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Objective To investigate the natural evolution of postoperative distal adding-on in Lenke 1A and 2A adoles-cent idiopathic scoliosis(AIS)patients,and to explore the risk factors for the progression of distal adding-on.Methods From Ju-ly 2006 to July 2012,a total of 197 AIS patients with Lenke 1A or 2A curves underwent posterior selective thoracic instrumenta-tion and fusion surgery.Among which,44 patients(22.3%)with postoperative distal adding-on were recruited in this study.There were 39 female and 5 male,with an average age of(15.0±2.1)years.The mean Cobb angle of main thoracic curve was 49.3°±9.3°. The first postoperative radiograph indicating distal adding-on and the last follow-up radiograph were compared:make the measure-ment of the disc angle below lowest instrumented vertebra(LIV),and the distance between the vertebra below LIV(LIV+1)and cen-tral sacral vertical line(CSVL).Distal adding-on could be classified into progressive group and non-progressive group according to its natural evolution during follow-up.If the disc angle increased> 5°or the LIV+1-CSVL distance increased>5 mm,the pa-tients were assigned into progressive group; Otherwise, the patients were assigned into non-progressive group. Using Student T test, χ2test or Fisher exact test, the predicted risk factors for progression were screened for further Logistic regression. Results Among the 44 patients enrolled in the study,17 patients(38.6%)had progressive adding-on while 27 patients(61.4%)had non-progressive adding-on.The Risser sign was significantly lower in progressive group than non-progressive group(t=4.399,P<0.001). Besides,more patients had LIV proximal to substantially stable vertebra(SSV)in progressive group than non-progressive group (Fisher exact test value=18.142,P<0.001).The improvement of shoulder imbalance was significantly better in progressive group than non-progressive group(t=3.011, P=0.002). According to Logistic regression, the low Risser sign and LIV proximal to SSV were independent risk factors for progression of distal adding-on.Moreover,the self-image domain of SRS-22 Scores was remark-ably lower in progressive group than non-progressive group(t=2.321,P=0.014).Conclusion Distal adding-on could be classi-fied into progressive group(40%)and non-progressive group(60%)according to its natural evolution.The risk factor for its progres-sion included skeletal immaturity and LIV proximal to SSV.Moreover,the progression of distal adding-on might compensate for the shoulder imbalance during follow-up.
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Objective To explore clinical characteristics and treatment for unexpected gallbladder carcinoma during laparoscopic surgery . Methods A retrospective analysis was made on clinical data of 12 cases of unexpected gallbladder carcinoma out of 4620 cases of laparoscopic cholecystectomy (LC) in our hospital from September 1997 to September 2015.Intraoperative frozen pathological diagnosis showed gallbladder cancer Nevin stage Ⅲin 1 case, and a conversion to open surgery of gallbladder cancer was conducted .The remaining 11 cases of gallbladder carcinoma were diagnosed by pathology after surgery .One case of Nevin stage Ⅰand 1 case of stage Ⅱwere not surgically treated .Of the other 9 cases of Nevin stage Ⅲ, there were 5 patients who refused surgery and 4 patients received open radical resection of gallbladder cancer at 10-18 d (mean, 14 d) postoperatively. Results The 5 cases of Nevin stage Ⅲwho refused open radical surgery were lost to follow-up.Two cases of stage Ⅰand Ⅱwere followed up for 63 months and 6 months after LC without recurrence .Of the 5 cases of stageⅢundergoing open radical surgery , 2 cases dead at 8 and 10 months postoperatively because of abdominal extensive metastasis and cachexia , and 3 cases dead at 10, 28, and 32 months postoperatively because of gallbladder carcinoma liver transfer . Conclusions The occurrence of unexpected gallbladder cancer should be taken into consideration during laparoscopic cholecystectomy .Timely and appropriate complementary therapy should be given .
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Objective To investigate the effectiveness of choledochoscopy and duodenoscopy in the treatment of residual calculus of the intrahepatic bile duct. Methods Clinical data of 573 cases of choledochoscopy and 36 cases of duodenoscopy from February 1985 to June 2004 were analyzed. Results Stones were completely removed under choledochoscope by way of T-tube sinus tract in 96.02% of patients (507/528) and by way of subcutaneous blind loop in 84.62% of patients (22/26). Percutaneous transhepatic choledochoscope placement was successfully conducted in 84.21% of patients (16/19) and stones were completely removed in 78.95% of the patients (15/19). The success rate of duodenoscopic cholangiography was 91.67% (33/36) and stones were completely removed under duodenoscope in 80.56% of patients (29/36). Conclusions Treatment of residual and recurrent calculus of the intrahepatic bile duct by choledochoscopy and duodenoscopy is effective and convenient.