Objective To investigate the application of transverse fascia in inguinal hernia repair. Methods In this study, 617 patients underwent inguinal hernia repair between January 1990 and December 2005 in our hospital were included, which were divided into two groups according to different operative ways: transverse fascia method group (n=337) and Bassini method group (n=280). Then intraoperative results, postoperative complications, and rehabilitated results of patients in two groups were compared. Results Compared with Bassini method group, the patients in transverse fascia method group did not show significant difference in operative time and blood loss during operation (Pgt;0.05). The differences of severe postoperative pain, testicular swelling, the time of the body’s restore for normal activities, and recurrence rate of patients between two groups were significant (Plt;0.05), while the difference of hematoma of scrotum and infection of incisional wound (Pgt;0.05). Conclusion The strengthening of posterior wall by transverse fascia and reconstruction of inner ring is a simple and effective method for inguinal hernia repair.
目的 探讨预防左半结肠癌伴梗阻Ⅰ期切除吻合术后吻合口漏发生的新方法。方法 将215例左半结肠癌伴梗阻接受术中结肠灌洗和Ⅰ期切除吻合等处理的患者分为两组。双管引流组术中经肛门放置肠腔内双管引流；扩肛组术中不放置肠腔内引流管，术后定时扩肛。对两组患者术后腹腔脓肿和吻合口漏发生率进行对比分析。结果 腹腔脓肿和吻合口漏发生率双管引流组分别为3.1%(4/130)和3.8%(5/130)，扩肛组分别为10.6%(9/85)和12.9%(11/85)，两组腹腔脓肿和吻合口漏发生率之差异均有显著性意义(P＜0.05)。结论 肠腔内双管引流法具有预防性结肠“内造瘘”、减压减张、冲洗洁净和持续性扩肛作用，能有效地预防和减少左半结肠癌伴梗阻I期切除吻合术后吻合口漏的发生。
ObjectiveTo discuss the clinical characteristics and the management of major complications after thoracic surgery.MethodsRetrospective research was conducted on 15 213 patients who underwent thoracic surgery from January 2008 to September 2018 in our hospital. Thirty-six (0.24%) patients died of postoperative complications. Based on whether major complications such as severe pulmonary pneumonia and other 13 complications were presented postoperatively, the patients were divided into a complication group (n=389, 294 males and 95 females, aged 61.93±10.23 years) and a non-complication group (n=14 785, 8 636 males and 6 149 females, aged 55.27±13.21 years) after exclusion of unqualified patients. The age, gender distribution, diagnosis, surgical approach, postoperative hospital stay, in-hospital costs and other clinical data were analyzed. And the treatment and outcomes of the complications were summarized.ResultsThe age, proportion of male, malignancy and esophageal diseases, postoperative hospital stay and in-hospital costs in the complication group were significantly more or higher than those in the non-complication group (P<0.05). The top three causes of death among the 36 deaths were pulmonary embolism (PE, 25.00%), severe pulmonary pneumonia (16.67%) and acute respiratory failure (16.67%), respectively. The top five complications among the severe complication group were pulmonary pneumonia (24.73%), pleural space (19.83%), anastomotic leak (17.48%), pulmonary atelectasis (11.51%) and PE (6.18%).ConclusionThoracic surgeons should recognize patients with high risk of severe complications preoperatively based on clinical characteristics and perform multi-disciplinary treatment for severe complications.
目的 探讨食管贲门癌术后非计划二次手术的原因及有效的预防和治疗措施。 方法 回顾性分析 2010 年 1 月至 2016 年 1 月在我院胸外科实施食管贲门癌手术 2 655 例患者的临床资料，37 例（1.4%）患者因严重并发症实施了非计划二次手术，其中男 28 例、女 9 例，年龄 65（48～79）岁，总结该 37 例患者的临床特征、二次手术的原因及治疗方法。 结果 吻合口瘘 11 例：1 例行空肠造瘘，2 例行胸壁切口清创+胸腔置管引流术，3 例行颈部切口清创+上纵隔置管引流术，5 例行胸腔探查术（其中 3 例行瘘口修补术），1 例胸胃瘘行胸胃部分切除+食管颈部旷置+空肠造瘘术。乳糜胸 13 例，经胸行胸导管结扎术，其中 1 例右胸结扎失败后再次经腹腔缝扎胸导管。胸腔出血 6 例行开胸探查止血，腹腔出血 2 例，分别经左胸及腹正中探查止血。1 例胸胃扭转，行吻合口切除+胃-食管端端再次吻合术。1 例因双侧声带麻痹行气管切开；1 例因肺大疱破裂气胸行胸腔镜下肺大疱切除术；1 例因肠梗阻行开腹探查粘连松解+空肠造瘘术。1 例胸内瘘患者因二次术后肺部感染死亡，其余患者均治愈出院。 结论 食管贲门癌术后二次手术的主要原因为吻合口瘘、乳糜胸及出血，提高首次手术质量是预防二次手术发生的关键，对需要行二次手术治疗的严重并发症，及时果断的决定可避免病情进一步恶化和提高二次手术的效果。
Objective To analyze the safety of surgical treatment and optimal surgical procedure for lung cancer patients with prior history of lung resection. Methods The medical records of 69 lung cancer patients with history of lung resection was retrospectively collected. There were 53 males and 16 females with a median age of 68 years ranging from 45 to 80 years. The risk factors for postoperative complications were analyzed using one-way ANOVA and logistic regression analysis. By comparing the data between the lobectomy and sublobectomy groups, the best surgical procedure was chosen. Results The 90-day mortality rate was 4.3%. Postoperative complication rate was 24.6%. Results of one-way ANOVA showed that blood loss during operation (P=0.020), tumor size (P=0.007), smoking (P=0.028) and FEV1%pre (P=0.018) were associated with increased major postoperative complications. Logistic regression analysis showed that FEV1%pre<77.0% (OR=0.935, 95%CI 0.888 to 0.984, P=0.010) and tumor size≥2 cm (OR=4.288, 95%CI 1.375 to 13.373, P=0.012) were independent risk factors for major postoperative complications. Lobectomy and sublobectomy groups had similar postoperative mortality and complication rate (P=0.063). Conclusion Surgical resection for selected lung cancer patients with history of lung resection is safe with low postoperative mortality and complication rate. Lobectomy with lymph node resection is the first choice if cardiopulmonary function permits. Pneumonectomy is not recommended.
目的 探讨直肠癌低位、超低位前切除并行横结肠预防性造口术后其并发症的护理对策。 方法 对2011年12月－2012年5月收治的43例低位直肠癌行预防性横结肠造口患者的临床资料进行回顾性分析，并就其发生并发症的原因及护理方法予以总结。 结果 43例患者均在直肠癌前切除术后行预防性横结肠袢式造口术。术后拔管时间2～5 d，造口排气时间19～73 h，均未出现吻合口瘘，但发生造口脱垂1例，造口回缩1例，造口周围皮肤疾病2例，经积极治疗护理后均痊愈出院。 结论 术后精心护理对降低横结肠造口术后并发症，提高患者生活质量，改善预后十分重要。
Objective To evaluate the clinical and histopathological manifestations of sympathetic ophthalmia after pars plana vitrectomy. Methods The clinical data of 8 patients with sympathetic ophthalmia out of 13 000 who underwent pars plana vitrectomy from Jan 1998 to Dec 2004 were retrospectively analyzed. In the 8 patients, 3 evoked eyes underwent ophthalmectomy and were observed histopathologically. Results The incidence of sympathetic ophthalmia was 0.06%. The time from vitrectomy to the occurrence of sympathetic ophthalmia ranged from 7 to 150 days, with a median of (77.8plusmn;50.8) days. All patients had decrease of visual acuity of the sympathetic eye, visual distortion, red eye, and opthalmalgia. The visual acuity was hand moving to 0.5 in the sympathetic eyes, and no light perception to 0.04 in the evoked eyes. Other clinical manifestations included binocular mutton-fat keratic precipitates, anterior chamber flare and cells, vitreous opacity, optic-disc edema and hyperaemia, and retinal edema at the posterior pole; 2 sympathetic eyes had exudative retinal detachment. The visual acuity increased to 0.4-1.2 in sympathetic eyes and light perception -0.25 in evoked eyes in all of the patients after treatment with oral administration of prednisone 1.0-1.5 mg/kg. In the 3 patients who had undergone ophthalmectomy because of total loss of visual acuity, and the pathological examination revealed infiltrated and thickeduvea due to lymphocytes, epithelioid cell nodules, infiltration of lymphocytes to sclerotic passages, and ocular atrophy were observed. Conclusion The incidence of sympathetic ophthalmia is 0.06%, which happened within 3 months after vitrectomy. The clinical manifestations and results of histological examinations accords with the characteristics of sympathetic ophthalmia. (Chin J Ocul Fundus Dis, 2007, 23: 112-114)
Objective To approach the clinical characters and therapeutic methods of retinal detachment(RD) after extracapsular catarat extraction(ECCE)with posterior chamber intraocular lens(PCIOL). Methods Sixty eight cases(68 eyes) of RD after ECCE with PCIOL were treated with sclerel buckling,microvitreo retinal surgery and intraocular gas,silicone oil injection and were reviewed. Results The retinas were totally reattached in 65 eyes(95.59%) which dropped to 94.12% in 6-60 months postoperatively.The resultant rate of visual acuity of the eyes with 0.1 or better was 79.41%,with 0.3 or better was 26.47%. Conclusion The main causes of RD after ECCE with PCIOL are similar to those of general RD,and most cases of RD after ECCE with PCIOL can be cured by surgical treatment. (Chin J Ocul Fundus Dis,1998,14:167-169)