ObjectiveTo analyze the clinical outcomes of extended thymectomy for myasthenia gravis (MG) patients under different surgical approaches, and to determine the factors affecting the prognosis of MG. MethodsThe MG patients who underwent extended thymectomy from January 2014 to March 2021 in our hospital were retrospectively collected. According to the surgical approach, they were divided into a subxiphoid group and an intercostal group, and the perioperative results and prognosis were compared between the two groups. A “good outcome” was defined as complete stable remission (CSR), pharmacological remission (PR) or minimal manifestations state (MMS); a “poor outcome” was defined as outcomes worse than MMS. Univariate and multivariate logistic regression analyses were performed to assess the factors associated with the good outcomes. ResultsA total of 187 MG patients were included in the study, including 82 males and 105 females, with a median age of 50 (36, 60) years. There were 134 patients in the intercostal group and 53 patients in the subxiphoid group. Compared with the intercostal group, although the operation time of the subxiphoid group was longer [200.0 (172.0, 232.0) min vs. 141.0 (118.0, 169.0) min, P<0.001], the intraoperative blood loss was less [10.0 (10.0, 20.0) mL vs. 20.0 (10.0, 50.0) mL, P<0.001], the postoperative hospital stay was shorter [3.0 (2.5, 4.0) d vs. 5.0 (3.0, 7.0) d, P<0.001], and the incidence of complications was lower [1 (1.9%) vs. 26 (19.4%), P=0.001]. A total of 159 (85.0%) patients were followed up for a median period of 46 (13, 99) months, with a good outcome rate of 90.6% and CSR rate of 33.3%. There were no statistical differences in PR, MMS or overall good outcome rates between the two groups (P>0.05). Multivariate logistic analysis showed that age≤50 years was an independent predictor for "good outcome" of MG patients. ConclusionExtended thymectomy via subxiphoid for MG is a safe, feasible and effective surgical approach.
Objective To discuss the optimal approach to treat suprascapular nerve compression syndrome. Methods From January 2000 to June 2003, 8 cases of suprascapular nerve compression syndrome were treated by surgical intervention to cut the transverse scapular ligament through posterior approach. Of the 8 patients, there were 2 males and 6 females (age ranged from 21 to 53) with duration of 6 months to 3 years. The change of symptom, muscle power, and muscle atrophy after operation were observed. Results One week after operation, pain around the scapular disappeared, muscle power of supraspinatus and infraspinatus muscles recovered to normal. One, 6, 12 and 16 months after the operation, the patients were followed up. No recurrence was observed. Muscle atrophy didn’t recover.Conclusion To treat suprascapular nerve compression syndrome with operation through posterior approach is easy to operate. When the suprascapular nerve is entrapped in scapular notch, this approach is a good choice.
Objective To summarize the development of endoscopic thyroid surgery and expound the advantages and disadvantages. Method Reviewed the domestic and foreign literatures on different ways of endoscopic thyroid surgery. Results Gagner tried accomplish subtotal parathyroidectomy with endoscope at the first time in 1996. And then, Hüscher improved the endoscope technology and applied on thyroidectomy in 1997. Henceforth, endoscopic thyroid surgery had developed rapidly, from small neck incision surgery, such as endoscopic assisted small neck incision thyroidectomy, to traceless neck surgery, such as thoraco mammary approach, areola approach, axillary approach, retroauricular approach, combined approach, etc., to traceless body surface skin surgery in recent years, such as natural cavity oral approach. Completed endoscopic surgery makes the incision scar hide or even disappear, which had attracted the attention and learning of thyroid specialist clinicians all over the world. The choice of patients was more and more broad and diverse, and all kinds of approaches had different advantages and disadvantages.Conclusions The advantages, disadvantages, indications and contraindications of various endoscopic approaches are different. According to the location differences of individual thyroid masses and the requirements for aesthetics, the most appropriate endoscopic thyroid approach is selected to achieve the optimal solution of manual approach.
From Jan. 1991 to Jan. 1994, 11 cases ofdifferent hip lesions with flexon contracture deformity were treated by combination of SmithPeterson and WatsonJones incisions in replacement of hip joint. All of them were followed-up for 1 to 3 years (an average of 1.9 years). According to pain, joint function, the excellent and good results were rated at 90.9%. This showed that from using the combined incisions, the hip joint was very well exposed, and release of hip flexion contracture could be acomplished in the same time. Bleeding fromoperation was reduced and the procedure was simple.
目的探讨多发性肋骨骨折切口及手术入路选择 方法回顾性分析赤峰学院附属医院2000年6至2013年12月手术治疗58例多发性肋骨骨折患者的临床资料，其中开胸组46例，胸腔镜组12例，男43例、女15例，年龄36（15～61）岁。 结果开胸手术组平均手术时间152 min，平均住院时间16 d；腔镜镜手术组平均手术时间125 min，平均住院时间12.5 d。46例开胸手术患者中44例术后胸壁稳定，自主呼吸排痰良好，16例肺挫伤较重有呼吸综合征（ARDS）倾向，术后经12～148 h呼吸机支持后恢复，1例死于合并食管下段破裂，术后第3 d突发腹腔大出血，分析为外伤性腹主动脉瘤破裂。3例患者切口部分裂开，均为环抱器骨板，1例胸骨骨折胸大肌皮瓣拉拢缝合治愈，另2例中1例取出裸露骨板，1例换药及二期缝合治愈。45例患者返院及电话随访6个月至3年，开胸组39例胸壁稳定，胸部X线片固定处均有骨伽形成，全组无难以耐受的肋间神经痛，腔镜手术组切口及固定肋骨处愈合良好。 结论实际操作中可根据骨折形态特点以后外侧“～”切口及垂直切口为基础做多种变形。胸腔镜下手术切口设计时要根据骨折断端位置，可能出现的胸内脏器血管损伤，综合考虑切口布局；最好操作孔及进镜孔处有骨折断端，方便内外结合固定，节省手术时间；同时要考虑出血脏器损伤的部位，方便止血修补或中转开胸；操作孔可以3～5个。
ObjectiveTo compare the clinical results of throacolumbar fractures treated through Wiltse paraspinal approach and conventional posterior approach. MethodsSeventy-six cases of single segmental thoracolumbar fractures (Type A) were treated by posterior reduction and pedicle screw instrumentation from January 2011 to January 2013. Thirty-five cases were treated through Wiltse paraspinal approach (group A), including 27 males and 8 females with an average age of 39.7 years. Forty-one cases were treated through conventional posterior approach (group B), including 30 males and 11 females with an average age of 41.6 years. The data including incision length, operation time, intraoperative blood loss, postoperative volume of drainage, the anterior vertebral height, Cobb angle and complications were compared between the two groups. ResultsAll operations were finished successfully. The incision length, operation time, intraoperative blood loss and postoperative volume of drainage were (8.3±1.9) cm, (74.0±21.9) min, (125.0 ±46.7) mL, and (51.0±42.6) mL respectively in group A, and (10.7±2.8) cm, (97.0±18.2) min, (245.0±56.1) mL, and (190.0±72.3) mL in group B respectively. There was significant difference between the two groups (P<0.05). The restoration of anterior vertebral height and the correction of Cobb angle were well maintained in both groups. The difference was statistically significant before and after treatment (P<0.05), but there was no significant difference between the two groups (P>0.05). There was no difference in the complication rate between the two groups (P>0.05). ConclusionCompared with conventional posterior approach, Wiltse paraspinal approach has the advantage of shorter operation time, less trauma and blood loss. It is a better option for the treatment of throacolumbar fractures.
Objective To review the research on different surgical approaches and MRI evaluation of total hip arthroplasty (THA), to clarify the possible muscle damage caused by different approaches, and to help clinicians avoid intraoperative muscle damage and identify the causes of certain muscle-related complications after operation. MethodsThe research literature on different surgical approaches and MRI evaluation of THA at home and abroad was extensively reviewed to summarize the MRI performance of the posterior approach, modified direct lateral approach, direct anterior approach, and minimally invasive anterolateral approach (also called Orthopadische Chirurgie Munchen approach). Results The traditional posterior approach mainly damages the short external rotator muscle group and increases the incidence of postoperative dislocation; the piriformis-keeping posterior approach significantly improves the quality of the pyriformis tendon in the postoperative period, but it may lead to damage to the intrapelvic portion of the piriformis muscle. The modified direct lateral approach mainly damages the gluteus medius muscle, which increases the risk of postoperative claudication. The direct anterior approach mainly damages the vastus tensoris muscle and may result in damage to the short external rotator muscle group and the muscles around the incision. The minimally invasive anterolateral approach primarily damages the superior gluteal nerve, which subsequently leads to denervation of the broad fascial tensor fasciae latae, and this approach may also result in injury to the gluteus medius and gluteus minimus muscles. The muscle damage status significantly affects prognosis, and the minimally invasive approach is more suitable for elderly patients. ConclusionMRI can clarify the different types of muscle damage caused by different surgical approaches. Minimally invasive approaches can reduce muscle damage and improve postoperative function compared with traditional approaches, and can benefit elderly patients more, but due to the small field, forcing to expand the surgical field will lead to unintended muscle damage and reduce postoperative function.
ObjectiveTo investigate the advantages and effectiveness of anterior neurovascular interval approach for fixation of ulna coronoid process fracture. MethodsBetween February 2011 and April 2015, 8 patients with ulna coronoid process fracture were treated with open reduction and internal fixation by anterior neurovascular interval approach. There were 5 males and 3 females, aged from 14 to 62 years (mean, 34 years). Fractures were caused by falling in 5 cases, traffic accident in 2 cases, and crashing in 1 case. The time between injury and operation was 1-6 days (mean, 3.5 days). According to Adams classification, there were 4 cases of type II, 1 case of type III, 2 cases of type IV, and 1 case of type V. In 1 patient with joint instability, lateral collateral ligament repair was given through another incision after fixation of coroniod fracture and the hinged external fixator, and plast splin was used to fix in the other patients; function exercise was done after removal of external fixtion. ResultsAll incisions healed by first intention, and no complications of neurovascular injury and deep infection occurred. All patients were followed up 6-48 months (mean, 22 months). The healing time of fracture was 8-15 weeks (mean, 12.6 weeks). Mild myositis ossificans occurred in 1 case. The flexionextension arc of the elbow was (125.00±7.07)° and the forearm rotation was (135.00±7.07)°, showing no significant difference when compared with those of normal side[(126.88±7.53)° and (139.38±8.21)°] (t=0.469, P=0.654; t=2.198, P=0.054). According to Morrey's scale, the results were excellent in 6 cases, good in 2 cases; the excellent and good rate was 100%. ConclusionAnterior neurovascular interval approach for reduction and internal fixation of ulna coroniod fractures has the advantages of simple operation, less trauma, and larger operative field. It can be used alone or combined with other surgical approaches.
ObjectiveTo investigate therapeutic effect and influence on survival of complete laparoscopic transesophageal hiatus approach approach and transabdominal combined thoracotomy approach in treatment of Siewert type Ⅱesophageal gastric junction adenocarcinoma (AEG).MethodsFrom January 2012 to December 2014, the patients with Siewert type Ⅱ AEG were collected in the Department of General Surgery (Gastrointestinal Surgery) of Weifang People’s Hospital, then who were designed into a transabdominal group and transabdominal combined thoracotomy group according to the operative approach method. The intraoperative and postoperative statuses were compared between these two groups.ResultsIn this study, 142 patients with Siewert type Ⅱ AEG were included, 83 in the transabdominal group and 59 in the transabdominal combined thoracotomy group. There were no significant differences in the baseline data such as the gender, age, preoperative histological differentiation, TNM stage, etc. between the two groups (P>0.05). Compared with the transabdominal combined thoracotomy group, in terms of the operation time, the volumes of intraoperative blood loss and blood transfusion, and the proportion of patients with blood transfusion were better (P<0.05); the postoperative hospitalization time, time to use analgesics, time of the first activity out of bed, and time of removed electrocardiographic monitoring were also earlier (P<0.05); the numbers of lymphadenectomy and metastatic lymph nodes were less (P<0.05) in the transabdominal group. But there was no significant difference in the rate of lymph node metastasis between the two groups (P>0.05). The total incidence of complications in the transabdominal group was lower than that in the transabdominal combined thoracotomy group (χ2=9.871, P=0.002). The median survival time was 39 months in the transabdominal group and 34 months in the transabdominal combined thoracotomy group. The survival had no significant difference between the two groups by the Kaplan-Meier analysis (χ2=0.281, P=0.596). The result of multivariate analysis showed that the TNM stage and lymph node positive rate were the independent factors influencing the survival of the patients with Siewert type Ⅱ AEG.ConclusionsAccording to results of this study, it is safe and effective for patients with Siewert type Ⅱ AEG to adopt a complete laparoscopic transabdominal approach. For elderly patients with poor cardiopulmonary function who can not tolerate transthoracic surgery, it could reduce postoperative complications and improve safety.
目的:总结髋臼骨折的手术入路和复位固定经验。方法:2006年1月至2008年2月经Kocher Langenbeck、髂腹股沟、前后联合入路手术治疗髋臼骨折52例。结果:随访6～36个月,优良率90.4％。术后发生创伤性关节炎10例,股骨头坏死2例,异位骨化10例,所有患者均骨愈合。结论:手术治疗髋臼骨折能较好地恢复骨盆形态及下肢活动功能,防止骨折畸形愈合。正确的选择手术入路和术中良好的复位固定是提高髋臼骨折疗效的基础。