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Objective:To investigate the effect of external dissection and internal ligation (MMH) in the treatment of grade Ⅲ to Ⅳ mixed hemorrhoids with anorectal resting hypertension and its prognostic risk factors.Methods:The clinical data of 48 patients with grade Ⅲ-Ⅳ mixed hemorrhoids complicated with rectal and anal resting hypertension treated by MMH in Nanjing Jiangbei people′s Hospital Affiliated to Nantong University from February 2018 to February 2020 were analyzed retrospectively (observation group), including 24 males and 24 females; The age ranged from 22 to 55 (41.87±7.52) years. Another 48 patients with grade Ⅲ-Ⅳ mixed hemorrhoids complicated with anorectal resting hypertension treated by PPH were selected as the control group, including 20 males and 28 females; The average age was (42.68±7.14) years. The clinical effective rates , pain score at 6, 24 and 72 h after operation, postoperative complications were compared between the two groups. Multiple logistic regression was used to analyze the related risk factors affecting the prognosis.Results:There was no significant difference in VAS score between the two groups at 6 h after operation ( t=0.25, P=0.807); the VAS score of the observation group at 24 h and 72 h after operation was lower than that of the control group ( t=7.044, P<0.001; t=5.307, P<0.001); the total effective rate of the observation group was higher than that of the control group (93.75% vs 77.08%, χ2=5.35, P=0.021); the total incidence of postoperative anal edema, defecation difficulty, bloody stool, anal pain and fecal incontinence in the observation group was lower than that in the control group, the difference was statistically significant (12.50% vs 33.33%, χ2=5.879, P=0.015). Age, course of disease, grading of internal hemorrhoids and treatment methods were related to the prognosis of patients ( P<0.05); logistic regression analysis showed that age (> 45 years), course of disease (>10 years), grade of internal hemorrhoids (grade Ⅳ) and treatment (PPH) were independent risk factors for prognosis of patients ( P<0.05). Conclusions:MMH has less complications, less postoperative pain and satisfactory curative effect in the treatment of Ⅲ to Ⅳ mixed hemorrhoids and anorectal resting hypertension. The older the patients, the longer the course of disease, the higher the degree of internal hemorrhoids and the choice of treatment methods were the risk factors for the prognosis. Early diagnosis and reasonable treatment are helpful to improve the prognosis of patients.
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Objective:To investigate the efficacy and feasibility of radiofrequency resection of supraglottic laryngeal carcinoma under a multifunctional opener.Methods:The clinical data of four cases of supraglottic laryngeal carcinoma (type T1N1M0 in two cases, T2N1M0 in one case, and T1N0M0 in one case) who received treatment in the Affiliated Hospital of Jining Medical University during January-June 2019 were retrospectively analyzed. Radiofrequency resection of supraglottic laryngeal carcinoma under a multi-functional opener combined with bilateral neck II-IV region lymph node dissection was performed. Swallowing, breathing and phonation were observed and analyzed based on references.Results:Among the four cases, two cases had a normal diet at 3 days after surgery, one case had a normal diet at 7 days after surgery, and one case had a normal diet at 16 days after surgery. Tracheotomy was not performed in any case. After surgery, breathing and speech communication were not affected.Conclusion:Radiofrequency surgery under a multifunctional opener can be used for treatment of early supraglottic laryngeal cancer. It is an effective treatment with minimal trauma, mild postoperative pain and promotes the early recovery of normal swallowing function.
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Objective To investigate the diagnosis and treatment of mammographic calcifications found by mammary molybdenum target inspection.Methods 150 women who were found out with breast calcifications by mammary molybdenum target inspection and had been treated with surgical excision biopsy were selected.Their clinical data were retrospectively analyzed.Results In 150 cases of mammographic calcifications,102 cases were benign lesions by pathologic diagnosis,and 48 cases were malignant.Compared the morphological characteristics of the benign and malignant breast calcifications,the nature of the lesion was associated with lesion size (x2 =5.55),the density of calcification (x2 =7.591) and the distribution of calcifications (x2 =11.859).Conclusion Mammographic calcifications found by mammary molybdenum target inspection has a certain clinical value for diagnosis and treatment of breast cancer,so such patients should be encouraged to do biopsy to diagnose or exclude breast cancer.
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Objective To explore the abdomen surgical incision infection risk factors,and to put forward prevention countermeasures.Methods 1 854 patients with abdominal surgery were selected as subjects.According to whether had surgical incision infection,they were divided into the infection group(76 cases)and the non -infection group(1 778 cases).Single factor analysis and Pearson correlation analysis were used to summarize abdominal surgical incision infection risk factors.Results Single factor analysis results showed that age,BMI,category of incision,operation timing,operation time,diabetes mellitus,drainage tube placement,summer were risk factors for abdominal surgery incision infection (t or χ2 =8.925,5.840,5.376,5.445,5.846,19.674,5.846,19.674,all P <0.05).Pearson correlation analysis showed that age,BMI,category of incision,operation timing,operation time,diabetes mellitus, drainage tube placement and summer surgery were risk factors for abdominal surgery incision infection (r =0.746, 0.689,0.746,0.689,0.691,0.548,0.760,0.548,all P <0.05).Conclusion Abdominal surgery incision infection is associated with many factors.It is necessary for all kinds of risk factors for targeted intervention to reduce incision infection rate.
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<p><b>OBJECTIVE</b>To explore the curative effect and the recessive loss of blooding of PFNA for the treatment of intertrochanteric fractures of femur.</p><p><b>METHODS</b>From January 2012 to January 2015, a total of 49 patients with intertrochanteric fractures of femur were treated with proximal femoral anti-rotation nail including 41 males and 8 females with an average age of 79 years old ranging from 65 to 91 years old. According to the modified Evans type, 1 case was type I, 12 cases were type II, 36 cases were type III. All cases were fresh fractures. Patients had hip pain, movement limited, joint swelling, bruising, extorsion deformity, X-ray and CT examination showed completely fractures. All patients were treated by closed reduction and PFNA internal fixation. Three comminuted fractures using closed reduction were not satisfied, then were treated by limited PFNA fixation after open reduction.</p><p><b>RESULTS</b>The patients' incision got the grade A healing, no complications such as infection and internal fixation failure happened. All patients were followed up from 6 to 36 months (means 22 months). The pain VAS score decreased from preoperative 7.70±1.97 to 1.00±0.26 at 6 months after operation(<0.01). Harris hip score improved from preoperative 8.70±4.19 to 91.70±5.31 at 6 months after operation(<0.01). The outcome at 6 months after operation was excellent in 34 cases, good in 7, poor in 1. The fracture healing time was from 8 to 16 weeks with an average of 12 weeks after operation. One patient with osteoporosis, crushing broken, poor compliance, associated with schizophrenia at the same time, appeared with the displacement of the femoral greater trochanter, with conservative treatment for healing.</p><p><b>CONCLUSIONS</b>Intertrochanteric fractures of femur are common in the elderly trauma, in pain relief, recovery of hip function, to provide quality of life for the patients, PFNA achieved satisfactory effect, but its existence is worth to pay close attention to the recessive loss of blood.</p>
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Objective To investigate the treatment of acute obstructive colorectal cancer.Methods The clinical data of 26 cases with acute obstructive colorectal cancer were analysed retrospectively and relevant literatures were reviewed.Results Radical right hemicolectomy was performed in 9 patients with obstructive right colonic cancer.Among 17 patients with obstructive left colorectal cancer,one-stage radical resection was perfomed in 12 cases,including one-stage anastomosis in 4 cases and Hartmann's operation in 8 cases.Palliative colostomy was performed in 3 cases.Right hemicolectomy and sigmoid colon loop colostomy was performed in 1 case of rectum cancer with ascending colon strangulation.One case refused surgery.Two cases died of MODS and 1 case with inflammatory ileus recovering from conservative treatment after operation.In the course of disease,septic shock and MODS happened in 3 cases,lung infection in 5 cases,heart disease in 2 cases and Hypoalbuminemia in 16 cases.Conclusions One-stage radical colectomy and anastomosis should be performed in patients with obstructive right colonic cancer.In order to reduce toxin absorption and prevent the deterioration of disease,Bowel decompression and removal of inflammatory exudate should be performed in patients with obstructive left colorectal cancer according to the damage control theory.Then effective and safe operation should be chosen in accordance with patients' status.Anti-infection and nutrition support treatment must be strengthened after operation.
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Objective To compare the efficacy and complications among three surgical treatments of femoral intertrochanteric fractures in elderly patients.Methods Totally 209 elderly patients with femoral intertrochanteric fracture were divided into 3 groups:DHS group[n =115,patients treated with dynamic hip screws (DHS)],PFNA group [n=57,patients treated with proximal femoral nails anti-rotation (PFNA)] and SEFT group [n=37,patients treated with singlearm external fixator technique (SEFT)].The length of hospitalization,operative time,bleeding volume,hip function scores and complications were compared among the three groups.Results All patients were followed up for 5-12 months (10.6 months in average).The length of hospitalization,operative time,bleeding volume,weight-bearing time and Harris hip score in postoperative 3 months were (14.3±2.7) d,(102.4±22.7) min,(240.8±38.4) ml,(50.2±7.7) d,(88.7±12.8) min in DHS group,(11.2±3.4) d,(50.3±15.6) min,(80.5±18.7) ml,(22.6±4.8) d,(92.6±15.4)min in PFNA group,(15.1±3.3) d,(35.8±10.9) min,(52.6±12.9) ml,(55.4±10.1) d,(87.3 ± 12.6) min in SEFT group,respectively.There were significant differences in the length of hospitalization,operative time,bleeding volume,weight-bearing time and Harris hip score in postoperative 3 months among the three groups (all P ＜ 0.05),while there was no significant difference in healing time among the three groups (all P＞0.05).The incidence of complications was highest in DHS group,higher in SEFT group,and lowest in PFNA group (all P＜0.05).Conclusions DHS is more suitable for patients with good physical condition and stable fractures.SEFT is suitable for patients with poor condition,who can not tolerate trauma,anesthesia and bleeding.PFNA has more advantages including stable fixation,less invasive,less complications and wide indications,which is more suitable for femoral intertrochanteric fractures than the other two treatments.
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Objective To investigate the clinical effect of tongue-shaped flap cut into the triceps and triceps both sides of the road approach road into the way of two surgical treatments of supracondylar fractures in children.Methods 90 patients with pediatric supracondylar fractures were chosen.50 cases of tongue-shaped flap to triceps road cut into were set as A group,40 patients taking brachial three muscles on both sides of the first approach were set as the B group.The clinical effects of the two groups were compared.Results The operative time,blood loss,cast immobilization time in B group was superior to group A ( P ＜ 0.05 ),there was statistically different.The pain score improvement in group B was significantly better than group A before and after treatment(P ＜0.05),the difference was statistically significant.After treatment,A group of patients with excellent results was in 22 cases,good in 24 cases,the fine rate was 92％.B group with excellent results was in 23 cases,good was in 16 cases,the good rate was 97.5％.The superior quality of the treatment effect in B group was better than A group( P ＜ 0.05),the difference was statistically significant.Conclusion The operative time,blood loss,time cast immobilization,pain improvement,the treatment effects for triceps both sides of the approach for the treatment of supracondylar fractures in children are better than the triceps tongue-shaped flap cut into the road,and there is high clinical value.
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ObjectiveTo evaluate the clinical effect of MSCT measurements in the pre- and postoperational osteal posterior cranial fossa for the adult patients of basilar invagination.Methods We reviewed the images of a cohort of 31 adult patients with basilar invagination,which were treated by surgical operation.According to the presence of atlantoaxial dislocation,the patients were divided into groups A and B.The basion-dens interval (BDI),atlanto-dental interval (ADI),space available of the spinal cord ( SAC),clivus-canal angle( CCA),Highly index( HI),and Chamberlian line(CBL) of the posterior cranial fossa were obtained in all the patients.Independent-sample Student's t test was used to compare the differences between groups A and groups B.Spearman correlations were analyzed between CT measurement data and effects of operations.ResultsIn Group A,the BDI,ADI,SAC,CCA,HI,CBL before and after surgery were 12.6 mm,8.3 mm,4.5 mm,3.3 mm;18.2 mm,20.8 mm,138.3°,150.4°,28.7 mm,43.4 mm,6.3 mm,3.3 mm respectively.There were significant differences ( t = 5.603,2.323,3.124,5.531,4.278 and 2.375,respectively,P ＜0.05 ).Preoperative JOA score in groups A was 10 points,and was 14 points after surgery.There was significant difference between the JOA scores before and after surgery ( t = 3.526,P ＜ 0.05 ).There were 7 effective cases and 4 stable cases after surgery in group A.Before and after surgery,JOA score and BDI,ADI,SAC,CCA,HI,CBL were significantly correlated( r = -0.667,- 0.673 ; - 0.571,- 0.619 ; 0.642,0.513 ; 0.525,0.558 ; 0.587,0.511 ; - 0.532,- 0.596,respectively,P＜0.05).The SAC,CCA,and CBL before and after surgery in group B were 18.3 mm,19.6 mm,146.8°,150.2°,2.7 mm,1.8 mm.The difference was statistically significant after operation ( t = 5.359,4.126,0.769,P ＜0.05).The BDI,ADI,and HI before and after surgery in group B were 7.2 mm,6.6 mm,2.4 mm,2.1 mm,39.3 mm,41.5 mm.And there were no significant differences (t = 1.482,2.374,0.153,P＞0.05).The preoperative JOA score in groups B was 11 points,and the postoperative score was 16 points.JOA scores before and after surgery were significantly different (t =2.874,P ＜0.05).There were 14 effective cases and 6 stable cases after operation in group B.The JOA score before and after surgery and BDI,ADI,and HI had no correlation (r =0.341,0.387;0.154,0.182; 0.192,0.167,P ＞0.05),and CBL,SAC and CCA were correlated (r = -0.756,-0.728;0.651,0.672; 0.726,0.695,P ＜0.05).ConclusionMSCT measurements for basilar invagination before and after surgery are helpful for understanding changes of osteal posterior fossa anatomy and comprehensive evaluation of surgical treatment.
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The International Association for the Study of Lung Cancer (IASLC) has presented the details of the IASLC/International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) Revised Staging Classification for Lung Cancer. The IASLC is the largest world-wide professional organization solely dedicated to reduce the worldwide burden of lung cancer. The IASLC recognizes that the staging classification will be most valuable and accurate if it is based on the evaluation of outcomes of large numbers of cases carefully collected and analyzed in an extensive worldwide database. The analyses of the T, N and M descriptors as well as the stage groupings were performed in 67,725 non-small cell lung cancer (NSCLC)patients. Survival was the primary outcome, measured from the date of diagnosis or date of protocol registration for clinical staging, or the date of surgery for pathologic staging. The remarkable efforts of the IASLC Staging Committee have resulted in an evidence-based, validated and robust revision of the international staging system for NSCLC. This landmark contribution will improve our care of patients and lays a strong foundation for future refinements based on an expanding knowledge of lung cancer behavior and biology. This review outlines the changes in the tumor, node, metastasis (TNM) descriptors and stage groupings anticipated in the official new stage classification system for NSCLC.
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Objective To investigate the role of sFas and sFasL in the development and progression of uterine cervix cancer(UCC)and the clinical significance of detecting them.Method Serum sFas and sFasL levels of 30 UCC patients were detected by enzyme-linked immunosobent assay (ELISA) before and after treatment (operation or chemotherapy),at the same time serum sFas and sFasL levels of 20 healthy volunteers were also detected by ELISA.Results Serum sFas and sFasL levels of UCC patients[(8.60±0.27),(2.96±0.65)μg/L] were obviously higher than those of healthy volunteers[(6.27±0.25),(0.21±0.05)μg/L],there was statistical significance (P＜0.05).Serum sFas and sFasL levels of those who had operations decreased obviously 2 weeks after the operation,serum sFas and sFasL levels of those who had chemotherapy 3 weeks later increased,there was statistical significance when compared before and after treatment (P＜0.05).Conclusions sFas and sFasL may play important roles in the development and progression of UCC,detection of serum sFas and sFasL levels may conduce to observe the changes of pathogenetic condition.
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Objective To investigate the therapeutic effects of fluorouracil implants in Stage Ⅲgastric carcinoma patients after radical gastreetomy. Methods The general state of health and cumulative survival of 200 stage Ⅲ gastric carcinoma patients undergone radical gastrectomy from January, 1999 to, December 2002 in the People's Hospital of Zhongshan City were analyzed, in which only 120 patients administrated fluorouracil implants during radical gastreetomy. The therapeutic effects of fluorouracil implants in stage Ⅲ gastric carcinoma patients after radical gastrectomy were observed. Results The differences of weight (P = 0.041), HGB(P =0.024), Plt(P =0.017), CEA(P =0.001), CA19-9(P =0.003) were significant between two groups. The incidence rate of nausea/emesis in group T (28 %) was higher than that in group O(17 %, P = 0.006), and incidence rates of myelosuppression(P =0.81), diarrhea(P =0.72), hepatic function lesion(P =0.97) and renal function lesion(P =0.20) were no significant. The cumulative 5-year survival rate of group T(45 %) was higher than that in group O (15 %, P =0.002). Conclusion Fluorouracil implants can improve the therapeutic effects on gastric carcinoma patients undergone radical gastrectomy.
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Objective To review the experience of surgical therapy for 113 patients with esophageal perforation or rupture re- suiting from different causes.Methods The causes resulting in esophageal perforation or rupture were summarized and the outcome of conservative and operative therapy were compared.Meanwhile,the outcome and mortality of operative therapy within or beyond 24 hours were compared.Results Twenty-eight patients with esophageal perforation or rupture occurring in the neck were all cured sue- cessfully.As for 85 patients with esophageal perforation or rupture in the chest,the curative rate of operative therapy(83.0%)was greater than that of conservative therapy(68.7 %)(P
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Objective To evaluate surgical results an d choice of various procedures for hypospadias repair in boys.323 cases of hypospa dias were treated from 1995-2002,and of these,205 boys whose average age was 5.1 years had underwent different surgical procedure for hypospadias. M ethods 205 boys with hypospadias were retrospectively analysed.MAGPA (5 cases),Mathieu(7),Onlay island flap(9) were given to boys of hypospadias wit hout chordee.Duckett procedure (127),Modified Denis-Browne (16),Bladder mucosa graft technique (16),Duckett plus Duplay techniques(25) were adopted for hypospa dias with chordee. Results There were 19 cases with uret hra fistula and 1 case with external orifice stricture of urethra.The success ra te for all cases was 90.2%,and morbidity of all complications was 9.8%.The compl ication for Duckett techniques was 7.8%(10/127),Modified Denis-Browne 12.5%(2/1 6),Mathieu 28.6%(2/7),Duplay plus Duckett 16.0%(4/25),Bladder mucosa graft techn ique 6.3%(1/16) and Onlay 11.2%(1/9). Conclusions It is suggested that a complete mastery of applications for different surgical approac h and a proper selection of various surgical methods according to individual pat ient’s condition can reduce complication of operation.