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Objective:To assess the long-term outcome and influencing factors of laparoscopic Heller myotomy plus Dor fundoplication(LHM+ Dor) for achalasia by a single operator.Methods:Fifty-four patients who underwent LHM+ Dor consecutively from January 2011 to December 2019 were retrospectively reviewed. Those who had already undergone surgical or endoscopic myotomy and who were complicated with cancer were ruled out. Symptom inquiry and esophagogram were conducted both before and after surgery for assessing surgical results. Esophagoscopy, esophageal manometry and 24 h pH monitoring were performed before surgery, and the effects of these preoperative factors on the long-term outcome were analyzed.Results:All patients had dysphagia for average 6.5 years, ranging from 0.5-30.0 years. Intra-operative mucosal perforation occurred in 4(7.4%) patients, and there were no postoperative morbidity and mortality. At a median follow-up of 5.2 years, the morbidity of dysphagia decreased from 100% before surgery to 5.5% after surgery( P<0.001), Eckardt scores from 4.85±1.64 to 0.71±1.08( P=0.000). After surgery, 94.4% of patients had excellent and good relief of symptoms and good control of gastroesophageal reflux, the morbidity of heartburn being 3.7%. At 5 years after surgery, the probability of being symptoms free(Eckardt score≤1) was 91.7% in patients without preoperative night cough, compared to 54.6% in those with preoperative night cough( P=0.047). The probability was 92.3% in patients with grade Ⅰ and Ⅱ dilation of the esophagus and 79.0% in patients with grade Ⅲ and Ⅳ dilation( P=0.027). At multivariate analysis, heavier esophageal dilation was the independent predicator for poor symptom control after surgery. Conclusion:LHM+ Dor can be safely performed and durably relieve achalasia symptoms. Severe esophageal dilation before surgery is an independent predictor of a poor response to surgery.
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Objective:To discuss the influence of post-abortion care (PAC) in the long-term immediate contraception after the induced abortion.Methods:A total of 9 025 child-bearing women of receiving the induced abortion and conventional nursing care from January 2017 to December 2017 in Dalian Maternal and Child Health Hospital were selected as control group and 9 048 child-bearing women of receiving the induced abortion and PAC from January 2018 to December 2018 were selected as study group. The contraception conditions and repeated abortion rate were compared.Results:Before surgery, the contraception conditions between two groups was not significantly different ( P>0.05). After surgery, the request rate of contraception in study group (76.65%, 6 935/9 048) was higher than that of control group (55.63%, 5 021/9 025), the difference was significant ( χ 2 value was 9.865, P<0.05). After 6 months of surgery, the non-contraception rate in study group (12.04%, 1 089/9 048) was lower than before surgery(58.74%, 5 315/9 048); the non-contraception rate in control group (35.66%, 3218/9 025) was lower than before surgery(61.21%, 5 524/9 025); there was significant difference after 6 months between two groups ( χ 2 value was 16.453, P<0.05). After 3 months and 6 months of surgery, the repeated abortion rate in study group was 0.11% (10/9 048) and 0.46% (42/9 048), which was significantly lower than control group (3.97%, 358/9 025 and 5.06%, 457/9 025), the difference was significant ( χ 2 value was 3.728, 3.942, P<0.05). Conclusions:PAC has high application value, which can improve their self-protection awareness, reduce the repeated abortion rate and guarantee the reproductive health. It is worthy of clinical promotion.
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Objective@#To compare the outcomes of gastrectomy with either wedge resection of the pancreas or pancreaticosplenectomy for adenocarcinoma of the esophagogastric junction (AEG) invading pancreas.@*Methods@#From May 2005 to December 2015, a total of 64 patients with AEG invading pancreas underwent gastrectomy with either wedge resection of pancreas (n=25) or pancreaticosplenectomy (n=39) at Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University. There were 53 males and 11 females, with a mean age of 60.2 years (range: 39 to 77 years). According to the AJCC esophageal cancer staging system, 8th edition, there were 27 patients in phase T4N0M0, 18 in phase T4bN1M0, 9 in phase T4bN2M0 and 10 in phase T4bN3M0. Follow-up was carried out every 6 months. The t-test for the measurement data and the χ2 test, Fisher exact test or Wilcoxon ran-sum test for the enumeration data were used between the two groups. Survival curves were generated using the Kaplan-Meier method, and compared using the Log-rank test. Multivariate analysis was undertaken using the Cox proportional hazard model (forward stepwise regression).@*Results@#In 39 patients who underwent pancreaticosplenectomy, incision infection occurred in 5 patients, anastomotic leak, peritoneal infection, lung infarction each occurred in 1 patient. There was 1 respiratory failure and 1 peritoneal infection in 25 patients undergoing wedge resection of the pancreas. There were no significant difference in the incidence of postoperative complications between the 2 groups (8/39 vs. 2/25, P=0.292), and no postoperative death in the study. Fifty-seven patients were followed up, with a follow-up rate of 89.1%. The 5-year overall survival rate was 32.3% in patients who underwent simultaneous gastrectomy and pancreaticosplenectomy, compared to 0 in those who underwent gastrectomy and wedge resection of the pancreas (χ2=4.484, P=0.034). The 5-year overall survival rate for patients who undergoing adjuvant chemotherapy was 32.3%, compared to 17.2% in whom underwent surgery alone (χ2=4.186, P=0.041).@*Conclusions@#Survival benefit from R0 resection by simultaneous gastrectomy and pancreaticosplenectomy for AEG invading the pancreas can be achieved. Adjuvant chemotherapy is necessary for these patients.
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Objective To explore the influence of high quality nursing interventions in patients with pernicious placenta previa and the neonate's prognosis. Methods The clinical data about 28 patients with pernicious placenta previa treated from January 2016 to January 2017 were reviewed;the high quality nursing interventions were applied(study group). 30 patients with pernicious placenta previa treated from December 2014 to December 2015 were selected;the conventional nursing cares were applied (control group). After intervention, the clinical prognosis for the infants and mom was analyzed. Results At the time of admission, the research group of state anxiety and trait anxiety and depression scale scores were 58.42±3.61,55.57±2.69,55.06±2.67,before discharge,patients in the study group,state anxiety and trait anxiety and depression scale scores were 42.19 ±2.16,47.20±2.74 and 44.25± 4.36,the control group were respectively 58.96±3.35,55.27±2.75,55.23±3.12,before discharge respectively 44.35± 3.13, 49.35 ± 3.13, 48.67 ± 5.16, two groups were SAI, TAI and SDS score comparison no statistical significance (t=0.591, 0.420, 0.222, P > 0.05), the difference between the two groups before discharge compared with statistical significance (t=3.038, 2.775, 3.511, P<0.01);the time of termination of pregnancy, postpartum hemorrhage and neonatal postpartum 1min Apgar scores of the study group were 36.15± 0.77,1 000.19 ± 14.21,9.13± 0.10,the control group were 33.50±0.66,1 516.71 ±29.08,8.79± 0.50, and the difference was statistically significant (t=14.102, 32.490, 3.531, P<0.01);comparison of body mass in two groups showed no statistical significance (P>0.05);group of maternal and neonatal complications for a total of 7.14% (2/28), significantly lower than the control group 20.00%(6/30), the difference between significant(χ2=7.050,P<0.01);evaluation of nursing measures of maternal satisfaction in the study group(95.23+4.65)was higher than that of the control group(91.36±5.63),the difference was statistically significant correlation (t=2.842,P<0.05). Conclusions The high quality nursing interventions have an obvious effect in patients with pernicious placenta previa.It can relieve the negative emotions and improve the mom&infant's outcomes and the clinical satisfaction.