Ambulatory surgery has been vigorously promoted in China while there is a lack of unified management norms. Shanghai has a long-term pilot operation of ambulatory surgery in China, which has a certain management foundation. And it has actively promoted the standardized management since 2014. This article introduces the development and preparation of the Shanghai local standard The Hospital Management Specification of Ambulatory Surgery and the main structure and key technical content of the standard, in order to promote the standardization of ambulatory surgery management for reference.
【Abstract】 Objective To investigate the effectiveness of pedicled sternocleidomastoid muscle flap in repairing defect after parotidectomy by comparing with direct suture. Methods The clinical data were retrospectively analyzed, which were from 73 patients with parotid tumor undergoing parotidectomy between January 2002 and April 2010. After parotidectomy, defects were repaired with pedicled sternocleidomastoid muscle flap in 38 cases (flap group) and with direct suture in 35 cases (control group). There was no significant difference in gender, age, disease duration, tumor location and size between 2 groups (P gt; 0.05). Meanwhile the complications, such as local introcession deformity, Frey’s syndrome and parotid gland fistula were observed. Results In flap group, the flaps were all alive and incisions healed by first intention; in control group, all incisions healed by first intention. All patients were followed up 6-98 months and no tumor recurred. There was significant difference in local introcession deformity between 2 groups (χ2=53.202, P=0.000). The parotid gland fistula was found in 1 case (2.6%) of the flap group and in 8 cases (22.8%) of the control group, Frey’s syndrome was found 1 case (2.6%) of the flap group and in 20 cases (57.1%) of the control group, showing significant differences between 2 groups (P lt; 0.05). Conclusion The use of pedicled sternocleidomastoid muscle flap for defect repair after parotidectomy can avoid the complications of local introcession deformity, Frey’s syndrome, and parotid gland fistula.
ObjectiveTo explore the effectiveness of the modified designed bilobed latissimus dorsi myocutaneous flap in chest wall reconstruction of locally advanced breast cancer (LABC) patients.MethodsBetween January 2016 and June 2019, 64 unilateral LABC patients were admitted. All patients were female with an average age of 41.3 years (range, 34-50 years). The disease duration ranged from 6 to 32 months (mean, 12.3 months). The diameter of primary tumor ranged from 4.8 to 14.2 cm (mean, 8.59 cm). The size of chest wall defect ranged from 16 cm×15 cm to 20 cm×20 cm after modified radical mastectomy/radical mastectomy. All defects were reconstructed with the modified designed bilobed latissimus dorsi myocutaneous flaps, including 34 cases with antegrade method and 30 cases with retrograde method. The size of skin paddle ranged from 13 cm×5 cm to 17 cm×6 cm. All the donor sites were closed directly.ResultsIn antegrade group, 2 flaps (5.8%, 2/34) showed partial necrosis; in retrograde group, 6 flaps (20%, 6/30) showed partial necrosis, 5 donor sites (16.7%, 5/30) showed partial necrosis; and all of them healed after dressing treatment. The other flaps survived successfully and incisions in donor sites healed by first intention. There was no significant difference in the incidence of partial necrosis between antegrade and retrograde groups (χ2=2.904, P=0.091). The difference in delayed healing rate of donor site between the two groups was significant (P=0.013). The patients were followed up 15-30 months, with an average of 23.1 months. The appearance and texture of the flaps were satisfactory, and only linear scar left in the donor site. No local recurrence was found in all patients. Four patients died of distant metastasis, including 2 cases of liver metastasis, 1 case of brain metastasis, and 1 case of lung metastasis. The average survival time was 22.6 months (range, 20-28 months).ConclusionThe modified designed bilobed latissimus dorsi myocutaneous flap can repair chest wall defect after LABC surgery. Antegrade design of the flap can ensure the blood supply of the flap and reduce the tension of the donor site, decrease the incidence of complications.
Objective To evaluate the efficacy and safety of local triamcinolone combined with conventional interventional therapy in the treatment of benign airway stenosis. Methods PubMed, Cochrane Library, EMbase, Web of science, wanfang, VIP and China National Knowledge Infrastructure were searched by computer between the establishment of the database and August, 2019, and all literatures on the local treatment of benign airway stenosis using triamcinolone combined with conventional interventional therapy were searched. According to inclusion and exclusion criteria, 2 researchers screened the literatures and performed the data extraction and methodological quality evaluation. Meta-analysis was performed with Revman5.2 and Stata software. Results In total, nine randomized controlled trials were included in this meta-analysis, including 449 patients with airway stenosis. The total result showed that in the comparison of short-term efficacy, there were no statistically significant differences in breathability score (SMD=–0.16, 95%CI –0.45 - 0.13, P=0.27), airway diameter (SMD=0.14, 95%CI –0.13 - 0.41, P=0.30), and cross-sectional stenosis rate (SMD=–0.01, 95%CI –0.36 - 0.34, P=0.96) between the treatment group and the control group. In the comparison of long-term efficacy, the breathability score (SMD=–2.53, 95%CI –3.78 - –1.28, P<0.05), airway diameter (SMD=1.31, 95%CI 0.83 - 1.78, P<0.05), cross-sectional stenosis rate (SMD=2.58, 95%CI: 2.11~3.08, P<0.05), and FEV1(SMD=0.42, 95%CI 0.13 - 0.70, P=0.004) of patients in the treatment group were all better than those in the control group. But in terms of adverse reactions, the incidence of bleeding in the airway between two groups was similar (RR=2.00, 95%CI 0.88 - 4.52, P=0.10), other adverse reactions such as blood glucose and plasma cortisol levels were mild, which can be relieved symptomatically. Conclusion Current evidence suggests that topical triamcinolone combined with conventional interventional therapy for benign airway stenosis has a better long-term clinical efficacy with fewer adverse reactions and better overall patient tolerance, which has clinical application value
ObjectiveTo investigate the effect of simvastatin and mechanical pretreatment on intimal hyperplasia of venous graft and its mechanism.MethodsTwelve New Zealand rabbits were selected and randomly divided into 4 groups: a blank control group, a simvastatin topical treatment group, a mechanical precondition group and a combined group (n=3 in each group). Ultrasound was used to evaluate the changes of graft wall and blood flow velocity in the graft, and pathological section was used to evaluate the intimal hyperplasia. Human umbilical cord endodermal cells were cultured in vitro. A simvastatin group and a solvent control group were set to detect YAP phosphorylation, downstream target gene expression and cell proliferation.ResultsVascular ultrasound showed that except the simvastatin topical treatment group, the flow velocity in vein grafts in the other three groups significantly increased 21 days after surgery compared with 7 days after surgery (P<0.01). Pathological sections showed that the thickness of new intima in the simvastatin topical treatment group, mechanical precondition group, combined group and blank control group were 45.56±4.11 μm, 201.28±16.71 μm, 143.57±7.82 μm, 249.45±13.33 μm, respectively, and there were statistical differences compared with the blank control group (P<0.05). In vitro results showed that compared with the solvent control group, cell death was observed in high concentration simvastatin (5 mmol/L) group, cell proliferation was inhibited in low concentration simvastatin (2.5 mmol/L) group (P<0.05), the expression of YAP protein in the simvastatin group was unchanged, but the expression of phosphorylated YAP protein significantly increased (P<0.05), and the expression of downstream target gene ccn1 was down-regulated (P<0.001).ConclusionIntravascular local application of simvastatin and mechanical preconditioning alone or in combination can inhibit intimal hyperplasia of venous graft. High concentration of simvastatin has cytotoxicity, while low concentration of simvastatin has inhibitory effect on cell proliferation. Simvastatin can inhibit the formation of new intima by inhibiting the entry of YAP into the nucleus and reducing the transcription of cell proliferation-related target gene ccn1.
Objective To investigate the most suitable anaesthesia method for the tension-free herniorrhaphy.Methods A total of 422 unilateral inguinal hernia cases from 2002 to 2005 were collected and randomly divided into the local anaesthesia group and epidural anaesthesia group. Observation indices and some relative data, such as operative duration, date of ambulation, date of foodintake, length of hospital stay, operation-correlated complications, anaesthesia complications, usage rate of ancillary drug, satisfactory rate for anesthesia, cost of hospitalization, were included and recorded in the questionnaire, and all the patients who took the tension-free herniorrhaphy were asked to answer it as the follow-up research. Results It was found that the occurrence of postoperative anaesthetic complications, the cost of hospitalization, length of stay of local anaesthesia group were significantly less than those of epidural anaesthesia group, and the date of moving and the date of foodintake were also significantly earlier than those of the other group (P＜0.05). However, there was no significant difference of operative duration, postoperative recovery situation and the satisfactory rate between two groups (P＞0.05).Conclusion The local anaesthesia is suitable for most of the tension-free herniorrhaphy, and it may be used as the conventional anaesthetic method.
Objective To obtain the full-length gene and functional domains of FXYD6 gene which is a cholangiocarcinoma related gene. Methods A new strategy with the integration of bioinformatics and molecular biology was used. Bioinformatical methods were used to analyze the full-length sequence, and to predict the functional domains of its protein. And the full-length sequence of FXYD6 was isolated by polymerase chain reaction from fetal hepatic, brain and spleen cDNA libraries, and then cloned in pGEM-T vector for sequence analyzing. Goldkey Sequence Analyzing Software was used to analyze the sequence of candidate domain without signal peptide.Results The full-length sequence of FXYD6 was isolated by Touch-down PCR from fetal hepatic and brain cDNA library, but was not from spleen cDNA library. The open reading frame Finder software was used in the National Center for Biotechnology Information website to find the most probable encoding regions of FXYD6 gene. And the +1 phase was selected as the template sequence, from 67 bp to 354 bp, to predict the functional domains by Goldkey Sequence Analyzing Software. The signal peptide was located from 1 amino acid (aa) to 17 aa， and the main domain was composed from 18 aa to 34 aa. The region between 35 aa and 57 aa was the transmembrane region. The FHYD peptide chain was highly conserved amino acids. Conclusion The study of full-length cDNA cloning of FXYD6 gene and its functional domains provides the basis for understanding the relationship between the structure and function of FXYD6. More work shall be performed on FXYD6 protein and its influence on the mechanism of cholangiocarcinoma.
ObjectiveTo evaluate the efficiency and clinical outcomes of endoscopic thoracic sympathectomy (ETS) with flexible thoracoscopy under local anesthesia with monitored anesthesia care in primary palmar hyperhidrosis. MethodsFrom March 2011 to March 2013, we performed ETS with flexible thoracoscopy under local anesthesia with monitored anesthesia in 23 patients with primary palmar hyperhidrosis (PH), including 10 males and 13 females with their age of 25.6±7.2 years (range, 17-32 years). T3 sympathectomy was performed with flexible endoscopy under local anesthesia with monitored anesthesia care. All patients were followed up until May 2014. ResultsDuring surgery, the vital signs of the patients remained stable. Operation time was 30-40 minites. The symptom of PH disappeared right in the surgery. All patients were discharged from the hospital on the 2nd postoperative day. One patient received unilateral sympathectomy because of pleural adhesion. Other 22 patients received follow-up to May 2014 and no reoccurrence was reported. ConclusionETS with flexible thoracoscopy under local anesthesia with monitored anesthesia is a safe, microinvasive and effective method.
Recently, the frequency of lung disease appears higher and more precise than previously estimated. Small pulmonary nodules (SPNs) are frequently detected on high-resolution computed tomography (CT) scans. For the reason of high rate of false positives by fine needle aspirate biopsy, small lung nodules often can not be confirmed by monitor or palpation with forceps. How to precisely locate and mark the nodule before the surgery is one of the most important things for video-assisted thoracoscopic surgery (VATS). We reviews the methods of location the pulmonary nodules before the surgery and analyzes the advantages and disadvantages of various methods.
ObjectiveTo learn further the local immunity changes of rectal cancer after neoadjuvant therapy and improve the cognition of this project. MethodsSixty cases of paraffin-embedded sections of the excised specimen from the two groups of middle and low rectal cancer patients, with (therapy group) or without (control group) neoadjuvant therapy, were studied respectively. Tumor infiltrating lymphocytes (TIL) in the two groups were counted under microscope, and also, dendritic cells (DC) were counted and morphology and distribution of the DCs were recorded through immunohistochemistry stain with monoclonal antibody, S-100. ResultsTILs and DCs in the two groups mainly assembled in the pericancerous tissues. The positive rate of TIL in therapy group was 75.00% (45/60) and 90.00% (54/60) in control group (χ2=10.58, P=0.014). S-100 positive DCs were (36.85±11.17)/HPF versus (26.50±7.68)/HPF in the therapy group and control group, respectively (P=0.001). ConclusionNeoadjuvant therapy for rectal cancer can influence the local tumor immunity enviroment by reducing TILs and increasing DCs.