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The etiology of diaphragmatic hernia in adults is mainly congenital and traumatic, its overall incidence in adults is low, and adult diaphragmatic hernia is easily misdiagnosed and missed diagnosis because of lacking specificity in clinical presentation. There is no clinical guidelines or consensus for the diagnosis and treatment of diaphragmatic hernia in adults. The authors inquire into the diagnosis and treatment of diaphragmatic hernia in adults by summarizing relevant litera-tures and combining with clinical practice, and recommend that multi-slice spiral computed tomo-graphy should be promptly refined for suspected cases, especially focusing on sagittal images. The symptomatic patients should be repaired promptly, with a preference for laparoscopic surgery, and mesh augmentation is recommended in those with larger defects.
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Objective@#To analyze relevant preoperative risk factors for microvascular invasion (MVI) in patients with small hepatocellular carcinoma and establish a prediction model.@*Methods@#A retrospective analysis of 157 cases of singlehepatocellular carcinoma with tumor diameter ≤5 cm undergoing hepatectomy at the First Affiliated Hospital of Fujian Medical University from Dec 2012 to Mar 2019 was conducted. There were 59 cases with MVI and 98 cases without MVI.According to different time periods, the enrolled cases were divided into modeling group (n=137) and validation group (n=20). The independent risk factors of small hepatocellular carcinoma with MVI were discussed and a prediction model was established by using preoperative specific imaging characteristics and clinical data.@*Results@#Multivariate Logistic regression analysis showed that AFP, imaging tumor maximum diameter and tumor margin status were independent risk factors for small hepatocellular carcinoma complicated by microvascular invasion. Preoperative prediction model was established according to the above factors : P=1/1+ [e
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Objective To analyze relevant preoperative risk factors for microvascular invasion (MVI) in patients with small hepatocellular carcinoma and establish a prediction model.Methods A retrospective analysis of 157 cases of singlehepatocellular carcinoma with tumor diameter ≤5 cm undergoing hepatectomy at the First Affiliated Hospital of Fujian Medical University from Dec 2012 to Mar 2019 was conducted.There were 59 cases with MVI and 98 cases without MVI.According to different time periods,the enrolled cases were divided into modeling group (n =137) and validation group (n =20).The independent risk factors of small hepatocellular carcinoma with MVI were discussed and a prediction model was established by using preoperative specific imaging characteristics and clinical data.Results Multivariate Logistic regression analysis showed that AFP,imaging tumor maximum diameter and tumor margin status were independent risk factors for small hepatocellular carcinoma complicated by microvascular invasion.Preoperative prediction model was established according to the above factors:P =1/1 + [e
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Objective To explore the application value of the extra-glissonian pedicle transection approach guided by arantius' ligament in laparoscopic left hemihepatectomy.Methods The retrospective cohort study was conducted.The clinical data of 57 patients who underwent laparoscopic left hemihepatectomy in the First Affiliated Hospital of Fujian Medical University from January 2015 to January 2018 were collected.There were 18 males and 39 females,aged from 29 to 75 years,with an average age of 57 years.Of the 57 patients,22 undergoing the laparoscopic left hemihepatectomy with extra-glissonian pedicle transection approach guided by arantius' ligament and 35 undergoing laparoscopic left hemihepatectomy with regular intra-glissonian pedicle transection approach were allocated into the extra-glissonian transection group and intra-glissonian transection group,respectively.Observation indicators:(1) intraoperative situations and postoperative short-term outcomes;(2) postoperative complications;(3) follow-up.Patients were followed up by outpatient examination and telephone interview to investigate postoperative recurrence of diseases up to June 2018.Measurement data with normal distribution were represented as Mean±SD and comparison between groups was analyzed using the t test.Count data were described as absolute number or percentage and comparison between groups was analyzed using the chi-square test.Results (1) Intraoperative situations and postoperative short-term outcomes:the operation time,dissection time of left hepatic pedicle,volume of intraoperative blood loss were (123± 37) minutes,(14± 5) minutes,(337± 169) mL in the extra-glissonian transection group and (148± 27) minutes,(22± 3) minutes,(495±203) mL in the intra-glissonian transection group,respectively,showing statistically significant differences between the two groups (t =2.992,7.733,3.045,P＜0.05).Cases with intraoperative blood transfusion,time of gastrointestinal recovery,time for postoperative drainage-tube removal,duration of postoperative hospital stay were 1,(1.8±0.9)days,(3.2±0.9)days,(8.2± 1.7)days in the extra-glissonian transection group and 4,(2.0± 0.8)days,(3.6±0.8)days,(10.0±4.0)days in the intra-glissonian transection group,respectively,showing no statistically significant difference between the two groups (x2 =0.171,t=1.304,1.857,1.622,P＞0.05).There was no uncontrolled hemorrhage or air embolism in the two groups.(2) Postoperative complications:3 patients had complications of Clavien-Dindo classification Ⅰ in the extra-glissonian transection group including 1 of pulmonary infection,1 of abdominal infection,1 of incisional infection and 7 had complications in the intraglissonian transection group including 2 of pulmonary infection,2 of liver sectional effusion,1 of subphrenic abscess,1 of biliary leakage,1 of incisional infection,showing no statistically significant difference between the two groups (x2=0.066,P＞0.05).Patients with postoperative complications were cured and discharged after symptomatic treatment.There was no perioperative death in the two groups.(3) Follow-up:57 patients were followed up for 5-41 months,with a median time of 23 months.Two and 1 patients had tumor recurrence and hepatolithiasis recurrence in the intra-glissonian transection group,without recurrence of hepatic hemangioma or cholangiocarcinoma.Five patients had tumor recurrence in the intra-glissonian transection group,without recurrence of hepatic hemangioma,hepatolithiasis or cholangiocarcinoma.The disease recurrence rate was 13.6％ (3/22) and 14.3％(5/35) in the extra-glissonian transection group and intra-glissonian transection group,respectively,showing no statistically significant difference between the two groups (x2 =0.104,P＞0.05).Conclusions Extraglissonian pedicle transection approach guided by arantius' ligament in laparoscopic left hemihepatectomy is feasible and effective,which can control hepatic blood inflow of left liver,simplify the surgery procedure and shorten dissection time of left pedicle,in order to save operation time and reduce volume of intraoperative blood loss.
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Objective To evaluate the feasibility and efficacy of laparoscopic liver resection (LLR) in elderly patients with hepatocellular carcinoma (HCC). Methods Twenty-nine elderly patients undergoing laparoscopic liver resection (LLR) and 58 elderly patients receiving open liver resection (OLR) for HCC were included from January 2013 to December 2015 in our department of Fujian Medical University. Two groups were 1:2 matched for gender ,tumor numbers ,and operative procedure.Besides ,general clinical data ,intraoperative data ,postoperative recovery ,and postoperative survival were compared. Results The postoperative hospital stay was shorter in the LLR group [(9.1±3.8)days]thanintheOLRgroup[(11.8±5.1)days](t= -2.66,P<0.05).Theincidence of portal triad clamping was lower in the LLR group than in the OLR group (34.5％ vs.60.3％ ,χ2 =5.18 ,P<0.05). The removal time of abdominal drainage tube was earlier in the LLR group (4.18 ± 1.94)days than in the OLR group (5.4 ± 2.1)days (t= -2.48 ,P<0.05). The overall survival (OS) showed no difference (37.08 months vs.38.72 months ,t=0.72 ,P=0.789). The disease-free survival (DFS) showed no difference (29.00 months vs.27.49 months ,t=0.53 ,P=0.467). Conclusions LLR in elderly patients with HCC can achieve the same long-term outcome as the conventional open hepatectomy ,and LLR has better short-term outcomes with obvious advantages of minimal invasion.
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Objective:To compare the short-and long-term outcomes of laparoscopic liver resection (LLR) with those of open liver re-section (OLR) for hepatocellular carcinoma (HCC). Methods:Clinical data from patients who suffered from HCC and received LLR or OLR from January 2013 to May 2016 in The First Affiliated Hospital of Fujian Medical University were analyzed restrospectively. To over-come selection bias, a 1:1 match was performed via a case-control study. After case-control matching was completed, 105 patients were included in each group. Short-term outcomes of operation and postoperation as well as long-term outcomes, including disease-free survival and overall survival rates, were evaluated. Relevant statistical methods were used for statistical analysis. Results: The postoperative hospital stay of the laparoscopic group was shorter (8.68 ± 2.82 vs. 10.61 ± 2.95 days, P<0.01) and its use of portal triad clamping was less (20.0%vs. 41.0%, P<0.01) than those of the open group. The abdominal drainage tube of the laparoscopic group was also removed at an earlier time than that of the open group (4.45±2.53 vs. 5.40±2.43 days, P<0.01). The 1-, 2-, and 3-year overall survival rates of the laparoscopic group were 96.88%, 87.54%, and 79.50%, respectively. By comparison, the 1-, 2-, and 3-year overall survival rates of the open group were 94.91%, 86.29%, and 76.37%, respectively (P=0.670). The 1-, 2-, and 3-year disease-free survival rates of the laparoscopic group were 72.09%, 60.16%, and 52.08%, respectively, while the 1-, 2-, and 3-year disease-free survival rates of the open group were 69.48%, 56.50%, 48.13%, respectively (P=0.388). Conclusion:LLR is a safe and feasible procedure. LLR in the selected patients with HCC showed similar long-term outcomes to those of OLR. The postoperative hospital stay of these patients who underwent LLR was shorter and their use of portal triad clamping was less than those of the patients who received OLR. The abdomi-nal drainage tube of the former was also removed at an earlier time than that of the latter. Therefore, the short-term outcomes of LLR were better than those of OLR.
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Objective To identify the correlation between doctors' job burnout and medical errors.Methods In stage 1,a cross-sectional retrospective survey on doctors' job burnout and medical errors was conducted for 300 doctors serving in the First Affiliated Hospital of Fujian Medical University,who were randomly sampled in June 2013.The survey covered basic demographic information,self-assessed job burnout and medical errors.In stage 2,231 doctors without medical errors in stage 1 were selected for a prospective study focusing on a follow-up on their medical errors within half a year.Results Medical errors were found to influence job burnout of doctors significantly.Multiple logistic regression analysis was made based on the three independent variables of A-emotional exhaustion,B-depersonalization,and C personal sense of accomplishment,and the dependent variables Y1 and Y2 indicating the occurrence or non-occurrence of common medical errors or serious medical errors,respectively.The calculation aims to identify if there is line relationship among the three independent variables.Conclusions This study suggests that all kinds of medical errors influence job burnout;scores of the three dimensions of job burnout may be predictors of occurrence of different medical errors.
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Objective To evaluate the efficacy and safety of endoscopic versus open component separation technique (CST) for abdominal hernia.Methods Systematic review was carried out to identify the controlled clinical studies comparing endoscopic CST with open CST for abdominal hernia.The Meta-analysis was performed with RevMan 5.2 software.Results The selection criteria was met in five studies.A total of 185 patients with abdominal hernia were included.Analysis of the data suggested that there was no significant differences in recurrence rate between endoscopic CST and open CST(P =0.84,risk difference =-0.01,95％ CI-0.12 to 0.10).However,endoscopic CST compared with open CST was associated with a significant reduction of postoperative wound complications (P ＜ 0.000 1,odds ratio =0.19,95％ CI 0.09 to 0.41).And there was no significant differences in operation time,intraoperative blood loss and postoperative hospital stay (all P ＞ 0.05).Conclusions As compared to open CST,endoscopic CST show equivalent clinical effects with similar recurrence rate.However,endoscopic CST was associated with a significant reduction of postoperative wound complications,and there was no significant differences in in operation time,intraoperative blood loss and postoperative hospital stay.