Objective To observe the clinical outcomes of Hangman fracture treated by anterior cervical discectomy and fusion. Methods A total of 41 patients with Hangman fracture were retrospectively analyzed, who underwent anterior cervical discectomy and fusion from May 2010 to May 2016. Intervertebral bone graft fusion was observed through postoperative radiographic images, and improvement of symptoms was evaluated by Visual Analogue Scale (VAS), Neck Disability Index (NDI) and Modified Japanese Orthopaedic Association Scale (m-JOA). Surgical complications were evaluated as well. Results No severe complications occurred after surgery, but 5 patients had a transient dysphagia, which relieved spontaneously. Thirty-five patients had a fusion of intervertebral bone graft 3 months after surgery, and the remaining 6 patients did at the last follow-up. The VAS score was improved from 4.5±1.6 pre-operatively to 2.4±1.7 immediately post-operatively (P>0.05), and was further improved to 0.7±0.9 at the last follow-up (P<0.05). The NDI score was improved from 29.3±10.9 pre-operatively to 13.2±5.4 immediately post-operatively (P<0.05), and was further improved to 4.6±3.1 at the last follow-up (P<0.05). The m-JOA score was improved from 8.4±2.3 pre-operatively to 11.6±3.5 immediately post-operatively (P<0.05), and was further improved to 14.3±2.0 at the last follow-up (P<0.05). Conclusion Anterior cervical discectomy and fusion can be used in Hangman fracture, which is safe and reliable.
Objective To compare right anterolateral minithoracotomy and traditional median sternotomy in the treatment of left atrial myxoma. Methods Forty-one patients with left atrial myxoma treated in our hospital from January 2009 to January 2018 were divided into two groups according to the operation method: a right anterolateral minithoracotomy group including 15 patients, with 7 males and 8 females, aged 45.1±15.4 years; a median sternotomy group including 26 patients, with 10 males and 16 females, aged 49.4±11.9 years. The clinical data of the two groups were compared. Results There was no significant difference in preoperative clinical data between the two groups. All patients completed the operation without perioperative death. There was no significant difference in the operation time, cardiopulmonary bypass time, aortic clamp time or the incidence of postoperative complications between the two groups. However, compared with the median sternotomy group, the right anterolateral minithoracotomy group had shorter duration of mechanical ventilation, ICU stay and postoperative hospital stay, and less volume of drainage and blood transfusion 24 hours after surgery (all P<0.05). After 3–106 months follow-up, no recurrence was observed in both groups. Conclusion Compared with traditional median sternotomy for left atrial myxoma resection, right anterolateral minithoracotomy is safe, effective and less traumatic. It can be used as a routine treatment for left atrial myxoma.
ObjectiveTo explore the effect of comprehensive nursing service in patients with autoimmune encephalitis (AE).Methods32 patients with AE were selected and treated in our hospital from January 2017 to January 2019. There are 16 patients in the observation group and the control group respectively. The observation group received comprehensive nursing service and the control group received routine nursing intervention. Total satisfaction of clinical nursing was compared between the two groups.ResultsCompared with 10 cases (62.50%) in the control group, 15 cases (93.75%) in the observation group had better overall nursing satisfaction, and the difference between the two groups was significant (P<0.05).ConclusionsFor patients with AE, comprehensive nursing service can significantly improve the quality of life of patients, which has clinical application value.
ObjectiveTo investigate the clinical effect and prognosis of laparoscopic complete mesocolic resection (CME) in the treatment of elderly patients with stage Ⅲ right colon cancer.MethodsClinical data of 280 elderly patients (aged 60 years or older) who underwent stage Ⅲ right hemicolectomy in the First Hospital of Lanzhou University from 2010 to 2015 were collected. Among them, 160 patients underwent laparoscopic CME treatment were set as the observation group, and 120 patients underwent conventional laparotomy were set as the control group. The mean operative time, intraoperative blood loss, postoperative first anal exhaust time, number of lymph nodes dissection, number of positive lymph nodes, length of hospital stay and postoperative complications were compared between the two groups. The postoperative local recurrence rate, distant metastasis rate, 3-year cumulative survival rate and postoperative recurrence risk factors were analyzed.ResultsThere were no statistically significant differences between the observation group and the control group in operative time, number of lymph node dissection, number of positive lymph nodes and postoperative distant metastasis rate (P>0.05). The amount of intraoperative blood loss, postoperative anal first exhaust time, days of hospitalization, and postoperative recurrence rate in the observation group were less or shorter or lower than those in the control group, with statistically significant differences (P<0.05). The 3-year survival rate in the observation group was higher than that in the control group (log-rank χ2 =11.865, P=0.001), and the disease free survival in the observation group was also higher than that in the control group (log-rank χ2=7.567, P=0.006). Logistic regression was used to analyze the cases of postoperative recurrence in the two groups, and it was found that the degree of tumor differentiation, vascular invasion and lymph node metastasis were independent risk factors for postoperative tumor recurrence.ConclusionLaparoscopic CME in the treatment of elderly patients with stage Ⅲ right colon cancer is effective, it is safe and feasible, which can effectively prolong the survival time of patients.
ObjectiveTo explore the practice of the evidence-based treatment strategy for cervical spinal cord injury. MethodsOne patient with cervical spinal cord injury was admitted to our hospital on January 3, 2013. We obtained medical evidences by searching databases and regulated the best treatment after evaluating the patient's comprehensive conditions. And then, the whole treatment strategy was fully implemented. Finally, the consequent results were evaluated. ResultsThe evidence-based medicine showed that the therapeutic targets were to save the residual function, prevent complications, and promote the recovery of neural function. Based on the real-time conditions of patient, we developed and practiced the evidence-based comprehensive rehabilitation programs, including absolute rest in bed, high-dose steroids, neurotrophic drugs, Chinese medicine rehabilitation and prevention of complications. After a follow-up of half a year, the patient obtained a good curative effect. The patient was saved from paralyzing. Moreover, the patient restored the capacity of standing, walking and a certain level of self-care ability. ConclusionFor the cervical spinal cord injury, treatment decision based on evidence-based medicine is more scientific, and it can ensure maximum benefit for the patients. Therefore, it is worthy of popularizing.
ObjectiveTo analyze the choice of initial antibiotic treatment for health care-associated pneumonia (HCAP). MethodA retrospective study was conducted in patients with HCAP hospitalized in the Emergency Department of West China Hospital from January 1st to December 31st, 2014. A total of 156 HCAP patients were divided into anti-multidrug-resistant treatment group (group A, n=72) and quinolone monotherapy group (group B, n=84). The baseline characteristics, comorbidities, severity, pathogen distribution, antibiotics and clinical outcomes were compared between the two groups. ResultsIn group B, there were 46 males and 38 females with the age of (59.9±10.9) years, and the pneumonia severity index (PSI) score was 89.5±22.7; in group A, there were 44 males and 28 females with the age of (62.2±12.2) years, and the PSI score was 94.4±23.6. The differeces between the two groups were not significant (P>0.05). The duration of using antibiotics in group B was (14.5±3.7) days, which was longer than that in group A[(12.8±3.8) days, P=0.005]. The detection rate of multidrug-resistant bacteria, the proportion of changing antibiotics, the average length of hospitalization, the proportion of using mechanical ventilation, the proportion of patients transferred into Intensive Care Unit and 30 days mortality in group B was 17.9%, 34.5%, (16.9±3.6) days, 11.9%, 9.5%, and 4.8%, respectively; which were similar to those in group A[15.3%, 22.2%, (17.3±3.9) days, 16.8%, 12.5%, and 4.2%, respectively] (P>0.05). ConclusionsIt is unnecessary for all HCAP patients to receive anti-multidrug-resistant treatment. We should regard the risk factors and the popular local features of microbiology to determine the choice of antibiotic treatment.
Objective To compare efficacy of laparoscopic and open duodenal circular drainage operation for superior mesenteric artery compressing syndrome (SMACS). Methods From December 2012 to December 2015, the clinical data of 23 cases of laparoscopic duodenal circular drainage operation (laparoscope group) and 28 cases of open duodenal circular drainage operation (open group) were analyzed. The operation time, intraoperative bleeding, postoperative ambulation time, postoperative analgesics usage, postoperative the first exhaust time, postoperative the first feeding time, postoperative hospitalization time and postoperative incidence of complications were compared. The patients were followed up to confirm the effect after the operation. Results There were no differences of the age, sex, and body weight index between the laparoscope group and the open group (P>0.05). The operation time had no significant difference between these two groups (P>0.05). Compared with the open group, the intraoperative bleeding was less (P<0.05), the postoperative ambulation time, postoperative the first exhaust time, postoperative the first feeding time, postoperative hospitalization time were shorter (P<0.05), the rates of postoperative analgesics usage, incision infection, pulmonary infection, and intestinal obstruction were lower (P<0.05) in the laparoscope group. The rates of anastomotic leakage and anastomotic bleeding, and total postoperative complications rate had no significant differences between these two groups (P>0.05). All the patients were followed up for 8–36 months. The clinical symptoms disappeared and the body weight increased to normal level in the two groups. Conclusions Preliminary results of in this study show that laparoscopic duodenal circular drainage operation in treatment of SMACS has some advantages such as less trauma, faster recovery, fewer complications and shorter hospitalization time. Laparoscopy will be an ideal choice for treatment of SMACS.
ObjectiveTo explore the clinical efficacy and security of early enteral nutrition (EN) on patients with gastric cancer after radical operation. MethodsSeventy cases who treated in Affiliated Hospital of Inner Mongolia Medical University from Dec. 2008 to Apr. 2013 were randomly divided into EN group (n=35) and parenteral nutrition (PN) group (n=35), analysis and comparison of nutrition indicators and recovery indicators between 2 groups were performed. ResultsThere were no significant differences on levels of count of white blood cell (WBC), serum albumin (ALB), prealbumin (PA), and transferring (TRF) before operation between the 2 groups (P > 0.05). On 3 and 7 days after operation, the levels of ALB, PA, and TRF were all higher in EN group (P < 0.05) besides level of count of WBC. In addition, hospital stay and hospitalization cost were both lower in EN group (P < 0.05), but there was no significant difference on postoperative exhaust time and complication incidence (P > 0.05). ConclusionsEN is a safe, effective, and economical method of nutritional supplements, and it is a preferred method of nutritional support for patients with advanced gastric cancer after operation at prophase, which is worthy to apply widely in clinical.
ObjectiveTo analyze the clinical effective of differentiated thyroid cancer and approach the correct treatment methods for it. MethodThe clinical and postoperative follow-up data of 137 patients with differentiated thy-roid cancer treated in this hospital from 2002 to 2012 were analyzed retrospectively. ResultsOne hundred and thirty-seven patients accepted individualization surgery, conventionalⅥregion lymph node dissection, and postoperative com-prehensive therapy.The rate of lymph node metastasis was 53.28%(73/137).Ⅵregion lymph node was confirmed to be positive by pathology which performedⅡ+Ⅲ+Ⅳregion lymph node dissection, the rate of lymph node metastasis was 41.10%(30/73).Multivariate analysis showed that penetrate capsule, pathologic type, and TNM stage were the independent risk factors for lymph nodes metastasis (P < 0.05).No death occurred perioperative period.The temporary hoarseness was found in 4 cases (2.92%), short-term hypocalcemia in 11 cases (8.03%).During postoperative average 6.5 years of follow-up, there were 5 cases (3.65%) of local recurrence, 11 cases (8.03%) of cervical lymph node meta-stasis, 3 cases (2.19%) of distant metastasis including 1 case of bone metastasis and 2 cases of pulmonary metastasis, and 16 cases (11.68%) of reoperation. ConclusionIndividualized surgical options, conventionalⅥregion lymph node dissection, and close follow-up management could reduce the postoperative complications and guarantee the treatment effect of differentiated thyroid cancer.