Objective To evaluate the indications, effectiveness and complications of vitreoretinal surgery using the 25G transconjunctival sutureless vitrectomy system (TSV25G) under the topical anesthesia. Methods The clinical and follow-up data of 22 eyes of 22 patients undergone vitreo-retinal surgery using TSV25G under the topical anesthesia were retrospectively analyzed. All of the patients were monocular sickened, including idiopathic macular hole in 10 eyes, idiopathic macular pucker in 6, vitreoretinal traction syndrome in 4, and vitreous hemorrhage associated with branch retinal vein occlusion in 2. Peeling of epiretinal membrane and/or internal limiting membrane, intra ocular laser coagulation, air-fluid exchange and tamponiding of C3F8 were performed according to the condition of diseases. The postoperative follow-up was 1-11 months, with the mean duration of 6.4 months. The effect of analgesia, cooperation with the patients, operative effect and complications in and after the surgery were observed. Results The operations finished successfully in all of the eyes under the topical anesthesia. The operation duration ranged from 20 to 25 minutes with average of 22 minutes. The patients cooperated with the doctor well without any discomfort. Two days after the surgery, edema of the wounded conjunctiva was found, and recovered 7 days later. A light pigment dot on the surface of the sclera could be seen at the first month. The complic ations included transient increasing of intraocular pressure in 2 eyes, feather-like opacity of lens in 5 eyes, vitreous hemorrhage in 1 eye, and air-bleb under conjunctiva in 2 eyes. No other complications related with the cut were fo und. The macular hole closed in 9 eyes with idiopathic macular hole, and the other 1 had the smaller but not closed hole. Idiopathic macular pucker, vitreoretinal traction syndrome, and vitreous hemorrhage associated with branch retinal vein occlusion were cured successfully. Conclusions Vitreoretinal surgery using the TSV25G under the topical anesthesia has many advantages such as simple procedure, short operation time, micro-invasion, less complications and rapid revovery, and mainly serves simple manipulation in some simple diseases such as idiopathic macular hole, vitreo-retinal traction syndrome, and simple hemorrhage. (Chin J Ocul Fundus Dis，2004，20：133-136)
ObjectiveTo explore the risk factors for lymph node metastasis in patients with T2 stage non-small cell lung cancer.MethodsThe clinical data of 271 patients with non-small cell lung cancer who underwent surgical treatment in our hospital from 2014 to 2017 were collected, including 179 males and 92 females, with an average age of 62.73±0.58 years. The patients were divided into N0, N1, and N2 groups according to the lymph node metastasis status. The clinical data of the patients in different groups were compared.ResultsThe body mass index (BMI, P=0.043), preoperative lymph node enlargement (P<0.001), and tumor diameter (P<0.001) were significantly different among groups. The BMI (OR=1.131, 95%CI 1.001-1.277, P=0.048) and preoperative lymph node enlargement (OR=3.498, 95%CI 1.666-7.342, P=0.001) were independent risk factors for N2 lymph node metastasis, and tumor diameter was an independent risk factor for both N1 (OR=1.538, 95%CI 1.067-2.218, P=0.021) and N2 (OR=1.814, 95%CI 1.196-2.752, P=0.005) lymph node metastasis.ConclusionPatients with high BMI or enlarged lymph nodes before surgery have a high risk for N2 lymph node metastasis, and those with large tumor diameter have a high risk for both N1 and N2 lymph node metastasis.
Objective To investigate the efficacy and safety of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia. Methods This study used a prospective randomized controlled study approach. A total of 60 day surgery patients requiring hysteroscopic surgery under general anesthesia admitted to Weifang People’s Hospital between October and December 2020 were randomly selected. All patients were divided into trial group and control group by completely random number table method, with 30 patients in each group. The trial group received paracervical block combined with total intravenous anesthesia with alfentanil, and the control group received total intravenous anesthesia with alfentanil. The general condition, operation time, recovery time, intraoperative propofol dosage, postoperative pain score, intraoperative motion response and postoperative nausea and vomiting incidence were compared between the two groups. Results There was no significant difference in age, body mass index and incidence of comorbidities between the two groups (P>0.05). There was no significant difference in the operation time, recovery time, pain score at 2 hours after operation, and incidence of nausea and vomiting between the two groups (P>0.05). In the control group, the dose of propofol [(34.07±12.67) vs. (28.33±9.10) mL], the pain score on awakening (1.50±0.78 vs. 0.77±0.50), and the incidence of body movement response (20.0 % vs. 0.0%) were higher than the trial group (P<0.05). Conclusion The use of paracervical block combined with alfentanil in hysteroscopic day surgery under total intravenous anesthesia can reduce the amount of propofol during the operation, reduce postoperative pain, and reduce perioperative adverse reactions, which has a good efficacy and safety.
Abstract： Objective To evaluate the safety, feasibility, and clinical outcome of complete video-assisted thoracoscopic surgery （VATS） lobectomy for patients with early-stage non-small cell lung cancer （NSCLC）. Methods We retrospectively analyzed the clinical data of 160 consecutive patients（the VATS group, 83 males and 77 females with average age at 60.8 years）with early-stage NSCLC who underwent complete VATS lobectomy between January 2005 andDecember 2008 in Zhongshan Hospital of Fudan University，and compared them with 357 patients（the thoracotomy group, 222 males and 135 females with average age at 59.5 years）who underwent open thoracotomy in the same period. Results The conversion rate of the VATS group was 5.0%（8/160）. The operation time of the VATS group was significantly shorter than that of the thoracotomy group（113.0 min vs.125.0 min, P=0.039）. Length of postoperative hospital stay was not statistically different between the two groups（10.3±4.3 d vs.9.1±4.6 d，P=0.425）. The postoperative morbidity of the VATS lobectomy group and the thoracotomy group was 9.4%（15/160）and 10.1% （36/357） respectively，and the postoperative mortality of the two groups was 0.6%（1/160）and 2.0%（7/357）respectively. There was no statistical difference in the mean group of lymph node dissection （2.4±1.5 groups vs.2.4±1.7 groups，P=0.743） and the mean number of lymph node dissection （9.8±6.3 vs.10.1±6.4，P=0.626） between the two groups. The overall 5-year survival rate of the VATS group was significantly higher than that of the thoracotomy group （81.5% vs.67.8%, P=0.001）. Subgroup analysis showed that the 5-year survival rate of pⅠa stage, pⅠb stage, and pⅢa stage was 86.0%, 84.5%, and 58.8% respectively in the VATS group, and 92.9%, 76.4%, and 25.3% respectively in the thoracotomy group. Conclusion Complete VATS lobectomy is technically safe and feasible for patients with early-stage NSCLC. The lymph node dissection extension of complete VATS lobectomy is similar to that of open thoracotomy, and long-term outcome of complete VATS lobectomy is superior to that of open thoracotomy. Randomized controlled trials of large sample size are further needed to demonstrate superiority.
Objective To explore the clinical effect of different types of free tissue transplantation on repairing tissue defects and reconstructing functions. Methods From November 2001 to September 2004, 14 types of freetissue transplantation and 78 free tissue flaps were applied to repairing tissue defects and reconstructing functions in extremities and maxillofacial region in 69 cases. Of the 69 cases, there were 53 males and 16 females (their ages ranged from 18 to 56, 31 on average). Five cases were repaired because of skin defects in foot, 22 cases were repaired because of skin defects in leg, 36 cases were repaired as the result of skin defects in hand or forearm and finger reconstruction, 3 cases were restored by virtue of ulna or radius defects, and 3 cases were repaired in maxillofacial region. There were 55 cases of open wound, in which 16 cases were infectious wound, 6 cases were osteomyelitis or pyogenic arthritis. There were 14 cases of noninfectious wound. The area of these tissue flaps ranged from 2.0 cm×1.5 cm to 43.0 cm×12.0 cm. The length of bone transplantation ranged from 10 cm to 15 cm. Results Arterial crisis occurred in 2 cases, venous crisis occurred in 2 cases.Seventysix flaps survived completely and 2 flaps survived partially which werelater healed. Fiftytwo cases were healed at stageⅠ, 13 cases were healed at stageⅡ(healing time ranged from 20 to 30 days), purulent infection occurred to 4cases(healing time ranged from 3 to 11 months). Bone healing time ranged from 6 to 8 weeks in finger reconstruction. Bone healing time ranged from 4 to 6 months in fibula transplantation. The function reconstruction and appearance were satisfying. The functions of all regions, where free tissues were supplied, were not disturbed. Conclusion Tissue transplantation and composite tissue transplantation are effective in repairing tissue defects and reconstructing functions.
Objective To compare the difference of effect while using homograft pericardium patch and Gore- tex patch in staged repair of tetralogy of Fallot（TOF） to enlarge the right ventricular outflow tract （RVOT）. Methods Twenty-eight patients with TOF who underwent the staged complete repair were divided into 2 groups according to the date of surgery. Gore-rex group, 13 cases, their RVOT were enlarged with Gore-tex patches. Cryopreserved homograft pericardium patch group, 15 cases, their RVOT were enlarged with cryopreserved homograft pericardium patches. Clinical results and follow-up results were compared. Results There were 1 operative death in Gore-tex patch group （7. 7%）, and 1 early postoperative death in cryopreserved homograft pericardium patch group （6. 7%）. Hemostasia time, the pericardial cavity drainage volume in cryopreserved homograft pericardium patch group were less than those in Gore-tex patch group （P〈0. 01）. All patients were followed-up for 0.8-4.5years. The residual obstruction rate at RVOT level in Gore-tex patch group was higher than that in cryopreserved homograft pericardium patch group by echocardiography （P〈0.01）. No calcification shadow was found on the chest X-ray. Conclusion Homograft pericardium is the tissue with high density and intensity, its elasticity and compliance are good. Using homograft pericardium patch may be helpful to decrease the residual obstruction of RVOT after operation. It can be adapted as a repairing material in heart surgery.
【Abstract】ObjectiveTo generally analyze the current situations of clinical research and applications in early enteral nutrition (EEN) after abdominal surgery. MethodsThe published papers about the current situations of clinical research and applications in EEN after abdominal surgery were reviewed. ResultsEEN after abdominal surgery seems to be safe and effective, produces a positive nitrogen balance, keeps the integrality of structure and function of the apparatus, protects gut barrier, and reduces or prevents septic complications. ConclusionEEN may be of more benefits and will be one of the best methods of nutrition support after abdominal surgery.
Objective To evaluate the anatomical and functional results of retinotomy in treatment of complicated retinal detachment. Methods Twenty-three eyes were treated with retinectomy during vitrectomy for complicated retinal detachment with proliferative vitreoretinopathy when complete reattachment of retina was not obtained despite careful mambrane peeling. After released the peripheral vitreoretinal contraction or pulled subretinal membranes, perfluorocarbon liquid injection, laser retinopexy and silicone oil tamponade were performed. Retinotomy size ranged from 30-degree to 360-degree (average 132-degree). Results Retinal attachment were obtained in all of the operated eyes at the end of the operation. Silicone oil was removed from 15 eyes (65．0%) within 3～11 months postoperatively. After a minimum follow-up of 6 months, the retinae were completely attached in 17 eyes ( silicone oil was not removed in 4 eyes ) and visual acuity of 0.02 or better was obtained in 11 eye (48．0%). Recurrent retinal detachment occurred in 2 eyes in which the silicone oil had been removed. The major complications were recurrence of the proliferation in 6 eyes (26．0%) and hypotony in 3 eyes (13．0%). Conclusion Retinotomy is beneficial to reattach the retina for eyes with advanced proliferative vitreoretinopathy in seemin gly inoperable cases. (Chin J Ocul Fundus Dis,2001,17:87-89)
With the rapid development of day surgery mode in China, day surgery management has shifted from extensive to refined, but there are still many problems in the information system of day surgery in Chinese hospitals. The Second Affiliated Hospital Zhejiang University School of Medicine has developed a day surgery information management system since 2018, established a pre-hospital and in-hospital day surgery ecological management, and integrated daily management concepts and management rules into the system through the whole-process information management. It realized the whole process, full data, closed-loop and path-based information management of day surgery. This paper introduces the day surgery information management system of the Second Affiliated Hospital Zhejiang University School of Medicine, and aims to share the experience of building the day surgery information management function module.
Objective To observe the clinical efficacy of external-route microsurgery for retinal detachment (RD). Methods In 36 patients (36 eyes) with single rhegmatogenous RD, the silica gel piece and/or buckling bands were preplaced, and drainage of subretinal fluid, retinal cryotherapy, e xamination of locating the holes, and intraocular injection of gas were performe d under surgical microscope. The surgical effects were compared with those of ot her simultaneous 37 patients with rhegmatogenous RD who underwent surgery under binocular indirect ophthalmscope. Results The simultaneous intraoperative observation of the fundus details and the sclera through the microscope was excellent in all cases. Under the surgical microscope, the reaction of r etinal cryotherapy was clearly visible without any serious surgical sequela. The observation of reaction of retinal cryotherapy and the orientation of the holes were not affected by mild opacity of the refractive media. Retinal reattachment was achieved in 31 eyes after the primary surgery and in 3 eyes after the secon dary surgery, with the final rate of rettachment of 94%. The best-corrected vi sual acuity was ＜0.1 in 6 eyes (16.7%), 0.1-0.4 in 15 eyes (41.7%), and ≥ 0.5 in 15 eyes(41.7%). The results were similar to those of the patients underwent surgery under indirect ophthalmoscope.Conclusion The external route microsurgery is simple, convenient, reliable, and effective. (Chin J Ocul Fundus Dis，2004，20：369-373)