To evaluate the present status of treatment of chronic pancreatitis, 116 consecutive patients with chronic pancreatitis during the last decade (1986～1996) have been surveyed retrospectively. The clinical date has been analized statisticaly. Etiology: biliogenic 56 cases (48.3%), alcoholic 17 (14.6%), idiopathic 34 (29.3%) and other 9 cases (7.8%). Better result was achieved in surgical treatment group (81 cases) than in conservative group (35 cases), pain free: 65.5% vs 33.3%. The accumulated five-year survival rate was 56.3%, 92.2% and 78.1% in alcoholic, billiogenic and idiopathic type of chronic pancreatitis respectively. Morbidity and mortality of diarrhea and diabetes mellitus increased at followup. The authors conclude that the chronic pancreatitis patients associated with obstruction of biliopancreatic duct should undergo operation early and will ameliorate abdominal pain.
Objective To explore the operative methods and effectiveness of open reduction and internal fixation for Bosworth fracture. Methods Between January 2005 and January 2012, 6 patients with Bosworth fractures caused by sprain were treated. There were 4 males and 2 females with an average age of 45.8 years (range, 24-73 years). The time from injury to operation was 1-5 days (mean, 1.8 days). They were all closed fractures. According to Lauge-Hansen classification, 6 cases were classified as supination-external rotation type. The surgical treatments included open reduction and internal fixation by plate and screws. Results Infection occurred in 1 case and was cured after dressing changing; primary healing of incision was obtained in the other 5 cases. Six patients were followed up 15 months on average (range, 12-24 months). The X-ray films showed fracture healing in all cases, with an average healing time of 9.5 weeks (range, 8-13 weeks). No loosening or breaking of internal fixator was observed during follow-up. The average full load-walking time was 12 weeks (range, 10-17 weeks). According to the ankle and hindfoot scale of American Orthopaedic Foot and Ankle Society (AOFAS), the average score was 89.5 (range, 81-94). Conclusion For Bosworth fractures, good results can be achieved by early diagnosis, open reduction and internal fixation.
ObjectiveTo summarize the surgical management of complicated mediastinal tumor involving the heart or great vessels. MethodsWe retrospectively analyzed the clinical data of 38 patients with complicated mediastinal tumor invading the heart and large blood vessels underwent extended thymectomy in our hospital between February 1997 and May 2014. There were 26 males and 12 females at age of 41.3± 13.6 years ranking from 4 to 68 years. Multiple personalized procedures were applied within the 38 patients and some patients underwent more than one procedure. Besides the resection of mediastinal tumor, 3 patients underwent partial right atrial resection. Sixteen patients underwent resection, plasty or grafting vessels. Ten patients took partial excision and repair of pericardium. Eight patients underwent pulmonary wedge resection. Two patients underwent lobectomy. Two patients required cardiopulmonary bypass. ResultAll operations were completed successfully. There was no perioperative mortality. The operating time was 105-282 min and blood loss was 200-1 500 ml. The postoperative complications rate was 23.7%. The incidence of ICU admission was 47.4% with an average ICU stay of 1.8 days. The average length of post-operative hospital stay was 11.2 days. The five-year survival rate was 57.0%. ConclusionSurgical resection of mediastinal tumor invading the heart or great vessels is complicated and highly risky. However, desirable clinical outcome can be achieved with comprehensive perioperative assessment and appropriate surgical procedures.
Epilepsy is one of the most common neurological diseases in children, about 2/3 can be seizure-free after anti-seizure medications (ASMs) treatment, but there are still some drug-resistant epilepsy (DRE) need surgical treatment, epilepsy surgery including excision surgery, dissociation surgery and palliative surgery, surgery can make 30%~40% DRE fully controlled. Clinicians usually choose to discontinue ASMs after seizure-free for 1 to 2 years after epilepsy surgery, but there has been controversy about whether to discontinue ASMs after surgery in children with epilepsy, how long to discontinue ASMs, the timing of ASMs withdrawal, and there is still a lack of unified guidelines. This article will comprehensively analyze and summarize the risk of recurrence after ASMs withdrawal in children with epilepsy.
【Abstract】Objective To analyze the clinical features of multiple primary colorectal carcinoma(MPCC). Methods Data in 21 patients with MPCC during the past 10 years in our hospital were analyzed retrospectively. Results The incidence of synchronous and metachronous carcinoma was 1.1% and 1.2% respectively. The sites and pathologic stages of tumors showed no significant difference compared with single colorectal carcinoma. 47.6% of the cases accompanied with colorectal adenoma. 77.8% of the MPCC could be found during operation. Patients with carcinoma involved rectum had relatively poor survival. Conclusion The full-course colonoscopy, careful intraoperative exploration and regular postoperative colonoscopic follow-up are essential in improving the diagnosis and prognosis of patients with MPCC.
Objective To explore the diagnosis and surgical treatment of tarsometatarsal joint complex injuries. Methods Between January 2000 and October 2009, 24 cases of tarsometatarsal joint complex injuries were treated. There were 14 males and 10 females with an average age of 38 years (range, 21-65 years). Injury was caused by a machine in 8 cases,by traffic accident in 12 cases, and by fall ing from height in 4 cases. All fractures were closed. The time from injury tohospital ization was 2-17 hours (5 hours on average). Open reduction and internal fixation with screw were performed. Results Incision healed by first intention in other patients except 1 patient who had effusion at incision. Twenty-three cases were followed up 12-47 months with an average of 23 months. X-ray films showed that all fractures healed after 9-15 weeks of operation (13 weeks on average). No compl ication was found, such as osteofacial compartment sydrome, nonunion infection, loosening or breakage of the internal fixator. According to Maryland scoring, the results were excellent in 7 cases, good in 8 cases, fair in 5 cases, and poor in 3 cases with an excellent and good rate of 65.2%. Conclusion Anatomical reduction and stable fixation are important for satisfying results in treating tarsometatarsal joint complex injuries.
From 1984 to 1994, 196 patients with massive upper gastrointestinal hemorrhage (hemorrhagic gastritis 137 cases, gastric ulcer 59 cases) caused by acute gastric mucosal lesions were treated in our hospital. As soon as the diagnosis was established, the stress factors in relation to acute gastric mucosal lesions and the factors damaging gastric mucosal barrier should he dispeled and hypovolemia should he corrected. In this group, the operative mortality were as follow: stress ulcer 6.3%, hemorrhagic gastritis 33.3%. According to this result, we consider that in cases of hemorrhagic gastritis the surgical operation must be considered with great care, but for stress ulcer with massive bleeding energetic surgical operation should be taken.
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 evaluate the cl inical effectiveness of open reduction and internal fixation in the treatment of occult Lisfranc injury. Methods Between July 2002 and July 2009, 47 patients with occult Lisfranc injuries underwent open reduction and internal fixation. There were 31 males and 16 females with an average age of 35.6 years (range, 19-66 years). Injuries were casused by traffic accident in 27 cases, fall ing from height in 11 cases, sport in 16 cases, and crush in 3 cases. Thelocations were left foot in 18 cases and right foot in 29 cases. Simple medial column was involved in 6 cases, medial and middle columns in 24 cases, middle and lateral columns in 13 cases, and three columns in 4 cases. Base fractures of metatarsal bone were identified in all cases. The time from injury to operation was 4-21 days (mean, 8.6 days). The unstable Lisfranc joints were reduced and fixed by plates, screws, staples, and Kirschner wire through 1 or 2 longitudinal dorsal incisions. Results One case had infection and wound was repaired with flap at 2 weeks after operation; the other wounds healed primarily. Thirty-two patients were followed up 28.3 months on average (range, 12-75 months). The mean time of fracture heal ing was 12.3 weeks (range, 9-15 weeks). Osteoarthritis at midfoot was found in 15 cases at last follow-up and arthrodesis was not needed. The results were excellent in 9 cases, good in 16 cases, fair in 4 case, and poor in 3 cases according to American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score system; the excellent and good rate was 78.1%. No re-dislocation occurred during the followup. Conclusion More attention should be paid to base fractures of metatarsal bone, operative exploration is conducive to diagnosis of occult Lisfranc injury. Suitable internal fixation should be selected according to injury type and concomitant injury. Anatomical reduction and stable fixation are the keys to reconstruct the joint stabil ity in the initial treatment of occult Lisfranc injury
Objective To review the appl ication progress of subtalar arthroereisis for the correction of pediatric flatfoot in children and to analyze the problems at present as well as to predict the trend of development in the field. Methods Domestic and abroad l iterature concerning the methods of subtalar arthroereisis applied in pediatric flatfoot in recent years was reviewed extensively and thoroughly analyzed. Results Subtalar arthroereisis has proved to yield good results for correction of the flatfoot in children. In addition to the advantages of subtalar arthroereisis for pediatric flatfoot treatment(simple procedure, mature technology, and less compl ications), it allows further surgery if needed. Conclusion Subtalararthroereisis is a simple and effective way to treat flatfoot in children, however, its biomechanics mechanism and managements to complication need to explore further.