ObjectivesTo systematically review the efficacy of absorbable barbed suture versus traditional absorbable suture in total knee arthroplasty (TKA).MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect clinical trials of absorbable barbed suture versus traditional absorbable suture in TKA from inception to November, 2017. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 6 randomized controlled trials (RCTs) and 5 cohort studies were included, involving 2 008 patients. Meta-analysis showed that the joint capsule suture time of the absorbable barbed suture group [MD=–4.31, 95% CI (–4.72, –3.90), P<0.000 01], the incidence of acupuncture injury during suture [OR=0.14, 95% CI (0.03, 0.61),P=0.009], and incision complication rate [OR=0.56, 95% CI (0.36, 0.88), P=0.01] were significantly lower than the traditional absorbable suture group, but the incidence of suture fracture [OR=23.03, 95% CI (3.08, 172.09),P=0.002] was higher, yet the difference was statistically significant. There were no significant differences in the incidence of superficial infection, deep infection, aseptic redness, incision dehiscence and KSS score at 3 months after operation (P>0.05).ConclusionsAvailable evidence suggests that the use of absorbable barbed sutures to close the TKA surgical incision shortens the time to suture the joint capsule, reduces the incidence of acupuncture injury as well as the overall incidence of incision complications without increasing superficial infection, deep infection, and sterility. The incidence of redness and incision splitting has no significant effects on joint function at 3 months after surgery, however the incidence of suture fracture is higher. Due to limited quality and quantity of the included studies, the above conclusions are required to be verified by more high-quality studies.
Objective To evaluate the feasibility of laparoscopic rectal resection (LR) in elderly and younger patients with rectal cancer. Methods From January 2008 to March 2009, 76 patients with rectal cancer undergoing elective rectal resection were included in this study. Older than 70 years named elderly group, in which LR was given to 16 cases, and open resection (OR) to 18 cases. Younger than 70 years named younger group, in which LR was performed in 23 cases, and OR in 19 cases. The results after LR and OR in rectal cancer between 2 groups of patients were compared. Results No surgery-assisted death occurred in either group. In 2 groups, ventilation time, intake food time and hospitalization after operation in LR were shorter than those of OR (P＜0.05， P＜0.01); intraoperative blood loss and the proportion of postoperative analgesia in LR were less than those of OR in 2 groups (P＜0.01); there were no significant differences between LR and OR (Pgt;0.05) in mean operation time or number of lymph node resected. In addition to the incision infection rate, the other complications rates and the postoperative life self-care rate between LR and OR were no significantly different in younger group (Pgt;0.05). In the elderly group, every complication rates of LR were lower than those of OR (P＜0.05), oppositely, the postoperative life self-care rate was higher (P＜0.01). Conclusions LR of rectal cancer can be applied to both elderly and younger patients. It is suggested that advanced age should not be the contraindication for LR, and by contrary elderly patients may be particularly indicated for lower postoperative complications rate compared to open surgeries.
【Abstract】Objective To investigate the safety and clinical significance of total thyroidectomy performed for benign thyroid disease. Methods Eighty-eight patients with benign thyroid disease were treated with total thyroidectomy. The postoperative complications were analyzed. Results With primary total thyroidectomy, the incidences of transient hypocalcemia and transient recurrent laryngeal nerve paralysis were 2.5% and 1.2% respectively. The incidences after reoperation were 28.6%（P＜0.05）and 28.6%（P＜0.01）respectively. No patients had permanent hypoparathyroidism and permanent recurrent laryngeal nerve injury. Conclusion Total thyroidectomy can be performed safely. It can avoid reoperation for the recurrence caused by the remainder thyroid.
Objective To investigate the effect of surgical treatment of patients with esophageal foreign bodies (EFBs), in order to provide a reference for its prevention. Methods We retrospectively analyzed the clinical records of 18 patients with EFBs treated in West China Hospital from June 2005 to December 2010. There were 13 males and 5 females with an average age of 57.50±15.28 years (30 to 82 years). All the 18 patients had a history of ingesting EFBs which were mainly animal bones (10/18). The EFBs were mostly in the upper segments of the esophagus (12/18). Sixteen patients had complications like perforations and severe mucosal injuries, while complications were not detected in the other 2 patients. Fifteen patients received surgical treatment, while the other 3 patients didn’t. Results As for the 15 patients with surgical treatment, the operative time was 136.33±92.86 minutes (50 to 410 minutes), and the hospital stay was 16.35±15.8 days (4.00 to 69.92 days). Three patients (of which,one aged at 78 years and one 82 years) died, among whom two died of multiorgan failure, and 1 died of respiratory failure. All the other 12 patients were discharged from the hospital. For the 3 patients without surgical treatment, the hospital stay time was 5.06±1.47 days ranged from 3.71 to 6.63 days. They were cured and left the hospital. Conclusion EFBs should be treated as early as possible to reduce severe complications. Surgery is still one of the mostly used treatments for EFBs. Senility and complications are the major causes of death. It should be comprehensively assessed whether the EFBs patients should receive operations and which operative procedures should be performed.
Objective To analyse the factors of complications aftertreatment of intertrochanteric fractures with Gamma nail. Methods From January 1998 to May 2004, 50 patients were treated with Gamma nail, including 18 males and 32 females and ageing from 47 to 82 years. The locations were the left side in 16 cases andthe right in 34 cases. According to Evans classification, there were 4 cases oftype Ⅰ, 2 cases of type Ⅱ, 23 cases of type Ⅲ, 10 cases of type Ⅳ and 11 cases of type Ⅴ. Results Fifty patients were followed up 429 months. Accordingto the Harris criterion for evaluation, the results were excellent and good in 35 cases, showing sthenic weight loading walking and normal range of motion of the hip joint. The postoperative complications appeared in 15 cases: 5 cases of coxa vara or coxa valga, 3 cases of rotation deformity of lower limb, 2 cases oftension screwprotrusions and lower shorten, 1 case of failure of internal fixation, 1 case of femoral fracture, 2 cases of coxalgia and 1 case of pain in knee joint and stiff knee joint. Conclusion The reason of complications was various, mainly lies in insufficient comprehension and analysis of the types of fractures, unfamiliarity with the characteristics and usage of the instruments and neglected rehabi litation instruction, inappropriate functional training and too early weight loading after operation.
With the development of surgical technology and the need of clinical, transesophageal echocardiography is more and more favored by clinicians. Although the transesophageal echocardiography has developed more than 20 years, yet it has not been widely used in operation at present in domestic. In addition, its application in surgery of children is more rare. It has been confirmed that intraoperative use of transesophageal echocardiography has good safety and wide range of application. We will summarize indications, complications, and the progress of the current technology from the scope of transesophageal echocardiography in pediatric surgery.
Objective To review the present clinical research situation of adjacent segment degeneration (ASD) after lumbar spinal fusion. Methods The recent literature concerning ASD in the concept, the incidence, the risk factors, and prevention was reviewed. Results The concept of ASD includes radiographic ASD and clinical ASD. The incidences of radiographic ASD and clinical ASD were 8%-100% and 5.2%-18.5%, respectively. The risk factors for ASD include both patient and surgical factors. Patient factors include age, gender, preoperative condition, and so on. Surgical factors include the length of the fusion, mode of fusion, internal fixator, sagittal balance, excessive distraction of disc space, and so on. It can prevent ASD to reduce the length of the fusion, to keep sagittal balance, and to use the non-fusion technology. Conclusion Many researches have proved that the incidence of ASD is increased after lumbar spinal fusion, and it can be reduced by the non-fusion technology. Non-fusion technology has obtained good short-term results. But the long-term results should be further observed because there are some complications.
Objective To expand the utilization of minimally invasive technologies for parapancreatic abscess, and summarize the application experience of choledochoscope for treatment of parapancreatic abscess. Methods The clinical data and treatment effectiveness of 36 patients with parapancreatic abscess from Dec. 2000 to Dec. 2008 were analyzed retrospectively. These patients had experienced percutaneous puncture and been placed drainage tube under the ultrasound guidance first, then expanded the sinus tract gradually, and performed debridement by choledochoscope. The flexibility of choledochoscope was used to remove the necrotic tissue and pyogenic membrane repeatedly by clamping, netting and vacuum aspiration in every domain. Results Thirty-six patients were performed percutaneous puncture and placed drainage tube, 3 cases were given canalis singularis, 7 cases were double tube, 26 cases were over three tube. The debridement times were 3-14 by choledochoscope, average 5.6 times. There were 6 cases with improving systemic symptoms, blood routine and temperature recovering normal, and drink and food recovering, then discharged from hospital with tube after 1-2 times of debridement. Length of stay was 25-132 d, average 76 d. The curing rate was 91.7% (33/36). Two cases were turned into open surgery because of broad necrotic tissue range combined with many abdominal cavity abscess with good postoperative recovery and cured. One case was dead of severe multiple organ failure combination. There were 2 patients with hemorrhage, 3 patients with external intestinal fistula. Conclusions The debridement of choledochoscope for parapancreatic abscess treatment is a simple, flexible and effective method. It changes the viewpoint that parapancreatic abscess can be cured only by operation drainage, decreases the patients’ trauma and accomplishes the idea of damage control by minimally invasive technologies.
Objective To evaluate the impact of portal or systemic venous pancreas graft drainage on patient and graft outcomes following simultaneous pancreas kidney transplantation (SPK). Methods We searched The Cochrane Library (2008, Issue 1), PubMed (1970 to Feb 2008) and EMBASE (1974 to Feb 2008) to find studies concerning the effect of systemic versus portal venous pancreas graft drainage on patient and graft outcomes. Meta-analyses were conducted using The Cochrane Collaboration’s RevMan 4.2 software. Results Three RCTs involving 401 simultaneous pancreas kidney transplants were included in our meta-analysis. Statistically significant differences were only observed in 3- and 5-year pancreas graft survival rates (P=0.03 and P=0.05). No significant difference was noted in patient or kidney graft survival rates. Conclusion Currently available evidences from RCTs does not support the effectiveness of portal drainage in preventing thrombosis, rejection or infection after SPK. Large-scale, long-term and appropriately designed RCTs are required to conclude whether portal and systemic drainage in pancreas transplantation are equivalent in terms of patient and graft survival.
Objective To investigate the effect of ventral urethroplasty for postoperative anastomotic stricture in patients with hypospadias. Methods From August 2000 to December 2005, 20 patients with anastomotic stricture after hypospadias repair were treated with ventral urethroplasty. The age ranged from 2 to 27 years with an average of 6.4 years. All patients showed dysuria after operation. Main clinical manifestation included dysuria and acraturesis. Interruption of urinary stream occurred in 17 cases; of them, 3 cases had urinary stasis and 4cases had frequent micturition, urgent micturition and pain in urination. Urethrography and cystourethrography showed 0.5-1.0 cm stricture with proximal dilat ion of urethra in 16 cases and obvious diverticularization in 9 cases. Urine routine examination showed that white blood cell was ++ to ++++ in 16 cases and pus cell was ± to++ in 13 cases.Results Twenty cases were followed up 2 months to 4 years (mean 2.3 years). All the cases achieved good results in urination with normosthenuria and normal force of urinary stream. No recurrent stricture, urethrocutaneous fistula, or penile curvature occurred. The cosmesis was satisfactory, and the results of urine routine examination was normal. Conclusion Ventral urethroplasty for postoperative anastomotic stricture inpatients with hypospadias is a simple and effective procedure.