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Abstract Introduction: Increasing abdominal pressures could affect pulmonary compliance and cardiac performance, a fact based on which the aim of the present study to detect the cardiopulmonary burden of multiple retractors application during supine versus lateral abdominal surgeries. We hypothesized that surgical ring multiple retractors application would affect the pulmonary and cardiac functions during both lateral and supine abdominal surgeries. Methods: Prospective observational comparative study on forty surgical patients subdivided into two groups twenty each, comparing pulmonary compliance and cardiac performance before, during and after retractors application, group (S) supine position cystectomy surgery, and group (L) lateral position nephrectomy surgery under general anesthesia, Composite 1ry outcome; dynamic compliance C-dyn and cardiac index CI and Other outcome variables ICON cardio-meter were also recorded. Results: C-dyn and C-stat were significantly decreased late during retractor application in lateral compared to supine surgery with significant decrease compared to basal values all over the surgical time. CI was significantly increased after retractor removal in both of the study groups compared to basal values. PAW P was significantly increased in -lateral compared to supine surgery -with significant increase compared to basal value all over the surgical time in both of the study groups. significant increase in DO2I compared to basal value during both supine and lateral positions. Conclusion: Surgical retraction results in a short-lived significant decreases in lung compliance and cardiac output particularly during the lateral-kidney position than the supine position compliance.
Subject(s)
Humans , Abdomen/surgery , Anesthesia, General/methods , Cardiac Output , Lung Compliance , Supine PositionABSTRACT
Neurosurgery is a highly specialized field: it often involves surgical manipulation of noble structures and cerebral retraction is frequently necessary to reach deep-seated brain lesions. There are still no reliable methods preventing possible retraction complications. The objective of this study was to design work chambers well suited for transcranial endoscopic surgery while providing safe retraction of the surrounding brain tissue. The chamber is designed to be inserted close to the intracranial point of interest; once it is best placed it can be opened. This should guarantee an appreciable workspace similar to that of current neurosurgical procedures. The experimental aspect of this study involved the use of a force sensor to evaluate the pressures exerted on the brain tissue during the retraction phase. Following pterional craniotomy, pressure measurements were made during retraction with the use of a conventional metal spatula with different inclinations. Note that, although the force values necessary for retraction and exerted on the spatula by the neurosurgeon are the same, the local pressure exerted on the parenchyma at the edge of the spatula at different inclinations varied greatly. A new method of cerebral retraction using a chamber retractor (CR) has been designed to avoid any type of complication due to spatula edge overpressures and to maintain acceptable pressure values exerted on the parenchyma.
Subject(s)
Humans , Brain/surgery , Neurosurgical Procedures/methods , Neurosurgery , Brain Neoplasms , EndoscopyABSTRACT
Objective:To investigate the application effects of self-developed rapid tracheotomy apparatus for acute tracheotomy.Methods:A total of 120 patients who underwent an acute tracheotomy in the Weihai Branch of The 970 Hospital of PLA Joint Logistics Support Force from January 2019 to December 2020 were included in this study. These patients were randomly divided into a rapid group and a conventional group, with 60 patients in each group. Patients in the rapid group underwent tracheotomy with a self-developed rapid tracheotomy apparatus. Patients in the conventional group underwent the standard steps of traditional tracheostomy. The operation time, incision length, amount of bleeding, and incidence of postoperative complications were compared between the two groups.Results:The operation time in the rapid group was significantly shorter than that in the conventional group [(4.5 ± 0.9) minutes vs. (19.3 ± 4.7) minutes, t = 23.86, P < 0.001]. The length of incision in the rapid group was significantly shorter than that in the conventional group [(2.8 ± 0.3) cm vs. (4.2 ± 1.3) cm, t = 8.68, P < 0.001]. The amount of bleeding during the surgery in the rapid group was significantly less than that in the conventional group [(4.4 ± 1.6) mL vs. (11.8 ± 4.1) mL, t = 12.99, P < 0.001]. The incidence of postoperative complications in the rapid group was significantly lower than that in the conventional group ( χ2 = 4.66, P = 0.031). Conclusion:The self-developed rapid tracheotomy apparatus for acute tracheotomy can be used to establish an artificial airway quickly and minimally invasively by simplifying the operational steps. It is remarkably innovative to increase safety with open-view operations and decrease the incidence of complications. It can be repeatedly sterilized and reused, which is worthy of clinical application and popularization.
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Pese a los avances de cirugía reconstructiva, el labio y paladara hendido unilateral (LPHU) representa un reto quirúrgico complejo cuando la brecha es mayor a 10 mm. En países de recursos limitados, la distancia geográfica, falta de centros de referencia multidisciplinarios, recursos económicos de las familias y actualmente, la pandemia; limita el acceso de pacientes al tratamiento prequirúrgico. El presente estudio descriptivo reporta 2 casos de LPHU completo, de similar tamaño por inspección visual profesional, sexo masculino, no asociados a síndrome. El propósito del mismo es hacer una revisión de dos técnicas de ortopedia prequirúrgica: Placa de Ortopedia Funcional Maxilar (OFM)-Moldeado Nasal (MN); y el Retractor Nasal (RN)-Taping, como alternativa de tratamiento a distancia. El paciente con placa OFM-MN fue tratado en el 2015, presencial, el paciente con RN-Taping, en el 2021 por telemedicina y un promotor de salud capacitado. Los resultados de simetría nasal y maxilar se midieron con software ImageJ, a través de 4 mediciones lineales y una angular, basadas en el método descrito por Barillas y de mediciones lineales realizadas a los modelos de yeso como las propuestas por Mazaheri. Las técnicas descritas para ambos pacientes lograron disminuir el ancho de la hendidura y moldear el cartílago alar del lado hendido. La técnica OFM-MN mostró ventajas en el desarrollo del arco maxilar promoviendo aumento de volumen de hueso y desarrollo en los tres planos del espacio sin colapso del arco. La técnica RN-Taping, restringió el arco maxilar, sin embargo, podría ser una alternativa de tratamiento a distancia.
Apesar dos avanços na cirurgia reconstrutiva, a fenda labiopalatina unilateral (LPHU) representa um desafio cirúrgico complexo quando o gap é maior que 10 mm. Em países com recursos limitados, distância geográfica, falta de centros de referência multidisciplinares, recursos econômicos das famílias e, atualmente, a pandemia; limita o acesso do paciente ao tratamento pré-cirúrgico. O presente estudo descritivo relata 2 casos de LPHU completa, de tamanho semelhante por inspeção visual profissional, do sexo masculino, não associada à síndrome. Seu objetivo é revisar duas técnicas ortopédicas pré-cirúrgicas: Placa Ortopédica Funcional Maxilar (OFM) - Moldagem Nasal (MN); e o Retrator Nasal (RN)-Taping, como alternativa de tratamento remoto. O paciente com placa OFM-MN foi atendido em 2015, pessoalmente, o paciente com RN-Taping, em 2021 por telemedicina e promotor de saúde treinado. Os resultados da simetria nasal e maxilar foram medidos com o software ImageJ, por meio de 4 medidas lineares e uma angular, com base no método descrito por Barillas e medidas lineares feitas nos modelos de gesso como os propostos por Mazaheri. As técnicas descritas para ambos os pacientes foram capazes de reduzir a largura da fenda e moldar a cartilagem alar do lado da fenda. A técnica OFM-MN apresentou vantagens no desenvolvimento do arco superior, promovendo aumento do volume ósseo e desenvolvimento nos três planos do espaço sem colapso do arco. A técnica RN-Tapingrestringiu a arcada superior, porém pode ser uma alternativa para tratamento remoto.
Despite the advances in reconstructive surgery, unilateral cleft lip and palate (UCLP) represents a complex surgical challenge when greater than 10 mm. In low resource settings, distance, lack of multidisciplinary centers, low income and currently, the pandemic; limits patients to access to presurgical treatment. This study reports 2 cases of complete UCLP, similar in size by professional visual inspection, male, not associated with any syndromes. The purpose is to review two presurgical orthopedic techniques: Maxillary Functional Orthopedic Plate (MFO) -Nasal Molding (NM) and Nasal Retractor (NR) -Taping as a teledentistry alternative. The patient with the FMO-NM plate was treated in 2015, in person; the NR-Taping patient, in 2021, by telemedicine and a trained health promoter. The results of nasal and maxillary symmetry were measured with ImageJ software, through 4 linear measurements and one angular, based on the method described by Barillas and linear measurements made on the plaster models such as those proposed by Mazaheri. The techniques described for both patients were able to reduce the width of the cleft and mold the alar cartilage on the cleft side. The OFM-MN technique showed advantages in the development of the maxillary arch by guiding growth and development in the three planes of the space without collapse of the arch. The NR-Taping technique restricted the maxillary arch but is an alternative to remote treatment
Subject(s)
Humans , Male , Surgery, Plastic , Cleft Lip , Cleft Palate , MaxillaABSTRACT
Objective:To investigate the effect of dynamic traction technique on postoperative complications, stress response and neurological function recovery in patients with petroclival meningioma undergoing microscopic resection.Methods:The clinical data of 80 patients with petroclival meningioma in Huanggang Central Hospital of Hubei Province from January 2017 to December 2019 were retrospectively analyzed. Among them, 38 cases were treated with automatic retractor technique (automatic traction group), and 42 cases were treated with dynamic traction technique (dynamic traction group). The operation time, postoperative hospital stay, postoperative complications of brain traction injury and the degree of Simpson tumor resection were compared between 2 groups. The levels of serum stress indexes before and after operation were detected, including C-reactive protein (CRP), interleukin-6 (IL-6) and white blood cell count (WBC). Karnofsky performance status (KPS) score was performed 6 months after operation, and the recovery rate of neurological function (KPS score≥80) and recurrence rate were counted.Results:There were no significant differences in operation time, postoperative hospital stay and the degree of Simpson tumor resection between 2 groups ( P>0.05). The incidence of postoperative complications of brain traction injury in dynamic traction group was significantly lower than that in automatic traction group: 4.76% (2/42) vs. 21.05% (8/38), the recovery rate of neurological function 6 months after operation was significantly higher than that in automatic traction group: 83.33% (35/42) vs. 39.47% (15/38), and there were statistical differences ( P<0.05 or<0.01). The serum CRP, IL-6 and WBC in dynamic traction group were significantly lower than those in automatic traction group: (24.11±5.86) mg/L vs. (28.42±5.94) mg/L, (10.52±2.29) pg/L vs. (12.45±2.46) pg/L and (9.24±2.43) ×10 9/L vs. (10.84±2.38) ×10 9/L, and there were statistical differences ( P<0.01). No recurrence was found in both groups. Conclusions:Dynamic traction technique in microscopic resection of petroclival meningioma can effectively reduce the postoperative complications of brain traction injury, reduce surgical stress, promote the recovery of neurological function, and improve the prognosis of patients.
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AIM: To investigate the efficacy of orbicularis oculi muscle resection combined with orbicularis oculi muscle shortening and lower eyelid retractor reduction in the treatment of elderly lower eyelid entropion.METHODS:A retrospective study was conducted among 97 elderly patients(175 eyes)with lower eyelid entropion who admitted to the hospital from June 2019 to June 2021. According to the treatment method, the patients were divided into control group(47 patients of 82 eyes treated with orbicularis oculi muscle resection)and combination group(50 patients of 93 eyes treated with orbicularis oculi muscle resection combined with orbicularis oculi muscle shortening and lower eyelid retractor reduction). The two groups were compared in terms of short-term curative effect, perioperative indexes, scores of symptoms and signs before and after surgery, width of palpebral fissure before and after surgery, direction of eyelashes, exposure rate of lacrimal caruncle, complications, and patient satisfaction.RESULTS: The total response rate in the combination group was significantly higher than that in the control group(95% vs 80%, P=0.004). The intraoperative blood loss, operation time and hospital stay of the combination group were significantly more/longer than those of the control group(P<0.001). The scores of symptoms and signs such as lacrimation, foreign body sensation, photophobia and irritation in the combination group after the surgery were significantly lower than those in the control group(all P<0.001). After surgery, the width of palpebral fissure, direction of eyelashes and exposure rate of lacrimal caruncle in the combination group were higher than those in the control group(P<0.001). The incidence of postoperative complications in the combination group was lower than that in the control group(8% vs 18%, P=0.032). The patient satisfaction scores of comfort level, trichiasis correction, scar appearance, eyes symmetry and appearance in the combination group were higher than those in the control group(all P<0.001).CONCLUSION: Orbicularis oculi muscle resection combined with orbicularis oculi muscle shortening and lower eyelid retractor reduction is effective and safe in the treatment of elderly lower eyelid entropion, which can meet the requirements of the patients.
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Introducción: Los subependimomas intracraneales son raros, representan el 0.2-0.7% de todos los tumores del sistema nervioso central1,2 y se originan en los ventrículos laterales en el 30-40% de los casos.3 Los síntomas usualmente se asocian a hipertensión endocraneana secundaria a hidrocefalia obstructiva.4 La resección completa del tumor es curativa en esta patología.5 El abordaje trans-surcal es seguro para lesiones ventriculares profundas y el uso de los retractores tubulares minimizan la retracción del parénquima cerebral evitando la compresión directa con valvas. Esto permite disminuir la presión del tejido cerebral que puede ocluir los vasos y producir isquemia local generando una lesión neurológica permanente. Descripción del caso: Se presenta el caso de una paciente de 66 años, diestra, con cefalea crónica que aumenta en frecuencia en el último mes. La resonancia cerebral contrastada muestra un tumor extenso en el ventrículo lateral izquierdo con signos de hidrocefalia obstructiva. Intervención: Se coloca la paciente en posición supina. Se hace una incisión bicoronal y se hace un abordaje trans-surcal F1/F2 izquierdo. Se coloca un retractor tubular guiado con el puntero de neuronavegación, introduciéndolo directamente en el parénquima cerebral y fijándolo al soporte de Leyla. Se colocó un catéter de ventriculostomía contralateral y se retira a las 48 horas sin complicaciones asociadas. La resonancia contrastada postoperatoria demuestra una resección completa del tumor. El análisis de patología reveló un subependimoma grado I de la clasificación de la Organización Mundial de la Salud. La paciente presentó transitoriamente apatía y pérdida del control del esfínter urinario que resolvieron completamente a las 3 semanas después de la cirugía. Se firmó un consentimiento firmado para la publicación de la información utilizada en este trabajo. Conclusión: La resección completa microscópica de un subependimoma extenso del ventrículo lateral izquierdo es factible a través de un abordaje tubular transulcal.
Introduction: Intracranial subependymomas are rare, representing only 0.2-0.7% of all central nervous system tumors1,2 and arise in the lateral ventricles in 30-40% of the cases.3 Symptoms depend on tumor location and usually arise when the cerebrospinal fluid (CSF) is blocked, generating a consequent intracranial hypertension.4 Microsurgical gross-total resection is possible and curative for these tumors.5 The transcortical/trans-sulcal approach is a safe approach for the access of deep-seated intraventricular lesions. The use of tubular retractor systems minimizes retraction injury when passing through the cortex and deep white matter tracts. This allows a decrease in the pressure on brain tissue that can occlude the brain vessels and produce local ischemia and a consequent permanent neurological injury. Case description: This is a case of a 66-year-old woman who presented chronic headaches that increased in frequency in the last month. Enhanced-brain MRI demonstrated a large left ventricular lesion with signs of obstructive hydrocephalus. Procedure: Patient was positioned supine. A bicoronal incision was used to perform a left frontal craniotomy. An F1/F2 transcortical/trans-sulcal approach was used. A guided tubular retractor is placed with the neuronavigation pointer, inserting it directly into the brain parenchyma and fixing it to the Leyla support. Postoperative postcontrast MRI demonstrated a complete resection of the tumor. Histopathological analysis revealed a subependymoma (World Health Organization Grade I). The patient presented transient apathy and loss of urinary sphincter control that completely resolved 3 weeks after surgery. Written informed consent was obtained for publication of information used for this work. Conclusions: A complete microsurgical resection of a large left ventricular subependymoma is feasible through a trans-sulcal tubular approach.
Subject(s)
Ventriculostomy , Brain , Intracranial Hypertension , Lateral Ventricles , Craniotomy , Neuronavigation , NeoplasmsABSTRACT
@#AIM: To evaluate the effects and complications of retractor repair combined with a lateral tarsal strip procedure and retractor repair alone for treating lower eyelid involutional entropion.<p>METHODS: This was a prospective study. Totally 79 cases(91 eyes)with involutional lower eyelid entropion who were hospitalized from January 2015 to February 2018 were divided randomly into observation group(41 cases 46 eyes, underwent combined procedure)and control group(38 cases 45 eyes, underwent retractor repair procedure). The clinical effects and the complications of the two groups were compared.<p>RESULTS: At 3mo postoperatively, there was no significant difference in the clinical effective rate(100% <i>vs</i> 98%, <i>P</i>=0.495)between the two groups. At 24mo postoperatively, the observation group had a higher clinical effective rate(98% <i>vs </i>84%, <i>P</i>=0.030). There were no complications occurred in the observation group, significantly fewer than the control group(11%,<i> P</i>=0.026).<p>CONCLUSION: Compare to retractor repair procedure, the combined procedure has a higher clinical effective rate and a lower complications rate.
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Objective@#To explore the clinical application effects of portable visual retractor in superficial temporal fascia flap harvesting.@*Methods@#From January 2010 to June 2019, 27 patients meeting the inclusion criteria and planning to perform operation of superficial temporal fascia flap harvesting were admitted to the Department of Plastic and Reconstructive Surgery of the First Clinical Medical Center of the People′s Liberation Army General Hospital. The patients were divided into traditional surgical method group [6 males and 3 females, aged (34±14) years], cold light source retractor group [6 males and 4 females, aged (35±16) years], and portable visual retractor group [7 males and 1 female, aged (30±14) years] according to way of superficial temporal fascia flap harvesting. The superficial temporal fascia flaps of patients in traditional surgical method group were resected by traditional way of resection, and the superficial temporal fascia flaps of patients in cold light source retractor group and portable visual retractor group were resected at assistance of cold light source retractor and portable visual retractor, respectively. Length of incision, operation time, intraoperative blood loss volume, postoperative drainage volume, and postoperative complication of patients in 3 groups were observed and recorded. Data were processed with Fisher′s exact probability test, one-way analysis of variance, least significant difference test, Kruskal-Wallis H test, and Bonferroni correction.@*Results@#The length of incision of patients in visual retractor group was (3.6±0.8) cm, significantly shorter than (12.6±1.6) cm in traditional surgical method group and (5.8±0.9) cm in cold light source retractor group (P<0.05). The incision length of patients in traditional surgical method group was significantly longer than that in cold light source retractor group (P<0.05). The operation time of patients in visual retractor group was 24.0 (23.3, 25.8) min, significantly shorter than 35.0 (30.5, 36.5) min in traditional surgical method group and 28.5 (26.8, 30.5) min in cold light source retractor group (H=16.5, 9.8, P<0.05). The operation time of patients in traditional surgical method group was significantly longer than that in cold light source retractor group (H=6.6, P<0.05). The intraoperative blood loss volume was (26±3) mL of patients in visual retractor group, significantly less than (34±4) mL in traditional surgical method group and (30±6) mL in cold light source retractor group (P<0.05). The intraoperative blood loss volume of patients in traditional surgical method group was significantly more than that in cold light source retractor group (P<0.05). The postoperative drainage volumes of patients in visual retractor group, cold light source retractor group, and traditional surgical method group were (33±4), (34±6), and (31±7) mL, respectively, and there were no significantly statistical differences in postoperative drainage volumes among patients in the three groups (F=0.3, P>0.05). There were no severe complications such as ischemia and necrosis of superficial temporal fascia flaps in patients of the three groups. One patient in cold light source retractor group had subcutaneous hematoma after operation, which was improved by removing stitches and hematoma.@*Conclusions@#Superficial temporal fascia flap harvesting at the assistance of portable visual retractor has the advantages of clear visual field, simple operation, short operation time, small incision, and less intraoperative blood loss.
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Introducción: Los quistes artrosinoviales espinales son lesiones infrecuentes que se originan principalmente en la región lumbar. Aunque el tratamiento conservador es posible, la resección quirúrgica es considerada el tratamiento de elección en pacientes sintomáticos. La inestabilidad postoperatoria es una preocupación. Las técnicas mínimamente invasivas (MISS) demostraron ser una alternativa válida que podría disminuir el riesgo de inestabilidad postoperatoria. Objetivo: Describir la importancia de la orientación facetaria en la elección del lado del abordaje (ipsilateral o contralateral) y la conservación de la unión articular en una serie de pacientes operados de quistes sinoviales lumbares por técnica tubular mínimamente invasiva. Material y métodos: Se evaluaron 8 pacientes con quistes sinoviales lumbares operados con técnica tubular mínimamente invasiva. Se analizó en RMN la relación entre la orientación de las facetas articulares y la vía de abordaje seleccionada, se evaluó además la resección de los quistes sinoviales y el grado de preservación facetaria postoperatoria. Información demográfica e intraoperatoria fue detallada. El resultado clínico fue valorado usando la Escala Visual Analógica (VAS) y los criterios de Macnab modificados para medir la satisfacción postoperatoria de los pacientes. El seguimiento mínimo fue de 6 meses. Resultados: Ocho quistes sinoviales fueron operados y resecados completamente. Cinco pacientes presentaron orientación facetaria coronal y 3 sagital los cuales fueron abordados del lado ipsilateral y contralateral respectivamente. En todos los casos se logró preservar al menos 2/3 de la unión facetaria del nivel comprometido. El tiempo promedio de cirugía fue de 110 minutos. Todos los pacientes fueron dados de alta dentro de las 24 hs. Se observó una mejoría de 6 puntos en el VAS. Según la escala de Macnab; 6 pacientes refirieron resultados excelentes, 1 bueno y 1 regular. No se registraron fístulas ni infecciones. Conclusión: La orientación de las facetas articulares definió el lado del abordaje. En facetas articulares con orientación coronal recomendamos el abordaje tubular ipsilateral y en facetas articulares con orientación sagital el abordaje contralateral. Esto permite una excelente exposición del quiste sinovial y la preservación de la articulación facetaria. Ensayos prospectivos con mayor tiempo de seguimiento y cohortes más grandes serían de utilidad para avalar nuestras recomendaciones.
Background: Spinal arthro-synovial cysts are uncommon lesions that largely originate in the lumbar area. Although conservative management is an option, surgical resection is considered the treatment of choice in symptomatic patients. Post-operative instability is of concern, however. Minimally-invasive surgery techniques have proven a valid option which might reduce post-surgical instability. The aim of this paper is to describe the importance of facet orientation in side selection for the surgical approach (ipsilateral or contralateral) and facet joint sparing in a series of patients undergoing minimally-invasive tubular surgery (MITS) for lumbar synovial cysts. Methods: Eight patients with lumbar synovial cysts undergoing MITS were assessed. Pre-operatively, magnetic resonance imaging (MRI) was performed to identify facet joint orientation and aid in surgical approach selection. Post-operatively, MRI was repeated to confirm resection of the synovial cysts and the level of post-surgical facet sparing. Demographic and intraoperative data were recorded, with post- versus pre-operative pain compared using a visual analog scale (VAS), and the modified Macnab criteria used to measure patients' post-operative satisfaction. Minimum post-operative follow-up was six months. Results: Eight synovial cysts were resected completely. Five patients had a coronal and three a sagittal orientation of their facet and were managed with an ipsilateral versus contralateral approach, respectively. In all cases, at least 2/3 of the involved facet joint was spared. Average surgical time was 110 minutes, and all patients were discharged within 24 hours. A mean 6-point improvement was observed in VAS pain severity. Using the Macnab scale, six patients reported excellent results, one a good result and one a fair result. No spinal leaks or infections were reported. Conclusions: Facet-joint orientation determines which side is used for the surgical approach. For facet joints with a coronal orientation, we recommend the ipsilateral tubular approach; while for joint facets with a sagittal orientation, the contralateral approach. This enables both excellent exposure of the synovial cyst and facet-joint sparing. Prospective trials with longer follow-up and larger cohorts are needed to validate our recommendations.
Subject(s)
Synovial Cyst , General Surgery , Lumbosacral RegionABSTRACT
Objective Evaluation of self-control suspension under the double hook system used to xiphoid thoracoscope fully the effect of thymectomy.Methods There were 17 cases of thymic adenoma diagnosed before surgery in November to December 2016,including 7 males and 10 females,aged(57 ± 10).The total thymomectomy was performed with a double hook method with a double hook procedure.Results All the 17 patients had smooth operation,and no clear hook related complications were observed after the operation.The operation was convenient and the thymus was completely removed.Conclusion It is worth populating that the double pull hook method is convenient and safe to remove the whole thymus gland.
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Objective To investigate the clinical effect of type A botulinum toxin and nipple retractor in correcting severe inverted nipples.Methods All the patients with bilateral severe inverted nipples that sought consulting in the Plastic and Reconstructive Surgery Center of Peking Union Medical College Hospital were included in this study and the patients were randomized into different treatment group with nipple retractor only or BTX-A (Lanzhou,China) combined with nipple retractor.In the combined therapy group,50 u BTX-A was injected into the bottom of each nipple.2 weeks later,nipple retractor was placed and kept wearing for 6 months.For the retractor only group,no BTX-A was used.All the patients were followed up at 1 month,3 months and 6 months after the operation.Nipple projection was measured according to the profile view of pre-and post-operation.Effectiveness and complication rate were compared between the two groups.Results 20 patients were included in this study.Average nipple projection in the combined therapy group was (1.12±0.13) cm,(0.95± 0.10) cm and (0.73±0.11) cm (3 months,6 months and 12 months post-operation,respectively),which had a significant difference from that of the retractor group [(0.81±0.10) cm,(0.72±0.12) cm and (0.53±0.10) cm].Total complication rate of combined group was also lower than that of retractor group.The complications of the combined therapy group included hypopigmentation (1 case),without skin ulcer or wire dislocation.However in the retractor group,complications included skin ulcer (2 cases),hypopigmentation (1 case) and dislocation (1 case).No severe complications such as nipple necrosis happened in both groups.Conclusions BTX-A combined with nipple retractor is an effective method in correcting severe inverted nipple with low complication rate.
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Objective To analyze the application effect of disposable surgery retractor which made of high polymer medical plastic.Methods From January 2016 to October 2016,80 patients of HCC who were treated with hepatectomy under general anesthesia in our hospital were randomly divided into the control group and the observation group according to different retractor during surgery.The control group used the traditional abdominal retractor during the sugery.Meanwhile,the observation group used disposable surgery retractor.The application effect between the two groups were compared.Results The satisfaction rate of surgical exposure and effect in surgeon of the observation group were higher than those of the control group.The wound pain time of patients in perioperative period and 1 month after surgery and chronic pain incidence in postoperative 6 months between the two groups were evaluated.It turned out that the difference in average pain score was statistically significant (P<0.05).Conclusion The disposable surgical retractor can improve the satisfaction rate of surgeons with better surgical exposure,and it can significantly reduce the damage of wound tissue,which effectively relieves the postoperative pain,shortens the time of postoperative pain,and reduces the incidence of chronic pain.
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@#AIM:To compare the clinical effect of the lower eyelid retractor muscle transposition and eyelid orbicularis muscle folding shorten combined with lower eyelid retractor muscle transposition in the treatment of senile lower eyelid entropion. <p>METHODS: Sixty-four cases(85 eyes)with senile lower entropion were divided into Group A(31 cases 42 eyes)and Group B(33 cases 43 eyes)according to the different ways of operation from January 2013 to October 2014 in our hospital. Patients in Group A were treated by eyelid retractor muscle transposition while patients in Group B treated by eyelid orbicularis muscle folding shortening combined with lower eyelid retractor muscle transposition. The short-term and long-term therapeutic efficacy and two-year recurrence rates after operation were compared between the two groups. <p>RESULTS: The short-term effective rate of patients in Group B was higher than that of Group A while the difference was not statistically significant(98% <i>vs</i> 95%, <i>P</i>>0.05). The long-term effective rate of patients in Group B was higher than that of Group A and the difference was statistically significant(95% <i>vs </i>83%)and two-year recurrence rate of patients in Group B was lower than that of Group A(5% <i>vs</i> 17%)and the difference was statistically significant(<i>P</i><0.05). <p>CONCLUSION:The clinical curative effect of eyelid orbicularis muscle folding shortening combined with lower eyelid retractor muscle transposition is better than single retractor muscle transposition in the treatment of senile lower eyelid entropion.
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Objective To explore the home-made U-shaped retractor ’ s effect on reducing the traction injury of recurrent laryngeal nerve in the video-assistance thyroidectomy . Methods The patients with unilateral and unifocal papillary thyroid microcarcinoma , which were diagnosed by ultrasound preparation and by pathological postoperation , were enrolled .They all underwent the ipdilateral lobectomy , isthmus resection and the clearance of central lymph nodes with video-assistance technology .From January 2013 to June 2014, 79 cases ( control group ) were received conventional method , by which the thyroid lobe was elevated onto the trachea surface.From January 2015 to March 2016, 71 cases (U-shaped group) accepted the procedure which adopted home-made U-shaped retractor to pull the thyroid lobe to carotid artery horizontally .The operations were completed by the same surgeon .There were no significant differences between the two groups in age , gender and lesion size , which is comparable .The incidence rate of hoarseness was compared postoperation . Results Postoperative hoarseness of the U-shaped group occurred in 6 cases (8.5%) and the control group in 17 cases (21.5%), which show a significantly statistical difference (χ2 =4.919, P=0.027).And there was no significant difference in voice recovery time [median:16.5 d (8-31 d) vs.18 d (4-50 d), Z=-0.246, P=0.806]. Conclusion In the video-assisted thyroidectomy , using the U-shaped retractor to pull the thyroid lobe laterally and horizontally will be beneficial to reduce the recurrent laryngeal nerve tension and the incidence of the retract injury .
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? AIM: To evaluate the visual outcomes and intraoperative and postoperative complications of phacoemulsification surgery in patients with cataract and pseudoexfoliation syndrome ( PEX ) and the usage of proper surgical techniques and appropriate devices intraoperatively.?METHODS: Sixty-seven eyes of 53 patients with PEX and cataract who had undergone phacoemulsification and intraocular lens ( IOL ) implantation surgery were evaluated retrospectively. The mean age was 71. 68 ± 9. 96 (53-89)y, and there were 24 (45%) males and 29 (55%) females. Nuclear, cortical, posterior subcapsular, and mature cataracts were all represented.? RESULTS: Nuclear cataract was significantly more common than other types ( P = 0. 00 ). The mean preoperative best corrected visual acuity ( BCVA) was 0. 99 ± 0. 30 ( SD ) ( 0. 40 - 1. 50 ) logMAR, and the mean postoperative BCVA was 0. 32±0. 31 (SD) (0. 00-1. 00) logMAR (P=0. 00). Iris retractors were used in 12 (18%) eyes. Capsular tension ring ( CTR) implantation was used in 15 ( 22%) eyes, it was planned in 8 ( 12%) and unplanned in 7 (10%). Posterior capsule rupture occurred in 4 ( 6%) eyes, and vitreous loss occurred in 2 ( 3%) eyes. Anterior vitrectomy was performed in these 2 eyes. Conversion to extracapsular cataract extraction ( ECCE ) was needed in these 2 ( 3%) eyes due to large posterior capsular rupture. Persistent corneal edema was observed in 4 (6%) eyes, and anterior chamber reaction in 5 (7%) eyes. IOL dislocation occurred in 4 ( 6%) eyes, but repositioning was only needed in 1 (1. 5%) eye. Posterior capsule opacification ( PCO ) requiring Nd: YAG laser capsulotomy developed in 13 (20%) eyes.?CONCLUSION: Postoperative visual acuities of patients with cataract and PEX are satisfactory. However, intraoperative and postoperative complications like posterior capsule rupture, vitreous loss, conversion to ECCE, persistent corneal edema, anterior chamber reaction and IOL dislocation may be observed. To avoid these complications, proper surgical techniques and the use of appropriate devices intraoperatively are essential.
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Background: A forward head posture (or chin poking) is perhaps the most common abnormality associated with NP and is commonly defined as the protrusion of the head in the sagittal plane so that the head is placed anterior to the trunk. Forward head posture can occur because of an anterior translation of the head, lower cervical flexion, or both, and it is claimed to be associated with an increase in upper-cervical extension. It is suggested that forward head posture leads to an increase in the compressive forces on the cervical apophyseal joints and posterior part of the vertebra and to changes in connective tissue length and strength (because of stretching of the anterior structures of the neck and shortening of the posterior muscles) resulting in pain. The objective of the study was to correlate neck pain with cervical angle and shoulder retractor power in non-traumatic neck pain patients. Methods: 50 clerical workers having non traumatic neck pain were included. Neck pain was measured on VAS, cervical angle was measured using photometric method and shoulder retractor power was measured. Results: VAS showed moderate positive correlation with cervical angles (0.63 and 0.72) and moderate negative correlation with shoulder retractor power (-0.59 and -0.71). A moderate positive correlation of craniocervical angle to VAS seen (0.66) whereas there was negative correlation with shoulder retractors I and II (-0.59 and -0.61) A positive correlation was seen between VAS and craniocervical angle but is moderately negative with shoulder retractors I (Rhomboids) and II (Middle trapezius) (0.78, 0.04, -0.69 and -0.64). Conclusion: A moderate increase in cranio vertebral & craniocervical angle showed plausible weakness in lower Trapezius and rhomboids among clerks` having Non-traumatic neck pain.
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Objective To compare the difference between self-made retractor and thyroid suspension in laparoscopic thyroidectomy,as well as exploring the feasibility and efficacy of self-made retractor.Methods Fifty nine thyroid patients were included in this study from Jan.2012 to Jun.2013 in our hospital.30 cases of laparoscopic thyroidectomy were completed by the help of self-made retractor while 29 cases were completed with thyroid suspension.The owration time,blood loss,drainage flow,hospital stays and short term effect were compared.Result The average operation time of retractor group (71.57 ± 9.56) min was shorter than the suspension group (79.90 ±10.61) min (P =0.002) The blood loss of retractor group (11.83 ±6.76) mL was less than the suspension group (17.24 ± 9.41) mL (P =0.014).The hospitalization time of retractor group (4.07 ± 0.45) days was similar with the suspension group (4.14 ± 0.52) min (P =0.573),The retractor group had shorter operation time,blood loss.There was statistical significance between them.There was no significance difference of hospital stays and discomfort.Neither group appeared of hoarseness,bucking,angulus oris numbness and other symptom.Conclusion Self-made retractor can reduce the operation time,blood loss.It is worth of clinical extension.
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[Summary] Between February 2010 and November 2014, a retractor fabricated by stainless steel tongue depressor was used in 30 cases of small incision appendectomy in our department .All the operations were performed via an incision 1.5-3 cm in length.No complications were found .Such self designed retractor can be clinically utilized with characteristics of cheapness , safety, and good exposure of operative field .