Clinical and radiologic comparison between oblique lateral interbody fusion and minimally invasive transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis / 中国骨伤

OBJECTIVE@#To compare the short-term clinical efficacy and radiologic differences between oblique lateral interbody fusion(OLIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for degenerative lumbar spondylolisthesis.@*METHODS@#A retrospective analysis was performed on 58 patients with lumbar spondylolisthesis treated with OLIF or MIS-TLIF from April 2019 to October 2020. Among them, 28 patients were treated with OLIF (OLIF group), including 15 males and 13 females aged 47 to 84 years old with an average age of (63.00±9.38) years. The other 30 patients were treated with MIS-TLIF(MIS-TLIF group), including 17 males and 13 females aged 43 to 78 years old with an average age of (61.13±11.10) years. General conditions, including operation time, intraoperative blood loss, postoperative drainage, complications, lying in bed, and hospitalization time were recorded in both groups. Radiological characteristics, including intervertebral disc height (DH), intervertebral foramen height (FH), and lumbar lordosis angle (LLA), were compared between two groups. The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical effect.@*RESULTS@#The operation time, intraoperative blood loss, postoperative drainage, lying in bed, and hospitalization time in OLIF group were significantly less than those in the MIS-TLIF group (P<0.05). The intervertebral disc height and intervertebral foramen height were significantly improved in both groups after the operation (P<0.05). The lumbar lordosis angle in OLIF group was significantly improved compared to before the operation(P<0.05), but there was no significant difference in the MIS-TLIF group before and after operation(P>0.05). Postoperative intervertebral disc height, intervertebral foramen height, and lumbar lordosis were better in the OLIF group than in the MIS-TLIF group (P<0.05). The VAS and ODI of the OLIF group were lower than those of the MIS-TLIF group within 1 week and 1 month after the operation (P<0.05), and there were no significant differences in VAS and ODI at 3 and 6 months after the operation between the two groups(P>0.05). In the OLIF group, 1 case had paresthesia of the left lower extremity with flexion-hip weakness and 1 case had a collapse of the endplate after the operation;in the MIS-TLIF group, 2 cases had radiation pain of lower extremities after decompression.@*CONCLUSION@#Compared with MIS-TLIF, OLIF results in less operative trauma, faster recovery, and better imaging performance after lumbar spine surgery.

Reflections on nomenclature and expansion of surgical indications for endoscopic spinal surgery / 国际外科学杂志

In recent years, with the development and maturity of endoscopic technique, endoscopic spinal surgery represented by water media and optical rigid endoscope has been widely used in the treatment of many disorders in the cervical, thoracic and lumbar spine. Endoscopic spinal surgery shows similar clinical effects as traditional open surgery or other minimally invasive procedures, and is favored by spinal surgeons due to its advantages of less trauma and rapid recovery after surgery. However, the large-scale application of endoscopic technique brings problems such as non-standard nomenclature and unreasonable indications. Therefore, this article will summarize the surgical nomenclature and indications of endoscopic spinal surgery, in order to provide a reference for spinal surgeons to understand and apply endoscopic technology reasonably.

Progress of endoscopic treatment for early-stage colorectal cancer and precancerous lesions / 肿瘤研究与临床

With the continuous development of endoscopic technology, more and more early-stage colorectal cancer and precancerous lesions have been found by endoscopy, and endoscopic treatment has dominated the treatment of early-stage colorectal cancer for its characteristics of small trauma, rapid recovery and good effect. At present, there are many methods of endoscopic treatment, but their indications are still controversial, and some new technologies still need further verified. Based on the latest guidelines at home and abroad and some hot issues, this article reviews the progress of endoscopic treatment of early-stage colorectal cancer and precancerous lesions, mainly including the indications of various endoscopic treatment methods, some important technical improvement of endoscopic treatment methods, and the application of some new endoscopic treatment technologies, in order to provide some references for the minimally invasive treatment of early-stage colorectal cancer and precancerous lesions.

Progress in minimally invasive techniques for pelvic fractures / 中华创伤骨科杂志

Minimally invasive treatment is the development trend in surgical techniques for pelvic fractures. There have been numerous minimally invasive techniques for pelvic fractures, each having its own advantages. This paper reviews the literature recently published at home and abroad concerning minimally invasive treatment of pelvic fractures so as to summarize the existing minimally invasive techniques for the fractures and their supporting theories, hoping traumatic orthopedists to know more about the minimally invasive techniques. As a result, Chinese traumatic orthopedists may formulate personalized treatment protocols to suit the specific condition of each patient so that the surgical invasion can be minimized and the intraoperative and postoperative complications reduced.

Minimally invasive percutaneous anterior column screwing assisted by blocking screws for pelvic and acetabular fractures / 中华创伤骨科杂志

Objective:To investigate the feasibility and clinical efficacy of percutaneous anterior column screwing assisted by blocking screws for pelvic and acetabular fractures.Methods:A retrospective analysis was conducted of the 13 patients who had been admitted from July 2019 to April 2022 for pelvic and acetabular fractures. There were 8 males and 5 females with an age of (49.1±13.3) years, 7 acetabular fractures (6 on one side and 1 on both sides; by the Letournel-Judet classification: 5 anterior column fractures on 6 sides, and 2 transverse and posterior wall fractures on 2 sides), and 6 pelvic fractures (5 complicated with pelvic posterior ring fracture; by the Tile classification: 1 case of type B2, 3 cases of type C1, and 2 cases of type C2). According to the anatomic zones of the anterior column, 5 fractures were at zone Ⅲ, 3 ones at zone Ⅳ, and 6 ones at zone Ⅴ. The time from injury to surgery ranged from 3 to 14 days, averaging (8.2±2.9) days. Anterograde anterior column screwing assisted by blocking screws was performed for all the 13 patients; the posterior ring was fixated with percutaneous sacroiliac joint screws for the 5 patients complicated with pelvic posterior ring fracture. The surgical time, intraoperative fluoroscopy frequency, and intraoperative bleeding volume for insertion of anterior column screws, fracture reduction quality, and hip joint function at the last follow-up were recorded.Results:A total of 14 anterior column screws were inserted percutaneously in the 13 patients. For insertion of anterior column screws, the surgical time was (65.0±10.2) min, the intraoperative fluoroscopy frequency (63.5±14.5) times, and the intraoperative bleeding volume for each screw less than 30 mL. All the incisions healed primarily after surgery, without such complications as iatrogenic neurovascular injury or poor wound healing. All the 13 patients were followed up for (11.1±2.2) months after surgery. In the patient with bilateral acetabular anterior column fractures for which 2 anterior column screws had been inserted, one screw had to be removed due to its displacement at 1 month after surgery; no such complications as loosening of internal fixation or fracture re-displacement was found in the other patients. All fractures healed after (10.2±2.1) months. According to the Matta scoring for quality of fracture reduction, 7 sides were excellent, 5 sides good, and 2 sides poor; according to the Majeed scoring for the 6 patients with pelvic fracture at the last follow-up, the efficacy was rated as excellent in 4 cases and as good in 2 ones; according to the modified Merle d'Aubigné & Postel scoring for the 7 patients with 8 acetabular fractures at the last follow-up, the efficacy was rated as excellent in 4 hips, as good in 3 hips, and as fair in 1 hip.Conclusion:For pelvic and acetabular fractures, minimally invasive percutaneous anterior column screwing assisted by blocking screws can result in fine clinical efficacy, in addition to its easy procedures, safety and reliability.

Fixation with a retrograde pubic ramus intramedullary nail for anterior pelvic ring fractures / 中华创伤骨科杂志

Objective:To explore the clinical efficacy of a retrograde pubic ramus intramedullary nail (RPRIN) in the treatment of anterior pelvic ring fractures.Methods:A retrospective study was conducted to analyze the 14 patients with anterior pelvic ring fracture who had been treated and followed up at Department of Traumatic Surgery, Tongji Hospital From June 2020 to February 2021. There were 10 males and 4 females with an age of (44.8±12.5) years. By the AO/OTA classification for pelvic fractures, 5 cases were type 61-A, 4 cases 61-B, and 5 cases type 61-C; by the Nakatani classification, 1 case belonged to unilateral zone Ⅰ fracture, 5 cases to unilateral zone Ⅱ fracture, 2 cases to unilateral zone Ⅲ fracture, 3 cases to right zone Ⅱ and left zone Ⅲ fracture, 2 cases to zone Ⅲ fracture on both left and right sides, and 1 case to zone Ⅱ fracture on both sides. The time from injury to operation was (7.8±1.8) days. All the anterior pelvic ring fractures were fixated with a RPRIN. The time and fluoroscopic frequency for placement of every single RPRIN, quality of fracture reduction, and pelvic function and incidence of postoperative complications at the last follow-up were recorded.Results:A total of 18 RPRINs were placed in the 14 patients. For placement of each RPRIN, the time was (35.9±8.6) min, and the fluoroscopic frequency (22.8±1.9) times. No complications such as infection occurred at any surgical incision after RPRIN placement. According to the Matta scoring, the quality of postoperative fracture reduction was assessed as excellent in 7 cases, as good in 5 cases and as fair in 2 cases. The 14 patients were followed up for (18.1+1.5) months. Their X-ray and CT images of the pelvis at the last follow-up showed that the fractures healed well and the intramedullary nails were placed in the cortical bone of the anterior ring of the pelvis. According to the Majeed scoring at the last follow-up, the pelvic function was assessed as excellent in 10 cases, as good in 3 cases and as fair in 1 case. One patient reported discomfort during squatting 2 months after operation but the symptom improved 3 months later without any special treatment. No patient experienced such complications as displacement or slippage of RPRIN, or pain at the insertion site.Conclusion:RPRIN is effective in the treatment of anterior pelvic ring fractures, showing advantages of small surgical incision, limited intraoperative fluoroscopy and short operation time.

Anterior percutaneous minimally invasive internal fixation with proximal humerus internal locking system inverted versus with a posterior single plate for distal humeral shaft fractures / 中华创伤骨科杂志

Objective:To compare the clinical effects between proximal humerus internal locking system (PHILOS) inverted and a posterior single plate in the anterior percutaneous minimally invasive internal fixation for distal humeral shaft fractures.Methods:A retrospective study was conducted to analyze the data of 65 patients with distal humeral shaft fracture who had been treated from January 2018 to May 2021 at Department of Orthopaedics, The Second Hospital of Fuzhou. The patients were assigned into 2 groups according to different treatment methods. In the observation group of 30 cases subjected to anterior percutaneous minimally invasive internal fixation with PHILOS inverted: 20 males and 10 females with an age of (41.5±11.6) years; type A in 5 cases, type B in 14 cases, and type C in 11 cases by AO fracture classification. In the control group of 35 cases subjected to anterior percutaneous minimally invasive internal fixation with a posterior single plate: 23 males and 12 females with an age of (39.9±11.2) years; type A in 7 cases, type B in 17 cases, and type C in 11 cases by AO fracture classification. The preoperative general data, operation time, intraoperative blood loss, total incision length, fracture healing time, and shoulder and elbow VAS scores, Constant-Murley shoulder function score, Mayo elbow performance score (MEPS), and complications at the last follow-up were recorded and compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). There were no significant differences either in operation time, fracture healing time, or shoulder or elbow VAS pain score, Constant-Murley shoulder function score, or MEPS at the last follow-up between the 2 groups ( P>0.05). The intraoperative blood loss was (59.7±26.6) mL in the observation group and (165.7±86.4) mL in the control group, and the total incision length was (10.7±2.1) cm in the observation group and (18.6±2.7) cm in the control group, showing statistically significant differences between the 2 groups ( P<0.01). There was no injury to the radial nerve or musculocutaneous nerves, incision infection or fracture nonunion in the observation group. There were 4 cases of iatrogenic radial nerve injury, 2 cases of incision infection and 1 case of fracture nonunion in the control group, yielding a complication rate of 20.0% (7/35). The difference in the incidence of complications was significant between the 2 groups ( P<0.01). Conclusion:In the treatment of distal humeral shaft fracture with anterior percutaneous minimally invasive internal fixation, PHILOS inverted has advantages of less soft tissue damage, less intraoperative bleeding, and a lower risk of iatrogenic radial nerve injury than the posterior single plate.

A clinical randomized controlled trail of an intelligent robot-assisted minimally invasive reduction system for treatment of unstable pelvic fractures / 中华创伤骨科杂志

Objective:To compare the short-term efficacy between our self-designed intelligent robot-assisted minimally invasive reduction system and conventional freehand reduction assisted by fluoroscopy in the treatment of unstable pelvic fractures by robot or fluoroscopy-assisted internal fixation with percutaneous screws.Methods:A prospective randomized controlled trial was conducted to include eligible 35 patients with unstable pelvic fracture who were admitted to Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from December 2021 to October 2022. They were randomized into 2 groups. The observation group[17 cases, 10 males and 7 females with an age of (44.0±17.4) years] was treated with robot-assisted minimally invasive reduction, followed by robot-assisted or fluoroscopic internal fixation with percutaneous screws; the control group[18 cases, 12 males and 6 females with an age of (38.8±15.0) years] was treated with freehand reduction assisted by fluoroscopy, followed by robot-assisted or fluoroscopic internal fixation with percutaneous screws. The 2 groups were compared in terms of operation time, intraoperative bleeding, successful reduction, reduction quality, incidence of surgical complications and postoperative functional scores.Results:The 2 groups were comparable because there were no significant differences in the preoperative general data between them ( P>0.05). The intraoperative fluoroscopy frequency[(32.4±17.5) times] and fluoroscopy time [(19.8±10.4) s] in the observation group were significantly lower or shorter than those in the control group [(60.8±26.6) times and (38.2±16.1) s], and the rate of successful reduction in the observation group was 100.0% (17/17), significantly higher than that in the control group[72.2% (13/18)] ( P<0.05). There was no significant difference between the 2 groups in intraoperative bleeding, operation time, reduction error, excellent and good rate of reduction after operation by Matta scoring, or Majeed functional score at 12 weeks after operation ( P>0.05). Conclusion:In the treatment of unstable pelvic fractures, since our self-designed intelligent robot-assisted minimally invasive reduction system can plan autonomously the reduction paths and accomplish minimally invasive reduction of the fracture with 3D images real-time monitoring, it is advantageous over conventional reduction methods in a higher success rate and less radiation exposure.

Retroperitoneal laparoscopy combined with lower abdominal incisions for the surgical treatment of upper urinary tract urothelial cell carcinoma in 52 patients / 中国基层医药

Objective:To investigate the feasibility and efficacy of retroperitoneal laparoscopy combined with lower abdominal incisions in the surgical treatment of upper urinary tract urothelial cell carcinoma.Methods:The clinical data of 52 patients with renal pelvic and ureteral cancer, who received radical nephrectomy using the retroperitoneal laparoscopy combined with a lower abdomen incision approach in Hubei Provincial General Hospital of Armed Police Force from April 2005 to December 2016, were retrospectively analyzed. All 52 patients had unilateral renal pelvic and ureteral cancer but with no lymph nodes or distant metastasis. During general anesthesia in a healthy side-lying position, patients underwent retroperitoneal laparoscopic radical nephrectomy. The affected ureter was clamped but not disconnected. Renal blood vessels were clamped with Hem-o-lock clips. Renal arteries and veins were cut off. Then the kidney was completely isolated. Three laparoscopic incisions were sutured. After taking the patients to be in the supine position, a 5-6 cm-long incision was made in the lower abdomen on the affected side. The lower ureter was dissociated from the bladder. A 1.5 cm-long bladder wall was dissected in the sleeve manner. The affected kidney and ureter were completely removed from the lower abdomen through the made small incision. A rubber drainage tube was inserted in another incision made at the lower end of the prior incision.Results:Operations were successful in all 52 cases. No cases were converted to open surgery, had blood transfused, or needed secondary surgery. There were no complications such as urinary leakage, incision infection, or massive bleeding. Postoperative pathology reported 41 cases of renal urothelial carcinoma and 11 cases of ureteral urothelial carcinoma. Forty-eight patients provided follow-up data, and four did not because of being lost. One patient died of a cardiovascular accident 13 months after surgery. Cystoscopy revealed that 47 cases had no bladder tumor, local or distant metastasis.Conclusion:The retroperitoneal laparoscopy combined with lower abdominal incisions approach is suitable for radical resection of renal pelvic or ureteral cancer owing to ease in operation, few requirements for surgical instruments, minimal invasion, and rapid recovery.

Progress on surgical treatment in gastric cancer / 国际外科学杂志

There are high burden of disease including a high incidence, relatively high proportion of late stage when diagnosed and poor overall prognosis in China regarding to the diagnosis and treatment of gastric cancer. Surgery remains as the major treatment for gastric cancer. Based on the latest guidelines, endoscopic surgery or gastrectomy is performed for early gastric cancer, and the standard surgery for locally advanced gastric cancer is D2 lymphadenectomy. Besides, this article will discuss about other research hotspots, such as expansion of lymph node dissection in selected patients, construction methods of adenocarcinoma of esophagogastric junction, especially Siewert type Ⅱ, minimally invasive techniques (laparoscopic gastrectomy and robotic gastrectomy), the surgical treatment for elderly patients with gastric cancer will be discussed also.

Risk factors of short-prognosis after minimally invasive surgery in elderly patients with hypertensive basal ganglia intracerebral hemorrhage / 国际外科学杂志

Objective:To investigate the short-term prognosis of elderly patients with hypertensive basal ganglia intracerebral hemorrhage after minimally invasive surgery and to analyze the risk factors.Methods:The clinical data of 96 elderly patients with hypertensive basal ganglia intracerebral hemorrhage admitted to the Department of Neurosurgery of Tongling People′s Hospital and Tongling Municipal Hospital from June 2016 to February 2021. According to the difference of prognosis, the patients were divided into good prognosis group( n=34) and poor prognosis group( n=62). The clinical data of the two groups were compared. Such as sex, age, basic disease (years of hypertension, diabetes), GCS score at admission, arterial systolic blood pressure at admission, blood glucose at admission, volume of cerebral parenchyma hemorrhage, whether there was a reexamination of head CT within 1 hour before operation, whether there was intraventricular hemorrhage, postoperative complications (pulmonary infection, intracranial infection, rebleeding), GOS score 1 month after operation.The metrological data of normal distribution were expressed by mean ± standard deviation ( ± s). Independent t test was used for comparison between groups. Chi-square test was used for comparison of counting data. Multivariate Logistic regression analysis was used to screen independent risk factors for short-term prognosis after minimally invasive surgery. Results:Among the 96 patients, Univariate analysis showed that there were significant differences in age, diabetes, admission GCS score, arterial systolic blood pressure (SBP), blood glucose at admission, head CT within 1 hour before operation, intraventricular hemorrhage, timing of operation and number of postoperative complications between the two groups. Multivariate Logistic regression analysis showed that age >75 years old( OR=4.358, 95% CI: 1.209-15.710), diabetes mellitus( OR=4.637, 95% CI: 1.793-11.990), admission GCS score≤ 8( OR=14.305, 95% CI: 2.694-75.950), blood glucose ≥10.0 mmol/L at admission( OR=3.229, 95% CI: 1.261-8.270), no reexamination of head CT within 1 hour before operation( OR=9.423, 95% CI: 1.827-48.599), intraventricular hemorrhage( OR=12.109, 95% CI: 3.336-43.961), operation time > 7 hours( OR=6.234, 95% CI: 1.986-19.570), the number of postoperative complications ≥ 2( OR=13.461, 95% CI: 3.624-49.999)were independent risk factors for short-term prognosis. Conclusions:Minimally invasive treatment of elderly hypertensive basal ganglia intracerebral hemorrhage can achieve satisfactory clinical outcomes. However, age >75 years old, diabetes, admission GCS score≤ 8, blood glucose ≥10.0 mmol/L at admission, no reexamination of head CT within 1 hour before operation, with intraventricular hemorrhage, operation time > 7 hours, the number of postoperative complications ≥ 2 are independent risk factors affecting short-term prognosis of patients. It is necessary to strengthen the perioperative management of patients, which is of great significance to improve the prognosis.

Development trend and new understanding of contemporary vitrectomy / 中华眼底病杂志

Vitrectomy is an important treatment for vitreoretinal diseases. After half a century of innovation and development, it has made a breakthrough from open type to micro-incision surgery. Minimally invasive vitrectomy has the advantages of wide indications and high cutting efficiency, which greatly improves the safety and efficacy of surgery, and minimizes the occurrence of trauma and complications during surgery. At present, with the development of surgical microscope system, ophthalmic microsurgery robot and other equipment, and the development and application of new artificial vitreous materials, vitrectomy is developing toward minimally invasive, accurate and intelligent development. The further development of vitrectomy innovative technology in the field of ophthalmology is hopeful in the future, so that clinicians can achieve the best surgical results with the minimum damage, and bring better light to patients.

Minimal invasive surgery for fragility fracture of pelvis in elderly patients / 中华老年医学杂志

Objective:To evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of elderly patients with fragility fracture of pelvis.Methods:Elderly patients with fragile pelvic fractures undergoing minimally invasive surgery and being followed up were retrospectively analyzed from January 2015 to December 2019.Based on the classification of pelvic fragile fractures(FFP), open reduction and internal fixation with pelvic anterior ring instability internal fixator(INFIX)plus posterior ring sacroiliac screw, or open reduction and internal fixation with iliac fossa approach, were performed for elderly patients with fragile pelvic fractures.The general data of all patients(age, sex, mechanism of injury)were recorded.Time from injury to operation, VAS(visual analogue scale)before and after operation, blood loss during operation, complications during hospitalization, time to ambulation, mortality, and Koval walking index at 2 year follow-up were recorded to evaluate clinical outcomes and complications of minimal invasive surgery for the treatment of fragility fracture of pelvis.Results:Thirty-two patients were followed up, including 11 males and 21 females, aged 65-88 years(76.9±5.5)years.The mechanism of injury was fall on the ground as a percentage of 59.4%(19/32), fall in the sitting position as a percentage of 25.0%(8/32), and 15.63%(5/32)had unknown history of trauma.The time from injury to operation was 3-36 days(9.6±3.3)days.There were 50.0%(16/32)type Ⅱ, 31.3%(10/32)type Ⅲ and 18.8%(6/32)type Ⅳ cases according to FFP classification.The mean blood loss during operation was(65.9±35.2)ml(range, 20-200 ml). The preoperative VAS score was 5-9 scores, with an average of(6.41±1.07)scores.The postoperative VAS score was 1-4(1.71±0.63). Average time from injury to operation was(9.6±3.3)days(range, 3~36). The incidence of complications during operation was 9.4%(3/32), including 1 case of gastrointestinal bleeding, 1 case of lower extremity deep vein thrombosis, and 1 case of superficial wound infection.Ambulation was at 4 weeks post-operation in 56.3%(18/32)cases, at 6 weeks post-operation in 31.3%(10/32)cases and at 8 weeks post-operation in 12.5%(4/32)cases.6.25%(2/32)patients died within 2 year follow-up.Koval walking index of the rest 30 patients included grade 1 in 46.9%(15/32)cases, grade 2 in 18.8%(6/32)cases, grade 3 in 6.3%(2/32)cases, grade 4 in 18.8%(6/32)cases and grade 6 in 3.1%(1/32)case(1 year after surgery, hemiplegia after cerebral infarction).Conclusions:Minimal invasive surgery achieves significant pain relief and early mobilization in patients with fragility fracture of pelvis.

New insight into silicone oil in the era of minimally invasive vitrectomy / 中华眼底病杂志

Silicone oil is widely used in intraocular filling of fundus disease after vitrectomy, which improves retinal reattachment rate andpostoperative visual function of patients. With the era of minimally invasive vitreous surgery coming, the utilization rate of silicone oil filling is decreasing, however, it still plays an indispensable role in the surgical treatment of complex fundus diseases. In the process of using silicone oil, the indications should be strictly selected, and the potential risks should be fully considered and possibly avoided. The study of vitreous substitutes with certain physiological functions is currently a research hotspot in the field of fundus diseases.

New insight into application and function of air or gas for vitreoretinal surgery / 中华眼底病杂志

At present, tamponade agent which being used in retinal surgery is mainly sterile air, gas and silicone oil. Sterile air is mostly used in the treatment of simple retinal detachment. Gas or silicone oil as tamponade is greatly applied for complicated retinal detachment. In recent years, with the application of micro-invasive vitrectomy under a wide-angle viewing system and perioperative anti-vascular endothelial growth factor drugs, application of intraocular filling materials also has changed. The application of silicone oil is significantly reduced. Percentage rate of gas as tamponade for retinal detachment is reduced. The application of sterile air as tamponade is rising. With selecting indication carefully and picking up the suitable air or gas, doctor will reduce the workload. It will also reduce the social burden and benefit patients.

Macular morphology and vascular parameters changes following micro-invasive vitrectomy in patients with severe non-proliferative diabetic retinopathy / 中华眼底病杂志

Objective:To observe the changes of macular morphology and blood flow after minimally invasive vitrectomy (PPV) in patients with severe non-proliferative diabetic retinopathy (sNPDR).Methods:A prospective clinical study. From January 2020 to April 2021, 17 consecutive sNPDR patients with 17 eyes who were diagnosed and received PPV treatment at the Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study. There were 12 males with 12 eyes and 5 females with 5 eyes; the average age was 55 years old; the average duration of diabetes was 11 years; the average glycosylated hemoglobin was 7.9%. Before the operation and 1, 3, and 6 months after the operation, all the affected eyes underwent best corrected visual acuity (BCVA), standard 7-field fundus color photography, and optical coherence tomography angiography (OCTA). An OCTA instrument was used to scan the macular area of the affected eye with in the range of 3 mm×3 mm to measure the central subfoveal thickness (CST), the thickness of the ganglion cell complex (GCC) in the macular area, the thickness of the retinal nerve fiber layer (RNFL), and the superficial capillary plexus (SCP) vessel density and perfusion density in the macular area, macular avascular zone (FAZ) area, a-circularity index (AI). Before the operation and 6 months after the operation, the least significant difference test was used for the pairwise comparison.Results:Before the operation, 1, 3, and 6 months after the operation, the FAZ area of the macular area were 0.34±0.14, 0.35±0.10, 0.37±0.10, 0.36±0.13 mm 2, respectively; AI were 0.52±0.13, 0.54±0.11, 0.57±0.10, 0.60±0.11; CST was 282.6±66.7, 290.4±70.9, 287.2±67.5, 273.2± 49.6 μm; GCC thickness were 77.1±15.5, 74.3±13.9, 72.6±16.2, 78.5±18.3 μm; the thickness of RNFL was 97.9±13.8, 101.3±14.6, 97.7±12.0, 96.1±11.4 μm, respectively. The overall blood flow density of SCP in the macula were (16.79±1.43)%, (16.71±1.82)%, (17.30±2.25)%, (17.35±1.22)%; the overall perfusion density were 0.32±0.02, 0.32±0.03, 0.33±0.03, 0.33±0.02, respectively. After the operation, the CST increased first and then decreased; the thickness of RNFL increased 1 month after the operation, and then gradually decreased. Comparison of the parameters before and 6 months after the operation showed that the AI improved, and the difference was statistically significant ( P=0.049); the difference in FAZ area and the thickness of CST, GCC, and RNFL was not statistically significant ( P=0.600, 0.694, 0.802, 0.712); There was no statistically significant difference in the retina SCP blood flow density and perfusion density in the macular area ( P=0.347, 0.361). Conclusion:Compared with before surgery, there is no significant change in macular structure and blood flow density in sNPDR patients within 6 months after minimally invasive PPV.

The era of minimally invasive vitreous surgery: new insights into diabetic retinopathy surgery / 中华眼底病杂志

Vitrectomy is the preferred surgical method for diabetic retinopathy, especially in the stage of proliferative diabetic retinopathy. Vitrectomy for diabetic retinopathy involves all aspects of vitrectomy, which is one of the signs of maturity of retinal surgeons. With the application of minimally invasive vitrectomy and perioperative anti-neovascularization drugs, indications and timing of surgery, perioperative medication, management of vitreous, and whether combined with cataract surgery have changed greatly, and new understanding is needed. Evidence-based clinical research on the timing of diabetic retinopathy surgery and perioperative drug use should be carried out to provide a new theoretical basis for the surgical treatment of diabetic retinopathy.

Uniportal thoracoscopic decortication in the treatment of chronic tuberculous empyema / 中华胸心血管外科杂志

Objective:To investigate the surgical procedure and outcome of uniportal thoracoscopic decortication in the treatment of chronic tuberculous empyema.Methods:From March 2019 to December 2019, the clinical data of 53 patients with chronic tuberculous empyema, who underwent uniportal thoracoscopic decortication in the Surgical Department of Wuhan Pulmonary Hospital were retrospectively analyzed. There were 40 males and 13 females. Age ranged from 16 to 69, averaged 36 years old.36 cases were on the right side and 17 cases on the left side, 38 cases were complicated with pulmonary tuberculosis. All cases had been diagnosed as tuberculous empyema by pathogeny and pathology test in preoperative or postoperative, and received tuberculosis management treatment between 2 and 12 months prior to surgery.The surgical procedure and clinical efficacy of uniportal thoracoscopic decortication were expounded in treatment of chronic tuberculous empyema.Results:Among the 53 patients, 49(92.45%) cases underwent uniportal thoracoscopic decortication, and 4(7.55%) cases changed to thoracotomy. The duration of surgery was 100-370 min, mean(234.53±56.06)min. Intraoperative hemorrhage was 50-1 400 ml, median value 300(175.0, 402.5)ml. Catheter retention time was 3-22 days, median value 8(6.00, 11.25)days. The incidence of surgical complications was 1.89%(1/53), the cure rate was 92.45%(49/53).Conclusion:If the perioperative evaluation and treatment are appropriate, and the operator is experienced, the uniportal thoracoscopic decortication is feasible, safe and effective in the therapy of chronic tuberculous empyema.

The effectiveness and safety of Morinidazole for acute complicated appendicitis undergoing laparoscopic appendectomy / 中华普通外科杂志

Objective:To analyze the effectiveness and safety of Morinidazole combined laparoscopic appendectomy for acute purulent appendicitis and acute gangrene appendicitis.Methods:We retrospectively retrieved 387 acute appendicitis patients who have received surgery or conservative treatment from Jan 2017 to Jun 2019. Firty four patients with Morinidazole + Etimicin bigeminy combined laparoscopic surgery were set to experimental group. The other 54 cases using ornidazole + levofloxacin bigeminy combined laparoscopic appendectomy were enrolled into control group after Propensity Score Matching.Results:After 1∶1 propensity score matching, there was no statistically significant difference between the two groups and control group in clinical features. The white blood cell count, C-reactive protein and calcitonin original inflammation index change were higher in experimental group than in the control group,both preoperatived and on post-op day1 and day 3 (all P<0.05). In the experimental group the length of hospital stay and analgesic drug usetime were shorter than in the control group (all P<0.05). Conclusion:Morinidazole combined laparoscopic appendectomy can effectively control the intra-abdominal infection caused by acute purulent appendicitis and acute gangrene appendicitis with less adverse reactions.

Current status and perspective of ambulatory colorectal surgery / 国际外科学杂志

With the development of minimally invasive surgery and the application of enhanced recovery after surgery (ERAS) protocol, the postoperative recovery of colorectal surgery was improved dramatically. Ambulatory colorectal surgery is gradually realized in this situation. In 2009, the first report of ambulatory colorectal surgery was published. And the results of several cohorts published in past 3 years showed that about one-third colorectal patients are the appropriate candidates of ambulatory colorectal surgery. Proper eligibility criteria, application of advanced minimally invasive surgery and enhanced recovery after surgery protocol, in combination with effective and strict complication surveillance and follow up after discharge, are the key points for the realization of successful ambulatory colorectal surgery. On the basis of reviewing and analyzing the history and current situation of daytime colorectal surgery, this paper will summarize the key point of daytime colorectal for clinical reference.