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1.
Article in Chinese | WPRIM | ID: wpr-907933

ABSTRACT

Guideline or consensus for the vaccination of children with special conditions like immunocompromised children may be more suitable for pediatricians.However, the vaccination of children in China is mainly performed by general practitioners or child health care practitioners in community health service centers.They need to master the screening knowledge of contraindications and precautions for the vaccination of children, and make the decision to referral to specialists.Based on the technical guidelines for Immunization of National Health Commission of the People′s Republic of China, Best Practices Guidance of the Advisory Committee on Immunization Practices and contraindications and precautions proposed by the Immunization Action Coalition, 20 suggestions for primary screening of children with vaccination contraindications and referral recommendations for primary care providers were developed by experts from the Integration of Medicine and Prevention in Children of Health Commission of Shenzhen Municipality.

2.
Journal of Clinical Hepatology ; (12): 2609-2612, 2020.
Article in Chinese | WPRIM | ID: wpr-829652

ABSTRACT

As lactate is elevated due to lactate metabolic disorder in liver failure, recent studies have shown that blood lactate has a high value in predicting the prognosis of liver failure. With reference to the research findings in recent years, this article introduces the prediction model of LiFe score and reviews the advances in the clinical application of blood lactate level in patients with liver failure in China and foreign countries. It is believed that a high lactate level is an independent risk factor for poor prognosis of liver failure patients, and it is proposed that lactate can be used as an important indicator to evaluate the severity and prognosis of liver failure and further optimize the scoring system for the prognosis of related liver diseases.

3.
Article in Chinese | WPRIM | ID: wpr-828125

ABSTRACT

The dynamic analysis of the implantation process of a new vena cava filter was carried out by finite element analysis method to reveal the influence of the angle, length, width and thickness of the filter rod on its mechanical properties and the inner wall of the blood vessel. The results showed that the high-stress and high-strain areas of the filter were mainly concentrated in the connection between the filter rod and the filter wire. With the increase of the angle of the filter rod, the maximum equivalent stress and the maximum elastic strain on the filter wall decreased, while the maximum equivalent stress on the vascular wall increased. With the increase of the length of the filter rod, the maximum equivalent stress and strain peak of the filter wall increased, but the maximum equivalent stress of the vessel wall decreased. With the increase of the width and thickness of the filter rod, the maximum equivalent stress of the filter wall, the maximum elastic strain and the maximum equivalent stress of the vessel wall all showed an upward trend. The static safety factor of all filter models was greater than 1, and the structure after implantation was safe and reliable. The results of this study are expected to provide a theoretical basis for the structural optimization and deformation mechanism of the new type vena cava filter.


Subject(s)
Finite Element Analysis , Vena Cava Filters , Vena Cava, Inferior
4.
Chinese Journal of Oncology ; (12): 63-67, 2019.
Article in Chinese | WPRIM | ID: wpr-810385

ABSTRACT

Objective@#Clinical evidences of surgically treated stage M1b non-small cell lung cancer (NSCLC) patients were limited. This study aimed to summarize the clinical data of these patients to explore the prognostic factors of this population.@*Methods@#From January 1999 to December 2012, the clinical data of 40 stage M1b NSCLC patients, including 24 males and 16 females, who underwent surgery were collected by Cancer Hospital, Chinese Academy of Medical Sciences. Kaplan-Meier method, log rank test and Cox risk regression model were used to analyze the prognose of these patients and their influence factors.@*Results@#A total of 40 patients were available for survival analysis. The Survival rates of the whole population at 1, 3 and 5 years were 70.0%, 40.0% and 22.5%, respectively. The median survival time (MST) was 31.5 months. The outcomes of 23 patients underwent primary tumor resection and local treatment of metastatic site (MST: 41.5 months) were significantly better than those of 13 patients with only primary tumor resection (MST: 15.5 months) and 4 patients with thoracic exploration (MST: 14.5 months) (P<0.05). Multivariate analysis showed that patients without pleural effusion, brain metastasis, chemotherapy and targeted therapy had a statistically better survival (P<0.05).@*Conclusions@#The overall survivals of surgically treated stage M1b NSCLC patients appear encouraging, and some selected patients may even achieve a long-time survival. Multimodality treatment including surgical lung resection and radical treatment of metastasis should be considered for these patients.

5.
Journal of Biomedical Engineering ; (6): 1024-1031, 2019.
Article in Chinese | WPRIM | ID: wpr-781832

ABSTRACT

The mechanical properties of nitinol iliac vein stent (NIVS) have been studied by many scholars at home and abroad, but the study on the mechanical properties of iliac vein stent under different release scales has not been reported yet. Based on the finite element analysis method, the mechanical properties of three self-developed NIVS were studied to reveal the influence of stent diameters (12, 14, 16 mm) and different release scales (80%, 90%) on its strength, fatigue life and vein wall biomechanical properties. With an increases in the release scales, the equivalent elastic strain, fatigue strength safety factors, and vessel wall equivalent stress exhibited a downward trend, while the most stressed cross-section coincided with the arc of stent-connecting rods. Through 30, 60 and 90 days' animal test, a narrowed vascular model was established in the iliac veins of 12 pigs, and the developed iliac vein stents were implanted to comprehensively evaluate the safety and effectiveness of the stent, and at the same time the mechanical properties of stents were verified to provide important reference for the type inspection and clinical trials of follow-up products.


Subject(s)
Alloys , Animals , Finite Element Analysis , Iliac Vein , Stents , Stress, Mechanical , Swine
6.
Article in Chinese | WPRIM | ID: wpr-774214

ABSTRACT

Vena cava filter is a filter device designed to prevent pulmonary embolism caused by thrombus detached from lower limbs and pelvis. A new retrievable vena cava filter was designed in this study. To evaluate hemodynamic performance and thrombus capture efficiency after transplanting vena cava filter, numerical simulation of computational fluid dynamics was used to simulate hemodynamics and compare it with the commercialized Denali and Aegisy filters, and in vitro experimental test was performed to compare the thrombus capture effect. In this paper, the two-phase flow model of computational fluid dynamics software was used to analyze the outlet blood flow velocity, inlet-outlet pressure difference, wall shear stress on the wall of the filter, the area ratio of the high and low wall shear stress area and thrombus capture efficiency when the thrombus diameter was 5 mm, 10 mm, 15 mm and thrombus content was 10%, 20%, 30%, respectively. Meanwhile, the thrombus capture effects of the above three filters were also compared and evaluated by in vitro experimental data. The results showed that the Denali filter has minimal interference to blood flow after implantation, but has the worst capture effect on 5 mm small diameter thrombus; the Aegisy filter has the best effect on the trapping of thrombus with different diameters and concentrations, but the low wall shear stress area ratio is the largest; the new filter designed in this study has a good filtering and capture efficiency on small-diameter thrombus, and the area ratio of low wall shear stress which is prone to thrombosis is small. The low wall shear stress area of the Denali and Aegisy filters is relatively large, and the risk of thrombosis is high. Based on the above results, it is expected that the new vena cava filter designed in this paper can provide a reference for the design and clinical selection of new filters.


Subject(s)
Blood Flow Velocity , Hemodynamics , Humans , Software , Thrombosis , Therapeutics , Vena Cava Filters , Vena Cava, Inferior
7.
Article in Chinese | WPRIM | ID: wpr-742957

ABSTRACT

Cerebral small vessel disease (CSVD) is an imaging and clinical syndrome caused by intracranial small vessel lesions.Studies have confirmed that CSVD is closely associated with the stroke outcomes.The overall burden is a concept based on a single imaging marker of CSVD,which can comprehensively reflect the severity of brain injury and identify high-risk stroke patients.This article reviews the correlation between the overall burden of the CSVD imaging and the stroke outcomes.

8.
The Journal of Practical Medicine ; (24): 2053-2057, 2018.
Article in Chinese | WPRIM | ID: wpr-697888

ABSTRACT

Objective To investigate the effect of ulinastatin on postoperative clinical outcomes in pa-tients undergoing elective laparoscopic colectomy. Methods 454 patients underwent elective laparoscopic colecto-my from January 2015 to September 2017 were included in this retrospective study. Patients were divided into 2 groups:ulinastatin group and control group. Propensity score matching was applied to balance the preoperative baseline differences between 2 groups. 155 patients in each group were successfully matched. Mixed linear model was used to exam the effect of ulinastatin on various clinical indicators within 3 days after the surgery,including in-flammation indicators(white blood cell counts,C reactive protein),liver function indicators(alanine transami-nase,aspartate transaminase,total bilirubin),renal function indicators(serum creatinine,blood urea nitrogen). Postoperative hospital length of stay was compared between 2 groups using student's t-test. Results Ulinastatin group showed significantly reduced postoperative white blood cell count and ? reactive protein level (P = 0.036 and 0.025)compared with the control group. The average mean inhibitory effects were 1.04×109/L and 23.93 mg/L respectively,which was 11.1% and 29.9% lower than that of the control group. Procalcitonin,transaminases,total bilirubin,serum creatinine,blood urea nitrogen levels and postoperative hospital length of stay showed no signifi-cant difference between the two groups(P > 0.05). Conclusion Ulinastatin can significantly reduce the level of inflammation response after laparoscopic colectomy,which is beneficial to the fast recovery.

9.
Article in Chinese | WPRIM | ID: wpr-707509

ABSTRACT

Objective To explore the effect of spinal sagittal balance on secondary vertebral fracture after percutaneous kyphoplasty (PKP) for osteoporotic vertebral compression fractures (OVCF).Methods The data were reviewed of the patients with single segmental OVCF who had undergone PKP at Department of Spine Surgery,Second Hospital of Lanzhou University from March 2014 to December 2015.Of them,21 had secondary vertebral fracture after PKP.As an observational group,they were matched with another 21 patients without secondary vertebral fracture after PKP as a control group (ratio:1:1) for age,gender,body mass index (BMI) and bone mineral density (BMD).Their standard standing plain radiographs of the whole spine were used to measure the parameters of spine-pelvis sagittal balance.The 2 groups were compared in sagittal balance parameters.Results The sagittal vertical axis (26.86 ± 33.55 mm) and thoracic kyphosis (47.62° ± 10.73°) in the observational group were significantly larger than those (4.05 ± 31.93 mm and 41.10 °±8.17°) in the control group (P <0.05);the lumbar lordosis (35.29°±8.77 °),sacral slope (22.71 ° ± 5.80°) and pelvic incidence (45.38° ± 7.49°) in the former were significantly smaller than those in the control group (41.71°±9.19°,27.43°±5.29° and 51.19°±8.44°) (P <0.05);there were no significant differences between the 2 groups in pelvic tilt or thoracolumbar kyphosis (P > 0.05).Conclusions The OVCF patients with larger sagittal vertical axis,larger thoracic kyphosis and smaller lumbar lordosis may be more likely to suffer secondary vertebral fracture after PKP.A larger pelvic incidence may be a protective factor against secondary vertebral fracture after PKP for OVCF patients.

10.
Article in Chinese | WPRIM | ID: wpr-659067

ABSTRACT

Objective To explore the advantages and disadvantages of regional citrate anticoagulation (RCA) mode by comparing to non-anticoagulation mode for continuous renal replacement therapy (CRRT)in patients with acute kidney injury (AKI) at high risk of bleeding.Methods The criterion for inclusion of patients was stage 3 of AKI selected according to Kidney Disease Improving Global Outcomes guideline.And those patients had high risk factors of bleeding as well as such as post-major opertion,coagulopathy (prothrombin time or activated partial thromboplastin time > 1.5 times the normal control,or prothrombin time > 18 s,activated partial thromboplastin time > 60 s),thrombocytopenia (< 50 × 109/L),and combined therapy with anticoagulant,antiplatelet or thrombolytic drugs.The CRRT was initiated within 4 h after randomization.The exclusion criteria was severe liver failure (serum total bilirubin > 171 μmmol/L).Continuous venovenous hemodiafiltration mode was employed in both groups,and the filter was changed routinely every 72 h,unless clotting developed in the extracorporeal circuit.Because the commercial calcium-free dialysate was not available in the market,this dialysate was prepared by the intensive care unit (ICU) nurses.Results Thirty two patients were equally divided in those two groups,and most of them were admitted to ICU after major surgery.There were no significant differences between the groups in data of blood gas analysis,hepatic/renal/coagulative functions,electrolyte,hemoglobin and platelet count before or after CRRT.The filter was more durable in RCA mode than that in non-RCA mode determined through Kaplan-Meier curve analysis (x2 =9.707,P =0.002),with the mean time (h) 36.01 (26.61-45.42)vs.22.04 (18.35-25.73).More packed red blood cells and platelet were required in non-RCA mode than those in RCA mode during CRRT.There was no significant difference in ICU mortality between RCA mode and non-RCA mode with 7/16 vs.9/16,P =0.724.Severe blood loss and malignant arrhythmia events did not occur in both modes.The body temperature,systemic electrolyte,post-filter ionized calcium levels and the ratio of total to ionized systemic calcium were basically preserved at a target range in RCA group during CRRT.Conclusions RCA-CRRT is a safe and effective mode for AKI patient with high risk of bleeding,which can extend the durability of filter,and lower the risk of blood loss.However,the study failed to show a mortality benefit with the RCA mode,and it could also increase the workload of nurses under the current domestic setting.

11.
Article in Chinese | WPRIM | ID: wpr-657223

ABSTRACT

Objective To explore the advantages and disadvantages of regional citrate anticoagulation (RCA) mode by comparing to non-anticoagulation mode for continuous renal replacement therapy (CRRT)in patients with acute kidney injury (AKI) at high risk of bleeding.Methods The criterion for inclusion of patients was stage 3 of AKI selected according to Kidney Disease Improving Global Outcomes guideline.And those patients had high risk factors of bleeding as well as such as post-major opertion,coagulopathy (prothrombin time or activated partial thromboplastin time > 1.5 times the normal control,or prothrombin time > 18 s,activated partial thromboplastin time > 60 s),thrombocytopenia (< 50 × 109/L),and combined therapy with anticoagulant,antiplatelet or thrombolytic drugs.The CRRT was initiated within 4 h after randomization.The exclusion criteria was severe liver failure (serum total bilirubin > 171 μmmol/L).Continuous venovenous hemodiafiltration mode was employed in both groups,and the filter was changed routinely every 72 h,unless clotting developed in the extracorporeal circuit.Because the commercial calcium-free dialysate was not available in the market,this dialysate was prepared by the intensive care unit (ICU) nurses.Results Thirty two patients were equally divided in those two groups,and most of them were admitted to ICU after major surgery.There were no significant differences between the groups in data of blood gas analysis,hepatic/renal/coagulative functions,electrolyte,hemoglobin and platelet count before or after CRRT.The filter was more durable in RCA mode than that in non-RCA mode determined through Kaplan-Meier curve analysis (x2 =9.707,P =0.002),with the mean time (h) 36.01 (26.61-45.42)vs.22.04 (18.35-25.73).More packed red blood cells and platelet were required in non-RCA mode than those in RCA mode during CRRT.There was no significant difference in ICU mortality between RCA mode and non-RCA mode with 7/16 vs.9/16,P =0.724.Severe blood loss and malignant arrhythmia events did not occur in both modes.The body temperature,systemic electrolyte,post-filter ionized calcium levels and the ratio of total to ionized systemic calcium were basically preserved at a target range in RCA group during CRRT.Conclusions RCA-CRRT is a safe and effective mode for AKI patient with high risk of bleeding,which can extend the durability of filter,and lower the risk of blood loss.However,the study failed to show a mortality benefit with the RCA mode,and it could also increase the workload of nurses under the current domestic setting.

12.
Article in Chinese | WPRIM | ID: wpr-617821

ABSTRACT

Hormone replacement therapy (HRT), involving giving sex steroid hormones such as estrogen alone or with a progestogen, is widely used in postmenopausal women.HRT helps to relieve menopausal symptoms and has also been shown to prevent osteoporosis.Although most observational studies have showed that HRT can reduce the risks of cardio-cerebrovascular diseases, the subsequent randomized controlled trials were inconsistent with the results.This article reviews the relationship between HRT and stroke from drug type, route of administration, estrogen dosage, and initiation time.

13.
Article in Chinese | WPRIM | ID: wpr-617792

ABSTRACT

Objective:To evaluate the prognosis of non-small cell lung cancer (NSCLC) patients with pleural dissemination after differ-ent surgical interventions. Methods:We retrospectively reviewed clinical and survival data of 153 NSCLC patients with pleural dissemi-nation who were diagnosed and treated in our hospital from May 2002 to May 2011. Results:The overall 3-and 5-year survival rates of all the patients are 38.5%and 24.2%, respectively, with a median survival time (MST) of 29.0 months. A total of 122 patients accept-ed primary tumor resection whereas the remaining 31 received pleural biopsy. The 5-year survival rate of the primary tumor resection group was 26.2%with a MST of 29.0 months and 16.1%for the pleural biopsy group with a MST of 24.0 months. The survival analysis showed no significant differences in the prognosis between the primary tumor resection and pleural biopsy groups (P>0.05). In the pri-mary tumor resection group, different surgical interventions (with or without lymph nodes dissection, with or without metastatic nod-ules resection, lobe, or partial lobe resection) had no effect on prognosis (P>0.05). Conclusion:Patients with pleural dissemination had poor prognosis. Different surgical interventions showed no survival benefits for patients with NSCLC regarding pleural dissemination. The role of surgery was to rule out or confirm pleural dissemination. The definite value of surgery still needs further exploration.

14.
Article in Chinese | WPRIM | ID: wpr-809487

ABSTRACT

Objective@#The present study was designed to evaluate the protective effects of oligomeric proanthocyanidins (OPC) in mice exposed to paraquat (PQ) , and to explore the molecular mechanism.@*Methods@#Four experimental groups were designed. Control group: 10 BALB/c mice were intraperitoneally injected with normal saline) . PQ group: 10 BALB/c mice were intraperitoneally injected with PQ (100 mg/kg) . PQ+OPC group: 10 BALB/c mice were administered with OPC (100 mg/kg) for 1 h before PQ (100 mg/kg) expo-sure. OPC group: 10 BALB/c mice were intraperitoneally injected with OPC (100 mg/kg) . The peripheral blood samples or lung tissue samples were collected at the designed time points for measuring the levels of oxi-dative stress indicators, the related protein levels of nuclear factor-kappa B (NF-κB) pathway and nuclear fac-tor erythroid related factor-2 (Nrf2) pathway.@*Results@#Compared with the control group, the level of reactive oxygen species (ROS) , the content of malondialdehyde (MDA) in the PQ group were significantly induced, and the activity of superoxide dismutase (SOD) in the PQ group was decreased in the peripheral blood. As com-pared with the PQ group, the level of ROS and the content of MDA in the PQ+OPC group were significantly re-duced, the activity SOD in the PQ+OPC group was increased in the peripheral blood; the level of ROS and the content of MDA were also reduced in lung tissues in the PQ+OPC group. Moreover, compared with the con-trol group, the phosphorylation of IκBα and the expression of NF-κB p65 were increased in lung tissues in the PQ group. The phosphorylation of IκBα and the expression of NF-κB p65 were decreased in lung tissues in the PQ+OPC group as compared with the PQ group. In addition, compared with the control group, the expressions of HO-1 and Nrf2 were increased in lung tissues in OPC group, and these were decreased in lung tissues in PQ groups. Furthermore, the expressions of HO-1 and Nrf2 were also increased in lung tissues in PQ+OPC as com-pared with the PQ group.@*Conclusion@#OPC could alleviate PQ-induced systemic toxicity in mice by regulating oxidative stress via NF-κB and Nrf2 pathway.

15.
Chinese Journal of Oncology ; (12): 732-736, 2017.
Article in Chinese | WPRIM | ID: wpr-809438

ABSTRACT

Objective@#To investigate the efficacy of tyrosine kinase inhibitor (TKI) treatment on non-small cell lung cancer (NSCLC) patients with postoperative recurrence who harbored uncommon EGFR mutations, and discuss the relationship between TKI treatment and prognosis.@*Methods@#A total of 39 relapsed NSCLC patients after surgery with EGFR uncommon mutations who were detected at Cancer Hospital, Chinese Academy of Medical Sciences between January 1999 and December 2013 were retrospectively analyzed in this study. Twenty patients were treated with EGFR-TKI after recurrence and 19 cases were not. The clinical characteristics of patients with EGFR uncommon mutations were evaluated, and the prognosis of TKI-treatment group and non-TKI treatment group was compared.@*Results@#In 39 relapsed NSCLC patients with EGFR uncommon mutations, insertion mutations and point mutations were included. The highest frequency of EGFR uncommon mutation happened in exon 20 (20/39, 51.3%). A total of 13 uncommon point mutations were detected in exon 18, 20 and 21. The most frequent rare point mutations located in exon 21, and there were 7 different point mutation sites in exon 21. G719S/C/A mutation in exon 18 was the most common type of point mutation (14/25, 56.0%). Survival after postoperative recurrence in TKI treatment group was obviously better than that in non-TKI treatment group, the median time after recurrence were 44 months and 23 months, respectively (P=0.044). However, the postoperative overall survival showed no differences between two groups (48 months vs 43 months, P=0.129).@*Conclusion@#NSCLC patients with postoperative recurrence who harbored rare EGFR mutations should be treated with TKI agent.

16.
Chinese Journal of Surgery ; (12): 451-454, 2017.
Article in Chinese | WPRIM | ID: wpr-808811

ABSTRACT

Objective@#To evaluate the safety and effectiveness of the Endurant stent graft for abdominal aortic aneurysm cases with proximal neck length <10 mm.@*Methods@#This study was a retrospective analysis. From January 2010 to May 2015, 22 consecutive abdominal aortic aneurysm patients with proximal neck length <10 mm were treated with endovascular aortic repair by Endurant stent graft in Department of Vascular Surgery, Zhongshan Hospital, Fudan University. There were 19 (86.3%) male cases, aging from 57 to 84 years. All patients underwent preoperative CT angiography and the anatomic parameters of abdominal aortic aneurysm were measured. All patients performed standard endovascular aortic repair first and if there was obvious proximal typeⅠ endoleak, the CUFF or the chimney technology were applied to observed the perioperative technical and the clinical success rate. During follow-up, the incidence of adverse events and the reintervention rate were observed.@*Results@#These 22 cases had proximal neck length 5 to 9 mm with the average of (7.2±1.4) mm. Immediate endoleak occurred in 5 patients with 4 cases of proximal typeⅠ endoleak, 3 cases were implanted proximal CUFF, 1 case implanted CUFF and left renal artery chimney. One case died perioperatively, the clinical success rate was 95.4%, the technical success rate was 77.3%. During the follow-up of 6 to 54 months, there was 1 case with delayed proximal type-1 endoleak, during operation the patient had no endoleak, but disappeared 6 months later without further intervention. So the incidence of adverse event was 4.5% and reintervention rate was 0.@*Conclusion@#The Endurant stent graft for abdominal aortic aneurysm cases with proximal neck length < 10 mm is safe and effective.

17.
Clinical Medicine of China ; (12): 811-813,814, 2016.
Article in Chinese | WPRIM | ID: wpr-604680

ABSTRACT

Objective To discuss clinical characteristics and surgical treatment of patients with pulmo?nary inflammatory myofibroblastic tumor(PIMT). Methods From April 2010 to June 2015 in Beijing Tiantan Hospital Affiliated to Capital Medical University, there were 15 cases patients diagnosed as PIMT and trea?ted. The clinical datas of the patients were analyzed retrospectively. The main clinical manifestations,pathological results,clinical treatment and prognosis of the patients and follow?up outcome were analyzed. Results There were 10 males and 5 females,at the age of 39 to 6 8 years old with the median age of 52. Among the 15 cases of patients with PIMT,1 case was recurrence,14 cases were initial treatment. The treatment reason was due to the abnormal physical examination,or cough and sputum with blood,or chest pain,or chest tightness or fever. Chest CT showed that the mass was round or class round, lobulated, part of them showed the burr shape edge. Immunohistochemistry showed that Vimentin positive and smooth muscle actin positive. All patients accept?ed the open chest or thoracoscope surgery. The main operations concluded partial resection,lobectomy or lobecto?my with lymph node eradication. No perioperative death occured,no complications such as postoperative bleed?ing,bronchial pleural fistula and other complications happened. The average follow?up time was from 8 to 58 months. Follow?up rate was 100. 0%(15/15). There was no tumor recurrence. Conclusion The clinical mani?festations of the pulmonary inflammatory myofibroblastic tumor is complex. The PIMT should be confirmed by pathologic examination,the main treatment is surgical resection with good prognosis and lower recurrence.

18.
Cancer Research and Clinic ; (6): 679-682, 2016.
Article in Chinese | WPRIM | ID: wpr-503154

ABSTRACT

Objective To compare the efficacy of laparoscopic and conventional open total mesorectal excision (TME) in the treatment of rectal cancer, and to explore the considerations of laparoscopic TME. Methods 75 cases of laparoscopic group and 61 cases of open surgery group were analyzed retrospectively, and cohort study was used to compare the perioperative indicators and clinicopathological results in the two groups. Results Between the laparoscopic group and the open surgery group, the operative incision [8.7 cm (8.0-10.0 cm) vs. 13.6 cm (10.0-16.0 cm)], the use of postoperative analgesics (8 cases vs. 23 cases), postoperative time to remove the drainage tube [5 d (5-6 d) vs. 6 d (6-8 d)], postoperative time to get out of bed [3 d (3-7 d) vs. 5 d (4-8 d)] and postoperative hospital stay time [6 d (5-18 d) vs. 8 d (6-25 d)] had statistical difference (all P<0.05). The cost of laparoscopic group was higher than that of open surgery group (each patient in laparoscopic group spent more about 7 000 yuan than ones in open surgery group ). There was a significant difference in the overall complication rate between the laparoscopic group and the open surgery group [6.7 % (5/75) vs. 13.1 % (8/61), P<0.05]. Conclusions The postoperative analgesics, removal of drainage tube time, hospital stay and other indicators in the laparoscopic TME are superior compared with those in the open surgery, but due to the use of high-value consumables, the cost of laparoscopic surgery is higher. Besides, laparoscopic resection of rectal cancer should be careful.

19.
Chinese Journal of Oncology ; (12): 530-533, 2015.
Article in Chinese | WPRIM | ID: wpr-286785

ABSTRACT

<p><b>OBJECTIVE</b>Video-assisted thoracoscopic (VATS) esophagectomy has been performed for more than 10 years in China. However, compared with the conventional esophagectomy via right thoracotomy, whether VATS esophagectomy has more advantages or not in the lymph node (LN) dissection and prevention of perioperative complications is still controversial and deserves to be further investigated. The aim of this study was to explore whether there are significant differences in this issue between the two surgical modalities or not.</p><p><b>METHODS</b>The results of lymph node dissection and perioperative complications as well as other parameters in the patients treated by VATS esophagectomy and those by conventional esophagectomy via right thoracotomy at our department from May 1, 2009 to July 30, 2013 were compared using SPSS 16.0 in order to investigate whether there was any significant difference between these two treatment modalities in the learning curve stage of VATS esophagectomy.</p><p><b>RESULTS</b>One hundred and twenty-nine cases underwent VATS esophagectomy between May 1, 2009 and July 30, 2013, and another part 129 cases with the same preoperative cTNM stage treated by conventional esopahgectomy via right thoracotomy were selected in order to compare the results of lymph node dissection and perioperative complications as well as other parameters between those two groups of patients. There were no significant differences in the sex, age, lesion locations and cTNM stage between these two groups. The total LN metastatic rate in the VATS esophagectomy group was 35.7% and that of the conventional esophagectomy group was 37.2% (P > 0.05). The total average number of dissected lymph nodes was 12.1 vs. 16.2 (P < 0.001). The average dissected LN stations was 3.2 vs. 3.6 (P = 0.038). The total average number of dissected LN along the left recurrent laryngeal nerve was 2.0 vs. 3.7 (P = 0.012). The total average number of dissected LN along the right recurrent laryngeal nerve was 2.9 vs. 3.4 (P = 0.231). However, there was no significant difference in the total average number of dissected LN in the other thoracic LN stations, and in the perioperative complications between the two groups. The total postoperative complication rate was 41.1% in the VATS group versus 42.6% in the conventional group (P = 0.801). The cardiopulmonary complication rate was 25.6% vs. 27.1% (P = 0.777). The death rate was the same in the two groups (0.8%). The VATS group had less blood infusion (23.2% vs. 41.8%, P = 0.001) and shorter hospital stay (15.9 days vs. 19.2 days, P = 0.049) but longer operating time (161.3 min vs. 127.8 min, P < 0.01).</p><p><b>CONCLUSIONS</b>In the learning curve stage of VATS esophagectomy, compared with the conventional esophagectomy, less LN number and stations can be dissected in the VATS group due to un-skillful VATS manipulation, especially it is more difficult in the LN dissection along the left recurrent laryngeal nerve. Therefore, it is more suitable to select patients with early esophageal cancer without obvious enlarged lymph nodes for VATS esophagectomy in the learning curve stage.</p>


Subject(s)
China , Esophageal Neoplasms , Pathology , General Surgery , Esophagectomy , Methods , Humans , Learning Curve , Length of Stay , Lymph Node Excision , Methods , Lymph Nodes , Operative Time , Postoperative Complications , Epidemiology , Recurrent Laryngeal Nerve , Thoracic Surgery, Video-Assisted , Thoracotomy
20.
Chinese Journal of Oncology ; (12): 53-58, 2014.
Article in Chinese | WPRIM | ID: wpr-328999

ABSTRACT

<p><b>OBJECTIVE</b>To evaluate and compare the value of stair climbing tests and conventional pulmonary function tests in the prediction of postoperative cardiopulmonary complications in non-small cell lung cancer patients underwent surgery.</p><p><b>METHODS</b>From April 1, 2010 to Jan. 30, 2012, a total of 162 patients with thoracic carcinoma underwent stair climbing test (SCT) and conventional pulmonary function tests (PFT) preoperatively. The correlation of postoperative cardiopulmonary complications with the SCT and PFT parameters were analyzed retrospectively using chi-square test, independent sample t test and binary logistic regression analysis.</p><p><b>RESULTS</b>Of the 162 patients, 19 without operation were excluded, due to an advanced stage (9 cases), poor cardiopulmonary function (5 cases), rejecting operation (4 cases) and exploration alone (1 case). 143 cases were eligible and evaluated eventually. Forty-one of the 143 patients (28.7%) had postoperative cardiopulmonary complications, but no death occurred. The patients were stratified into groups based on the time of stair climbing 5 stories (18.36 m, t, <92 s, ≥ 92 s). Exercise oxygen desaturation (EOD) during the stair climbing test (<5%, ≥ 5%) and the difference between the pulse at resting state and the pulse at end of stair climbing test (ΔP, <55 beats/min, ≥ 55 beats/min), respectively. The rate of postoperative cardiopulmonary complications was significantly higher in the group with t ≥ 92 s, EOD ≥ 5% and ΔP < 55 beats/min (38.5%, 42.0% and 35.1%, respectively) than that in the group with t<92 s, EOD<5% and ΔP ≥ 55 beats/min (16.9%, 21.5% and 18.2%, respectively). Binary logistic regression analysis showed that postoperative cardiopulmonary complications were independently correlated with EOD and lung function which did not meet the requirement of the lung resection operation mode.</p><p><b>CONCLUSIONS</b>A symptom-limited stair climbing test is a safe, simple and low-cost method to evaluate the cardiopulmonary function preoperatively. It can predict the occurrence of postoperative cardiopulmonary complications in non-small cell lung cancer patients. Conventional pulmonary function tests and stair-climbing test can be recommended to be routinely performed in all patients with non-small cell lung cancer before thoracic surgery.</p>


Subject(s)
Carcinoma, Non-Small-Cell Lung , General Surgery , Exercise Test , Humans , Lung Neoplasms , General Surgery , Postoperative Complications , Diagnosis , Respiratory Function Tests , Retrospective Studies
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