【 Abstract 】 Objective To investigate the features and risk factors of bacterial infection after orthotopic liver transplantation (OLT) and summarize the experiences for prevention and treatment of infection. Methods The clinical materials of 79 patients underwent OLT from December 2004 to January 2007 were reviewed. The incidence and sites of postoperative bacterial infections as well as species of bacteria and the situation of drug resistance were retrospectively analyzed. Results Thirty-two (40.5%) out of 79 patients developed bacterial infections. Infection mainly occurred in lung, abdominal cavity and blood, which were mainly caused by Escherichia coli, staphylococcus aureus, klebsiella pneumoniae, staphylococcus epidermidis and enterococcus bacteria. The main risk factors included delayed restoration of gastrointestinal function (gt;5 d), poorly preoperative liver function (Child C grade), hypoproteinemia and persistent postoperative hyperglycemia (gt;11.0 mmol/L). Perioperative decontamination in digestive tract was a protective factor in the prevention of bacterial infection. Conclusion Bacterial infection is one of the most severe complications after OLT. Therefore, it is very important to remove those risk factors, make early diagnosis and take effective treatment ．
Objective To investigate the application of transverse fascia in inguinal hernia repair. Methods In this study, 617 patients underwent inguinal hernia repair between January 1990 and December 2005 in our hospital were included, which were divided into two groups according to different operative ways: transverse fascia method group (n=337) and Bassini method group (n=280). Then intraoperative results, postoperative complications, and rehabilitated results of patients in two groups were compared. Results Compared with Bassini method group, the patients in transverse fascia method group did not show significant difference in operative time and blood loss during operation (Pgt;0.05). The differences of severe postoperative pain, testicular swelling, the time of the body’s restore for normal activities, and recurrence rate of patients between two groups were significant (Plt;0.05), while the difference of hematoma of scrotum and infection of incisional wound (Pgt;0.05). Conclusion The strengthening of posterior wall by transverse fascia and reconstruction of inner ring is a simple and effective method for inguinal hernia repair.
Complications of proliferative diabetic retinopathy have become the major indications of vitrectomy. The surgery, however, is not basically a causative therapy. The visual function after operation depends on the degree of retinal ischemia and damage induced. The surgery itself has a potential for severe complications. Therefore it is important to better understand the pathology and to master surgical strategy and techniques in order to improve surgical outcomes and reduce the surgical complications. (Chin J Ocul Fundus Dis,2007,231-233)
PURPOSE:To assess the effects of silicone oil removal on the complications associated with its use. METHODS:Retrospective analysis of the results of silicone oil removal after vitreous surgery for retinal detachment in 913 eyes in National Ophthalmology Centre of French. The follow-up period was at least six months and the mean duration of oil tamon- ade was 6.4 months. RESULTS :Retinal detachment recurred in 7.3%. The development of cataract continued after silicone oil removal. No patient retained a clear lens in the eye with oil remained in situ for more than 3 months. TWO of 5 eyes with keratopathy at the time of oil removal recovered after the oil removal ;but the corneas of another 4 eyes became dystrophic after the oil removal. Twelve of 15 eyes with secondary ocular hypertension incontrollable through medicinal treatment relieved after oil removal ,but another 11 eyes became hypertensive after oil removal. Persistent emulsive droplets wre found in anterior chamber angles of the above 11 hypertensive eyes and the 7 eyes with keratopathy. CONCLUSINOS:Early removal of silicone oil after retinal detachment operation might delay the development of cataract but can not avoid its occurence ,and ocular hypeitension and keratopathy can be prevented by early and complete removal of silicone oil. Chin J Ocul Fundus Dis,1997,13: 22-23）
Objective To observe the therapeutic effect of poly tetrahydrofurfuryl co-lactic acid(copolymer C4) as the biodegradable vitreous substitutes on rhegmatogenous retinal detachment.Methods Vitreoretinal surgery with copolymer C4 tamponades was performed on 32 pigmented rabbits (64eyes) with rhegmatogenous retinal detachment. The rate of reattached retina and the post operative cornplications were observed.Results Three months after the operation, reattached retina was found in 96. 4%, glaucoma in 5.5%, cataract in 10.9%, and copolymer emulsion in 10.2% of all the eyes.Conclusion copolymer C4 may withstand the retinal tear effectively for 3 months, and can be a valuable vitreous substitutes. (Chin J Ocul Fundus Dis，2004，20：27-28)
ObjectiveTo explore the effects of modified telescopic embedding anastomosis in surgical treatment of esophageal and cardiac carcinoma. MethodsWe retrospectively analyzed the clinical data of 160 patients with esophageal or cardiac cancer undergoing surgery in our group from January 2014 through May 2015. There were 119 males and 41 females with a mean age of 61.6±7.1 years. Sixty-four patients received Sweet esophagectomy and 96 patients underwent minimally invasive Mckeown esophagectomy, and all the patients received end to side mechanical anastomosis. The patients were divided into a modified group and a traditional group according to the embedding types. There were 34 males and 12 females aged 61.7±6.4 years in the modified group undergoing modified telescopic embedding. There were 85 males and 29 females aged 62.2±7.5 years in the traditional group undergoing traditional interrupted horizontal mattress suture embedding. The anastomostic time and postoperative complications were compared between the two groups. ResultsCompared with the traditional group, obviously lower incidence of anastomotic fistula (0.0% vs. 12.3%, χ2=4.478, P=0.013), shorter anastomosis time (28.9±2.9 min vs. 30.0±3.1 min, t=-1.983, P=0.049), but a higher incidence of anastomotic stenosis (30.4% vs. 3.5%, χ2=23.799, P=0.000) in the modified group were found. There were no significant differences in the incidences of pulmonary complications, cardiovascular complications, laryngeal recurrent nerve injury, or perioperative mortality between the two groups (P>0.05). ConclusionModified telescopic embedding anastomosis is safe and feasible in surgical treatment of esophageal and cardiac carcinoma, and can effectively reduce the incidence of anastomotic fistula.
ObjectiveTo assess the safety for removing nasogastric tube(NGT)within postoperative 24 h in Whipple pancreaticoduodenectomy (PD)patients. MethodsThe clinical data of 310 patients performed classic Whipple PD from January 2008 to March 2013 in this hospital were analyzed retrospectively. The patients were divided into early (≤24 h after operation)removing NGT group and late( > 24 h after operation)removing NGT group according to the time of NGT duration. The ratio of NGT reinsertion, time of solid diet tolerance, hospital stay, mortality, and major complications associated with PD were compared between two groups. Results①The demography and preoperative comorbidities characteristics were similar(P > 0.05).②There was no statistical difference of ratio of NGT reinsertion between two groups(P=0.450).③The differences of rates of major complications associated with PD and mortality were not statistically different(P > 0.05)by univariate analysis, but the rate of total complications in the early removing NGT group was significantly lower than that in the late removing NGT group (P=0.014)by multivariate analysis.④The average time of solid diet tolerance(P=0.013)and average hospital stay(P < 0.001)in the early removing NGT group were significantly shorter than those in the late removing NGT group. ConclusionFor patients comfort, NGT following PD should be removed as early as possible even immediately after extubation for selective patients.
Objective To observe the efficacy of vitreoretinal surgery on proliferative diabetic retinopathy (PDR) in patients with type 1 and type 2 diabetes mellitus (DM). Methods Retrospectively analyzed the clinical data of 451 patients with DM (71 with type 1 and 380 with type 2) who underwent PDR from June 1999 to October 2003. The follow-up period was at least 14 months with the average of 29 months. The pre-and post-operative visual acuity, progression and regression of iris neovascular (INV), neovascular glaucoma (NVG), and the reattached and being attached rate of retina were observed and compared between the two groups. The effect of different types of DM on vitreoretinal surgery for PDR were observed. Results The preoperative data showed that the number of type 1 DM patients with severe PDR was more than the type 2 DM patients: the rate of grade VI PDR, the visual acuity lower than 0.1, INV and NVG were all higher that which in type 1 DM patients. The increased ratio of postoperative visual acuity was 64.8% (46/71) in type 1 DM patients and 72.4% (275/380) in type 2 DM patients (P=0.196). There were 75.0% patients with PDR combined with rubeosis iridis in type 1 DM group and 60.0% in type 2 DM group (P＝0.678);the rate of new rubeosis iridis after surgery was 6.3% in type 1 DM group and 5.6% in type 2 DM group (P＝0.822). The intraocular pressure of NVG eyes were all controlled effectively in both type 1 and type 2 DM groups, and INV did not regressed only in one case in type 1 DM group. In the patients with preoperative retinal detachment at the grade VI of PDR, the rate of retinal reattachment after on off operation was 87.2% in type 1 DM group and 89.8% in type 2 DM (P＝0.611); the rate of retina being-attachment after one-off surgery were 90.1% in type 1 DM group and 93.4% in type 2 DM group, respectively (P＝0.323). Conclusion There was no obvious difference of surgical efficacy on the two types of DM in patients with PDR. (Chin J Ocul Fundus Dis,2007,23:248-251)
Objective To investigate the effect of CT-guided percutaneous lung puncture biopsy and nursing of postoperative complications. Methods We retrospectively analyzed the clinical data of 522 patients who underwent CT-guided percutaneous lung biopsy between May and August 2014 in the Department of Lung Cancer Center. Effect of the puncture biopsy, postoperative complications and nursing measures were summarized. Results After surgery, 507 cases of diagnosis were confirmed, 10 were not confirmed, and 5 cases of puncture were unsuccessful. There were 203 cases of complications, including 122 cases of pneumothorax (23.4%), 56 of hemoptysis 56 (10.7%), 20 of pleural effusion (3.8%), 4 of pleural reaction (0.8%), and 1 of mediastinal emphysema (0.2%). All the above complications were cured after positive symptomatic treatment and nursing care. There were no such complications as severe hemopneumothorax, severe hemoptysis or needle tract metastasis. Conclusions CT-guided percutaneous lung puncture biopsy is a safe and reliable method, but there are some patients with complications. Observation and postoperative care are particularly important. Timely detection and positive care will achieve satisfactory results.
Objective To summarize the application of different types of perineal and vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body for patients with primary or recurrent advanced rectal cancer with distal vagina or perineal body invasion， and to review the advantages and shortages and the application range of common reconstructive surgical procedures. Method The clinical data of 10 rectal cancer patients underwent extended surgery with distal vagina and perineal body resection accompanied with or without hysterectomy from October 2009 to September 2013 were summarized. Results There was no perioperative mortality. Omental flaps were used for obliteration of pelvic defect in 4 patients. The uterus was pushed backward to fill the pelvic defect after severing the round ligament in 2 patients. A reversed pedicled sigmoid flap was employed for reconstruction of the vagina in 2 patients. The reversed flap of anterior vaginal wall was used for vaginal and perineal reconstruction in 3 patients. Three cases had postoperative complications， in which included 1 patient with pelvic sepsis who underwent reoperation for drainage， 2 patients with perineal wound infection. All other patients had an uneventful healing postoperatively. Conclusions Some types of one-stage pelvic and perineal-vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body could produce an expedited wound healing with acceptable morbidity. Despite the well documented pedicled musculocutaneous flap for reconstruction， omental flap， pedicled sigmoid flap， overturn of anterior vaginal wall for reconstruction and pushing-back of the uterus for filling pelvic cavity might also result in reduced pelvic and perineal associated complications. Pedicled musculocutaneous flap is better reserved for huge pelvic and perineal defect and should be recommended among Chinese surgeons.