Object ive To explore the ef fect s of di f ferent surgical methods on plantar ulcer s in leprosy. Methods The cl inical data of 71 patients with leprosy plantar ulcers and treated with different surgical methods between October 1950 and October 2006 were analyzed retrospectively. In group A, 34 cases underwent debridement, including 26 males and 8 females aged 53-88 years old (average 72.4 years old); the course of ulcer averaged 29.0 years; the size of ulcer ranged from 5 cm × 3 cm × 2 cm to 11 cm × 7 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 25 cases andsevere in 9 cases according to the self-designed evaluation system. In group B, 22 cases received foot pressure rebuilding surgery, including 19 males and 3 females aged 48-83 years old (average 69.8 years old); the course of ulcer averaged 33.5 years; the size of ulcer ranged from 5 cm × 3 cm × 2 cm to 12 cm × 7 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 12 cases and severe in 10 cases. In group C, 15 cases were repaired with the transposition of toe flap, foot arch flap, acrotarsium flap, or medial tibia flap, including 11 males and 4 females aged 43-73 years old (average 64.6 years old); the course of ulcer averaged 29.3 years; the size of ulcer ranged from 6 cm × 3 cm × 2 cm to 11 cm × 5 cm × 3 cm; the disabil ity degrees of the affected foot was mild in 9 cases and severe in 6 cases. No significant differences were evident among three groups in terms of the general information (P gt; 0.05), except for the difference between group A and group C on age (P lt; 0.05). Results Group A: 19 out of 34 cases healed and the average heal ing time was 46.8 days; all patients were followed up for 2-45 years (average 17.2 years); the rate of ulcer heal ing 1 year after operation was 55.9% (19/34); 12 healed ulcer patients relapsed at average 1.5 years after operation; the rate ofulcer heal ing at last follow-up was 20.6% (7/34). Group B: 18 out of 22 cases healed and the average heal ing time was 29.2 days; all patients were followed up for 2-50 years (average 13.3 years); the rate of ulcer heal ing 1 year after operation was 81.8% (18/22); 7 healed ulcer patients relapsed at average 3.3 years after operation; the rate of ulcer heal ing at last follow-up was 50.0% (11/22). Group C: 14 out of 15 cases healed and the average heal ing time was 27.1 days; all patients were followed up for 3-12 years (average 8.8 years). The rate of ulcer heal ing 1 year after operation was 93.3% (14/15); 7 healed ulcer patients relapsed at average 4 years after operation; the rate of ulcer heal ing at final follow-up was 46.7% (7/15). For the rate of ulcer heal ing 1 year after operation, there was a significant difference between group A and group B, and between group A and group C (P lt; 0.05), but no significant difference was evident between group B and group C (P gt; 0.05). For the rate of ulcer heal ing at the final follow-up visit, there was a significant difference between group A and group B (P lt; 0.05), but no significant difference was evident between group A and group C, and between group B and group C (P gt; 0.05). Conclusion The surgical treatment of plantar ulcers in leprosy should include the alleviation of the plantar high-pressure zone and the transposition of the flaps, providing good short-term and long-term therapeutic effect.
目的 观察多西他赛三药及两药联合对胃癌根治术后辅助化学疗法（化疗）的疗效比较及不良反应。 方法 回顾性分析解放军总医院2006年1月－2011年12月42 例胃癌根治术后患者的临床资料，其中有22例、20例患者分别接受以多西他赛为基础的三药、两药联合辅助化疗。三药联合：多西他赛注射液+铂类+氟尿嘧啶/卡培他滨片/替吉奥；两药联合：多西他赛注射液+氟尿嘧啶/卡培他滨片/替加氟或多西他赛注射液+铂类；主要观察终点：无疾病生存期（DFS），次要观察终点：预后因素分析、复发转移情况、不良反应及亚组分析。 结果 两组中位DFS分别为9.530、7.170个月（P=0.646）；性别、年龄、肿瘤浸润深度、脉管癌栓、淋巴结清扫范围是患者早期复发转移的不良预后因素，三药联合组肝转移率高于两药联合组（P=0.008）；主要不良反应为恶心、呕吐、白细胞减少、腹泻、脱发、血小板减少等，多为1～2级，可耐受，三药联合组较两药联合组易出现不良反应（P=0.011），以恶心、呕吐为主。 结论 胃癌根治术后以多西他赛为基础的辅助化疗三药、两药联合对患者疗效及预后无明显差异，且两种辅助疗法不良反应基本可耐受。
目的 探索手术对低出生体重先天性心脏病患儿的临床疗效以及围术期的处理办法。 方法 回顾性分析 2012 年 1 月至 2015 年 6 月我院行心内直视根治性手术的 788 例低出生体重先天性心脏病患儿的临床资料，其中男 379 例，女 409 例，平均年龄 4.5（1～6）个月，出生时平均体重 1 780～2 500（1 844.6±44.5）g。对患儿手术时间、围术期处理以及手术成功率等情况进行观察分析。 结果 心内直视根治术平均手术时间 110～240（132±18）min，平均体外循环时间 32～120（80±20）min，平均主动脉阻断时间 15～45（35±11）min，平均呼吸机辅助治疗时间 5～96（15±5）h。患儿术后治愈总有效率达到 96.8%，死亡率 3.2%，患儿的治愈效果较显著。 结论 加强围术期处理可以有效地提高患儿的存活率，改善患儿的生活质量，因此低出生体重先天性心脏病患儿早期治疗方式值得在临床工作中推广应用。
目的 总结多发性骨髓瘤（multiple myeloma, MM）的发病特征及临床特征，分析比较不同治疗方案对MM的疗效及不同类型与不同临床特征的MM治疗效果。 方法 回顾性分析2003年1月-2008年1月128例MM患者的发病和临床特征，以及与治疗效果的关系，并对不同治疗方案、不同类型间的疗效进行比较。 结果 MM患者发病的中位年龄为59岁，临床上以不明原因的骨痛、贫血、感染和球蛋白增高为主要表现。128例患者中行方案一（马法兰、强的松/地塞米松、反应停）的总有效率为53.3%（32/60）；方案二（环磷酰胺、长春新碱、马法兰、强的松、卡氮芥、阿霉素）为44.4%（8/18）；方案三（长春新碱、阿霉素/表阿霉素/脂质体阿霉素、地塞米松）为68.5%（24/35），方案四（硼替佐米、地塞米松/反应停）的总有效率为86.6%（13/15）。方案一和方案二间、方案三和方案四间疗效差异无统计学意义（Pgt;0.05），方案三、方案四的疗效均优于方案一和方案二（Plt;0.05）。IgG型总有效率为63.2%（48/76），IgA型为60.9%（14/23），kappa轻链型为42.8%（6/14），lammda轻链型为46.2%（6/13）。IgG型和IgA型间的疗效差异无统计学意义（Pgt;0.05），但IgG型、IgA型的疗效均优于kappa轻链型和lammda型（Plt;0.05）。不同类型及使用不同方案的患者，其中位生存期及3年和5年的生存率差异无统计学意义（Pgt;0.05）。 结论 MM患者发病高峰年龄介于40～70岁，骨痛和贫血是最常见的首发症状。长春新碱、阿霉素/表阿霉素/脂质体阿霉素、地塞米松以及硼替佐米、地塞米松/反应停方案总体疗效相当，但后者完全缓解率高于前者。
Objective To evaluate the clinical efficacy of fistula repair by stapler technique in patients with cervical tracheoesophageal fistula. Methods Retrospective analysis of 8 patients with cervical tracheoesophageal fistula who accepted operative treatment in the Department of Thoracic Surgery, Lanzhou University Second Hospital from October 2014 to October 2016 was conducted. There were 5 males and 3 females at a mean age of 46.4±13.9 years ranging from 23 to 67 years. The fistula was induced by tracheal intubation in 4 patients, by esophageal foreign bodies in 2, by tracheal stent in 1 and by esophageal diverticulum in 1. The fistula was closed by stapler technique. The surgical effects were evaluated through Karnofsky performance score (KPS), image assessment, patient satisfaction score and assessment of improvement in feeding-induced bucking. Results The operations were performed successfully with time of 117.5±6.6 min and intraoperative blood loss of 60.0±7.0 ml. After the operations, the patients did not suffer incision bleeding and infection, hoarseness, dyspnea, drinking-induced bucking, fistula relapse, tracheoesophageal stenosis or any other complications, and no death occurred during the perioperative period. The chest X-ray test was performed 1 week later showed that the pulmonary infection disappeared, and only 1 patient suffered from esophageal stenosis 1 year later. The postoperative KPS score was 90.0±7.0 points, which significantly improved in contrast to preoperation (P<0.01). Postoperative pulmonary infection area reduced significantly (P<0.05), tracheoesophageal fistula disappeared, postoperative patients satisfaction rate was 90%, and assessment of feeding-induced bucking was excellent. Conclusion Using stapler technique to repair cervical tracheoesophageal fistula is safe, easy and useful, with less operation time and postoperative complications.
Objective To evaluate the safety and mid- to long-term efficacy of surgical correction of isolated partial anomalous pulmonary venous connection (IPAPVC). Methods We retrospectively collected consecutive patients who were diagnosed with IPAPVC and underwent surgical correction at Fuwai Hospital of Chinese Academy of Medical Sciences and Fuwai Yunnan Cardiovascular Hospital from June 2009 to May 2019, summarized the basic preoperative and intraoperative data of patients, analyzed the postoperative and mid- to long-term follow-up results. Results A total of 54 patients were enrolled, including 29 males and 25 females, with an average age of 16.20±2.40 years, ranging from 1 month to 62 years. There were 28 (51.9%) patients with varying degrees of arrhythmia, 22 (40.7%) patients with cardiac insufficiency, and 39 (72.2%) patients with pulmonary hypertension. According to Bordy's typing, 14 (25.9%) patients were classified as type A, 23 (42.6%) type B, 4 (7.4%) type C, 5 (9.3%) type D and 8 (14.8%) mixed type. Transthoracic echocardiography was performed in the whole group of patients and the accuracy of staging diagnosis was 66.7% (36/54), and cardiac CT angiography (CTA) was performed in 37 patients and the accuracy of staging diagnosis was 94.6% (35/37). All surgical procedures were assisted with cardiopulmonary bypass, aortic cross-clamping time was 0-219 (67.02±5.23) min, cardiopulmonary bypass time was 40-261 (105.09±5.23) min, and there was no serious intraoperative complication. Postoperative tracheal intubation time was 0-230 (13.33±4.20) h, intensive care unit stay was 0-13 (1.89±0.28) days, postoperative hospital stay was 5-18 (7.20±0.38) days, and follow-up time was 16-140 (62.58±5.12) months. There were 2 (3.7%) all-cause postoperative deaths, including 1 in-hospital death and 1 death during the follow-up, and there was no intraoperative death. Among the survivors, there were 3 patients with surgery-related complications: 1 patient had atrial septal defect with the second surgical treatment, 1 early obstruction of the superior vena cava and 1 arrhythmia. Two patients had complications of IPAPVC (atrial fibrillation, collateral circulation) prior to surgery and underwent the second surgery with a poor prognosis, and 1 patient had preoperative cardiac insufficiency and atrial fibrillation, whose symptoms persisted for a long time during the follow-up. Conclusion IPAPVC accounts for a lower percentage of partial anomalous pulmonary venous connection, transthoracic echocardiography combined with CTA improves diagnostic accuracy, and IPAPVC should be treated with elective surgery after diagnosis. The surgical approach should be individualized with imaging features such as disease staging, number of drains and drainage location. Surgical treatment of IPAPVC is safe and effective, and regular follow-up is warranted.
Objective To determine the effect of interlocking intramedullary nail in treatment of open tibial and fibula fractures and analyze the method to promote the bone union. Methods From December 2003 to June 2006, thirtyfive patients with open tibial and fibula fracture were treated with emergency debridement, interlocked intramedullary fixation for tibia and fixed fibula at the same time. During operation, the bone marrow was collected and grafted into the fracture gaps. Among them, there were 27 males and 8 females, involving in 22 left legs and 13 right legs. Their ages ranged from 19 to 65 years, with an average of 34.7 years. The location of fracture was the middle of the tibia and fibula in 16 cases, the distal 1/3 of the tibia and fibula in 12 cases and the proximal 1/3 in 7 cases. According to the Gusitilo classification of open injuries, there were 7 cases of type I, 19 cases of type II, 8 cases of type III a and 1 case of type III b. The mean range of knee motion was 48.3° (45-70°). The mean time from injury to operation was 4.3 hours (50 minutes to 7 hours). Results The mean operation time was 94 minutes (60-132 minutes) and the mean blood loss was 122 mL (100-350 mL). The wound healed by first intention in 32 patients. Incision was sutured in 2 cases of type III a fractures after operation 4 days, gastrocnemius flap graft was performed in 1 case of type III b fracture 1 week after operation. They all achieve good heal ing. No fractures spl it off, no iatrogenic nerve and vascular injury occurred, no osteofascial compartment syndromes or deep vein thrombus happened. Tension bl isters appeared in 1 case of type II fracture after operation and subsided after 5 days. Patients were followed up for 14-43 months (mean 22 months). The X-ray films showed that fracture union was observe in 30 cases after 14 weeks of operation, in 3 cases after 18 weeks and in 1 caseafter 22 weeks of operation. The fractures union time was 15.2 weeks on average. About 2 cm nonunion in lateral tibial appeared in 1 case of type I fracture. No fracture occurred again. The mean range of knee motion was 127° (121-135°). The mean HSS score was 96.5 (87-100) at the end of the follow-up. The excellent and good rate was 100%. Conclusion The curative effect of interlocking intramedullary nail is definite in treatment of open tibial and fibula fractures and it can enhance fracture union to plant bone marrow into the fracture gaps.
ObjectiveUnder the principle of promoting the reform of TCM payment methods, analyzing the difference in efficacy and cost of treatment using Western medicine or traditional Chinese medicine, and providing health economics basis for the reform of payment methods for advantageous diseases of TCM. MethodsData from the first page of medical records of 4 Chinese hospitals and 4 western hospitals of the same level were collected from 2020 to 2021 in typical areas, focusing on four typical TCM advantageous diseases that were consistent with diabetes, cervical spondylosis, arthralgia syndrome in the lumbar area or pelvic inflammation, and a total of 14 958 cases were included through propensity score matching. Under the assumption of same disease, same effect and same price, the age, bed days, total cost, discharge condition and reoperation condition of the same disease in 90 days were analyzed and compared between the two groups. ResultsIn terms of outcomes, the experimental group showed significantly better discharge outcomes compared with the control group for the four diseases. In terms of cost, the control group had higher total costs for arthralgia syndrome in the lumbar area and cervical spondylosis, while the control group had lower total costs for diabetes. After controlling for treatment effects, the control group had higher costs for cervical spondylosis and pelvic inflammatory disease compared to the experimental group, while the control group had lower costs for diabetes and arthralgia syndrome in the lumbar area compared to the experimental group. ConclusionThe experimental group shows better treatment effectiveness for the four TCM-dominant diseases. The control group has higher costs for cervical spondylosis and pelvic inflammatory disease when discharge outcomes are limited, while the control group has lower costs for diabetes and arthralgia syndrome in the lumbar area. This highlights the necessity of reforming the payment methods for TCM-dominant diseases. Additionally, the development of TCM-dominant diseases should focus on addressing the high demand for elderly chronic diseases in TCM.