ObjectiveTo discuss the treatment of retroperitoneal tumors infiltrating celiac trunk. MethodFifteen cases of retroperitoneal tumors who underwent surgery in our hospital between December 2014 to December 2015 were reviewed and analyzed. ResultsAll of the 15 cases had underwent operation, and the blood loss was 300-2200 mL (mean of 600 mL), operation time was 125-600 minutes (mean of 240 minutes). Length of stay in cases of celiac trunk resected was 10-23 days (mean of 15.1 days), and length of stay in cases of celiac trunk nonresected was 15-132 days (mean of 35.2 days). Thirty cases of them were complete resection, and 2 cases were mostly resection. Eight cases of them did not injure celiac trunk, 1 case suffered from complication, 7 cases injured celiac trunk and all of them suffered from complication. There were significant statistical difference in incidence of complications (χ2=8.14, P=0.01) in cases of celiac trunk injury or not. All the cases were followed up for 3-13 months (mean of 6.3 months), 2 cases recurred during the follow-up period, 1 case was leiomyosarcoma, and another 1 was malignant fibrous histiocytoma who underwent celiac trunk resection. ConclusionsWhen retroperitoneal tumors infiltrates celiac trunk, we can resect the celiac trunk, but we must follow a certain principle.
Conduit failure and conduit airway fistula are rare complications after esophagectomy, however they can be catastrophic resulting in high mortality. Survivors can expect a prolonged hospital course with multiple interventions and an extended period of time prior to being able to resume oral nutrition. High index of suspicion can aid in early diagnosis. Conduit failure usually requires a period of proximal esophageal diversion and staged reconstruction. Conduit airway fistulas may be amenable to endoscopic repair but this has a high failure rate and many patients will require surgical repair with closure of the fistula and interposition of vascularized tissue to minimize recurrence.
Objective To evaluate the rescue intubation induced by ketamine and midazolam in patients with acute respiratory failure.Methods 81 patients with acute respiratory failure admitted between June 2010 and June 2012 were recruited in the study. They were randomly divided to a MF group to receive 0. 05 mg/kg of midazolam + 1 to 2 μg/kg of fentanyl ( n =41) , and aMK group to received 0. 05 mg/kg of midazolam + 0. 5 to 1 mg/kg of ketamine ( n =40) for rescue intubation. The APACHEⅡ score on initial24 hours after admission in ICU, length of ICU stay, and 28-day mortality were recorded. The differences in arterial blood pressure, heart rate, respiration rate, and blood oxygen saturation before intubation and 10 minutes after intubation were compared. Incidences of hypotension and other adverse events and difficult intubation were also recorded.Results The midazolamdose in the MK group was significantly less than that in the MF group ( P lt; 0. 01) . The blood pressure in both groups decreased. The systolic blood pressure dropped most significantly in the MF group ( P lt;0. 05) . The incidence of hypotension was 41. 5% in the MF group, significantly higher than that in the MK group ( 20. 0% , P lt;0. 05) . The incidence of hypotension had no correlation with midazolamdosage ( P gt;0. 05) . There was no significant difference in adverse events except for the arrhythmia between two groups. The length of ICU stay and 28-day mortality were similar in both groups ( P gt; 0. 05) . The incidence of difficult tracheal intubation was nearly 50% in both groups.Conclusions In patients with respiratory failure, rescue intubation induced by ketamine can reduce the dose of midazolam and reduce the incidence of hypotension without more complications. The optimal dose of ketamine in induced tracheal intubation requires further study.
Objective To summarize the methods andskills of anterior cervical locking plate systems in clinical application and to analyze the causes of some complications as well as give some preventive or remedial countermeasures. Methods From 1998 to 2002, 159 patients with cervical spondylotic myelopathy,fracturedislocation,tumor or tuberculosis of the cervical spine were treated with anterior locking plate systems. The complications were reviewed and analyzed. Results Ten kinds of complications related to anterior locking plate systems occurred in 21 patients. Most of the complications were caused by improperly-selecting implants, experience and technique deficiency. Conclusio The important preventive or remedial countermeasures are correctly-selecting patients, meticulous preoperative preparation, properly-selecting implants, standard and skillful manipulation and rational postoperative protection.
Objective To explore the influence of cirrhotic portal hypertension and its complications on liver transplantation. Methods The literatures of the recent years on influence of hepatic cirrhotic portal hypertension on liver transplantation were reviewed. Results Splenomegaly, hypersplenism, portal vein thrombosis, portosystemic shunt and collateral flow in cirrhotic patients will increase the difficulty of liver transplantation and lead to more postoperative complications. Appropriate handling of these conditions can achieve a higher success rate of liver transplantation. Conclusion Correct management of end-stage cirrhotic portal hypertension and its complications can expand the indications of liver transplantation and improve long-term survival rates.
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.
Objective To study the diagnostic procedures and management of aortic stent graft infection. Methods Clinical data of 4 patients with aortic stent graft infection from 1998 to 2008 were analyzed retrospectively. Results Primary disease was thoracic endovascular aortic repair in 2 cases and endovascular aneurysm repair in another 2 cases. Constitutional symptoms and abscess information on imaging studies were presented in all patients. Salmonella choleraesuis was revealed in 2 cases. Surgical debridement, drainage and systematic antimicrobial therapies were given to 2 patients. The remaining 2 patients were managed with antimicrobial therapy only. During follow-up, there was no recurrence of infection. Conclusions Infection of aortic stent graft infection is a rare but potentially devastating complication. Radiologic studies can serve as important adjuncts in the diagnosis of endovascular graft infections. Several treatment options are available, some cases may be managed with conservative treatment.
Abstract： Objective To summarize the clinical experiences of performing extracorporeal membrane oxygenation (ECMO) on patients with heart and respiratory failure, and compare the clinical outcomes of Medtronic system and Quadrox PLS system. Methods We retrospectively analyzed the clinical data of 121 heart and respiratory failure patients who underwent ECMO treatment in Fu Wai Hospital from December 2004 to December 2009. Based on the different systems used, 121 patients were divided into two groups. In group M, there were 65 patients including 41 males and 24 females, with an age of 26.6±25.9 years; and they accepted Medtronic ECMO system treatment. In group Q, there were 56 patients including 39 males and 17 females, with an age of 32.4±23.9 years and they underwent Quadrox PLS ECMO system treatment. The evaluation of the clinical outcomes of these two different systems was based on the comparison of transmembrane pressure drop (TMPD), anticoagulation, hemolysis, plasma leakage, organ function, complication and hospital mortality between the two groups. Results Compared with group M, ECMO with Quadrox PLS system was associated with lower TMPD (at the beginning of ECMO: 15.0±6.0 mm Hg vs.28.0±5.0 mm Hg, P=0.000; 24 hours later: 16.0±5.0 mm Hg vs. 30.0±7.0 mm Hg, P=0.000) and less thrombus formation(7.1% vs.23.1%, P=0.037), less plasma leakage (0.0% vs. 50.8%, P=0.000), less hemolysis (14.3% vs. 29.2%, P=0.047). There were no significant differences between the two groups in support duration, complication rate, and hospital mortality(Pgt;0.05). Conclusion Both devices have similar effects for safe clinical application, but Quadrox PLS ECMO system has a relatively high biocompatibility with lower TMPD, less plasma leakage, and thrombus formation.
ObjectiveTo investigate the effect of surgery and influence of posttreatment with non-standardized and standardized operation by reviewing and analyzing the sporadic medullary thyroid carcinoma operation cases. MethodsThe clinical data of 26 patients with sporadic medullary thyroid carcinoma treated by surgery from January 2000 to March 2013 in this hospital were analyzed retrospectively.These patients were divided into non-standardized operation group and standardized operation group (total thyroidectomy with lymph node dissection) according to the operation models.The biochemical cure rate, the complication rates of recurrent laryngeal nerve injury and hypopara-thyroidism of these two groups were investigated and compared. ResultsThe 1-year biochemical cure rate had no statistical difference between the non-standardized operation group and standardized operation group (84.21% versus 100%, χ2=1.249 4, P > 0.05), the 1-year recurrence rate was 15.79% and 0, respectively.The 5-year biochemical cure rate of the standardized operation group was significantly higher than that of the non-standardized operation group (100% versus 16.67%, χ2=4.444 4, P < 0.05).The 5-year recurrence rate was 0 and 83.33%, respectively.However, there was no obvious difference between the two groups on the injury rate of recurrent laryngeal nerve (χ2=0.070 8, P > 0.05), as well as the rate of hypoparathyroidism (χ2=2.722 7, P > 0.05). ConclusionsCompared with the non-standardized model, the standardized operation model (total thyroidectomy with lymph node dissection) shows a higher cure rate and a lower recurrent rate, and it does not increase the complication rates of hypoparathyroidism and recurrent laryngeal nerve injury
Objective To evaluate the diagnostic value and safety of surgical lung biopsies ( SLB)in patients with interstitial lung disease ( ILD) . Methods A retrospective analysis was performed on patients undergoing SLB, who were obtained from Chinese literatures through searching PubMed, CBM,Wanfang database, VIP information and CHKD from 2000 to 2010. The data from Affiliated Drum Tower Hospital, Nanjing University Medical College from2000 to 2010 was also reviewed. Results A total of 398cases underwent SLB, including open lung biopsy ( OLB) in 221 cases and video-assisted thoracoscopic lung biopsy ( VATLB) in 177 cases. SLB yielded a specific diagnosis for 386 cases. The total postoperative complication rate was 12. 1% and mortality rate was 2. 0% . The diagnostic yield, post-operative complication rate, and mortality rate between VATLB and OLB had no significant difference. Conclusion SLB is a useful and relatively safe procedure for diagnosis of ILD.