In order to investigate the causes, diagnosis, treatment, outcome and prevention of iatrogenic nerve injury in the neck, 8 cases with iatrogenic nerve injuries were analyzed. Among them, 5 cases were accessory nerve injury, 3 cases were brachial plexus injury. All of the cases were treated by surgical methods, including neurolysis, repair by direct suture, nerve graft and transposition. After 1-3 years follow up the effect was excellent in 2 cases who were accessory nerve injury, good in 5 cases, and poor in 1 case who was brachial plexus injury. It was concluded that high responsibility of surgeons and careful manipulation during operation were the key to prevention of nerve injuries.
31 cases of iatrogenic cholangic injury reported. 28 cases followed from 9 months to 6 years. iatrogenic cholangic injury is not an uncommon occurence main cases are inregular procedures, and carelessness in this group, only 9 cases were found intraoperatively. The main manifestations after injury were aggravating jaundice and/or bilious peritonitis. Symptoms, signs, B-type ultrsound and sometimes ERCP were used for diagnosis. Once the injury ascertained ends are the best treatment, an alternative Roux-Y Cholangiojejunostomy was also commonly used. In this group, 4 cases received the first methos and all with good results; 23 patients treated by the second methos, 17 were uneventful, 4 experienced more or less abdomenal pain, 2 suffered difinite repeated cholangitis and another 1 died.
Objective To summarize the classification, diagnosis, and treatment of iatrogenic bile duct injury. Method The clinical data of 27 cases of iatrogenic bile duct injuries who treated in Central Hospital of Huzhou City from 2008–2013 were retrospectively analyzed. Results The classification of 27 cases: 5 cases of type Ⅰ, 18 cases of type Ⅱ, 2 cases of type Ⅲ, 2 cases of type Ⅳ. Diagnosis: 11 cases were immediately discovered at the time of the initial operation, include 1 case of type Ⅰ, 8 cases of type Ⅱ, 1 case of type Ⅲ, 1 case of type Ⅳ; 10 cases were detected in early stage after the initial operation, include 2 cases of type Ⅰ, 7 cases of type Ⅱ, 1 case of type Ⅲ; 6 cases were detected in delayed stage after the initial operation, include 2 cases of type Ⅰ, 3 cases of type Ⅱ, 1 case of type Ⅳ. Treatment effect: 17 cases for excellent, 5 cases for good, 4 cases for bad, the well recover rate was 84.6% (22/26). One case died after operation. A total of 26 cases were followed up, 1 case was lost to follow up. During the follow-up period, bile leakage occurred in 3 cases, infection of incision occurred in 2 cases, cholangitis occurred in 3 cases, and bile duct stricture occurred in 2 cases. Conclusions The best time of repairing for the iatrogenic bile duct injuries is at the time of the initial operation or early stage. According to the type of injury and the time of the injury was diagnosed, timely and effective treatment by intervention and (or) surgery is the key.
ObjectiveTo investigate the natural outcome of spontaneous closure of iatrogenic atrial septal defect (IASD) in patients with atrial fibrillation after transseptal catheterization and the influencing factors affecting its healing.MethodsA total of 122 patients who underwent percutaneous left atrial appendage occlusion in West China Hospital, Sichuan University from September 2014 to February 2018 were selected for observation and follow-up. General information of the patients was collected. Each patient underwent transthoracic echocardiography and transesophageal echocardiography before the surgery or 45 days, 3 months, 6 months and 1 year after the surgery, observing the atrioventricular size, cardiac function and atrial septal defect size. The natural outcome of IASD and influencing factors and prognosis of IASD were analyzed.ResultsThe healing rate increased gradually with the follow-up time; the median healing time was 180 days [95% confidence interval (169.5, 190.5) days]. The difference in the effect on IASD healing rate between the gender and atrial fibrillation type was not significant (P>0.05); being older than 70 years old was the influence factor for the IASD healing rate (P<0.05). There was no statistically difference in right heart size and systolic and diastolic function between the unhealed group (n=18) and the healed group (n=63) after a 1-year follow-up (P>0.05), but the left ventricular size was bigger in the unhealed group than that in the healed group (P<0.05). The follow-up time points had a significant effect on the size of the left atrium, and the left atrium in the healing group after 1 year follow-up was significantly smaller than before. There was no significant difference among the different follow-up time points and no interaction between grouping and follow-up time (P>0.05). ConclusionsWith the extension of follow-up time, the healing rate increases gradually. Larger left atrium and ventricular size and the age over 70 may be related to the healing of IASD.
Nerve injury following operation is one of the main causes of the iatrogenic peripheral nerve injury. In order to learn lessons from these cases, one hundred and seven cases of peripheral nerve injury complicated with the orthopedic operations were analyzed. Forty-four cases were cutting injury during operation, made up 41% of all cases and 27 cases were stretch and compression injury, made up 25%. The involved nerves included 41 radial nerves and 24 common peroneal nerves, composing 60.7% of all nerve injury. The operations responsible were mainly the bone and joint operations, which made up 81%. The cause, prophylaxis, diagnosis and treatment were discussed. The rich appropriate knowledge of anatomy and responsibility of the surgeon were emphasized in order to prevent the occurrence of complication. Once the injury was suspected, diagnosis should be made promptly and effective treatment should be performed in time.
目的 探讨医源性胆管损伤的原因、诊治及预防。方法 回顾性分析25例医源性胆管损伤。结果 医源性胆管损伤多发生于胆囊切除术，主要原因有人为因素、胆管解剖变异、局部病理因素等。胆管一旦损伤，如果首次处理不当，则可引发一系列严重并发症。各种类型的胆管损伤应采取不同方法及早处理，对胆漏、腹腔感染较重者先行胆道及腹腔引流术，3个月后再作胆道重建或修复术，手术方法以胆管空肠RouxenY吻合术最为理想。结论 提高医生对胆管损伤的警觉性，术中细致地解剖和规范的操作，是预防医源性胆管损伤的关键。
Objective To summarize the etiology mechanism and treatment of iatrogenic blepharoptosis after double eyelid surgery in Asia. Methods To extensively review the literature related to iatrogenic blepharoptosis after double eyelid surgery, and to summarize and analyze the related anatomical mechanism, existing treatment options, and indications. ResultsIatrogenic blepharoptosis is a relatively common complication after double eyelid surgery, sometimes it is combined with other eyelid deformities such as sunken upper eyelid and wide double eyelid, which makes it difficult to repair. The etiology is mainly caused by improper adhesion of tissues and scars, improper removal of upper eyelid tissue, and injury of a link of levator muscle power system. Whether blepharoptosis occurs after double eyelid surgery by incision or suture, it should be repaired by incision. The principles of repair include surgical loosening of tissue adhesion, anatomical reduction, and repair of damaged tissues. The key is to use surrounding tissues or transplanted fat to prevent adhesion. ConclusionWhen repairing iatrogenic blepharoptosis clinically, appropriate surgical methods should be selected based on the causes and severity of the blepharoptosis, combined with treatment principles, in order to achieve better repair results.
Objective To explore the measures for early diagnosis and treatment of iatrogenic injury in the distal part of common bile duct. Methods The clinical data of 20 patients with iatrogenic injury in the distal part of common bile duct treated in our hospital from 1990 to 2008 were analyzed retrospectively. Results The injuries of 15 cases were found during the operation: 11 cases were treated with 3-stoma (bile duct, pancreas, duodenum)+Oddi sphinctreoplasty (OSP), 1 case with OSP+choledochojejunostomy, 2 cases with the perforated common bile duct suture repair+T tube drainage, 1 case with T tube drainage; All of them were cured after surgery. The other 5 cases were not found during the primary operation, 2 cases in which were cured with several operations, the other 3 were dead from infectious shock. Conclusions Early diagnosis and treatment of iatrogenic injury in the distal part of common bite duct can obtain perfect effects. Different procedures should be performed according to different degrees of the injury. The perfect preoperative imaging examination and intraoperative choledochoscopy before bile duct exploration may reduce the occurrence of the injury.