed respectively.Results:The operation time in group B was less than that in group A [ (302.6±96.7)min vs (349.2±105.6)min, P<0.05], with statistically significant difference; The amount of intraoperative bleeding in group B was less than that in group A [(227.0±197.3)ml vs (331.4 ± 277.3)ml, P<0.05], with statistically significant difference; The postoperative hospital stay in group B was shorter than that in group A[(11.5±4.1)d vs (13.8±5.1)d, P<0.05], with statistically significant difference; The incidence of postoperative complications in group B was lower than that in group A (2.44% vs 18.75%, P<0.05), with statistically significant difference. The liver resection rate in group B was lower than that in group A (29.27% vs 52.08%, P<0.05). Conclusions:Through the establishment of a reasonable access to the liver, the application of ureteroscope and holmium laser technology in patients with hepatolithiasis complicated with biliary cirrhosis can achieve better diagnosis and treatment results, and this technology can be gradually promoted and applied in the clinic.
ABSTRACT
Objective:To analysis the application value of rigid ureteroscope combined with holmium laser in diagnosis and treatment of complicated hepatolithiasis guided by three-dimensional visualization technology.Methods:50 patients with complex hepatolithiasis treated in Hunan People′s Hospital from October 2016 to March 2019 were selected as the study subjects. They were divided into observation group and control group by simple random method. 20 cases underwent rigid ureteroscope combined with holmium laser under the guidance of three-dimensional visualization technology were taken as observation group, 30 cases underwent rigid ureteroscope combined with holmium laser by traditional imaging diagnosis were taken as control group. The differences between the two groups in operation time, intraoperative bleeding volume, stone residual rate, postoperative hospital stay and postoperative complications were statistically analyzed.Results:The residual rate of calculi in observation group was 10% (2/20), while it was 40% (12/30) in control group; the amount of bleeding during operation in the observation group was (170.9±18.0)ml, and it was (371.6±37.0)ml in the control group; the operation time of observation group was (179.0±14.3)minutes, and it was (340.2±24.3)minutes in the control group; the postoperative hospital stay of observation group was (8.3±1.5)days, and it was (10.1±1.8)days in the control group; postoperative biliary hemorrhage occurred in 1 cases of the observation group, biliary tract leakage occurred in 2 cases, postoperative biliary hemorrhage occurred in 3 cases of the control group, biliary tract leakage occurred in 4 cases.Conclusions:Rigid ureteroscope combined with holmium laser guided by three-dimensional visualization technology can further improve the clinical efficacy in the diagnosis and treatment of complex hepatolithiasis. which is worthy of clinical application.
ABSTRACT
Two male patients aged 33 and 38 years with mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS)admitted in our hospital in 2016 and 2017 were reported.The main symptoms included abdominal pain and distension,numbness and weakness of the limbs.MRI showed mild ventriculomegaly with deepened sulcus and widened cerebral fissure,deepened bilateral cerebellar sulcus and the widened cleavage,atrophy of cerebellum and brainstem,and manifestations of acute cerebral infarction.Gene analysis showed mutation of mitochondrial DNA(mtDNA) A3243G.After definite diagnosis was made,patients reveived coenzyme Q10,ATP and vitamin supplements for improving circulation,and neurotrophic drugs for symptomatic treatment.The symptoms were slightly improved after treatment and two cases were followed-up as outpatients.
ABSTRACT
Objective To investigate the application value of acoustic radiation force impulse imaging (ARFI) in differential diagnosis of small solid thyroid nodules coexisting with Hashimoto's thyroiditis (HT).Methods A total of 136 patients with 155 small solid nodules (≤1 cm in diameter) confirmed by pathology were included.The small solid nodules were divided into HT group and normal group.All patients underwent virtual tissue imaging (VTI) and virtual touch tissue quantification (VTQ).The stiffness of small solid thyroid nodules in two groups was respectively scored based on VTI images,and the area ratios of nodules in VTI images to gray scale images were calculated.Taking pathological diagnosis as the gold standard,the ROC curve were performed to explore the optimal points and efficacy of area ratio and shear wave velocity (SWV) in the diagnosis of malignant nodules in two groups respectively.Results Regarding VTI score≥4 as the diagnostic standard of malignant nodules,the sensitivity of HT group and normal group in diagnosis of malignant nodules had significant difference (64.29％[27/42] vs 81.69％[58/71],P＜0.05).In two groups,the area ratio and SWV of malignant nodules were significantly higher than those of benign nodules (all P＜0.05).The area ratio and SWV of thyroid benign nodules and malignant nodules had no significantly difference between two groups (all P＞0.05).Taking 1.41 as the cutoff point of area ratio,the sensitivity and specificity in diagnosis of malignant nodules in HT group were 85.7％ and 88.9％.Taking 2.87 m/s as the cutoff point of SWV,sensitivity and specificity in diagnosis of malignant nodules in HT group were 85.7％ and 94.4％.Taking 1.40 as the cutoff point of area ratio,the sensitivity and specificity in diagnosis of malignant nodules in normal group were 91.5％ and 95.8％.Taking 2.67 m/s as the cutoff point of SWV,the sensitivity and specificity in diagnosis of malignant nodules in normal group were 88.7％ and 95.8％.Conclusion ARFI technology can evalu-ate the hardness of the small solid thyroid nodules through the intuitive VTI images and objective SWV values in HT,which is helpful in diagnosis of malignant nodules in HT backgroud.
ABSTRACT
Objective: To support the distribution of health resources in China better. Methods: According to the related data of resident health, health resources and marketing index in China from 2005 to 2010, related conclusion was given by using stochastic frontier analysis and fixed effect panel analysis method to establish the change trend of technical efficiency in different provinces and cities. Results and Conclusion: (1) The distribution of technical efficiency in different provinces and cities are asymmetric and generally low;(2)there are obvious differences of technical efficiency among different areas;(3)government input in medical and health field should be focused on central and western areas.
ABSTRACT
Objective To investigate the operative techniques for refractory cholelithiasis. Methods The clinical data of 521 patients with refractory cholelithiasis who had been admitted to People's Hospital of Hunan Province from January 1990 to December 2007 were retrospectively analyzed. Results All patients received surgery. After the operation, 3 patients died of liver and kidney failure, the remaining 518 patients were cured without severe complications. The results of B ultrasound and computed tomography showed residual stones in 78 patients (15.1%). Four hundred and twenty-three patients (81.7%) were followed up for 5 months to 17 years (mean, 7.5 years), and the rate of positive effect was 90.1% (381/423). Conclusions Most of the refractory cholelithiasis can be cured radically. Individualized surgical planning, fine and standard surgical procedure are key to the treatment effect.
ABSTRACT
The teaching methods in anesthesiology practice to traditional Chinese medicine students was discussed.Watching for the first step, then simulation and manipulation on patients should be abided by. Paying more attention to patients’ safety and avoiding any fault to patients should be emphasized . The one to one and hand by hand teaching method should also be used to train the students' clinic thought and practical ability.
ABSTRACT
OBJECTIVE:To discuss the prevention and cure of anaphylactic shock caused by trasylol.METHODS:The anaphylactic shock was statistically analyzed among3862cases that were given slight dosage of trasylol before operation by intravenous drip.Among which,82cases had anaphylactic shocks,which accounted for2.12%of the total.RESULTS&CONCLUSION:The incidence rate of anaphylactic shock from trasylol by intravenous drip is quite high,thereby preparation of prevention and emergency treatment should be ready.