ABSTRACT
Hepatectomy is a major radical treatment for liver cancer. Although the hepatectomy is of great difficulty for the complicated anatomical structure and rich blood supply of liver, the operative mortality is less than 5% in most treatment centers currently along with the upgrading surgical instruments and developing surgical technology. Nevertheless, it is urgent clinical topic to furtherly reduce the incidence of complication in the wake of hepatectomy, which reaches up to 15%~50%. To standardize the peri-operative management of hepatectomy, on the basis of the standardization for diagnosis and treatment of primary hepatic carcinoma (2019), the Cancer Prevention and Treatment Expert Committee revise and update to produce the expert consensus on the peri-operative management of hepatectomy for liver cancer (2021) according to the opinions of experts in different areas. This consensus takes account of the Chinese characteristics of diagnosis and treatment of liver cancer and follows the concept of enhanced recovery after surgery (ERAS), which will provide reference for the peri-operative management.
Subject(s)
Humans , China , Consensus , Hepatectomy , Liver Neoplasms/surgeryABSTRACT
Objective To contribute the patient-centered nursing mode and discuss its influence on stress reaction at peri-operational period and postoperative rehabilitation of emmergency surgical patients. Methods A total of 108 emergency surgery patients admitted to Xiangyang No.1 People's Hospital Affiliated of Hubei University of Medicine from January 2014 to January 2017 were enrolled as research subjects, and they were divided into an observation group and a control group according to difference in nursing modes, 54 cases in each group. During the peri-operational period, the patients in control group were given routine nursing mode, while in the observation group, the patients received patient-centered nursing mode. The blood pressure, heart rate and levels of various kinds of hormone (insulin, cortisol, epinephrine) and interleukin-6 (IL-6) before and after intervention were measured; the Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) were used to evaluate the psychological stress changes; after operation, the rate of using analgesics, incidence of postoperative infection, Visual analogue scale (VAS), anus exhaust time, off-bed activity time and sleep quality scale scores were recorded to evaluate the quality of patients' postoperative rehabilitation. Results The diastolic blood pressure, systolic blood pressure, heart rate and levels of insulin, cortisol and IL-6 in two groups before operation and 2 hours after operation were significantly higher than those on admission, while the levels of epinephrine were lower than the level on admission, the degrees of increase or decrease of the observation group were slower than those of the control group, and the changes were more significant at 2 hours after operation [diastolic blood pressure (mmHg, 1 mmHg = 0.133 kPa) was 120.58±13.09 vs. 135.35±15.44, systolic blood pressure (mmHg) was 74.69±10.97 vs. 80.50±11.34, heart rate (bpm) was 83.47±11.64 vs. 92.59±12.00, insulin (mmol/L) was 12.58±1.62 vs. 15.96±1.46, cortisol (μg/L) was 128.72±20.53 vs. 140.47±21.58, epinephrine (ng/L) was 38.96±7.24 vs. 35.25±8.01, IL-6 (ng/L) was 157.64±27.06 vs.183.45±29.37, all P ＜ 0.05]. After interference, the HAMA and HAMD scores of the two groups were significantly lower than those before intervention, and the degree of decrease in the observation group was more obvious (HAMA score: 11.58±2.16 vs. 16.74±2.80, HAMD score: 9.42±2.03 vs. 13.38±2.71, both P ＜ 0.05); the rate of using analgetic [25.93% (14/54) vs. 57.41% (31/54)], incidence of postoperative infection [3.70% (2/54) vs. 16.67% (9/54)], VAS scores (4.63±1.21 vs. 6.87±1.74), anus exhaust time (days: 1.53±0.33 vs. 1.86±0.26), off-bed activity time (days: 1.57±0.19 vs. 1.72±0.24) and sleep quality scale scores (5.84±2.07 vs. 9.33±2.39) in observation group were significantly less than those in control group (all P ＜ 0.05). Conclusion The contribution and application of patient-centered nursing mode in treating emmergency surgery patients during peri-operational period is helpful to ameliorate the patients' degree of physiological and psychological stress reactions, and this mode has important significance in promoting the quality of patients' postoperative rehabilitation.
ABSTRACT
Objective: To assess the risk factors for peri-procedural myocardial infarction (PMI) occurrence in patients after percutaneous coronary intervention (PCI) based on the new standard of US Society for cardiovascular angiography and interventions (SCAI). Methods: According to SCAI standard, a total of 3371 relevant patients with 3516 elective PCI in our hospital were enrolled. The baseline clinical features, coronary angiography (CAG) findings and PCI procedural elements were retrospectively studied, the independent risk factors for PMI occurrence were identified by multivariate Logistic regression analysis. Results: There was 108/3516 (3.1%) PMI occurred in all patients. Multivariate Logistic regression analysis presented that age (OR=1.037, 95% CI 1.016-1.058), treating multi-vessel lesions (OR=1.697, 95% CI 1.095-2.629), treating at least 1 bifurcation lesion (OR=1.869, 95% CI: 1.213-2.878) and the total length of lesion (OR=1.016, 95%CI 1.009-1.024) were the independent risk factors for PMI occurrence. Conclusions: Age, treating multi-vessel lesions, at least one bifurcation lesion and the total length of lesion were the independent risk factors for PMI occurrence in patients after elective PCI.
ABSTRACT
Objective To evaluate the effect of multidisciplinary intervention on antimicrobial prophylaxis in neurosurgical patients undergoing craniotomy for tumor resection.Methods By standardizing preoperative disinfection and surgical procedures, training and education of antimicrobial use, conducting quality control activities, and performing periodic feedback of supervised results, efficacy of improvement of antimicrobial prophylaxis in neurosurgical patients undergoing craniotomy for tumor resection in a hospital was observed.Results In 2013 and 2014, incidences of surgical site infection(SSI) were 7.66%(17/222)and 6.80%(27/397) respectively,there was no significant difference between two groups(X2 =0.158,P>0.05).Prophylactic use of antimicrobial agents in surgical patients were as follows: cefuroxime(n=495), cefazolin(n=103), cefathiamidine(n=9), clindamycin(n=8), and cefotaxime(n=4), types of used antimicrobial agents were rational.In 2014, the implementation rate of necessary intra-operative antimicrobial adding was 95.02%, which was higher than 87.66% in 2013(X2=7.969,P48 hours, which was lower than 57.66% in 2013, difference was significant(X2=42.88,P<0.05).Conclusion Multi-intervention measures, including standard preoperative disinfection and surgical procedures, education and training, quality control circle, and feedback of supervised results can improve standard antimicrobial prophylaxis in neurosurgical patients undergoing craniotomy for tumor resection.
ABSTRACT
Objective To propose SHA.LIN nephrolithometry scoring system for assessing and predicting the stone-free rate of percutaneous nephrolithotomy ( PCNL) and to investigate the clinical value of SHA.LIN scoring system for nephrolithiasis in patients undergoing PCNL .Methods A literature review from 1976 to 2014 was performed to identify clinically relevant and reproducible variables that could affect the outcomes of PCNL. Six reproducible variables available from preoperative noncontrast-enhanced computed tomography were measured , including stone size ( S) , hydronephrosis ( H) , anatomic distribution (A), length of tract(L), indicator of CT(I), number of involved calices(N) and was named as SHA.LIN nephrolithometry scoring system .A retrospective analysis was conducted of clinical data of 116 patients with nephrolithiasis undergoing PCNL from June 2011 to March 2015. The general conditions , preoperative information , stone characteristics and perioperative variables were collected . The correlation of nephrolithometry scores based on SHA.LIN scoring system with stone-free status, operation time, blood loss, length of hospital stay and postoperative complications were analyzed . Receiver operating characteristic ( ROC) curves was drawn to detect sensitivity and specificity of SHA .LIN score in predicting the stone-free rates of PCNL.Results The SHA.LIN score was 9.13 ±2.24 in this cohort.The stone free rate was 75.9%(88/116).Postoperative complications occurred in 32 (27.6%) cases.In those patients with stone free, the SHA.LIN score was 8.27 ±1.62, significantly lower than that in those patients with residual stones 11.86 ±1.72 ( t =-10.069, P=0.000) .The SHA.LIN score showed significant correlation with the postoperative stone free status, operation time, estimated blood loss (P0.05).The area under curve of ROC curves for the SHA.LIN scoring system was 0.923 ( 95%CI 0.870 -0.975 ) . Conclusions The SHA.LIN nephrolithometry scoring system can predict postoperative stone-free status of PCNL and can be used for disease related assessment.Further research is required to evaluate its performance in predicting peri-operative variables and postoperative complications .
ABSTRACT
Objective We used the method ot Meta analysis to evaluate the effect of the comfort care in Chinese patients with breast cancer in peri-operative period.Methods The randomized controlled trials on the comfort care in patients with breast cancer in peri-operative period were collected using the databases of China National Knowledge Infrastructure (CNKI),Wanfang Periodical Databases and Chinese Science Technology Periodical Databases which were analyzed by RevMan 5.3 software.Results Twelve randomized controlled trials were included in the study.The results of Meta-analysis revealed that the comfort care were effectively on anxiety condition,the degree of pain,the incidence rate of complicating diseases after surgery and degree of satisfaction on nursing than the conventional nursing,OR value and 95％CI were 0.26(0.13-0.50),9.98(6.00-16.61),0.24(0.13-0.42) and 4.74(2.84-7.90).Conclusions The comfort care can improve the state of anxiety,relieve the pain,reduce the postoperative complications and improve the degree of satisfaction of the patients.
ABSTRACT
Objective: To observe the liver function changes and to analyze the risk factors in patients at peri-operative period of cardiopulmonary bypass surgery. Methods: A total of 108 patients with cardiopulmonary bypass surgery were observed for their liver function at prior and 1, 2, 3, 6 days post-operation, the related risk factors for lever damage were studied by uni- and multivariate regression analysis. Results: Compared with pre-operative indexes,① at 1, 2, 3 and 6 days post-operation, aspartate aminotransferase (AST), direct bilirubin (DBIL) were increased, serum albumin (ALB), cholinesterase (CHE) were decreased, and at 1, 2, 3 days post-operation, total bilirubin (TBIL) was increased, at 1, 2, 3 days post-operation, alkaline phosphatase (ALP) was decreased, while it increased at 6 days post-operation, allP Conclusion: Multiterm of liver function could be damaged at the early stage after cardiopulmonary bypass surgery; cardiopulmonary bypass time and lactic acid level at 1 day after operation were the independent risk factors for peri-operative damage of liver function in relevant patients.
ABSTRACT
Objective To compare the efficacy of the radical resection by laparoscopy versus open approach in perioperative period on the patients with rectal carcinoma,and investigate the feasibility,safety and oncological clearance of the laparoscopy.Methods The clinical data of 44 patients who underwent radical resection of rectal carcinoma by laparoscopy in our hospital were reviewed and compared with another 53patients who underwent an open approach in the same period.The surgery-related data,postoperative recovery status,tumor radical resection index,and postoperative complications by laparoscopy were analyzed by statistics,and compared with those by open approach,and evaluated the deference of too kinds of operation.Results This study showed a longer surgical time (260.45 ± 67.46) min vs ( 179.25 ± 40.92) min,P ＜0.05,a less intra-operative blood loss( 125.20 ±61.80) mL vs ( 198.02 ± 131.24) mL,P ＜0.05,in laparoscopic group compared with open approach.Meanwhile,it also showed an earlier recovery of bowel functions for discharge gas from anus,taking in food,and out-of-bed activity (4.34 ± 1.55) d vs(5.45 ± 1.55) d,P ＜0.05,in the laparoscopic group compared with open approach.There was no statistical difference of incidence of post-operative complications (5 cases vs 11 cases,P ＞0.05) between the two groups and the laparoscopic approach was also equal to the open approach as regard to post-operative stay (15.34 ±6.62) d vs (16.82±5.73) d,P ＞0.05,and demand of intra-operative blood transfusion (4 case vs 8 cases,P＞0.05 ).Conclusions Compared with open surgery,the radical resection of rectal carcinoma by laparoscopy has shown obvious advantages in smaller incision,less blood loss,less pain,earlier recovery of bowel and bladder functions,and earlier out-of-bed activity.And it is also possible by laparoscopy approach to decrease the post-operative complications and post-operative stay.Meanwhile,there is no significant deference on oncological clearance for laparoscopy compared with open approach during perioperative period,while the long term follow-up data is still needed to support the results.
ABSTRACT
Objective To explore the complications and prevention for the peri-operative period of hepatic cancer arterial chemotherapy embolism (TACE). Methods 565 hepatic cancer sufferers' medical record through TACE therapy were analyzed retrospectively. Results The complications could be divided into three types according to complications genesic date:during the puncture and intubation,23 local hematomas, 14 arterial intima damnification; during the TACE operation period, 112 bellyache,242 spew,3 chough; after the TACE operation, 528 fever, 264 bellyache ,3 liver abscess,2 hepatorenal complication. The research results indicated that the most complications could be cured or lightened. Only 5 sufferers died within two weeks. Conclusion There were many kinds of complications during TACE operations, and the sufferers could get well and the complications could be effectively reduced if the nurse got along abortively during the whole operation.
ABSTRACT
@#ObjectiveTo evaluate the effect of rehabilitation nursing in the peri-operative period of the first-stage combined anterior-posterior approach surgery in the sacral tumor resection.Methods15 patients with sacral tumor received psychological intervention, gastrointestinal preparation, exercises of perineum sphincter contraction and relaxation training before the operation. Changes of patients' vital signs and nerve function were observed after the operation, and rehabilitation training and instruction were performed.ResultsAll cases were followed up for 2～37 months. Except one case died of tumor transfered to lung, all of other cases had a satisfactory curative effect in the near future, and their local symptom released and the functions of urination and defecation were kept well.ConclusionRehabilitation nursing in the peri-operative period plays an important role in surgical treatment of sacral tumor. It affects the rehabilitation and function restitution obviously and can reduce the occurrence of complication effectively.
ABSTRACT
Objective: To explore the psychological status and therapeutic efficacy of peri-operative psychological intervention among patients with oral carcinoma.Method: psychological statuses of 60 patients with oral carcinoma were investigated,and specific peri-operative psychological interventions were performed according to features and initiating factors of their psychological crisis,in order to provide references for the therapy of oral carcinoma.Result: Common psychological crises among patients with oral carcinoma such as anxiety and fear have been dramatically decreased by proper psychological investigation and peri-operative psychological intervention.Conclusion: Psychological investigation contributes to a great improvement of psychological status of patients with oral carcinoma.Therefore,in addition to routine peri-operative medical treatment,an effective psychological investigation is also crucial for patients with oral carcinoma to cure the disease and regain health.