Objective To analyze the current status of day surgery in West China Hospital of Sichuan University and compare it with the Recommended Catalogue of Day Surgery (2022 Edition), in order to provide reference for the update and expansion of day surgery procedures in hospitals. Methods The day surgical procedures carried out in West China Hospital of Sichuan University from October 2009 to July 2023 were collected. The day surgical procedures were classified based on surgical specialties, types of procedures, methods of operation, and surgical grading, etc. The day surgical procedures in West China Hospital of Sichuan University were compared with those in the Recommended Catalogue of Day Surgery (2022 Edition). Results A total of 576 types of daytime surgeries were carried out in West China Hospital of Sichuan University, involving 15 specialties. A total of 662 types of day surgeries were recommend in the nationally recommended catalogue for daytime surgery, involving 11 specialties. Among the nationally recommended surgical procedures, West China Hospital of Sichuan University had carried out 233 types of surgical procedures, and 26 additional types of surgical procedures were carried out as outpatient surgeries. According to the classification of surgical difficulty, the Level Ⅱ and Ⅲ surgeries were mainly carried out in West China Hospital of Sichuan University, and the Level Ⅱ surgeries were mainly recommend in the nationally recommended catalogue for day surgery. Conclusions The high-quality development of day surgery in China should not be limited to the supplement of surgical procedures. It is necessary to strive to increase the proportion of minimally invasive and fourth-level surgeries while ensuring medical quality and safety, and improve the overall medical level of day surgery.
Objective To explore the value of extracorporeal membrane oxygenation(ECMO) combined with hypothermia therapy for children patients with refractory cardiac arrest after congenital heart disease surgery. Methods From January 2013 to June 2016, we conducted a prospective study of 23 children (18 males, 5 females at age of 7±11 months) who underwent ECMO for refractory cardiac arrest after congenital heart disease surgery. All patients were randomly divided into two groups: a standard group (11 patients) and a hypothermia group (12 patients). The patients of the standard group received standard therapy (the core body temperature maintaining at 37.0℃) and the hypothermia group received hypothermia therapy (the core body temperature maintaining at 33.0℃). The hospital discharge rate, the rate of weaning from ECMO and the morbidity were compared between the two groups. Results Eleven of 23 patients (47.8%) were weaned from ECMO successfully and 7 of 23 patients (30.4%) discharged from hospital. The hospital discharge rate between the hypothermia group (n=6, 50.0%) and the standard group (n=1, 9.1%) had no statistical difference (χ2=4.537, P=0.069). The rate of weaning from ECMO of the hypothermia group (n=9, 75.0%) was higher than that of the standard group (n=2, 18.2%, χ2=7.425, P=0.006). The morbidity between the two groups had no statistical difference. Conclusion Extracorporeal cardiopulmonary resuscitation can improve the survival rate of the children who suffered from refractory cardiac arrest after congenital heart disease surgery. There is no evidence that ECMO combined with hyperthermia therapy is better than the only ECMO in improving the discharge rate. But ECMO combined with hypothermia therapy has higher rate of weaning from ECMO than that of the only ECMO.
Objective To investigate the clinical characteristics of primary malignant tumors of the left atrium and the late results of surgical treatment. Methods The clinical experience with surgical treatment of 13 primary malignant tumors of left atrium was analyzed retrospectively. Complete resection of malignant tumor was achieved in 7 cases(53.8％ )，and subtotal resection was achieved in 3 cases(23.0％), only biopsy was performed in 2 patients(15.4％ )because of extensive metastasis of tumor. Heart transplantation was performed in 1 case(7.7％). Results There was no hospital death. The pathological diagnosis was undifferentiated sarcoma in 5 cases, leiomyosarcoma in 2 cases, malignant transformation of myxoma in 2 cases, angiosarcoma in 1 case, fibrosarcoma in 1 case, malignant fibrous histocytoma in 1 case and malignant hemangiopericytoma in 1 case. There were 11 patients followedup for 3 months to 65 months and showed 9 late death due to recurrence or metastasis. There was 2 patients lost of follow-up. Conclusion Primary malignant tumors of the left atrium should be resected to relieve symptoms caused by local tumor growth. Surgery provides control of primary tumor and allows the potential for cure or longterm survival with effective adjuvant therapy. The prognosis of these patients is still poor.
Objective This study analyzed the pattern and influence factors of lymph node metastasis in thoracic esophageal cancer to provide a reference for the lymph node dissection for esophageal cancer. Methods Clinical data of 177 patients with thoracic esophageal cancer receiving the lymph node dissection in our department from 2015 to 2016 were retrospectively analyzed. There were 125 males and 52 females with a median age of 64 years, ranging from 18 to 86 years. We excluded cervical esophageal cancer and adenocarcinoma of the esophagogastric junction and analyzed the relationship between lymph node metastasis and tumor pathological type, depth of invasion, degree of differentiation and length. Results Of the 177 patients, 76 (42.9%) were found to have lymph node metastasis. In the 4 977 dissected lymph nodes, metastasis was identfied in 361 (7.3%) lymph nodes. The rate of lymph node metastasis in thoracic esophageal carcinoma was not related to the location and length of the tumor (P>0.05), but related to the depth of invasion and the degree of differentiation (P<0.05). Conclusion Lymph node metastasis is prone to present in the early stage of thoracic esophageal cancer. According to the characteristics of lymph node metastasis in thoracic esophageal carcinoma, we need have a standardized, systematic and focused lymph node dissection.
Abstract： Objective To study the molecular mechanism of pathologic states related to cardiopulmonary bypass (CPB) and screen the differential proteins from the serum before and after CPB in the open heart surgery patients. Methods By the twodimensional gel electrophoresis (2DE), we took the blood samples from each of the sixteen open heart surgery patients 30 minutes before CPB, 1 hour after CPB, and 24 hours after CPB. The protein spots were analyzed by the PDQuest image analysis software and the differential protein spots were identified by matrixassisted laser desorption/ionizationtime of flightmass spectrometry (MALDITOF-MS). Then, enzymelinked immunosorbent assay (ELISA) was used to determine the expression level of serum amyloid A protein (SAA) in the serum of healthy people and the enrolled patients before and after CPB. Results Through 2DE in combination with massspectrometry, 7 proteins altered in expression were identified, including SAA, haptoglobin (HPT), leucinerich alpha2-glycoprotein (A2GL), hemoglobin subunit beta (HBB), serine/threonineprotein phosphatase 2A -regulatory subunit B″ subunit gamma (P2R3C), transthyretin (TTHY), and T-complex protein 11-like protein2 (T11L2). ELISA analysis showed that SAA levels in healthy people and the open heart surgery patients 30 minutes before CPB were not statistically different (t=-1.955, P=0.056), while the SAA level rose from 54.47±48.32 μg/ml 30 min before CPB to 1 017.78±189.92 μg/ml 24 hours after CPB in the serum of open heart surgery patients． Conclusion The results of this pilot study illustrate that SAA, HPT, A2GL, HBB, P2R3C, TTHY and T11L2 may be the molecule markers of pathologic state related to CPB. Acute phase reaction happens intensively after CPB in human body.
ObjectiveTo analyze the current situation of enhanced recovery after surgery (ERAS) application in colorectal surgery in China, and summarize the existing problems.MethodsAfter the questionnaire was developed, members of the Chinese Society of Colorectal Cancer were selected as respondents and results were collected by online questionnaire. All the respondents volunteered to visit the homepage of the questionnaire through the link address. After completing the questionnaire, they were saved and submitted.ResultsA total of 120 questionnaires were sent out and finally 107 respondents completed the electronic questionnaire survey. Among them, 73 (68.2%) routinely carried out ERAS programmes and 34 (31.8%) didn’t carry out ERAS programmes. Among the 11 ERAS programmes, most surgeons carried out 3–7 ERAS programmes, among which 4 ERAS programmes was the most (25 surgeons, 23.4%). The survey results for different ERAS programmes showed that only 4 out of 11 ERAS programmes had implemented more than half of the respondents. Respondents with older than 45 years old were more inclined not to undergo mechanical bowel preparation before surgery (P<0.001) and were more likely early postoperative oral intake (P=0.008), respondents with more than 1 000 hospital beds were more likely to select preoperative oral carbohydrate (P=0.012) and postoperative multimodal analgesia (P<0.001), respondents with more than 200 cases of colorectal surgery per year were more inclinedto take oral carbohydrate before surgery (P=0.018), and respondents whose rate of minimally invasive surgery was higher than 50% were more inclined to choose multimode analgesia (P=0.047). On the contrary, the respondents in the tumor hospitals recommended shortening the length of postoperative hospital stay and recommending early discharge (P=0.014). Hospitals that routinely performed ERAS (P<0.001), preoperative oral carbohydrate (P<0.001), without preoperative gastric tube (P=0.019), early postoperative drinking water (P=0.012), and early postoperative oral feeding (P=0.038) were associated with a shorter average postoperative hospital stay.ConclusionERAS has not been popularized in the field of colorectal surgery in China, and there are differences between different doctors and between different hospitals, which still need to be promoted continuously.
Objective To discuss the effect and prognosis of the Da Vinci surgical system assisted surgical treatment for complex hepatolithiasis. Methods The clinical data of 15 patients with complex calculus of intraheoatic duct who accepted surgical therapy at General Hospital of the Second Artillery Corps of PLA from January 2009 to August 2011 were analyzed retrospectively. Results All operations of 15 patients were performed successfully, no case of converting to laparotomy， no injury of the important blood vessels and organs in surgical procedures. Postoperative complications occurred in 4 cases （26.7%）. Among them, there were 1 case （6.7%） of hemobilia, 1 case （6.7%） of lung infection, 2 cases （13.3%） of liver surface bleeding, and no case of death and liver failure occurred during the perioperative period. All patients （100%） had follow-up visited with a median time of 11 months （ranging from 3 months to 2 years）, 12 cases （80.0%） acquired good curative effect, 3 cases （20.0%） of residual stones were found, 1 case （6.7%） of recurrence stones were found. Conclusion There are enormous potential for Da Vinci surgical system assisted surgical treatment of complex hepatolithiasis, which can be used in elderly patients，and patients with multiple surgical history, poor liver function, acute cholangitis, and so on.
Obesity is a disease state characterized by the accumulation of abnormal or excessive fat that threatens human health. With the rapid development of the economy and society and the change in lifestyle, obesity is highly prevalent in our country and has become an important disease that threatens the health of the population. Different from traditional non-surgical treatments, metabolic and bariatric surgery has a definite curative effect, is not easy to rebound, has good safety, and has sufficient evidence of clinical benefit, which can make many obese patients, especially those with moderate to severe obesity, fully recover. The treatment of obesity has become an important means in the comprehensive treatment of obesity. This article intends to describe the application of bariatric metabolic surgery in the comprehensive treatment of obesity from three aspects: bariatric surgery indications, surgical method selection, and perioperative multidisciplinary intervention.
ObjectiveTo summarize a patient diagnosed as Bismuth type Ⅲa hilar cholangiocarcinoma who unerwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy, meanwhile we reviewed the current status of surgical treatment of hilar cholangiocarcinoma at home and abroad.MethodsTo retrospectively summarized and analyzed the clinical data of one case of Bismuth type Ⅲa hilar cholangiocarcinoma. The preoperative total bilirubin of this patient was 346.8 μmol/L, and this patient underwent the curative surgery combined with partial portal vein resection and reconstruction+hilar bile duct formation+Roux-en-Y choledochojejunostomy after reducing jaundice by percutaneous transhepatic biliary drainage (PTBD). Then we retrieved domestic and foreign related literatures.ResultsOperative time of this patient was about 290 min and intraoperative bleeding was about 350 mL. No intraoperative blood transfusion occurred. The results of pathological examination showed middle-differentiatied adenocarcinoma of hilar bile duct with negative tumor margins and no regional lymph node metastasis (0/14). The postoperative recovery was uneventful with hospital stay time of 9 days and without any complication. The patient had been followed-up in the outpatient department for 3 years,and was generally in good condition. The evidence of recurrence or metastasis wasn’t found.ConclusionsPre-operative biliary drainage can improve the safety of operation and reduce the incidence of postoperative complications, extend liver resection for the patient with Bismuth type Ⅲa hilar cholangiocarcinoma, which can improve R0 resection rate and extend postoperative survival.
Objective Discussed the postoperative seizure control situation of children with focal cortical dysplasia (FCD),which took Transmantle sign (T2WI or T2 FLAIR sequence inward extension cone high signal in the direction of ventricle) as the main MRI performance, and analyzed the influence of various factors on the prognosis of surgery.MethodsRetrospective analysis was performed on 56 children with FCD with Transmantle signs as the main MRI signs confirmed by pathology in Qilu Children's Hospital of Shandong University from May 2015 to March 2020, including 33 males and 23 females, with an average age of (4.8±0.13) years old, and their imaging and clinical data were analyzed. Analyzed the pathological types and main MRI signs, the range of epileptiform discharge, and Engel classification after surgery. Analyzed the effect of surgical method, type of onset, age of operation, epileptic site, course of disease and perioperative epileptic seizure on the surgical prognosis of children.ResultsPostoperative pathology showed that all the 56 cases both were FCDⅡb, in addition to the Transmantle sign, the MRI performance were also accompanied by focal blurring of gray and white matter, abnormal cortical structure, and abnormal signal foci in gray and white matter. Intraoperative EEG monitoring results showed that the epileptiform discharge area in all cases was larger than the lesion range showed by MRI. Postoperative Engel classification: 25 cases of gradeⅠ (43.8%), 18 cases of gradeⅡ (31.3%), 4 case of gradeⅢ (6.3%), 9 cases of gradeⅣ (18.8%). Surgical resection and perioperative seizures are independent factors affecting the prognosis of children (P<0.05).Conclusionsurgical methods and perioperative seizures were closely related to the prognosis of children.