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AIM: To investigate the efficacy of valve removal technology in improved endoscopic dacryocystorhinostomy.METHODS: Prospective randomized controlled study. A total of 92 patients(98 eyes)with nasolacrimal duct obstruction who underwent endoscopic dacryocystorhinostomy in our hospital from November 2020 to September 2022 were selected as the study subjects and they were randomly divided into group A(traditional group)and group B(improved group). The nasal mucosal flap was preserved after incision of the nasal mucosa in group A, the lacrimal sac flap and nasal mucosal flap were trimmed to an appropriate shape after the incision of the lacrimal sac, and the lacrimal sac flap the nasal mucosal flap were matched up. Group B made a “□” shaped incision on the nasal mucosa to remove the complete square nasal mucosa tissue. After the lacrimal sac was incised, the lacrimal sac mucosa was preserved as much as possible, and then the residual nasal mucosa was trimmed to make the lacrimal sac flap close to but not in contact with the residual nasal mucosa. Furthermore, the intraoperative bleeding volume and surgical duration of two groups of patients were recorded, and follow up until 3 mo postoperative. Nasal endoscopy and lacrimal duct flushing examinations were performed at 1 and 3 mo postoperative, respectively. The proliferation of granulation tissue within 5 mm of the ostial postoperative and the therapeutic effect were observed.RESULTS: At 3 mo postoperatively, 6 patients(7 eyes)who were lost to follow-up were excluded. A total of 44 eyes were included in group A, and 47 eyes were included in group B. The bleeding volume [27.00(22.00, 41.00)mL] and the surgical duration [35.00(33.00, 42.00)min] in group B were significantly lower than those in the group A(P<0.001). At 1 mo postoperatively, granulation tissue hyperplasia was observed within 5 mm of the ostial in 12 eyes of group A. In group B, granulation tissue hyperplasia was observed within 5 mm of the ostial in 1 eye. At 3 mo postoperatively, there were 9 eyes in group A with ostial adhesions but incomplete closure, and 2 eyes with complete closure; group B had 1 eye with mild adhesions at the ostial site and no ostial closure. The postoperative complications in the group B were significantly less than those in the group A(P<0.05), and the therapeutic effect was better than that in the group A(P<0.05).CONCLUSION: The application of valve removal technology in improving endoscopic dacryocystorhinostomy not only significantly reduces intraoperative bleeding and surgical duration, but also effectively reduces postoperative complications and improves surgical efficacy.
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To investigate the value of head and neck CT angiography(CTA)in the evaluation of intraoperative hemorrhage of carotid body tumours. Head and neck CTA images of 36 patients with carotid body tumours confirmed by pathology were retrospectively analyzed.Patients were divided into two groups based on the intraoperative bleeding volume:<500 ml and≥500 ml groups.The patient's age,sex,Shamblin classification,size of the lesion,number of blood supply arteries,course of the disease,plain scan,and enhanced CT value between two groups were compared and analyzed.Logistics regression equation was established based on the CTA parameters with significant differences between the two intraoperative bleeding volume groups,and combined parameter was acquired.The receiver operating characteristic curve was established based on CTA single and combined parameters. The bleeding volume during the operation of carotid body tumors was significantly correlated with the age of patients(=0.019),the maximum diameter of tumours on axial images(=0.003),the maximum upper and lower diameters(=0.004),Shamblin classification(=0.012),and number of blood supply arteries(<0.001).The area under the receiver operating characteristic curve of the number of feeding arteries,the maximum diameter of axial images,maximum upper and lower diameters,Shamblin classification,and combined parameters were 0.865,0.781,0.806,0.766,and 0.927,respectively.When the optimal critical value was 0.408,the Youden index was 0.794,and the corresponding accuracy,sensitivity,and specificity were 0.919,0.909,and 0.923,respectively. Preoperative head and neck CTA can be used to evaluate the intraoperative blood loss.Combined parameters has the best diagnostic performance compared with single parameters.
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Humans , Carotid Body Tumor , Diagnostic Imaging , Computed Tomography Angiography , Head , Neck , Retrospective StudiesABSTRACT
BACKGROUND: It is still lack of sufficient clinical evidence whether the patients can benefit from the routine use of elastic bandages after total knee arthroplasty. OBJECTIVE: To explore whether the use of elastic compression bandage after first total knee arthroplasty is beneficial to the prognosis of patients. METHODS: Totally 60 knee osteoarthritis patients who received bilateral knee arthroplasty in the Department of Joint Surgery, West Coast Hospital Branch of Affiliated Hospital of Qingdao University were selected from September 2017 to September 2018. One limb of the patient was covered with a general surgical dressing, while an elastic bandage was applied from the instep to the middle of the thigh (elastic compression bandage group). One limb was covered only with a general surgical dressing (control group). All patients signed the informed consent. The study was approved by the Hospital Ethics Committee. Circumference (thigh, knee and calf), flexural activity (range of motion) and visual analogue scale of the lower extremities were measured at 1, 2, 3 and 7 days after the operation by professionals who were not involved in patient management. Drainage volume 24 hours after operation and the occurrence of complications within 30 days after operation were recorded. RESULTS AND CONCLUSION: (1) At 1, 2, 3, and 7 days after surgery, circumference of thigh, knee and calf was smaller in the elastic compression bandage group than in the control group. Range of motion of the knee was better in the elastic compression bandage group than in the control group (P < 0.001). (2) At 1 and 2 days after surgery, resting visual analogue scale scores were higher in the elastic compression bandage group than in the control group (P < 0.001). At 7 days, resting visual analogue scale scores were lower in the elastic compression bandage group than in the control group (P < 0.001). No significant difference in visual analogue scale scores was found between the two groups at 3 days. Sports visual analogue scale scores in the elastic compression bandage group were higher than in the control group at 1 and 2 days (P < 0.001). However, no significant difference in sports visual analogue scale scores was detected between the two groups at 3 and 7 days. (3) There was no difference in wound-healing complications between the two groups, but the sample size was too small for meaningful statistical analysis. (4) There was a statistically significant difference in drainage volume between the two groups at 24 hours after surgery. (5) No deep infection, venous thrombosis or reoperation occurred within 30 days. (6) It is concluded that the application of elastic compression bandage from the instep to the middle of the thigh after the first total knee arthroplasty can effectively reduce the swelling of the operative limb and postoperative blood loss, increase the flexion and extension of the operative limb, which is conducive to the rapid recovery after the operation. It is worth popularizing and applying.
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Objective: To explore the value of three-dimensional power Doppler ultrasound (3D-PDU) in predicting bleeding volume during cesarean surgery in patients with placenta previa. Methods: Clinical data of 141 patients with placenta previa who underwent 3D-PDU examinations before cesarean surgery and the bleeding volume during cesarean surgery were retrospectively reviewed. The patients were classified into implanted placenta previa group (n=66) and non-implanted placenta previa group (n=75). The differences of vascularization index (VI), flow index (FI), vascularization flow index (VFI) and bleeding volume were compared between the 2 groups, and the correlation was analyzed. ROC curve was used to evaluate the efficacy of each index in predicting bleeding volume during cesarean surgery. Results: Antenatal VI, FI, VFI and bleeding volume of the implanted placenta previa group were higher than those of non-implanted placenta previa group (all P<0.05). In all 141 patients, VI and VFI were positively correlated with the bleeding volume during cesarean surgery (r=0.702, 0.737, both P<0.001). In implanted placenta previa group, VI, FI and VFI were positively correlated with the bleeding volume in cesarean section (r=0.680, 0.492, 0.722, all P<0.001). In non-implanted placenta previa group, VI and VFI were positively correlated with the bleeding volume during cesarean surgery (r=0.861, 0.832, both P<0.001). The area under ROC curve of VI, FI and VFI in all 141 patients were 0.911, 0.798 and 0.937 (all P<0.001), in implanted placenta previa group were 0.966, 0.722 and 0.938 (all P<0.05), while in non-implanted placenta previa group were 0.885, 0.856 and 0.966, respectively (all P<0.001). Conclusion: Antenatal 3D-PDU can be applied in predicting bleeding volume in patients with placenta previa during cesarean surgery.
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Objective To evaluate the perioperative blood loss and blood transfusion in liver transplantation patients.Methods Retrospectively selected and classified 119 patients with liver transplantation medical recordsaccording to the clinical diagnosis of age,gender.Analyzed (disease)patients' blood coagulation index 24 h before surgery,intraoperative and postoperative perioperative bleeding,and blood red blood cell suspension,frozen plasma,cold precipitation,coagulation factor injection lossplateletpheresis.Results There were no significant differences in the amount of blood loss and the amount of blood preparations duringthe perioperative period of liver transplantation according to the age and sex of patients (P＞0.05);According to the clinical diagnosis of different groups,the diagnostic group (primary liver cancer group,hepatitis B cirrhosis group and severe hepatitis group) patients with a single platelet transfusion dosewas similar (P＞0.05)withsuspended red blood cells (U) at 8.4+11.9,16.2+15.7,18.1+13.5,frozen plasma (U) at 8.2+7.1,18.1+15.6 and 18.2+ 17.9 respectively andcold precipitation (U) at 9.5+ 8.2,17.1 + 16.318.5 + 16.4 (P＜ 0.05);The diagnosis group surgery before and after immediate PT (s) were 15.6+3.8,24.6+4.1,APTT (s) were 44.3+5.8,84.9+9.2,TT (s) were 20.4 +4.5,40.1+6.2,and Fib(s) were 2.6+0.8 and 1.3+0.9 (P＜0.05);however,there was no significant difference in the 24 h PT,APTT,TT and Fib between the two groups after diagnosis (P＞0.05).Conclusion Ascientific,safe and reasonable selection of perioperative blood preparation for clinical diagnosis for different liver transplantation patients is critical to the success rate and prognosis of liver transplantation;the evaluation of coagulation indexes at each interval can help guiding the blood transfusion during liver transplantation.
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Objective To assess the effect and safety of intraarticular infusion combined with intravenous injection of tranexamic acid on hemorrhage in patients underwent total knee replacement (TKR).Methods A total of 180 patients who underwent TKR in the People's Hospital of Hebi City from January 2014 to January 2017 were selected.The patients were divided into control group,low dose group and high dose group according to the tranexamic acid dose,60 cases in each group.All patients were treated with tranexamic acid 10 mg · kg-1 by intravenous drip within one hour before operation.After the incisions were sutured,the patients in the control group were treated with physiological saline 100 mL by intraarticular infusion,the patients in the low dose group and high dose group received intraarticular infusion of tranexamic acid 1 and 2 g respectively,the drainage tube was opened after one hour's occlusion.The operation time,hemoglobin level,postoperative blood loss,total blood loss and complications were observed and recorded.Results There was no significant difference in hemoglobin level in the three groups before operation (P ＞ 0.05).The hemoglobin level in the high dose group was significantly higher than that in the low dose group and the control group (P ＜ 0.05),but there was no significant difference in hemoglobin level between the low dose group and the control group at one day after operation (P ＞ 0.05).The hemoglobin level in the low dose group and the high dose group was significantly higher than that in the control group (P ＜ 0.05),and it in the high dose group was significantly higher than that in the low dose group at two days after operation (P ＜ 0.05).There was no significant difference in the operation time in the three groups (P ＞ 0.05).The postoperative blood loss and total blood loss in the low dose group and the high dose group were significantly lower than those in the control group (P ＜ 0.05),and them in the high dose group were significantly lower than those in the low dose group (P ＜ 0.05).The incidence of complications in the control group,low dose group and high dose group was 8.33％ (5/60),10.00％ (6/60) and 8.33％ (5/60) respectively,there was no significant difference in the incidence of complications among the three groups (x2 =0.100,P ＞ 0.05).Conclusion Intraarticular infusion combined with intravenous injection of tranexamic acid can effectively reduce blood loss in patients with TKR.Increasing the dose of intraarticular infusion of tranexamic acid within a certain range can further improve the hemostatic effect,and it does not increase the complications.
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Objective To explore comparison between methotrexate and uterine arterial embolization in β-HCG, bleeding volume and success rate of women with cesarean scar pregnancy after cesarean section.Methods 42 patients who were diagnosed with cesarean scar pregnancy after cesarean section were collected.All patients were randomly divided into uterine arterial embolization group and methotrexate group,21 cases in each group corresponding treatment were given respectively, after the treatment, the serum levels of β-HCG, bleeding volume and success rate were detected in all patients.Results After treatment, compared with methotrexate group, the serum level ofβ-HCG was lower in the uterine arterial embolization group,and the difference was statistically significant(P<0.05); the bleeding volume was lower in the uterine arterial embolization group(P<0.05); the success rate was higher in the uterine arterial embolization group(P <0.05).Conclusion Compared with methotrexate,the uterine arterial embolization can significantly reduce the serum level ofβ-HCG in patients with cesarean scar pregnancy after cesarean section,reduce the amount of bleeding, improve the success rate of treatment.
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PURPOSE: We evaluated the bleeding volume after surgery for trochanteric fractures of the femur in patients treated with antiplatelet agents according to surgical timing. MATERIALS AND METHODS: We selected 20 patients who had trochanteric fractures of the femur treated with antiplatelet agents from January 2009 to June 2010. Group I included 9 patients who discontinued antiplatelet medication and had delayed operations at an average of 6.5 days and Group II included 11 patients who underwent early operations within 24 hours. Group I included 2 males and 7 females; their average age was 77.8 years (range 59~86). Group II included 4 males and 7 females, with an average age of 73.5 years (range 61~84). We compared the two groups' volume of intraoperative bleeding, the preoperative and postoperative hemoglobin levels and the volume of postoperative transfusion. The Mann-Whitney U test was used for statistical analysis. RESULTS: The volume of intraoperative bleeding was 88 ml in group I and 106 ml in group II (p>0.01). The difference in the hemoglobin was a decrease of 2.4 mg% in group I and a decrease of 2.2 mg% in group II (p>0.01). The volume of postoperative transfusion was 0.6 pints in group I and 1 pint in group II (p>0.01). CONCLUSION: We found a similar bleeding volume regardless of operative timing after surgery for trochanteric fractures of the femur in patients treated with antiplatelet agents.