目的 探討腹腔鏡術中聯合結腸鏡治療結直腸小占位病變的可行性和臨床應用價值。方法對我院2006年12月至2009年5月期間23例行腹腔鏡聯合結腸鏡手術的結直腸小占位病變患者的臨床資料進行回顧性分析。結果 所有患者均在腹腔鏡下完成手術，無中轉開腹。 手術時間80～200 min，平均140 min; 出血80~120 ml，平均100 ml。 9例息肉病變行局灶切除，術中經快速冰凍切片病理證實4例早期癌及10例不典型增生均行相應腸段切除。 術后1例出現輕度肺炎，經積極抗炎對癥治療后痊愈，其余患者恢復良好。 所有患者術后第1天即離床活動，住院時間5～10 d，平均7 d。結論 腹腔鏡術中聯合結腸鏡治療結直腸占位是安全可行的，有助于結直腸病灶及切緣的準確定位，可縮短手術時間，值得臨床進一步推廣應用。
Objectives To systematically review the efficacy of polytetrafluoroethylene (PTFE) covered stent grafts vs. bare stent grafts in transjugular intrahepatic portosystemic shunt (TIPS) for portal hypertension. Methods PubMed, EMbase, The Cochrane Library, and ClinicalTrial.gov were searched online to collect randomized controlled trials (RCTs) and cohort studies of PTFE-covered stent grafts vs. bare stent grafts for portal hypertension from inception to Jan 11th, 2017. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed by RevMan 5.3 software. Results A total of 4 RCTs and 11 cohort studies involving 2 422 patients (1 070 PTFE-covered stent grafts patients and 1 352 bare stent grafts patients) were included. The results of meta-analysis showed that compared with the bare stent grafts group, the PTFE-covered stent grafts group had higher patency rate of intrahepatic shunt (HR=0.38, 95%CI 0.31 to 0.47, P<0.000 01) and survival rate (HR=0.59, 95%CI 0.44 to 0.79,P=0.000 5), lower postoperative complications rate (including gastrointestinal bleeding and refractory ascites) (HR=0.44, 95%CI 0.33 to 0.58, P<0.000 01) and encephalopathy rate (HR=0.76, 95%CI 0.57 to 0.99,P=0.05). Conclusions Current evidence shows that compared with the bare stent grafts, the PTFE-covered stent grafts could effectively improve patency rate of intrahepatic shunt and survival rate with less postoperative complications rate and encephalopathy rate. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo explore the effect of laparoscopic partial recto-sigmoid resection with rectopexy for adult complete rectal prolapse. MethodsClinical data of 32 adult patients with complete rectal prolapse who underwent laparoscopic partial recto-sigmoid resection with rectopexy in our hospital from May. 2010 to May. 2013 were analyzed. ResultsAll operations were performed successfully and all patients were cured, no one transferred to open surgery. The mean of operation time was 114.7 min (95-167 min), the mean of operative blood loss was 80 mL (55-150 mL), and the mean of hospital stay was 9.8 d (6-14 d). All patients were followed up for 3-48 months (mean of 25.6 months), and anal function of them recovered well. During the follow-up period, there were no operative complications and recurrent case. ConclusionsLaparoscopic partial recto-sigmoid resection with rectopexy is a safe and effective procedure for the treatment of adult complete rectal prolapse, with minimal invasion, quick recovery, and a low recurrence rate. It provides a novel surgical method with a high value of clinical application.
ObjectiveTo provide the evidence for diagnosis and treatment of the complication by describing the distribution and drug sensitivity of pathogens in patients with prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA). MethodsBetween January 2003 and June 2013,65 cases (65 knees) with PJI after primary TKA were treated.There were 28 males and 37 females with an average age of 63.2 years (range,37-80 years).The median interval between PJI and primary TKA was 2.8 years (range,2 weeks to 11 years),including 29 left knees and 36 right knees.Prosthesis loosening could be found in 27 cases by X-ray examination.The average value of C-reactive protein and erythrocyte sedimentation rate was 37.4 mg/L (range,12.5-197.0 mg/L) and 63.2 mm/1 h (range,29.3-73.8 mm/1 h) respectively.Preoperative and intraoperative synovial fluid as well as intraoperative tissue samples should be submitted for aerobic and anaerobic culture.The four types of infections were made according to the Tsukayama et al.classification standards. ResultsThe patients were all diagnosed as having PJI.There were 5(7.69%) type I infections,4(6.15%) type ⅡA,8(12.31%) type ⅡB,3(4.62%) type Ⅲ,and 45(69.23%) type IV according to the Tsukayama et al.classification standard.Bacterial culture results were negative in 12 cases and positive in 53 cases,the main pathogen was Gram-positive cocci (39/53).The most common organism identified was Coagulase-negative Staphylococcus (24/53) followed by Staphylococcus Aureus (12/53).Resistant bacterium accounted for 61.11%(22/36) of Staphylococcus.These bacterium were all sensitive to vancomycin,linezolid,meropenem,and fluconazole;and highly resistant to erythrocin,penicillin,and cefoxitin.The main pathogenic bacteria of Coagulase-negative Staphylococcus and Staphylococcus aureus had highest resistant rate to penicillin. ConclusionGram-positive cocci is the main pathogen in patients with PJI after primary TKA,which is highly resistant to penicillin and macrolides.Antibiotic treatment of this complication should be based on the result of drug sensitivity test,vancomycin and linezolid may be used before the result of drug sensitivity test.It is important to pay attention to rare and multiple resistant bacteria.
ObjectiveTo prepare platelet-derived growth factor receptor β (PDGFRβ)-targeted near-infrared molecular probe and evaluate its potential in optical molecular imaging of lung cancer.MethodsPDGFRβ-specific affibody Z-tri was recombinantly expressed in Escherichia coli (E. coli) and purified using affinity chromatography. In vitro cell-binding of Z-tri was analyzed by flow cytometry. Cellular distribution of Z-tri in tumor grafts was determined by protein-tracing. The molecular probe CF750-Z-tri was prepared by conjugating near-infrared fluorescent dye CF750 to Z-tri. The optical images of xenografts of lung cancer were obtained by using CF750-Z-tri combined with optical imaging system.ResultsPDGFRβ-specific affibody Z-tri was highly expressed in E. coli and purified to homogeneity. Z-tri could bind PDGFRβ-positive cells but not PDGFRβ-negative cells cultured in vitro. In the tumor xenografts of human lung cancer, intravenously injected Z-tri was predominantly distributed on cells overexpressing PDGFRβ. The near infrared fluorescent dye CF750 was efficiently conjugated to Z-tri. Optical images with high contrast of lung cancer xenografts were produced by using the near-infrared fluorescent probe CF750-Z-tri combined with optical imaging system.ConclusionThe near-infrared fluorescent probe CF750-Z-tri can be used for optical imaging of human lung cancer, which takes great potential in optical imaging-guided surgery of lung cancer.
ObjectiveTo investigate the mid-term effectiveness of debridement with prosthesis retention for periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA), and analyze the influence factors that affected the effectiveness.MethodsA clinical data of 45 cases with PJI after THA (16 cases) and TKA (29 cases) that were treated with debridement with prosthesis retention between January 2011 and January 2015 were collected and analyzed. There were 19 males and 26 females with a mean age of 58.4 years (range, 23-78 years). PJI occurred after primary joint arthroplasty in 40 cases and after revision in 5 cases. The mean time interval between the performance of infection symptoms and the arthroplasty or revision was 15.5 months (range, 0.5-72.0 months). The time interval between the performance of infection symptoms and debridment was 35 days (range, 3-270 days). There were early postoperative infections in 13 cases, acute hematogenous infections in 24 cases, and late chronic infections in 8 cases. X-ray films showed that the location of prosthesis was good. The results of bacilli culture showed that 28 cases were positive and 17 were negative. Twelve cases had sinuses. Length of stay, Hospital for Special Surgery (HSS) score, and Harris score were recorded to evaluate risk factors by using a multivariate logistic regression.ResultsThe mean length of stay was 22.6 days (range, 5-79 days). All patients were followed up 24-74 months (mean, 52 months). There were 33 cases that retained the prosthesis without further evidence of infection with the success rate was 73.3%. There were significant differences in Harris score and HSS score between pre- and post-operation (P<0.05). The univariate analysis results showed that the failure of debridement with prosthesis retention had a significant correlation with sinus developing and duration of infection symptoms more than 14 days (P<0.05). Multivariate logistic regression analysis results showed that sinus developing was an independent risk factor of failure (P<0.05).ConclusionDebridement with prosthesis retention plays an important role in treating PJI after THA and TKA. These patients with sinus performing and duration of infection symptoms more than 14 days have higher risk to develop infection again.
ObjectiveTo explore the clinical characters and histopathologic differences between patients with culture-positive and culture-negative prosthetic joint infection (PJI). MethodsBetween January 2012 and July 2013, 66 PJI patients in accord with diagnostic criteria were enrolled. According to the results of preoperative aspiration and intraoperative cultures, the patients were divided into culture-negative group (CN group, n=21) and culture-positive group (CP group, n=45). There was no significant difference in gender, age, height, weight, and body mass index between 2 groups (P>0.05). Preoperative C reactive protein (CRP), erythrocyte sedimentation rate (ESR), and prosthesis survival time were compared between 2 groups. Intraoperative frozen sections and paraffin sections were both performed to identify infections, and histological typing was performed according to Morawietz's methods. ResultsThe preoperative CRP was (1.29±1.84) mg/ dL in CN group and (5.08±9.57) mg/dL in CP group, showing significant difference (t=2.094, P=0.038). The preoperative ESR was (22.86±28.42) mm/1 h in CN group and (36.74±31.26) mm/1 h in CP group, showing significant difference (t=7.761, P=0.000). The median survival time of prosthesis was 72 months (range, 8-504 months) in CN group and 25 months (range, 15 days-300 months) in CP group, showing significant difference (U=2.231, P=0.026). Morawietz's histological typing results showed that 2 cases were rated as type I, 7 cases as type II, and 12 cases as type III in CN group; 6 cases were rated as type I, 25 cases as type II, 13 cases as type III, and 1 case as type IV in CP group. The positive culture rate was 68.18% (45/66), and pathogenic bacteria was dominated by Staphylococcus, accounting for 68.89%. ConclusionThe patients with culture-negative PJI have slow onset and mild inflammatory response, so comprehensive diagnosis should be made based on pathological detection, laboratory examination, and intraoperative cultures.
ObjectiveTo evaluate the inflammatory markers in patients with ankylosing spondylitis (AS) or non-inflammatory diseases undergoing total hip arthroplasty (THA) and to ascertain the variation trend of perioperative inflammatory markers and the influence of inflammation markers after THA. MethodsBetween January 2013 and December 2014, 153 consecutive patients with AS were included. According to the range of motion (ROM), the patients were divided into ankylosis group (ROM: 0°; group A, n=92) and stiff group (ROM: 3-46°; group B, n=61); 120 noninflammatory diseases patients having no bacterial infection and undergoing primary THA served as non-inflammatory group (group C). The inflammatory markers including C-reactive protein (CRP), interleukin-6 (IL-6), and erythrocyte sedimentation rate (ESR) concentrations were measured before operation and at 1, 3, 5, and 7 days after operation, and the complication was observed. ResultsPerioperative serum CRP, IL-6, and ESR increased at first after operation, and then decreased in 3 groups. There were significant differences in CRP and ESR between at pre- and post-operation (P<0.05); the IL-6 at 1, 3, and 5 days after operation were significantly higher than that at preoperation (P<0.05), but no significant difference was found between at 7 days and at preoperation (P>0.05). CRP, IL-6, and ESR of group B were significantly higher than those of group A at preoperation (P<0.05); CRP and IL-6 of groups A and B were significantly higher than those of group C at preoperation and at 1 day after operation (P<0.05); ESR of groups A and B was significantly higher than that of group C at preoperation, and at 1 day and 3 days after operation (P<0.05); and no significant difference was shown among 3 groups at the other time points (P>0.05). No inflammatory activity or increased complication was observed. ConclusionAS and non-inflammatory diseases show similar change trend of inflammatory markers at preand post-operation. The inflammatory activity of AS has no significant effect on the changes of inflammation markers and does not increase the incidence of postoperative complications.
Mixed reality is a new digital hologram technology after virtual reality and augmented reality, which combines the real world with the virtual world to form a new visualization environment. At present, mixed reality has been applied in various fields, but its application in medical field is still in the exploratory stage. With the rapid development of the digital age, the prospect of the combination of mixed reality and medicine is boundless. It is believed that mixed reality will bring subversive changes in medical training, disease diagnosis, doctor-patient communication, clinical diagnosis, treatment and so on in the near future. In this paper, the application of mixed reality in medicine was summarized.
Objective To investigate effectiveness of the medial ankle branches propeller " Tennis racket-like” flap in repair of heel-ankle tissue defect. Methods Between June 2011 and June 2016, 50 patients with heel-ankle tissue defects were treated. There were 40 males and 10 females, with a median age of 35.6 years (range, 6–58 years). The defects were caused by trauma in 44 cases, scar deformity after trauma in 2 cases, chronic ulcer in 2 cases, and squamous cell carcinoma in 2 cases. The defects located at heel in 20 cases, ankle in 15 cases, and heel-ankle in 15 cases. The size of heel-ankle tissue defect ranged from 3.5 cm×2.0 cm to 13.0×10.0 cm. The course of disease ranged from 3 hours to 2 months (mean, 28 days). All wounds were repaired by the medial ankle branches propeller " Tennis racket-like” flap in a size of 3.8 cm×2.2 cm–13.4 cm×10.3 cm. The donor site was directly sutured in 5 cases or repaired by skin grafting in 45 cases. Results All flaps survived and wounds healed by first intention. Partial necrosis of skin grafting occurred in 1 case, and the wound recovered by change dressing. The other skin grafting survived and wounds healed by first intention. Forty-eight patients were followed up 12 months after operation. The appearance, sensory, and function of repaired heel-ankle flaps were satisfactory. Conclusion For heel-ankle tissue defect repair, the medial ankle branches propeller " Tennis racket-like” flap has advantages of the high survival rate, reliable blood supply, and sensory recovery.