ObjectiveTo compare efficacy of laparoscopic or open hepatectomy in benign liver tumors patients with different difficult operations. MethodsAccording to the inclusion and exclusion criteria, the patients with benign liver tumors who underwent hepatectomy in the Affiliated Hospital of Xuzhou Medical University from September 2014 to March 2021 were collected. The enrolled patients were assigned into low, medium, and high difficulties by the Hasegawa liver resection surgical difficulty score model, then the patients were matched by propensity score matching. The liver function and inflammatory indexes, intraoperative bleeding, operative time, total hospital stay, postoperative complications, and hospitalization expenses of patients with benign liver tumors after laparoscopic (laparoscope group) or open (open group) hepatectomy were compared. ResultsA total of 209 patients who met the inclusion and exclusion criteria were enrolled in this study. According to the Hasegawa criteria, there were 59, 89, and 61 patients with low, medium, and high difficulties respectively. After 1∶1 propensity score matching, 18, 34, and 14 patients in the laparoscope group and open group were matched respectively. There were no statistic differences in the baseline data between the laparoscope group and open group (P>0.05). ① For the patients with low and medium difficulties, compared with the open group, the different values of alanine aminotransferase, aspartate aminotransferase, white blood cell count, and neutrophil percentage were lower (P<0.05), the intraoperative bleeding and total hospital stay were less or shorter (P<0.05), and the albumin were higher (P<0.05) in the laparoscope group. There were no statistic differences in these indexes among the patients with high difficulty (P>0.05). ② Compared with the open group, the operative time of the laparoscope group was shorter in the patients with low difficulty (P<0.05) and longer in the patients with high difficulty (P<0.05), and there was no statistic difference in patients with medium difficulty (P>0.05). ③ The postoperative complications had no statistic differences between the two groups for the patients with low and high difficulties (P>0.05), while which in the laparoscope group were lower than in the open group for the patients with medium difficulty (P<0.05). ④ The hospitalization expenses of the laparoscope group was higher than the open group for the patients with high difficulty (P<0.05), while which had no statistic differences between the two groups for the patients with low and medium difficulties (P>0.05). ⑤ The total hospital stay of the laparoscope group was shorter than the open group (P<0.05) no matter which difficult operation.ConclusionsAccording to results of this study, laparoscopic hepatectomy has more obvious advantages as compared with open hepatectomy for patients with low or medium difficulty, which could greatly shorten hospital stay and accelerate rehabilitation of patients. Even for patients with high difficulty, laparoscopic hepatectomy still shows an advantage of shortening hospital stay.
Objective To summarize our experience on leaflet extension in reoperation after tricuspid valve repair in children at age≤15 years and to explore the application indicators and skills of this technique. Methods We retrospectively analyzed the clinical data of 23 children who underwent reoperation after tricuspid valve repair in Xinhua Hospital between January 2006 and October 2015. There were 15 males and 8 females with a mean age of 8.7 years, ranging from 5 to 15 years. The leaflet was extended by artificial pericardium patch. After surgery, warfarin anticoagulation therapy was done, and international normalized ratio was maintained 2.0 to 3.0. Results The average cardiopulmonary bypass time was 87-132 (98.5±35.7) minutes, and average aortic cross-clamping time was 56-97 (68.40±23.78) minutes. One patient died in hospital. There were 3 patients with complications including respiratory failure in 1 patient, acute renal failure in 1 patient, and right heart insufficiency in 1 patient. All the children cured and were followed up for 5 months to 10 years, with a mean follow-up of 3.5 years. One patient died during the follow-up. Six patients suffered mild to moderate tricuspid regurgitation and tricuspid valve function of the rest patients was good. No other redo-valve surgery or complications correlated to anticoagulation occurred. Conclusion Leaflet extension in reoperation after tricuspid valve repair in children is useful with optimistic middle to long term efficacy and needs intensive care therapy during the perioperative period.
ObjectiveTo investigate the value of proton magnetic resonance spectroscopy (1H-MRS), gradient dual-echo, and triple-echo sequences in the quantitative evaluation of treatment effect of fatty liver at 3.0T MR.MethodsThirty patients with fatty liver diagnosed by CT or ultrasound who admitted in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital between August 2017 and May 2018, were enrolled and undergone gradient dual-echo, triple-echo, and 1H-MRS examination before and 3 months after treatment. The fat index (FI) and relative lipid content (RLC) were measured. Fatty liver index (FLI) was calculated from blood biochemical indicators, waist circumference, and BMI at the same time. With the reference standard of FLI, the results before and after treatment measured from MRI were analyzed.ResultsThere were significantly differences of FLI, FIdual, FItriple, and RLC before and after treatment (t=5.281, P<0.001; Z=–3.651, P<0.001; Z=–3.630, P<0.001; Z=–4.762, P<0.001), all indexes decreased after treatment. FIdual and FItriple were positively correlated with FLI before (rs=0.413, P=0.023; rs=0.396, P=0.030) and after treatment (rs=0.395, P=0.031; rs=0.519, P=0.003), the highest correlation factor was FItriple to FLI after treatment. There were no significant correlation between RLC and FLI before and after treatment (P>0.05).ConclusionsIt is feasible to quantitatively evaluate the treatment effect of fatty liver by using 1H-MRS, gradient dual-echo, and triple-echo sequences. Gradient triple-echo sequences has better accuracy, which is technically easy to implement and more suitable for clinical development.
bjective To observe the therapeutic effect of laser photocoagulation on diabetic retinopathy (DR)at different stages.Methods A total of 534 eyes of 304 patients with DR diagnosed by fundus fluorescein angiography (FFA) were enrolled in this study. In the 534 eyes, 92 with nonproliferative DR (NPDR) had the bestcorrected visual acuity(BCVA) of 0.52plusmn;0.32,108 with preproliferative DR (PPDR) had the BCVA of 0.49plusmn;0.23,196 with early PDR had the BCVA of 0.20plusmn;0.31,and 138 with highrisk PDR had the BCVA of 0.17plusmn;0.22． According to the rules of ETDRS, retinal photocoagu1ation,pan retinal photocoagu1ation or extrapanretinal photocoagu1ation were performed on the paitents with NPDR,PPDR,and highrisk PDR,respectivelyThe patients were followed up for 10-18 months after the operations and the results of the examinations at the last time were regarded as the criteria for judgement. The examination of BCVA and ocular fundus and FFA were performed with the time interval of 3 months．The judgement for BCVA was(1)improved:improved ge;2 lines;(2) kept still: changed within 2 lines;(3)decreased:decreased ge;2 lines.And the effect on BCVA was positve when it was improved or kept still.The judgement for the therapeutic effect on DR was:retinal edeama was alleviated,leakage of hemorrhage was obsorbed,microaneurysm disappeared or decreased, neovascularization (NV) was relieved completely or partly,nonperfusion area disappeared or narrowed, and no new NV or nonperfusion area came into being. Results After the operations, BCVA in NPDR,PPDR and early PDR groups was improved or kept still in 73(79.3%),83(76.9%)，and 146 eyes (74.5%), respectively,without any statistical difference among these three groups（P＞0.05）.BCVA in highrisk PDR group was significant lower than that in the NPDR,PPDR,and early PDR groups (P＜0.05). The positive rate of therapeutic effect on DR was 89.1%,85.2%,82.7% in NPDR,PPDR,and early PDR groups, respectively without any statistical difference among the groups(P＞0.05). The positive rate of therapeutic effect on DR in highrisk PDR group was significant lower than that in the NPDR,PPDR,and early PDR groups(P＜0.05). Conclusion The prognosis of DR at different stages after laser photocoagulation is different;timely and effective laser photocoagulation is important to prevent the development of the disease and decrease the blindness rate.
ObjectiveTo observe the clinical effect of vitrectomy with internal limiting membrane peeling and air tamponade in the treatment of idiopathic macular hole (IMH).MethodsA prospective, non-randomized controlled case cohort study. Twenty eyes of 20 patients with IMH in Ophthamology Department of The Second Hospital of Jilin University from September 2016 to January 2017 were included in this study. There were 4 males (4 eyes) and 16 females (16 eyes), with the mean age of 60.60±9.50 years and the mean disease course of 9.55±15.5 months. The stage of macular hole ranged from Ⅱ to Ⅳ. All patients underwent BCVA, intraocular pressure, spectral-domain OCT (SD-OCT) and multifocal ERG examinations. The BCVA examination was performed using the international standard visual acuity chart, which was converted into logMAR visual acuity. The minimum diameter (MIN), bottom diameter (BD), height (H), the defective diameter of ellipsoid zone, the defective diameter of external limiting membrane (ELM) of the macular hole were measured by SD-OCT (German Heidelberg). Then the macular hole index (MHI=H/BD), hole traction index (THI=MD/BD) and hole diameter index (DHI=H/MD) were calculated. The response density in P1 wave was detected by mf-ERG. The logMAR BCVA was 1.18±0.54. There were 5 eyes with less than 400 μm MIN, 13 eyes with 400-700 μm MIN and 2 eyes with over than 700 μm MIN. All the patients were underwent vitrectomy with internal limiting membrane peeling and air tamponade. According to the SD-OCT image features after surgery, IMH closure was divided into type Ⅰ closed, type Ⅱ closed and unclosed. The follow-up was equal or greater than 3 months. The closure rate of IMH, BCVA and the changes of microstructure parameters of macular area were observed. Spearman correlation analysis was used to analyze the correlation between BCVA and the wave response density in P1 before surgery and the efficacy after IMH surgery.ResultsClosure rate of IMH: 18 eyes (90.0%) were completely closed (all type Ⅰ closed). The closure rate of macular hole with the MIN less than 400 μm was 100.0% (5/5), 400-700 μm was 92.3% (12/13), and over than 700 μm was 50% (1/2). BCVA: the mean logMAR BCVA at 1 week, 1 month, 3 months after surgery were 0.83±0.54, 0.65±0.41, 0.48±0.34, and there was statistically significant difference between preoperative and postoperative BCVA (t=3.382, 4.459, 5.250; P=0.003, 0.007, 0.004). The outcomes of SD-OCT at 3 months after surgery: 18 eyes (90.0%) with intact ELM. The defective diameter of ellipsoid zone was 260.34±272.08 μm, there was statistically significant difference between before and after surgery (t=13.545, P=0.002). The outcomes of mf-ERG: the P1 wave response density of the ring 1 and ring 2 after surgery were increased compared with before surgery (t=-16.748, -6.151; P＜0.01,＜0.01). The results of Spearman correlation analysis: there was a positive correlation between postoperative BCVA and preoperative MIN, the defective diameter of ellipsoid zone and ELM, and postoperative the defective diameter of ellipsoid zone (r=0.56, 0.59, 0.68, 0.52; P=0.010, 0.006, 0.001, 0.019). The postoperative BCVA was negatively correlated with the P1 wave response density of ring 1 and ring 2 of mf-ERG (r=－0.34, －0.16; P=0.006, 0.020). The IMH closure had a significant negative correlation with MIN and the defective diameter of ELM (r=－0.449, －0.449; P=0.047, 0.047). MHI and THI were positively correlated with the closure of the hole (r=0.474, 0.546; P=0.035, 0.013). Intraocular pressure increased in 2 eyes during the follow-up period, and returned to normal within 1 week after the administration of antihypertensive drugs. There were no complications during or after the operation.ConclusionsVitrectomy with internal limiting membrane peeling and air tamponade in the treatment of IMH is safe and effective. The MIN, MHI THI are significantly correlated with the curative effect after IMH surgery, which could be used as the index to predict and evaluate the curative effect. The response density of ring 1 and ring 2 in P1 wave of mf-ERG is signifi-cantly improved compared with before surgery, and which is negatively correlated with BCVA.
ObjectiveTo evaluate the effects of multi-disciplinary diagnosis and treatment model based on doctor-patient shared decision making on treatment outcomes, quality of life and postoperative complications of breast cancer patients. MethodsA total of 100 breast cancer patients were included in this study through a prospective randomized controlled design, and were randomly divided into control group and intervention group, with 50 patients in each group. The control group received traditional treatment mode, while the intervention group implemented a multidisciplinary treatment mode based on doctor-patient sharing decision making. The results of treatment, quality of life and postoperative complication rate were compared between the two groups. ResultsThe completion rate of adjuvant radiotherapy and chemotherapy in the intervention group was 94.0%, which was higher than that in the control group (80.0%), and the difference was statistically significant (P=0.037). The satisfaction rate of postoperative breast appearance in the intervention group was 90.0%, which was higher than that in the control group (60.0%), with statistical significance (P<0.001). There was no significant difference in grade Ⅲ/Ⅳ toxicity between the two groups (P>0.05). After treatment, the scores of patients’ quality of life in the intervention group were higher than those in the control group, and the difference was statistically significant (P<0.05). The incidence of postoperative complications in the intervention group was 6.0%, which was lower than that in the control group (22.0%), and the difference was statistically (P=0.021). ConclusionsThe application of multidisciplinary diagnosis and treatment model based on doctor-patient sharing decision-making in the treatment of breast cancer patients has significantly improved the treatment effect and quality of life, and effectively reduced the rate of postoperative complications. This model provides a new approach to the treatment of breast cancer that is more personalized, comprehensive and efficient.
Objective To compare the efficacy of intravitreal triamcinolone(IVTA) injection and IVTA combined with macular laser grid photocoagulation（MLGP）to treat macular edema.Methods Consecutive 89 patients （109 eyes）diagnosed with macular edema by examinations of ocular fundus and optical coherence tomography (OCT).The visual acuity was hand moving-0.8 (0.19plusmn;0.13)；the intraocular pressure（IOP）ranged from 7 mm Hg to 21 mm Hg（1 mm Hg=0.133 kPa）and the average IOP was 13.78 mm Hg.All the patients received OCT and microperimetry examinations，the central macular thickness was （570plusmn;182）mu;m；the average light sensitivity was （5.07plusmn;3.94） dB and the fixation percentage was 70.67% within 4 deg;area around the macular fovea. All the patients received IVTA treatment，39 patients（48 eyes）further received MLGP 1 month later (IVTAMLGP group). The remaining 50 patients (61 eyes) without MLGP treatment was the IVTA group. Best corrected visual acuity (BCVA),IOP,lens,OCT and microprimetry examinations before and after IVTA (1,3,6,12 months) were followed and analyzed.Results On the 12th months，the BCVA in IVTAMLGP and IVTA group was （0.41plusmn;0.20）、（0.24plusmn;0.19）respectively (P＜0.05)；the central macular thickness was （309plusmn;187） and （487plusmn;206） mu;m respectively（P＜0.05）；the mean light sensitivity of 4deg; central macular was （8.24plusmn;4.64）and（6.30plusmn;3.22）dB respectively（P＜0.05）；the fixation percentage was（87.01plusmn;19.70）% and（78.85plusmn;20.41）% respectively （P＜0.05）. During the followup recurrent macular edema was noticed in 28 eyes of IVTA group and 8 eyes of IVTAMLGP group.Conclusions IVTA combined with MLG was more effective than IVTA to cure macular edema.
目的 总结 14 例原位心脏移植的治疗经验。 方法 回顾性分析 2006 年 1 月至 2015 年 9 月我院行原位心脏移植术终末期心脏病患者的临床资料，其中男 11 例、女 3 例，年龄 22～62（46.7±10.1）岁。4 例使用抗 Tac 单克隆抗体诱导治疗，10 例使用巴利昔单克隆抗体诱导治疗。采用 4℃ 组氨酸-色氨酸-酮戊二酸（HTK）液保护供心。2 例采用经典式原位心脏移植，12 例采用双腔静脉法行心脏移植。术后采用环孢素或他克莫司+吗替麦考酚酯+激素三联抗排斥方案。 结果 术后早期 1 例因多器官功能衰竭合并严重感染死亡。早期并发症有：败血症 1 例，硬膜外血肿 1 例，急性肾功能不全 1 例，移植物右心功能不全 2 例，低心排血量并需要体外膜肺氧合支持 1 例。术后长期随访：截至 2016 年 6 月，2 例失访，1 例于术后 30 个月因自行停服抗排斥药物死于急性排斥，1 例于术后 36 个月死于肺癌。余 9 例存活 9～121 个月，生活质量良好。 结论 心脏移植是治疗终末期心脏病的有效方法，熟练的手术技巧、合理的免疫抑制治疗，围术期管理经验、密切监测和治疗感染和排斥及患者依从性均影响着心脏移植的效果。
ObjectiveTo describe the current situation of the prevalence of hepatic hydatidosis, analyze the clinical characteristics and treatment method of the disease, in order to provide scientific basis for personal treatment plans of hepatic hydatidosis. MethodThe clinical data of 121 patients with recurrent hepatic hydatidosis treated between July 2006 and December 2013 were analyzed retrospectively. The general information of hydatid disease of liver, mass of liver, clinical manifestations, laboratory test results, treatment method, effectiveness of the treatment during hospitalization, and follow-up results were collected and analyzed. ResultsMost of the patients were adults from Sichuan and Tibet, and the majority of them had no clear occupation or clear animal contact history and had not taken raw or fresh meat. Lesions in the right lobe occurred in 87 cases, accounting for 71.90%. Abdominal pain and distension were the main clinical manifestations. Twenty-five (20.66%) of these patients were associated with hepatic dysfunction, among whom 23 patients had mild hepatic dysfunction. Alpha-fetoprotein level was increased in one (0.83%) of these cases. A total of 119 of the 121 patients received surgical treatment (98.35%) and all the surgeries were successful. Follow-up results revealed that three of the patients had recurrence. ConclusionsHepatic hydatidosis is an epidemic mainly in the Tibetan district of the West of China. The disease mainly occurs in the right lobe of the liver, which mainly causes mile liver damage. Hepatocellular carcinoma has not been found in these cases. Surgery treatment is the main therapy for liver hydatidosis and may result in good effectiveness.