Objective To probe CT grading criteria of vascular invasion in pancreatic cancer. Methods Retrieved articles in CNKI and PubMed about value of CT in preoperative assessment of vascular invasion in pancreatic cancer last ten years. Results Multislice helical CT is considered the best imaging method to assess the invaded peripancreatic vessels in pancreatic cancer. There are different CT criteria of vascular invasion in pancreatic cancer based on extension of hypodense tumor and its relation to blood vessels, on the degree of circumferential contiguity of tumor to vessel, on the degree of lumen stenosis, and on the degree of contiguity between tumor and vessels combined vascular caliber. Conclusion CT grading criteria are not uniform, each one has defects.
ObjectiveTo clarify the effectiveness of preoperative pulmonary rehabilitation (PPR) and provide evidence for the application of PPR on lung cancer patients by meta-analysis.MethodsAccording to inclusion and exclusion criteria, literatures related to PPR on lung cancer patients were retrieved from major databases between the date of establishment of each database and January 2019, and then data required were extracted from the selected literatures. Meta-analysis was conducted by RevMan 5.0.ResultsTwelve randomized controlled trials were involved in meta-analysis, including 658 patients who were well-diagnosed and prepared for surgery, with 307 patients in the PPR group and 351 patients in the control group. The results of the meta-analysis showed that in the PPR group, the pulmonary function including forced vital capacity [MD=0.31, 95%CI (0.21, 0.42), P<0.01], forced expiratory volume in one second [MD=0.27, 95%CI (0.20, 0.34), P<0.01] and activity tolerance including 6-minute walk distance [MD=50.55, 95%CI (35.98, 65.13), P<0.01] were significantly better than the control group, and the postoperative complication rate was lower ［MD=0.28, 95%CI (0.18, 0.43), P<0.01］, postoperative hospital stay was shorter [MD=–2.09, 95%CI (–2.41, –1.77), P<0.01].ConclusionsA period of PPR on lung cancer patients can improve postoperative pulmonary function and activity tolerance, and reduce postoperative complications and hospital stay, which is beneficial to postoperative recovery.
The effects of preoperative selective arterial perfusion chemotherapy (PSAPC) in the treatment of 20 cases of histologically confirmed gastric cancers is reported in which 12 patients were operated on, and a comparison with that of general chemotherapy in 10 cases of gastric cancers (as controls) was made. In the PSAPC group, besides the improvement of clinical symptoms and singns, the cancer cells of lesions in situ and metastatic lymph nodes have different degrees of degeneration and necrosis. This result show significant differences in two group comparison (Plt;O.01). We conclude that the PSAPC has good short-term effect and little side-effect. It can improve the resection rate and radical resection rate, and prevent the iatrogenic metastasis and implantation during operation, and decrease the postoperative recurrence of the patients with gastric cancer.
ObjectiveTo explore the application effect of preoperative health education in patients with glaucoma. MethodsA total of 120 patients with glaucoma who underwent the surgery from February 2013 to December 2014 were randomly divided into control group and observation group, with 60 cases in each. The routine health education was performed on the patients in the control group while the personalized health education (on the basis of adopting the knowledge of the self-designed questionnaire) on the ones in the observation group. The results of Self-rating Anxiety Scale (SAS), Self-rating Depressive Scale (SDS), extent of disease knowledge, and nursing satisfaction were observed. ResultsAfter health education, the scores of SAS and SDS was 29.9±7.6 and 32.0±7.8, respectively in the observation group, which were significantly lower than those in the control group (34.9±7.9 and 35.9±8.3, P<0.05). Awareness of related knowledge and nursing satisfaction were 53 patients (88.3%) and 57 patients (95.0%) in observation group and 49 patients (81.7%) and 53 patients (88.3%) in the control group, (P>0.05). ConclusionPreoperative health education can improve the patients psychology and may reduce the occurrence of complications.
Objective To determine the influence and significance of combinative assessment of 64 multi-slice spiral computer tomography (MSCT) with serum amyloid A protein (SAA) or fibrinogen (FIB) on the selection of operative procedures of rectal cancer under the multidisciplinary team. Methods Prospectively enrolled 240 patients diagnosed definitely as rectal cancer at West China Hospital of Sichuan University from February to June 2009 were randomly assigned into two groups. In one group named MSCT+SAA group, both MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT+FIB group, both MSCT and FIB combinative assessment were made for preoperative evaluation. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation procedures, respectively, and the relationship between the choice of operation procedures and clinicopathologic factors was analyzed. Results According to the criteria, 234 patients were actually included into MSCT+SAA group (n=118) and MSCT+FIB group (n=116). The baseline characteristics of two groups were statistically similar (Pgt;0.05). For MSCT+SAA group, the accuracies of preoperative staging T, N, M and TNM were 72.9%, 83.1%, 100% and 80.1%, respectively. For MSCT+FIB group, the accuracies of preoperative staging T, N, M and TNM were 68.1%, 75.0%, 100% and 74.1%, respectively, and there was not a statistically significant difference (Pgt;0.05). There was also not a statistically significant difference of the accuracy of prediction to operative procedures in two groups (99.6% vs. 96.6%, Pgt;0.05). The preoperative T staging (P＜0.001), N staging (P＜0.001), TNM staging (P＜0.001), serum level of SAA (P＜0.001), serum level of FIB (Plt;0.001) and distance of tumor to the dentate line (P＜0.05) were associated to the operative procedures. Conclusions Combinative assessment of MSCT and FIB could improve the accuracy of preoperative staging and operative procedures prediction, however, it may be not superior to MSCT plus SAA.
Atrial fibrillation is one of the most common complications after coronary artery bypass grafting (CABG), with the occurrence rate of approximate 30%, which leads to hemodynamic instability, reduces survival rate, prolongs hospitalization, and increases patients' economic burden. Previous numerous studies have shown lots of preoperative, intra-operative and postoperative factors can predict the occurrence of new onset atrial fibrillation after CABG. If we can identify the specific patients at high risk for developing atrial fibrillation before operation, we may prevent atrial fibrillation more effectively, avoiding unnecessary prophylactic treatment and its risk. This review only focuses on research progress of preoperative predictors.
Objective To evaluate whether to defer abdomen surgery in patients having poorly controlled or untreated hypertension before operation. MethodsThe perioperative clinical data of 531 patients with hypertension in our hospital from January 1997 to December 1998 was retrospectively analyzed. ResultsThe modility of perioperative hypertensive events was not significantly different, between controlled and uncontrolled patients with grade one and grade two（Pgt;0.05）. In grade three and systolic hypertension, certain complications in patients with poorly controlled hypertension were higher than in those with wellcontrolled hypertension（P＜0.05）. Conclusion The patients with grade one and grade two hypertension are not at increased operative risk. In patients with grade three and systolic hypertension, perioperative complications are increased and elective surgery should be postponed until their blood pressure is brought under 24/14.7 kPa （180/110 mm Hg） over 1 to 2 weeks.
ObjectiveTo analyze the current situation of day surgery patients’ withdrawal from hospitalization, and put forward reasonable and effective measures and suggestions.MethodsDescriptive statistical analysis and trend chi-square test were conducted on the hospitalization withdrawal rate of day surgery in the Day Surgery Ward of the Second Affiliated Hospital Zhejiang University School of Medicine from 2012 to 2020. The reasons for hospitalization withdrawal and the operation methods of withdrawn cases from 2019 to 2020 were descriptively analyzed.ResultsFrom 2012 to 2020, the hospitalization withdrawal rate of day surgery decreased from 4.48% to 2.19%, with a significant decrease and a linear downward trend (χ2trend=138.500, P<0.001). From 2019 to 2020, patient factor was the most important reason for hospitalization withdrawal of day surgery, accounting for 79.72%; secondly, long waiting time for surgery, abnormal examination results, inadequate preoperative evaluation, medical insurance reimbursement, epidemic situation in 2020 and other reasons had affected the patients’ hospitalization withdrawal of day surgery to varying degrees. Endoscopic lithotripsy accounted for the largest proportion (210 cases, accounting for 20.87%) in the withdrawn procedures from 2019 to 2020, followed by minimally invasive rotary resection for breast lesions (126 cases, accounting for 12.52%).ConclusionImproving preoperative evaluation, strengthening preoperative communication, implementing efficient medical treatment, and shortening the waiting time for surgery can reduce the rate of hospitalization withdrawal of day surgery.
Objective To summarize recent advances on preoperative staging strategies in rectal cancer. Methods Relevant references about preoperative staging strategies were collected and reviewed. The multimodal preoperative evaluation (MPE) system recently documented was focused on. Results The comparably accurate T and M stage could be achieved preoperatively by following an appropriate available method; however, the N stage’s accuracy was still not satisfying. The MPE system， incorporating with the advantages of transrectal ultrasound， computerized tomography and serum amyloid A protein in a multi-disciplinary mode could display the most accurate preoperative staging for rectal cancer currently. Conclusion The MPE has potential prospects in preoperative staging of rectal cancer， and can provide the most accurate preoperative staging for rectal cancer at present.
Objective To systematically review the efficacy of preoperative rehabilitation for patients with total knee replacement. Methods Electronic databases including The Cochrane Library, EMbase, PubMed, CBM, CNKI and WanFang Data were searched to collect randomized controlled trials (RCTs) about preoperative rehabilitation for total knee replacement from inception to January 2017. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then RevMan 5.3 software was used to perform meta-analysis. Results A total of 13 RCTs involving 745 patients were included. The results of meta-analysis showed that, the TUG scores (6 weeks: MD=–1.31, 95%CI –2.29 to –0.32, P=0.009; 3 months: MD=–1.59, 95%CI –2.03 to –1.15, P<0.000 01), 3 months knee flexion ROM scores (MD=4.75, 95%CI 0.63 to 8.86, P=0.02) in the preoperative rehabilitation group were higher than those in the control group. The 3 months VAS scores (MD=–0.95, 95%CI –1.70 to –0.20, P=0.01) in the preoperative rehabilitation group was lower than that in the control group. There were no statistical differences between two groups in WOMAC scores (MD=–5.61, 95%CI –12.84 to 1.62, P=0.13), SF-36 scores (MD=13.15, 95%CI –10.51 to 36.81, P=0.28), knee extension ROM scores (6 weeks: MD=0.60, 95%CI –1.02 to 2.21, P=0.47; 3 months: MD=–2.76, 95%CI –8.45 to 2.92, P=0.34), HSS scores (MD=0.54, 95%CI –0.46 to 1.54, P=0.29), and 6 minutes test scores (MD=–8.75, 95%CI –51.53 to 34.03, P=0.69). Conclusion Current evidence shows that preoperative rehabilitation can improve the postoperative knee function after operation and significantly reduce the pain. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify above conclusion.