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Vitreous surgery for severe ocular trauma

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)

十字交叉心的外科治疗

目的 总结4例十字交叉心外科治疗的临床经验，以提高对该病的认识。 方法 2004年3月~2008年1月手术治疗4例十字交叉心患者（平均年龄3.2岁；平均体重10.9 kg）。1例采用心内隧道修补术（intravetricular tunnel rapair IVR），1例采用双向Glenn手术，1例采用双侧双向Glenn术，1例采用IVR+大动脉转位术（arterial switch operation， ASO）。 结果 住院死亡1例，为采用IVR者，死于低心排血量综合征。2例行双向Glenn手术患者术后随访6~12个月，生长发育良好，SpO2 88%左右；1例行IVR+ ASO者，随访6个月，心脏较术前略缩小，生长发育良好。结论 十字交叉心病理解剖复杂，必须根据不同的解剖特点选择不同的手术方法，明确的术前诊断是优化手术方式的先决条件。

Analysis of focal cortical dysplasia with children whose epilepsy was unrelieved thoroughly after operation based on MRI

ObjectiveTo analyze the causes of unrelieved epilepsy thoroughly in children with isolated focal cortical dysplasia (FCD) based on MRI.MethodsRetrospective analysis of MRI and clinical data of 21 children with isolated FCD during July 2014 to January 2018, which confirmed by pathology and unrelieved thoroughly after operation performed, the pathological types and MRI signs were analyzed, as well as the frequency of different MRI signs in FCD of each pathological type. Analyzed the possible factors of surgical failure.ResultsAmong the 21 cases, there were 15 males and 6 females, with an average age of (5.7±0.3) years and an average course of disease of (3.4±0.5) years.MRI signs of this part of the children were mainly manifested by blurred focal gray matter boundaries, abnormal cortical structure changes (thickening and/or thinning), transmantle signs (abnormal cone signals extending from subcortical white matter to the ventricle) and abnormal gray matter signals, which were similar to MRI signs of FCD with satisfactory postoperative epilepsy control. 17 cases (80.9%) appeared epileptic discharge after operation in the EEG monitoring area 2 weeks to 6 months, FCD type I and type Ⅱ accounted for 35.3%, 64.7% respectively. During intraoperative EEG monitoring, no epileptiform discharge was observed in the transmantle sign region in 6 cases, and the region was retained, and only the surrounding abnormal discharge cortex was removed, complete removal of the tansmantle sign and surrounding abnormal discharge area was performed in 2 cases, and different degrees of epileptic epilepsy were observed in both methods.ConclusionMRI signs of isolated FCD with unrelieved epilepsy after operation were nonspecific, there were still epilepsy of varying degrees after all epileptogenic lesions have been removed, the cause may be related to potential epileptic factors.

Analysis of the safety and feasibility of two closed thoracic drainage methods after video-assisted thoracoscopic lung volume reduction surgery

ObjectiveTo investigate the effects of closed thoracic drainage with single tube or double tubes after video-assisted thoracoscopic lung volume reduction surgery.MethodsRetrospective analysis was performed on 50 patients (39 males, 11 females) who underwent three-port thoracoscopic lung volume reduction surgery in our hospital from January 2013 to March 2019. Twenty-five patients with single indwelling tube after surgery were divided into the observation group and 25 patients with double indwelling tubes were divided into the control group.ResultsThere was no significant difference in pulmonary retension on day 3 after surgery, postoperative complications, the patency rate of drainage tube before extubation, retention time or postoperative hospital stay (P>0.05). Postoperative pain and total amount of nonsteroidal analgesics use in the observation group was less than those in the control group (P<0.05). ConclusionIt is safe and effective to perform closed thoracic drainage with single indwelling tube after video-assisted thoracoscopic lung volume reduction surgery, which can significantly reduce the incidence of related adverse drug reactions and facilitate rapid postoperative rehabilitation with a reduction of postoperative pain and the use of analgesic drugs.

Clinical Preliminary Observations on Laparoscopic Staging of Gastric Cancer

目的：探讨腹腔镜检查对胃癌分期的价值。方法: 2007 年1月至2007 年11 月收治的胃癌患者14 例胃癌患者在全麻下行腹腔镜检查。结果: 腹腔镜T分期与术后病理检查结果符合率为92.9％，术前临床T分期与术后病理检查结果符合率为64.3%。腹腔镜分期显著优于临床分期Plt;0.05。在14例术前临床分期均未发现腹膜转移的病例中，腹腔镜探查发现有腹膜转移（P1-P3）者4例，腹腔镜对腹膜转移的评估显著优于临床分期P lt;0.05。结论: 腹腔镜可作为常规检查手段的一种补充，能对进展期胃癌进行准确的诊断和分期，有助于手术决策制定及估计治疗结果与预后，避免不必要的剖腹探查。

A clinical analysis on child patients with retraction of silicon oil after operation of rhegmatogenous retinal detachment

Objective To probe the clinical feature and complications of extraction of silicon oil after operation of simple rhegmatogenous retinal detachment in child patients. Methods The clinical materials of 22 patients (22 eyes) of child patients (5~14 years old) and 11 cases (11 eyes) of adult patients with simple rhegmatogenous retinal detachment undergone surgical treatment and subsequent retraction of silicon oil tampon, were reviewed and analyzed retrospectively. The reasons of extraction silicon tampon, ocular complications of intrao cular silicon tamponade and the changes of visual acuity pre- and post-extraction of silicon tamponade in above 2 groups were explored. Results The main reason for the extraction and complications of silicon oil tamponade were similar in both groups. The rate of occurrence of the complications in either group rose as time went on . There was no significant difference in change of visual acuity between two groups after the extraction of silicon oil tampon. Conclusion The responses to silicon oil after the operation for simple rhegmatogenous retinal detachment is quite similar in either children or adult patients,and there is no obvious difference between child and adult patients in the results of silicon oil extraction. (Chin J Ocul Fundus Dis，2000，16：139-212)

Logistic Regression Analysis of Risk Factors for Surgical Site Infection after Hepatobili-ary and Pancreatic Surgery

Objective To study the influence factors of surgical site infection (SSI) after hepatobiliary and pancreatic surgery. Methods Fifty patients suffered from SSI after hepatobiliary and pancreatic surgery who treated in Feng,nan District Hospital of Tangshan City from April 2010 and April 2015 were retrospectively collected as observation group, and 102 patients who didn’t suffered from SSI after hepatobiliary and pancreatic surgery at the same time period were retrospectively collected as control group. Then logistic regression was performed to explore the influence factors of SSI. Results Results of univariate analysis showed that, the ratios of patients older than 60 years, combined with cardiovascular and cerebrovascular diseases, had abdominal surgery history, had smoking history, suffered from the increased level of preoperative blood glucose , suffered from preoperative infection, operative time was longer than 180 minutes, American Societyof Anesthesiologists (ASA) score were 3-5, indwelled drainage tube, without dressing changes within 48 hours after surgery, and new injury severity score (NISS) were 2-3 were higher in observation group (P＜0.05). Results of logistic regression analysis showed that, patients had history of abdominal surgery (OR=1.92), without dressing changes within 48 hours after surgery (OR=2.07), and NISS were 2-3 (OR=2.27) had higher incidence of SSI (P＜0.05). Conclusion We should pay more attention on the patient with abdominal surgery history and with NISS of 2-3, and give dressing changes within 48 hours after surgery, to reduce the incidence of SSI.

Clinical observation on diode laser choroidotomy for drainage of subretinal fluid

Purpose To evaluate the safety and efficacy of draining subretinal fluid with transchoroidal probing by using the traditional needling and diode endolaser probing. Methods The investigation included 70 consecutive patients(74 eyes) with rhegmatogenous retinal detachment undergoing scleral buckling surgery.Seventy cases were randomly divided into 2 groups,group A 34 cases(36 eyes)with the needle drainage procedure and group B 36 cases(38 eyes) with the diode probe respectively.The safety and efficacy were compared in between the 2 groups. Results No operative failure was found in these 2 groups.In group A,subretinal hemorrhage occurred in 3 eyes,and retinal incarceration,retinal preforation in one eye. No significant complication occurred in group B. Conclusion Diode laser drainage has the advantage in that it may reduce the incidence of operative complication with drainage.This technique might be used in any case requiring drainage of subretinal fluid especially of rhegmat　ogenous retinal detachment in cases of shallow retinal detachment. (Chin J Ocul Fundus Dis,1998,14:202-203)

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Dieulafoy 病 21 例临床分析

目的 探讨 Dieulafoy 病的病因、临床表现、诊断及治疗。 方法 回顾性分析笔者所在医院于 1998–2014 年期间收治的 21 例 Dieulafoy 病患者的临床资料。 结果 21 例 Dieulafoy 病患者的发病诱因：饮酒 6 例，长期服用非甾体类抗炎药 6 例，食辛辣食物刺激 5 例，精神刺激 1 例，其余 3 例无诱因。临床表现：均突发起病，17 例表现为呕血及大量黑便，3 例表现为大量呕血，1 例仅表现为黑便。所有病例入院后行急诊胃镜检查，确诊 20 例，1 例漏诊。病变位于胃底部 4 例，位于胃体近贲门小弯侧 13 例，位于胃角 2 例，位于十二指肠球部2 例。20 例行内镜下止血治疗，15 例经内镜下止血成功，5 例失败。内镜止血成功的 15 例患者获访 8～20 个月，中位数为 14 个月，随访期间均未再出血。6 例行外科手术治疗，包括胃镜引导下腹腔镜胃楔形切除 3 例，胃镜引导下腹腔镜单纯血管缝扎 1 例，开腹胃大部切除术 1 例，腹腔镜胃大部切除术 1 例。术后 6 例患者获访 6～14 个月，中位数为 9 个月，随访期间 5 例未再出血；1 例于术后 6 个月再次出血，但出血量少，经抑酸、止血等保守治疗后出血停止。 结论 急诊胃镜是诊断 Dieulafoy 病的首选方法。Dieulafoy 病的治疗首选内镜下止血，内镜止血不成功者可考虑手术治疗，手术方式首选双镜联合局部楔形切除术。