目的观察S100吸收性止血绫（absorbable stanching satin S100，ASS）在肝脏外科的止血效果。方法将40例择期行肝部分切除术的患者随机分成两组，应用ASS贴敷肝断面为ASS组（n=20），肝断面不用任何局部止血材料为对照组（n=20），分别于术后2 h、12 h、24 h及72 h观察腹腔引流情况，其中重点观察引流量。结果ASS组术后腹腔引流量较对照组明显减少，差异有显著性意义（P＜0.01）;ASS组术后无漏胆发生，对照组术后有2例发生漏胆; ASS组的腹腔引流管拔管时间及平均住院日均小于对照组，但差异无显著性意义（Pgt;0.05）。结论ASS在肝脏部分切除术中具有安全、有效的止血作用，特别是对于伴有凝血机能障碍的患者。
Objective To investigate and evaluate prevention and treatment of seroma by transposition of tissue flaps and Arista hemostatic powder after regional lymph node resection in patients with malignant tumors. Methods Twelve patients (6 males, 6 females; aged 31-81 years, with metastatic tumors underwent prevention and treatment of seroma with the tissue flaps and Arista hemostatic powder spray after regional lymph node resection. The metastatic tumors involved the axilla in 1 patient with breast carcinoma, the iliac and inguinal regions in 2 patients with carcinomas of theuterine cervix and the rectum, and the inguinal region in 9 patients, including4 patients with malignant fibrous histiocytoma（3 in the thigh, 1 in the leg）,2 patients with squamous carcinomas in the leg, 1 patient with synovial sarcomain the knee, 1 patient with epithelioid sarcoma in the leg, and 1 patient with malignant melanoma in the foot. As for the lymph node removal therapy. 1 patientunderwent axillary lymph node removal, 2 palients underwent lymph node removal in theiliac and inguinal regions, and 9 patients underwent lymph node removal inthe inguinal region. Meanwhile, of the 12 patients, 6 patients underwent transpostion of sartourius flaps with Arista hemostatic powder, 3 patients underwent transposition of the rectus abdominis myocutaneous flaps (including 2 patients treatedwith Arista spray befor the wound closure and 1 patient treated by transposition of local skin flaps with Arista spray used again),and 3 patients underwent only the suturing of the wounds combined with Arista. At the same time, of the 12 patients,only 4 patient underwent the transplantation of artificial blood vessels. Results The follow-up for 2-10 months after operation revealed that 10 patients, who had received the transposition of tissue flaps and the spray of Arista hemostatic powder, had the first intention of the incision heal with seroma cured. Nine patients were given a preventive use of Arista hemostaticpowder and therefore no seroma developed. The combined use of the transpositionof tissue flaps and Arista hemostatic powder spray achieved a success rate of 100% in the prevention or treatment of seroma. However, 1 patient developed microcirculation disturbance 24 hours after operation and underwent disarticulation of the hip; 1 patient developed pelvic cavity hydrops and died 10 months after operation. Conclusion The combined use of transposition of tissue flaps and Arista hemostatic powder spray can effectively prevent or treat seroma after regional lymph node removal in a patient with malignant tumor.
ObjectiveTo investigate the effectiveness of partial anterior cruciate ligament (ACL) suture repair with wide awake local anesthesia no tourniquet (WALANT) technique.MethodsBetween July 2017 and July 2019, 18 patients with partial ACL injury were admitted. There were 10 males and 8 females, with an average age of 40.5 years (range, 22-57 years). There were 5 cases on the left knee and 13 cases on the right knee. Forteen cases had a clear history of trauma or sports injury, and 4 cases had no obvious cause. The time from injury to operation was 1-6 months (median, 3 months). Partial ligament was sutured using WALANT technique under arthroscopy. The operation time, total hospital stay, and postoperative hospital stay were recorded. Lachman test and anterior drawer test were performed to evaluate the knee joint stability after treatment, and Lysholm and International Knee Documentation Committee (IKDC) scores were used to evaluate the knee function. Five-point Likert scaling were used to evaluate postoperative patient satisfaction.ResultsThe operation time was 30-100 minutes (mean, 64.2 minutes). The total hospital stay was 2-12 days (mean, 4.5 days). Postoperative hospital stay was 1-4 days (mean, 1.8 days). All incisions healed by first intention after operation, and no surgery-related complications occurred. All patients were followed up 12-36 months (mean, 19.1 months). Lachman test and anterior drawer test were negative after operation. Lysholm score and IKDC score at 6 and 12 months after operation were significantly higher than those before operation, and at 12 months after operation were higher than those at 6 months after operation, the differences were significant (P<0.05). At last follow-up, according to five-point Likert scaling of patient satisfaction, 7 cases were very satisfied, 10 cases were relatively satisfied, and 1 case was general. The total patient satisfaction rate was 94.4% (17/18). MRI scan showed the good ligament tension.ConclusionUsing WALANT technique to repair partial ACL injuries under arthroscopy can retain the patient’s own ligament tissue to the maximum extent and achieve satisfactory short-term effectiveness.
ObjectiveTo analyze the causes and prevention principles of hepatic venous hemorrhage during laparoscopic hepatectomy.MethodLiteratures about the causes and prevention of hepatic venous hemorrhage during laparoscopic hepatectomy were collected, and then made an review with our own clinical experience.ResultsIntraoperative hepatic venous hemorrhage was one of the most dangerous complications during laparoscopic hepatectomy. The main reasons for its occurrence included subjective and objective factors. Through accurate preoperative assessment, rigorous attitude during operation and superb surgical skills, intraoperative control of the prsessure difference between the internal and external veins, could significantly reduce the incidence of intraoperative venous bleeding. For the hepatic vein bleeding that had occurred, the correct evaluation and treatment during the operation could reduce the adverse effect on the surgical efficacy.ConclusionCorrectly understand the causes of hepatic venous hemorrhage during laparoscopic hepatectomy, prevent and manage various techniques before and during operation can carry out laparoscopic hepatectomy more safely.
The International Society on Thrombosis and Hemostasis (ISTH) recently released the first ISTH guideline for antithrombotic treatment of COVID-19, which provides recommendations on anticoagulant and antiplatelet agents for patients with COVID-19 in different clinical settings. The target audience includes clinicians in internal medicine, intensive care, infectious diseases, hematology, vascular medicine, residents, family physicians, and other health care providers providing inpatient or outpatient care to COVID-19 patients. This article interprets the important parts of ISTH guideline.
【摘要】 目的 观察氨甲环酸在肝切除术中止血的有效性和安全性及对凝血功能的影响。 方法 将2009年3-11月间收治的50例肝切除患者，随机分为对照组（C组)和氨甲环酸组（T组)各25例。T组给予氨甲环酸100 mg/kg（总量≤5 g)，C组给予等量生理盐水。于术前30 min先给予负荷量20 mL，剩下的则静脉泵入，泵注速度均为15mL/h。观察患者术中及术后出血和输血总量，比较患者术前和术后24 h血常规和凝血功能状态。 结果 患者术前的一般情况无统计学差异(Pgt;0.05)。T组患者的术中出血和输血量均低于C组（Plt;0.05)，且术后凝血功能改变无统计学意义(Pgt;0.05)。 结论 氨甲环酸在肝切除术中可以有效减少出血和输血量，且对术后凝血功能无显著影响，无严重不良反应，是一种安全有效的止血药物。【Abstract】 Objective To observe the efficiency and safety of tranexamic acid on reducing the hemorrhage in hepatectomy and the effect on blood coagulation. Methods A total of 50 patients with hepatocellular carcinoma who underwent hepatectomy from March to November 2009 were randomly divided into the control group (Group C, n=25) and the tranexamic acid group (Group T, n=25). The patients in Group T were administered to with tranexamic acid (100 g/kg), and the total dosage was not more than 5 g. The patients in Group C were administered to with normal saline, and the dosage was the same as the Group T. Both groups were given loading dose 20 ml, and the rest was intravenous pumped by 15 mL/h. The total bleeding volume, blood transfusion, blood routine and coagulation before surgery and 24 hours after surgery were compared between the two groups. Results The backgrounds, operative procedures did not differ much between the two groups. The total bleeding volume and blood transfusion in Group T were less than that in Group C, and coagulation did not changed evidently. Conclusion In the operation of hepatectomy, tranexamic acid can decrease hemorrhage and transfusion effectively, and would not change coagulation and has no serious adverse effect. It is a kind of safe and effective antihemorrhagic.
ObjectiveTo clarify the effects of tourniquet use on pain, early rehabilitation, blood loss, incidence rate of thrombosis in primary total knee arthroplasty (TKA) through a randomized controlled trial. MethodBetween Janurary 2014 and August 2015, 168 patients with knee osteoarthritis undergoing primary TKA were randomly allocated to tourniquet group (n=84) or non-tourniquet group (n=82) . There was no significant difference in gender, age, body mass index, affected side, osteoarthritis grading, disease duration, preoperative range of motion (ROM), visual analogue scale (VAS), Hospital for Special Surgery (HSS) score, and hemoglobin (Hb) between 2 groups (P>0.05) . The operation time, hospitalization time, 90°knee flexion time, straight leg lifting time, and ambulation time were compared between 2 groups. Intraoperative blood loss, Hb decrease, postoperative VAS score, HSS score, ROM, and postoperative complications were recorded and compared. ResultsThere was no significant difference in operation time (t=-1.353, P=0.178) . The patients were followed up 3-20 months (mean, 12 months) in tourniquet group, and 3-22 months (mean, 13 months) in non-tourniquet group. No significant difference was found in Hb decrease (t=-1.855, P=0.066) and transfusion rate (23.81% of tourniquest group vs. 25.61% of non-tourniquest group) (χ2=0.072, P=0.788) between 2 groups. Significant difference was found in the incidence rate of thrombosis between tourniquet and non-tourniquet groups (10.71% vs. 2.44%) (χ2=4.592, P=0.032) , and the intraoperative blood loss of tourniquet group was significantly less than that of non-tourniquet group (t=-16.066, P=0.000) . The 90°knee flexion time, straight leg lifting time, ambulation time, and hospitalization time of tourniquet group were significantly later than those of non-tourniquet group (P<0.05) . The tourniquet group had significantly higher VAS score at 3, 5, 7, and 14 days after operation (P<0.05) and lower HSS score at 28 days after operation (t=-4.192, P=0.000) than non-tourniquet group, but there was no significant difference in the ROM between 2 groups (t=0.676, P=0.500) . ConclusionsThe use of a tourniquet during TKA will increase knee pain and thrombotic events, but can not decrease total blood loss and transfusion rate. A tourniquet use during TKA is unfavorable for early rehabilitation progress.
Objective To analyze clinicopathologic characteristics of 1 008 patients with gallbladder polyps by minimally invasive gallbladder-preserving surgery, and to explore hemostatic effect of 0–4 ℃ cold saline plus different concentrations norepinephrines in flushing gallbladder mucosa bleeding. Methods The clinical data of 1 008 patients with gallbladder polyps by the minimally invasive gallbladder-preserving surgery from 2009 to 2016 in the General Hospital of Xinjiang Military Command were retrospectively analyzed. The clinicopathologic types of gallbladder polyps and the relationship between the operation time and the recurrence of gallbladder polyps were analyzed, the hemostatic effects of 0–4 ℃ cold saline plus different concentrations (0, 16, 24, and 30 mg/L) norepinephrines in flushing gallbladder mucosa bleeding (The hemostatic effect was reflected by the time of flushing gallbladder mucosa bleeding) were compared. Results One thousand patients with non-tumorous gallbladder polyps successfully underwent the minimally invasive gallbladder-preserving surgery, another 8 cases patients with tumorous gallbladder polyps underwent the cholecystectomy immediately. There were 128 cases of single polyps and 880 cases of multiple polyps. The polyp diameters of 910 cases were 5–10 mm and 98 cases were 10–15 mm. The pathological analysis indicated that there were 912 (90.5%) cases of the cholesterol polyps, 74 (7.3%) cases of the inflammatory polyps, 14 (1.4%) cases of the adenoid hyperplasia, and 8 (0.8%) cases of the neoplastic polyps ［adenoma 6 cases, adenocarcinoma (T0N0M0) 2 cases］. The gallbladder polyps recurrences were found in 30 (3.0%) cases during 1–8 years of follow-up (average 4 years), all of them were the multiple and cholesterol polyps. The flushing gallbladder mucosa bleeding time of 0–4 ℃ cold saline plus 0, 16, 24, and 30 mg/L concentraions norepinephrine was (44±5) min, (33±6) min, (17±5) min, and (17±4) min in the 125, 230, 555, and 98 patients with gallbladder polyps, respectively. The time of flushing gallbladder mucosa bleeding between the other concentration groups had significant difference (P<0.05) except for between the 24 mg/L concentration group and the 30 mg/L concentration group (P>0.05). The operation time was (62±21) min and (60±19) min of the 30 patients with gallbladder polyps recurrence and the 970 patients without gallbladder polyps recurrence, which had no significant difference (P>0.05). Conclusions Cholesterol polyp is a common pathological type of gallbladder polyp, inflammatory polyp and adenomyosis polyp are uncommon, and multiple polyps are common. Hemostatic effects of 0–4 ℃ cold saline plus different concentraions norepinephrine in flushing gallbladder mucosa bleeding are desirable, expecially at a 24 mg/L concentraion norepinephrine is the most effective. No correlation is found between operation time and recurrence of gallbladder polyp.