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@#AIM: To observe the clinical effect of compound trabeculectomy and air filtration injection in the anterior chamber in the treatment of chronic primary angle closure glaucoma, and to evaluate the safety and effectiveness of air filtration injection in the treatment of chronic primary chronic angle closure glaucoma.<p>METHODS: In a retrospective study, 129 patients(183 eyes)with chronic primary chronic angle closure glaucoma admitted to our hospital from September 2015 to June 2017 were divided into air injection group and control group. Patients in the air injection group(68 cases, 97 eyes)were treated with compound trabeculectomy and air filtration injection into the anterior chamber. Patients in the control group(61 cases, 86 eyes)were treated with compound trabeculectomy. The follow-up time was from 3 to 6mo with an average of 4.5mo.The visual acuity, intraocular pressure, bleb formation and complications were observed, and the unplanned reoperation, length of stay and total cost of stay were recorded. <p>RESULTS: The incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation in the air injection group was lower than that in the control group, the days of hospitalization in the air injection group were shorter than that in the control group, and the cost of hospitalization in the air injection group was lower than that in the control group(<i>P</i><0.05). There was significant difference in intraocular pressure between different groups(<i>F</i>group=42.394, <i>P</i>group<0.001; <i>F</i>time=7.373, <i>P</i>time<0.001; <i>F</i>time×group=23.903, <i>P</i>time×group<0.001). Intraocular pressure at different time points was compared between groups. There was significant difference(<i>P<</i>0.001)in intraocular pressure of 1, 3d and no significant difference(<i>P</i>>0.05)in 3, 7d between the two groups. There was no significant difference(<i>P</i>>0.05)in the flash of anterior chamber of 1, 3, 7d and 1mo between the two groups. There was no significant difference(<i>P</i>>0.05)in the changes of vision and the formation of filtering blebs between the two groups in 3mo(<i>P</i>>0.05).<p>CONCLUSION:Combined trabeculectomy and air filtration in the anterior chamber for chronic primary angle closure glaucoma can reduce the incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation, not aggravate the inflammatory reaction in the anterior chamber, safely retain the residual visual function of patients, shorten the length of stay in hospital and the total cost of hospitalization, and have no effect on the formation of intraocular pressure, vision and filtering bleb obvious influence.
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@#AIM: To observe the clinical effect of compound trabeculectomy and air filtration injection in the anterior chamber in the treatment of chronic primary angle closure glaucoma, and to evaluate the safety and effectiveness of air filtration injection in the treatment of chronic primary chronic angle closure glaucoma.<p>METHODS: In a retrospective study, 129 patients(183 eyes)with chronic primary chronic angle closure glaucoma admitted to our hospital from September 2015 to June 2017 were divided into air injection group and control group. Patients in the air injection group(68 cases, 97 eyes)were treated with compound trabeculectomy and air filtration injection into the anterior chamber. Patients in the control group(61 cases, 86 eyes)were treated with compound trabeculectomy. The follow-up time was from 3 to 6mo with an average of 4.5mo.The visual acuity, intraocular pressure, bleb formation and complications were observed, and the unplanned reoperation, length of stay and total cost of stay were recorded. <p>RESULTS: The incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation in the air injection group was lower than that in the control group, the days of hospitalization in the air injection group were shorter than that in the control group, and the cost of hospitalization in the air injection group was lower than that in the control group(<i>P</i><0.05). There was significant difference in intraocular pressure between different groups(<i>F</i>group=42.394, <i>P</i>group<0.001; <i>F</i>time=7.373, <i>P</i>time<0.001; <i>F</i>time×group=23.903, <i>P</i>time×group<0.001). Intraocular pressure at different time points was compared between groups. There was significant difference(<i>P<</i>0.001)in intraocular pressure of 1, 3d and no significant difference(<i>P</i>>0.05)in 3, 7d between the two groups. There was no significant difference(<i>P</i>>0.05)in the flash of anterior chamber of 1, 3, 7d and 1mo between the two groups. There was no significant difference(<i>P</i>>0.05)in the changes of vision and the formation of filtering blebs between the two groups in 3mo(<i>P</i>>0.05).<p>CONCLUSION:Combined trabeculectomy and air filtration in the anterior chamber for chronic primary angle closure glaucoma can reduce the incidence of shallow anterior chamber, malignant glaucoma and unplanned reoperation, not aggravate the inflammatory reaction in the anterior chamber, safely retain the residual visual function of patients, shorten the length of stay in hospital and the total cost of hospitalization, and have no effect on the formation of intraocular pressure, vision and filtering bleb obvious influence.
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Objective@#To summarize the characteristics of abdominal-pelvic unplanned reoperation (URO) in a cancer hospital.@*Methods@#Retrospectively descriptive cohort research was adopted. The classification of diseases was based on ICD-10, and surgical classification was based on ICD-9-CM-3. Medical record summary database from 2008 to 2018 in Beijing Cancer Hospital was collected, and all URO information of abdominal-pelvic surgery was retrieve. The time of URO, disease type, surgery type and cause were statistically analyzed. Distribution of main disease incidence and constituent ratio, and the application of major surgery and surgery type composition ratio were analyzed as well.@*Results@#From 2008 to 2018, a total of 46854 cases underwent abdominal-pelvic surgery (including gastrointestinal, hepatic-biliary-pancreatic, gynecological, urological, or esophageal cancer surgery) and 713 patients received URO (1.52%), including 486 males and 227 females (2.14:1.00) with a mean age of (58.1±12.2) years. A total of 246 patients (34.50%) had comorbidity, and with comorbidity: without comorbidity was 1.13:1.00. The hospital stay was (44.5±43.0) days, and the total cost was (178000±112000) yuan. There were 22 deaths (3.09%). The median interval between URO and the first operation was 8 (0 to 131) days. The highest rate of URO was 2.45% (89/3629) in 2012, while the lowest was 0.95% (53/5596) in 2015. The top 3 major cancer types of URO included colorectal cancer (222 cases, 31.14%), gastric cancer (166 cases, 23.28%) and esophageal cancer (45 cases, 6.31%). The cancer types with the highest URO rate included pancreatic cancer (3.97%, 30/756), gastric cancer (1.81%, 166/9171) and colorectal cancer (1.80%, 222/12333). The top 3 surgical procedures resulting in URO were rectal resection (109 cases, 15.29%), total gastrectomy (79 cases, 11.08%), and total pancreatectomy (64 cases, 8.98%). Focusing on 497 URO cases from 2012 to 2018, 465 cases (93.56%) followed relatively difficult grade III and IV surgery, while only 32 cases (6.44%) followed grade I and II surgery. The top 5 main causes of URO were bleeding (225 cases, 31.56%), anastomotic leak (225 cases, 31.56%), infection (89 cases, 12.48%), intestinal obstruction (53 cases, 7.43%), and wound dehiscence (35 cases, 4.91%), adding up to a total of 87.94% of all URO.@*Conclusion@#This study summarizes the epidemiology of abdominal - pelvic URO in our cancer institution, providing the solid baseline for future investigation of URO and the subsequent formulation of corresponding prevention and intervention measures.
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Objective To analyze the main causes for unplanned re-operation of prostatic cancer.Methods The clinical data of 4 patients with prostatic cancer who underwent an unplanned re-operation were analyzed retrospectively between September 2014 and July 2019 in our hospital.Preoperative data of patients was collected as follows:mean age of 65 years,ranged from 56 to 71 years.tPSA ranged from 5.17-13.20 ng/ml.Gleason score of 3 + 3 in 1 case,3 +4 in 2 cases,4 +4 in 1 case.pTNM pT2a in 2 Cases,pT2b in 2 cases.LRP(extraperitoneal approach) in 1 case,RARP(transperitoneal approach) in 3 cases.Results The main causes for unplanned re-operation were as follows:perioperative hemodynamic instability(75％,3/4),post-operative fever(25％,1/4).All 4 re-operations were performed by urologists using Laparoscopic exploration of abdomen.Conclusions Inadequate and inappropriate surgical hemostasis are the key to lead a second-look surgery of prostatic cancer.A complete hemostasis could help to lower the re-operation rate.Laparoscopic exploration of abdomen could be one of the choices to deal with re-operation after minimally invasive radical prostatectomy.
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Objective@#To analyze the main causes for unplanned re-operation of prostatic cancer.@*Methods@#The clinical data of 4 patients with prostatic cancer who underwent an unplanned re-operation were analyzed retrospectively between September 2014 and July 2019 in our hospital.Preoperative data of patients was collected as follows: mean age of 65 years, ranged from 56 to 71 years.tPSA ranged from 5.17-13.20 ng/ml.Gleason score of 3+ 3 in 1 case, 3+ 4 in 2 cases, 4+ 4 in 1 case. pTNM pT2a in 2 Cases, pT2b in 2 cases. LRP(extraperitoneal approach) in 1 case, RARP(transperitoneal approach) in 3 cases.@*Results@#The main causes for unplanned re-operation were as follows: perioperative hemodynamic instability(75%, 3/4), post-operative fever(25%, 1/4). All 4 re-operations were performed by urologists using Laparoscopic exploration of abdomen.@*Conclusions@#Inadequate and inappropriate surgical hemostasis are the key to lead a second-look surgery of prostatic cancer.A complete hemostasis could help to lower the re-operation rate.Laparoscopic exploration of abdomen could be one of the choices to deal with re-operation after minimally invasive radical prostatectomy.
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Objective To analyze the main causes for unplanned re-operation of pheochromocytoma (PCC) and explore the countermeasures on reducing the re-operation rate.Methods The clinical data of 6 patients with pheochromocytoma who underwent an unplanned re-operation were analyzed retrospectively between September 2011 and December 2016 in our hospital.There were 4 males and 2 females with a mean age of 46 years,ranged from 24 to 60 years.Only 1 patient had paroxysmal hypertension and headache,and the other 5 patients had no symptoms or atypical symptoms.Tumors of 3 cases were located in adrenal,and 3 were extra-adrenal PCCs.The average size of tumors was 5.25cm,ranged from 3 to 10 cm.Among the 6 cases,2 cases were diagnosed as PCC preoperatively and underwent adequate preparationwith stable hemodynamics during the first operation,who encountered post-operative bleeding soon after the surgery.Four cases were misdiagnosed,with poor preoperative preparation and operation was aborted.One case was misdiagnosed as bladder carcinoma and underwent transurethral resection.Results All 6 re-operations were performed by urologists.The main causes for unplanned re-operation were as follows:perioperative hemodynamic unstability (50％,3/6),post-operative bleeding (33.3％,2/6),uncertainty of surgical outcome (16.7％,1/6).Conclusions A precise diagnosis and an adequate preoperative preparation are the key to prevent a second-look surgery.An appropriate surgical approach and a complete surgical hemostasis could help lowering the re-operation rate.
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Objective To explore the effect of unplanned reoperation (URO) on clinical efficacy after radical resection of gastric cancer (GC),and its causes and risk factors analysis affecting URO.Methods The retrospective case-control study was conducted.The clinicopathological data of 4 124 patients who underwent radical resection of GC in the Union Hospital of Fujian Medical University between January 2005 and December 2014 were collected.The initial operation was open or laparoscopic radical resection of GC.Observation indicators:(1) initial operation situations,results of pathologic examination and follow-up situations;(2) postoperative recovery situations;(3) causes and time interval of URO after radical resection of GC;(4) univariate analysis affecting URO after radical resection of GC;(5) multivariate analysis affecting URO after radical resection of GC.Follow-up using outpatient examination,telephone interview and Wechat was performed to detect postoperative 30-day recovery of patients.Measurement data with normal distribution were represented as (-x)±s,and comparisons between groups were done using the independent-sample t test.Count data and univariate analysis were done using the chi-square test or Fisher exact probability.Multivariate analysis was done using the logistic regression model.Results (1) Initial operation situations,results of pathologic examination and follow-up situations:① Initial operation situations of 4 124 patients,2 608 and 1 516 underwent respectively laparoscopic surgery and open surgery;2 259 and 1 865 underwent respectively total gastrectomy and distal gastrectomy.② Results of pathological examination of 4 124 patients:883,468,959 and 1 814 were respectively in T1,T2,T3 and T4a stages;1 414,571,683 and 1 456 were in N0,N1,N2 and N3 stages;1 073,825 and 2 226 were in Ⅰ,Ⅱ and Ⅲ stages.③) All the 4 124 patients were followed up within 30 days after initial operation,with a follow-up rate of 100.000％(4 124/4 124),including 52 with URO and 4 072 without URO,with a early URO rate of 1.261％ (52/4 124).(2) Postoperative recovery situations:of 4 072 patients without URO,575 had postoperative complications,with an incidence of 14.121％ (575/4 072);17 died after operation,with a mortality of 0.417％ (17/4 072),and duration of postoperative hospital stay was (14.0±9.0) days.Of 52 patients with URO,23 had complications after reoperation,with an incidence of 44.231％ (23/52);6 died after reoperation,with a mortality of 11.538％ (6/52),and duration of postoperative hospital stay was (28.0± 13.0) days.There were statistically significant differences in above indicators between groups (x2=37.550,t=10.900,P＜0.05).(3) Causes and time interval of URO after radical resection of GC:total time interval between initial operation and URO of 52 patients was (6.9±6.7)days.Causes of URO of 52 patients:23 (2 deaths),7,6 (2 deaths),5,5 (1 death),3,2 and 1 (death) patients were respectively due to intraperitoneal hemorrhage,anastomotic bleeding,anastomotic leakage,intra-abdominal infection,small bowel obstruction,dehiscence of abdominal incisions,enteric perforation and pancreatic fistula,and time intervals between initial operation and URO of them were respectively (3.9±3.8)days,(0.9±_0.5)days,(7.9±4.7) days,(14.9±4.6)days,(16.4±9.9) days,(10.0±6.O)days,(6.7±5.2) days and 12.0 days.(4) Univariate analysis affecting URO after radical resection of GC:results showed that age,body mass index (BMI) and volume of intraoperative blood loss were risk factors affecting URO after radical resection of GC (x2 =5.468,7.589,5.041,P＜0.05).(5) Multivariate analysis affecting URO after radical resection of GC:results showed that age ＞ 70 years old,BMI ＞ 25 kg/m2 and volume of intraoperative blood loss ＞ 100 mL were independent risk factors affecting occurrence of URO after radical resection of GC (odds ratio =1.950,2.288,1.867;95％ confidence interval:1.074-3.538,1.230-4.257,1.067-3.267,P＜0.05).Conclusions URO can increase postoperative complications and mortality,and extend duration of hospital stay after radical resection of GC.Intraabdominal bleeding,anastomotic bleeding and anastomotic leakage are the main causes affecting occurrence of URO after radical resection of GC,and age ＞70 years old,BMI ＞ 25 kg/m2 and volume of intraoperative blood loss ＞ 100 mL are independent risk factors affecting occurrence of URO after radical resection of GC.
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Objective@#To investigate the causes and impacts of unplanned reoperations (UO) in patients underwent colorectal cancer surgery, and its effect on the length of hospital stays and hospitalization fees of these patients.@*Methods@#we retrospectively analyzed the data of colorectal tumor patients underwent resection and UO from January 2014 to November 2017 in Cancer Hospital, Chinese Academy of Medical Sciences (CAMS). Student t tests, ANOVA analysis and chi-square test were used to compare the paired data and data of multiple groups, respectively.@*Results@#There were 5 923 cases who underwent colorectal cancer surgery from 2014 to 2017. Among them, 75 cases further accepted UO, the incidence rate of UO was 1.27%. Among the 75 patients of UO, 60 were male and 15 were female, 21 patients underwent colonic operation and 54 patients underwent rectal operation. The average length of hospital stays were 25.8 days and the average hospitalization fees were 110 647.04 yuan. The gender construction, surgical site, average length of hospital stays and hospitalization fees of UO were significantly different from those of operative colorectal tumor patients during this period (all P<0.01). There were 40 patients underwent anastomotic fistula, 11 patients underwent stoma complications and 10 patients underwent bowel obstruction, respectively, which accounts for the three most common causes of UO after colorectal cancer surgery, and the total incidence was 81.3%. The interval of reoperation and the first operation significantly impacted the average length of hospital stays of UO patients (P=0.003), while marginally affected the hospitalization fees (P=0.847).@*Conclusions@#UO are more possible to occur to the male patients who undergo rectal operation. The length of hospital stays and hospitalization fees of UO are significantly increased when compare to those of operative colorectal cancer patients. The time of reoperation significantly impacts the length of hospital stays but has little effect on the hospitalization fees of UO patients.
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Objective To analyze the reasons and outcomes of the unplanned re-operation in renal transplant recipients during perioperative period,and to summarize the corresponding strategies.Methods From January 2014 to September 2017,the clinical data of 20 cases of kidney transplantation which had a total of 22 unplanned re-operations were retrospectively analyzed.All patients were given quadruple immunosuppression with antibody induction and tacrolimus (TAC) and mycophenolate mofetil (MMF) plus prednisone (Pred).We analyzed the reasons,occurrence time,effect of re-operation and the renal function,as well as survival rate of all graft and recipient.The delayed graft function (DGF),acute rejection (AR) and incidence of pulmonary infection were monitored as well.Results Up to September 2017,during the follow-up of 1-36 months,the overall rate of unplanned re-operation was 4.6％,and 2 patients underwent 3 operations.For the reasons of re-operation,there were 18 cases of bleeding (13 cases of blood oozing from the wound surface,3 cases of renal parenchyma rupture because of rejection,and 2 cases of rupture of renal artery infection),2 cases of renal artery thrombosis and 2 cases of the repair of leakage of urine.Two operations were performed within 1 days for 9 cases,2-5 days for 5 cases,6-10 days for 3 cases,above 10 days for 45 cases.There was no deaths during the perioperative period.One patient died of rupture of exiliac aneurysm 3 months after the operation.One patient died of cerebral hemorrhage 6 months postoperation.The death censored graft survival rate was 72.2％ (13/18) and the incidence of DGF was 55 ％.Conclusion The major reason of unplanned re-operation for renal transplantation is associated with bleeding of various causes.And the incidence of DGF is high.If the secondary operation was performed with the correct decision,the kidney allograft recovers well.
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Objective@#To investigate the causes of 30-day unplanned revision surgery following one-stage posterior vertebral column resection (PVCR) for severe spinal deformity and the methods of prevention and management.@*Methods@#A total of 112 severe deformity patients underwent one-stage PVCR for surgical treatment in the 306th Hospital of People′s Liberation Army from May 2010 to December 2015 were retrospectively reviewed. Six patients required reoperation within 30 days after PVCR, including 2 males and 4 females with average age of 21 years (ranging from 12 to 38 years). Four cases were congenital kyphoscoliosis, 1 was post-laminectomy kyphoscoliosis and 1 was post-tuberculous angular kyphosis. Three cases associated with preoperative neurologic deficit (Frankel C in 1 patient and D in 2 patients). The causes, management and outcomes of unplanned revision surgery within 30 days after PVCR were recorded.@*Results@#The total incidence of unplanned revision surgery within 30 days following PVCR was 5.4% (6/112). There was 1 case due to cerebrospinal fluid leak, 5 cases with varying degrees of new neurologic deficits, the causes were as followed: dural buckling in 1 case, residual bone compression in 1 case, epidural hematoma compression in 2 cases, spinal subdural hematoma in 1 case. All the 6 cases underwent surgical exploration again, including further dural repair, decompression and hematoma clearance. After unplanned reoperation, 6 cases recovered completely. The average follow-up time after surgery was 30.8 months (ranging from 10 to 60 months). The major curve at coronal plane was improved from preoperative 87.7° to 34.2°, with a mean correction of 61.0% at final follow-up; the sagittal kyphosis curve was improved from preoperative 119.5° to 45.5°, with a mean correction of 61.9% at final follow-up. Two patients′ neurological status improved from Frankel D to Frankel E, one patient′s neurological status improved from Frankel C to Frankel E.@*Conclusions@#One-stage PVCR could be an effective method for treatment of severe spinal deformity. The causes of 30-day unplanned reoperation after PVCR are as followed: cerebrospinal fluid leak, dural buckling, residual bone compression and hematoma compression. Timely surgical exploration can gain good clinical outcomes.