目的探讨术后早期肠梗阻的临床特点、诊断及治疗。方法对10例术后早期肠梗阻患者进行回顾性分析。结果10例均为机械性肠梗阻。保守治疗6例，其中治愈5例，死亡1例； 手术治疗4例，其中3例术中有绞窄性肠梗阻征象，均治愈。1例术中发现为广泛癌性粘连，行部分粘连松解术，术后第8天再发肠梗阻，保守治疗1天无效，患者自动出院。结论术后早期肠梗阻诊断并不困难； 保守治疗多数有效，故宜先行保守治疗； 可疑肠绞窄时应及时中转手术。
ObjectiveTo investigate the feasibility and safety of non-intubation anesthesia in thoracic surgery.MethodsFrom September 2017 to December 2019, 296 patients were operated at department of thoracic surgery in our hospital. There were 167 males and 129 females with an average age of 50.69±12.95 years, ranging from 16 to 76 years. The patients were divided into two groups according to whether they were intubated: 150 patients were in a non-intubation group, including 83 males and 67 females with an average age of 49.91±13.59 years, ranging from 16 to 76 years, and 146 patients were in an intubation group including 84 males and 62 females with an average age of 51.49±12.26 years, ranging from 16 to 74 years. Intraoperative data, postoperative recovery, inflammatory response of the two groups were compared.ResultsThere was no statistical difference between the two groups in operation time, blood loss, the lowest oxygen saturation or other indicators (P>0.05). But the highest partial pressure of carbon dioxide of the non-intubation group was higher than that of the intubation group (P=0.012). The non-intubation group was superior to the intubation group in postoperative recovery and inflammatory response (P<0.05).ConclusionThe non-intubation anesthesia is safe and maneuverable in thoracic surgery, and it has some advantages in accelerating postoperative rehabilitation.
目的 探讨术后早期炎症性肠梗阻的诊断和治疗。方法 对我院1995年至1999年间收治的16例术后早期炎症性肠梗阻患者的临床资料进行回顾性分析。结果 15例患者经胃肠减压、抗生素、理疗、肾上腺皮质激素及中药等治疗治愈，平均治疗时间11天； 中转手术治疗1例，无1例肠坏死。结论 术后早期炎症性肠梗阻的特点有： ①多在手术后7天左右出现梗阻症状，多由腹腔内炎症所致广泛粘连引起； ②症状以腹胀为主，腹痛相对较轻，较少发生肠绞窄； ③治疗应首选非手术疗法。
ObjectiveTo analyze differences in postoperative pathological stage characteristics of colorectal cancer (CRC) patients with different marital status in Database from Colorectal Cancer (DACCA). MethodsAccording to the established screening conditions, the patients were collected from the updated version of DACCA on January 23, 2023, and then assigned into three categories according to marital status: married, unmarried, widowed or divorced patients. The differences in postoperative pathological staging, peripheral nerve involvement, pathological tumor regression grade (TRG), cancer nodules, and high-risk factors among the CRC patients with different marital statuses were analyzed. ResultsA total of 6 947 data matching the screening criteria were collected, including 113 unmarried patients (1.6%), 6 315 married patients (90.9%), and 519 divorced or widowed patients (7.5%). The analysis results showed that the pathological TNM staging (Ⅰ–Ⅳ staging: H=19.030, P<0.001;Ⅰ+Ⅱ and Ⅲ+Ⅳ staging: χ2=19.124, P<0.001), pathological T staging (H=7.147, P=0.028), and high-risk factors grading (H=10.246, P=0.006) had statistical differences. The trend presented that the proportions of the patients with earlier pathological TNM staging and T staging (Ⅰor T1 staging) in the married patients were the highest among the 3 marital statuses patients, and the proportions of the later staging (Ⅳ or T4 staging) were the lowest in the married patients. The same trend was found in the high-risk factors grading. However, there were no statistical differences in other pathological features such as peripheral nerve involvement, pathological TRG, and cancer nodules among the CRC patients with 3 marital statuses (P>0.05). ConclusionsThrough data analysis in DACCA, it is found that CRC patients with different marital statuses exhibit certain differences in postoperative pathological stage characteristics, especially in terms of pathological TNM staging, pathological T staging, and high-risk factor grading. However, this conclusion needs to be objectively regarded. From a statistical perspective, the samples size of patients with 3 marital statuses in this study is different. In the future, further analysis can be conducted by balancing the samples size on this basis. From a clinical perspective, there may be more influencing factors, so objective analysis should be conducted after eliminating interference factors one by one.
Objective To explore the risk factors of postoperative anxiety in patients with pancreatic cancer undergoing total pancreatectomy. Methods A total of 31 patients who underwent total pancreatectomy for pancreatic cancer between July 2011 and December 2016 were collected and analyzed in this retrospective study. The patients’ postoperative Self-Rating Anxiety Scale scores were collected, and the exposure factors were analyzed to identify the risk factors of postoperative anxiety through univariate analysis and multiple logistic regression analysis by SPSS 21.0 statistical software. Results In the 31 patients, there were 17 males and 14 females, with an average age of (66.16±9.09) years, an average body mass index of (21.11±3.10) kg/m2, and an average postoperative hospital stay of (14.58±7.47) days. There were 23 patients (74.2%) with postoperative anxiety, and 30 patients (96.8%) with hyperglycosemia required insulin therapy. The total perioperative mortality was 3.2%. In the univariate analysis, age (P=0.012), smoking history (P=0.043), preoperative diabetes mellitus (P=0.012), postoperative bile leakage (P=0.043), and postoperative abdominal infection (P=0.026) were related factors of the postoperative anxiety. In the multiple logistic regression analysis, patients without preoperative diabetes was an independent risk factor of postoperative anxiety (P=0.013). Conclusions For patients undergoing total pancreatectomy, it is needed to pay attention to the patients’ postoperative psychological conditions and assess the postoperative anxiety, especially for those without preoperative diabetes. To improve the life quality and long-term survival of these patients, health education and psychological intervention are needed.
ObjectiveTo analyze the occurrence of postoperative pulmonary complications (PPC) and the risk factors in patients with spontaneous pneumothorax who underwent micro single-port video-assisted thoracoscopic surgery (VATS).MethodsA total of 158 patients with spontaneous pneumothorax who underwent micro single-port VATS in our hospital from April 2017 to December 2019 were retrospectively included, including 99 males and 59 females, with an average age of 40.53±9.97 years. The patients were divided into a PPC group (n=21) and a non-PPC group (n=137) according to whether PPC occurred after the operation, and the risk factors for the occurrence of PPC were analyzed.ResultsAll 158 patients successfully completed the micro single-port VATS, and there was no intraoperative death. The postoperative chest tightness, chest pain, and dyspnea symptoms basically disappeared. During the postoperative period, there were 3 patients of pulmonary infection, 7 patients of atelectasis, 4 patients of pulmonary leak, 6 patients of pleural effusion, 1 patient of atelectasis and pleural effusion, and the incidence of PPC was 13.29% (21/158). Multivariate logistic regression analysis showed that lung disease [OR=32.404, 95%CI (2.717, 386.452), P=0.006], preoperative albumin level≤35 g/L [OR=14.912, 95%CI (1.719, 129.353), P=0.014], severe pleural adhesions [OR=26.023, 95%CI (3.294, 205.557), P=0.002], pain grade Ⅱ-Ⅲ 24 hours after the surgery [OR=64.024, 95%CI (3.606, 1 136.677), P=0.005] , age [OR=1.195, 95%CI (1.065, 1.342), P=0.002], intraoperative blood loss [OR=1.087, 95%CI (1.018, 1.162), P=0.013] were the risk factors for PPC after micro single-port VATS.ConclusionThere is a close relationship between PPC after micro single-port VATS and perioperative indexes in patients with spontaneous pneumothorax. Clinically, targeted prevention and treatment can be implemented according to the age, pulmonary disease, preoperative albumin level, intraoperative blood loss, degree of pleural adhesion and pain grading 24 hours after surgery.
ObjectiveTo explore the clinical value of three early predictive scale of lung injury (ALI) in patients with high risk of acute lung injury (ALI) after lung cancer surgery.MethodsA convenient sampling method was used in this study. A retrospective analysis was performed on patients with lung cancer underwent lung surgery. The patients were divided into an ALI group and a non-ALI group according to ALI diagnostic criteria. Three kinds of lung injury predictive scoring methods were used, including lung injury prediction score (LIPS), surgical lung injury prediction (SLIP) and SLIP-2. The differences in the scores of the two groups were compared. The correlation between the three scoring methods was also analyzed. The diagnostic value was analyzed by drawing receiver operating characteristic (ROC) curves.ResultsA total of 400 patients underwent lung cancer surgery, and 38 patients (9.5%) developed ALI after operation. Among them, 2 cases progressed to acute respiratory distress syndrome and were treated in intensive care unit. There were no deaths. The predictive scores of the patients in the ALI group were higher than those in the non-ALI group, and the difference was statistically significant (all P<0.001). There was a good correlation between the three scoring methods (allP<0.001). The three scoring methods had better diagnostic value for early prediction of high risk ALI patients after lung cancer surgery and their area under ROC curve (AUC) were larger than 0.8. LIPS score performed better than others, with an AUC of 0.833, 95%CI (0.79, 0.87).ConclusionThree predictive scoring methods may be applied to early prediction of high risk ALI patients after lung cancer surgery, in which LIPS performs better than others.
Objective To investigate the joint effects of selective digestive decontamination (SDD) and glutamine (Gln) on preventing intestinal bacterial translocation of orthotopic piggyback liver transplantation and to observe the incidence of postoperative pneumonia in rabbit. Methods Thirty rabbits received orthotopic piggyback liver transplantation and were randomly divided into three groups (SDD group, SDD+Gln group and control group). Mixed emulsion of tobramycin, polymyxin E and nystatin were given to the rabbits in SDD group. Same dosage of the above components plus Gln were given to the rabbits in SDD+Gln group. Samples of portal vein blood, ileum tissue and lung tissue were obtained in each group at different phases during and after operation, the pathological changes of ileum tissue, the bacterial translocation in blood of portal vein and the incidence of postoperative pneumonia were detected. Results The mixing section area of intestinal blood capillaries in SDD+Gln group was smaller compared with control group (P＜0.05， P＜0.01) and SDD group (P＜0.05) while the portal vein was obstructed for 15, 30 and 45 min, and after the operation, respectively. The length of ileum villus in SDD+Gln group was longer than that in control group (P＜0.05) and in SDD group (P＜0.05) before the portal vein was obstructed, but the length of ileum villus in control group gradually became longer and eventually exceeded that in SDD+Gln group at the time of 45 min after the portal vein was obstructed (P＜0.05). After the operation, the length of ileum villus in SDD+Gln group was significantly longer than that in SDD group (P＜0.05) and control group (P＜0.01). At the time of 45 min after the obstruction of portal vein and 30 hours after operation, the positive rate of cultured bacterial in the blood of portal vein in SDD+Gln group was significantly lower than that in control group (P＜0.05, P＜0.01). The incidence of postoperative pneumonia in SDD+Gln group and SDD group were significantly lower than that in control group (P＜0.05,P＜0.01). Conclusion Gln could nourish intestinal epithelium of mucous membrane.When combined with SDD, it could decreased the incidence of intestinal bacterial translocation occurred during the obstruction of portal vein and after operation, so as to decrease the incidence of postoperative pneumonia.