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@#AIM: To analyze the curative effect and safety of modified dacryocystorhinostomy with simple anterior flap anastomosis in the treatment of chronic dacryocystitis.<p>METHODS: A total of 99 patients(113 affected eyes)with chronic dacryocystitis who underwent dacryocystorhinostomy in the hospital between March 2016 and July 2018 were enrolled in the retrospective study. They were divided into the traditional group(traditional dacryocystorhinostomy, 46 cases, 52 affected eyes)and the modified group(modified surgery with simple anterior flap anastomosis, 53 cases, 61 affected eyes)according to the surgical procedures. The surgical results, rates of granulation tissue formation around the anastomotic stoma at different time after surgery, rates of nasal mucosal epithelialization, size of the anastomotic stoma, the occurrence of surgical complications and the recurrence rate during 1a of follow-up were compared between the two groups.<p>RESULTS: The grade of curative effect in the modified group was better than the traditional group(75.0% <i>vs </i>95.1%)during 6mo of follow-up(<i>P</i><0.05). The total cure rate was higher than that of the traditional group(<i>P</i><0.005). The rates of granulation tissue formation(3.8%, 5.7%, 9.4%)in the modified group at 1mo, 3mo and 6mo after surgery were lower than those in the traditional group(64.2% <i>vs</i> 39.1%, <i>P</i><0.001). The rate of nasal mucosal epithelialization in the modified group was higher than that in the traditional group(25.63±4.76 <i>vs </i>11.34±3.52mm2, <i>P</i><0.01)at 1mo after surgery. The area of anastomotic stoma in the modified group was larger than that in the traditional group(25.63±4.76 <i>vs </i>11.34±3.52mm2,<i>P</i><0.01)at 6mo after surgery. The incidence rates of postoperative hemorrhage and complication in the modified group and the recurrence rate in 1y of follow-up were lower than those in the traditional group(<i>P</i><0.05).<p>CONCLUSION: The cure rate of patients undergoing modified dacryocystorhinostomy with simple anterior flap anastomosis is higher than those undergoing traditional surgery. The former can promote nasal mucosal epithelialization, maintain the size of anastomotic stoma and prevent the formation of surrounding granulation tissue. It is safe and effective, with few complications and low recurrence rate.
RESUMEN
@#AIM: To analyze the curative effect and safety of modified dacryocystorhinostomy with simple anterior flap anastomosis in the treatment of chronic dacryocystitis.<p>METHODS: A total of 99 patients(113 affected eyes)with chronic dacryocystitis who underwent dacryocystorhinostomy in the hospital between March 2016 and July 2018 were enrolled in the retrospective study. They were divided into the traditional group(traditional dacryocystorhinostomy, 46 cases, 52 affected eyes)and the modified group(modified surgery with simple anterior flap anastomosis, 53 cases, 61 affected eyes)according to the surgical procedures. The surgical results, rates of granulation tissue formation around the anastomotic stoma at different time after surgery, rates of nasal mucosal epithelialization, size of the anastomotic stoma, the occurrence of surgical complications and the recurrence rate during 1a of follow-up were compared between the two groups.<p>RESULTS: The grade of curative effect in the modified group was better than the traditional group(75.0% <i>vs </i>95.1%)during 6mo of follow-up(<i>P</i><0.05). The total cure rate was higher than that of the traditional group(<i>P</i><0.005). The rates of granulation tissue formation(3.8%, 5.7%, 9.4%)in the modified group at 1mo, 3mo and 6mo after surgery were lower than those in the traditional group(64.2% <i>vs</i> 39.1%, <i>P</i><0.001). The rate of nasal mucosal epithelialization in the modified group was higher than that in the traditional group(25.63±4.76 <i>vs </i>11.34±3.52mm2, <i>P</i><0.01)at 1mo after surgery. The area of anastomotic stoma in the modified group was larger than that in the traditional group(25.63±4.76 <i>vs </i>11.34±3.52mm2,<i>P</i><0.01)at 6mo after surgery. The incidence rates of postoperative hemorrhage and complication in the modified group and the recurrence rate in 1y of follow-up were lower than those in the traditional group(<i>P</i><0.05).<p>CONCLUSION: The cure rate of patients undergoing modified dacryocystorhinostomy with simple anterior flap anastomosis is higher than those undergoing traditional surgery. The former can promote nasal mucosal epithelialization, maintain the size of anastomotic stoma and prevent the formation of surrounding granulation tissue. It is safe and effective, with few complications and low recurrence rate.
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[Objective ] To investigate the improvement of the surgical treatment effect on cerebral palsy with spastic diplegia by performing modified surgeries since 2004. [Method ] Twenty-three cases of severe cerebral palsy with spastic diplegia were operated, 14 male, 9 female; age 3 ～ 12 years; the average age of 5.7 years; their main symptoms were unable to stand and walk independently, with severe hypermyotonia of both lower extremities, and a scissoring type of gait when standing, hip and knee flexing contracture, ankle and foot equinovarus. Physical examination: there was hypermyotonia of the iliopsoas, adductor musculus, hamstrings, triceps surae, anterior and posterior tibial muscle, flexor pollicis longus and flexor digitorum longus. The muscle tone was 3 ～4 grade according to Ashworth criterion. Treatment: The intramuscular tenotomy, fascial division or sliding elongation were performed, to lengthen the tendon of the joint flexion contracture, the lateral half of anterior tibial muscle tendon was transferred laterally to balance the muscle force at the foot. Finally, both lower extremities were fixed by a new designed external frame, to straigthen the articular genu, keep both ankles and feet in neutral position, both lower extremities abducting 30°, and to correct all joint deformities. Family rehabilitation programs started after the external frame was removed 6 weeks later. [Result] All cases were followed up in 1 ～3 years with the average 2. 2 years. The results were evaluated as excellent, good and ineffective, according to correction of the joint deformities, the ability to stand and walk, and parent's satisfaction to the treatment. Of them 21 cases were excellent, 2 cases good, and no ineffective case. [ Conclusion ] For the severe cerebral palsy with spastic diplegia in children, reasonable release of the tight tendons of the multi-joint flexion contracture, balance of muscle force at the foot, correction of all deformities and fixation of the lower extremities with the new external frame, and long term of family rehabilitation after the surgery, are more effective treatment.
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The authors have analyzed the clinicopathologic data of 855 patients with early gastric cancer (EGC) who underwent D2 lymph node dissection during the 7-year period between January 1990 and December 1996 in order to evaluate the factors influencing lymph node metastasis and to establish the clinical indications and guidelines for modified surgery in EGC patients. The overall rate of lymph node metastasis was 13.5% (115/855). There was a significant statistical difference for lymph node metastasis between men (67/575, 11.7%) and women (48/280, 17.1%)(p<0.05). In mucosal cancer, the rate of lymph node metastasis was 4.7% (20/427), and in submucosal cancer, it was 22.2% (95/428), which is a significant difference between the two groups. There was also a significant difference for lymph node metastasis between the elevated types (EGC type I and IIa) and the depressed types (type IIb, IIc, and III), 8.4% (13/154) and 14.6% (102/701), respectively (p=0.05). There were only one lymph node positive case (1/82, 1.2%) among the elevated mucosal cancers. Smaller tumors((10 mm) showed a significantly lower incidence of lymph node metastasis than larger tumors (11 mm)(p<0.01); 4 cases invoving tumors of less than 11 mm had lymph node metastasis(2 mucosal and 2 submucosal lesions). Differentiated mucosal carcinomas showed a significantly lower incidence of lymph node metastasis than undifferentiated carcinomas (0.9% vs 8.5%, p<0.001), whereas there was no significant difference between differentiated and undifferentiated submucosal cancers. There were 14 cases of EGC with metastasis in the secondary lymph node group (N2) consisting of 5 men and 9 women, with a mean age of 53 years. Among them, the 7 cases under the age of 50 were all female patients. For thses 14 case, the average tumor size was 34 mm (15~90 mm), and the majority of were depressed types (11 cases) and undifferentiated type (12 cases). These results suggest that modified surgery is indicated as an optimal treatment option for mucosal cancer with elevated and/or differentiated type tumors, on the basis of not only radicality but also postoperative quality of life.