Objective To summarize the visual outcome of patients with severe ocular trauma treated with vitreous surgery. Methods Clinical data of 188(191 eyes) with severe ocular trauma treated with vitreous surgery in a period from November 1996 to April 1998 were analysed retrospectively. Results The study included penetrating injury in 56 eyes, foreign bodies in the posterior segment in 70 eyes, blunt injury in 41 eyes , and globe rupture in 24 eyes. Main complications included endophthalmitis in 35 eyes, choroidal bleeding in 20 eyes, retinal detachment in 60 eyes, and vitreous hemorrhage in 97 eyes. Post-opera-tively, out of 188 eyes, except for 3 of patients too young to examine, visual acuity improved in 133(70.7%), including 85(45.2%) with visal acuity 0.02-1.0, 46(24.5%) remained unchanged; and 9(4.8%) had worse vision. Among 34 with no-light-perception, 12 had light-perception or over. Conclusion A majority of severe trauma eyes can be salvaged with considerable visual recovery after adequate and timely vitreous surgery. (Chin J Ocul Fundus Dis,1999,15:4-6)
Objective To evaluate the curative effects of vitreoctomy or simple scleral buckling on retinal multiple-tear detachment associated with tracted anterior flap. Methods The clinical data of 89 eyes in 89 patients with retinal multiple-tear detachment associated with tracted anterior flap diagnosed in Jan, 1999-Jan, 2002 were retrospectively analyzed. In the 89 patients, 41 had undergone vitreoctomy and 48 had undergone scleral buckling without vitrectomy. In the duration of 2- to 36-month follow-up with the mean of (11.02±7.90) months, visual acuity, retinal reattached rate and postoperative complication were examined and the results in the 2 groups were compared. Results In 41 eyes underwent vitreocotmy, successful reattachment was found in 38 (92.7% ); visual acuity increased in 33 (80.5%), didn′t change in 6 (14.6%), and decreased in 2 (4.9%); leakage of flocculent membrane in anterior chamber occured was found in 2 (4.9%), complicated cataract in 3 (7.3%),and severe proliferative vitreoretinopathy (PVR) in 3 (7.3%). In 48 eyes underwent scleral buckling, 41 (85.4%) had success reattachment; visual acuity increased in 36 (75.0%), didn′t change in 4 (8.3%), and decreased in 8 (16.7%); leakage of flocculent membrane in anterior chamber was found in 6 (12.5%), complicated cataract in 9 (18.8 %), and severe PVR in 8 (16.7%). Conclusion There isn′t any difference of the success rate of the surgery between vitrectomy and scleral buckling for retinal multiple-tear detachment associated with tracted anterior flap.The better visual acuity and less complications are found in the vitrectomy gro up than those in the scleral buckling group. (Chin J Ocul Fundus Dis，2004，20：209-211)
Objective To investigate the clinical efficacy and surgical timing of vitrectomy combined with silicone oil tamponade for severe infectious endophthalmitis. Methods Sixty-two patients (62 eyes) with endophthalmitis, diagnosed by the examinations of the best corrected visual acuity (BCVA), intraocular pressure, slit-lamp microscopy, direct and (or) indirect ophthalmoscopy and ocular B-ultrasound. There are 44, 17 and 1 eyes with posttraumatic, postoperative and endogenous infectious endophthalmitis, respectively. The patients were randomly divided into the group A (32 eyes) and B (30 eyes). The former was treated immediately by vitrectomy combined with silicone oil tamponade after diagnosis, while the latter was treated by the same surgery after drug treatment depended on patientsprime;choice. Vitreous purulence was taken in all patients before vitrectomy for bacterial, fungal culture and drug sensitivity test. 19/62 (30.65%) vitreous samples were positive for culture. The follow-up was ranged from 6 to 26 months. The visual acuity, intraocular pressure and eye retention situation before and after surgery were comparatively analyzed. Results In group A, endophthalmitis was controlled in all eyes after surgery; the visual acuity and intraocular pressure improved significantly after surgery (chi;2=43.72, 6.83; P＜0.05). In group B, endophthalmitis was controlled in 19/30 eyes (63.33%) after surgery; evisceration was performed on 11 eyes (36.67%) because of the atrophy of the eyeball. There was no significant difference of visual acuity before and after surgery. Conclusions Vitrectomy combined with silicone oil tamponade is an effective way to cure severe infected endophthalmitis. Performing the surgery immediately after the diagnosis is the key to achieve good effect.
目的总结腹腔镜阑尾切除术(laparoscopic appendectomy，LA)的应用经验。方法回顾性分析我院2009年5月至2010年8月期间153例行LA手术患者的临床资料。结果153例中男74例，女79例; 年龄8～76岁，平均32.5岁。其中慢性阑尾炎7例，急性单纯性阑尾炎41例，急性化脓性阑尾炎81例，急性坏疽穿孔性阑尾炎24例。149例在腹腔镜下顺利完成手术，4例因阑尾周围组织水肿及粘连明显、镜下解剖不清而中转开腹。手术时间30～90 min，平均51 min。住院时间3～8 d，平均5 d。发生脐部戳孔感染5例。随访1～12个月（平均5个月），无术后出血、腹腔脓肿及粘连性肠梗阻发生。结论LA创伤小，疤痕小，恢复快，住院时间短，并发症少，安全性高。
One hundred and five hepatic resection were performed from 1984 to 1994. Six of these patients complicated with subphrenic infection after hepatectomy, of whom two patients died of liver failure. Subphrenic dropsy occureeed in nine cases. Subphrenic infection is easy to occur in: right or extend lobectomy, massive blood loss at operation, and in postoperative bleeding which subjects to laparotomy for lemostasis. Seecure hemostasis, avoidence of hepatic tissue devitalization during operation and effective subphenic drainage aree essential to reduce the incidencee of subphrenic infection, and routine bacterial culture of subphrenic drainage fluid will help to select propre antibiotic.
ObjectiveTo explore the clinical significance of detecting serum intact parathyroid hormone (iPTH) and drainage fluid parathyroid hormone (dPTH) after thyroidectomy in forecasting parathyroid function.MethodsThe clinical data of 95 thyroidectomy patients in the same treatment group from March 2018 to September 2018 were retrospectively analyzed, which in the Department of Thyroid-Breast Surgery, the Second Affiliated Hospital of Kunming Medical University. According to the surgical method, the patients were divided into 3 groups: isthmus and unilateral thyroidectomy (partial resection group, n=33), total thyroidectomy (total resection group, n=33) and total thyroidectomy and central lymph node excision (radical resection group, n=29). The negative pressure drainage tube was placed in the operative area. The iPTH and serum calcium were detected before and the first day after operation. The dPTH was detected in the first day and the second day after operation. Serum calcium, iPTH and dPTH were statistically analyzed.ResultsThere were no significant differences in operative time, hospital stay and blood loss between the total resection group and the radical resection group (P>0.05), but the partial resection group were all less than the other two groups (P<0.01). On the first day after operation, the iPTH in the three groups were lower than that before operation, and the iPTH was significantly decreased in the total resection group and the radical resection group, with statistically significant difference (P<0.05). The dPTH in the three groups were significantly increased on the first and second day after operation (P<0.05), but there was no statistically significant difference between the three groups (P>0.05). There was no statistically significant difference in serum calcium between the three groups on the first day after operation (P>0.05).ConclusionsThe levels of iPTH, dPTH and serum calcium after thyroidectomy can comprehensively forecast the parathyroid function. Preventive calcium supplementation can reduce the occurrence of postoperative symptomatic hypocalcemia, which is conducive to the recovery of parathyroid function.