ObjectiveTo summarize research progress of the effect of knee flexion position on postoperative blood loss and knee range of motion (ROM) after total knee arthroplasty (TKA).MethodsThe relevant literature at home and abroad was reviewed and summarized from mechanism, research status, progress, and clinical outcome. The differences of clinical results caused by different positions, flexion angles, and keeping time were compared.ResultsKeeping knee flexion after TKA can reduce postoperative blood loss through the angle change of blood vessels and increase knee early ROM by improving flexion muscle strength. When the flexion angle of the knee is large and the flexion position is keeping for a long time, the postoperative blood loss and the knee ROM can be significantly improved. However, the amount of blood loss and ROM are not further improved in the patients with keeping knee flexion for more than 24 hours compared with less than 24 hours.ConclusionKeeping knee flexion after TKA is a simple and effective method to reduce postoperative blood loss and improve knee ROM. However, the optimal knee flexion angle and time are needed to be further explored.
ObjectiveTo understand the follow-up needs of postoperative patients with thyroid cancer and analyze its influencing factors, so as to provide a reference for the establishment of a follow-up management system for patients with thyroid cancer.MethodsConvenience sampling was used to conduct a questionnaire survey on the follow-up need, recovery, anxiety, and stress of patients after thyroid cancer surgery in 2 tertiary A hospitals from March to April in 2020. The self-designed follow-up needs questionnaire, the Quality of Recovery Questionnaire 15 (QoR-15), the Generalized Anxiety Disorder-7 (GAD-7), and the Perceived Stress Scale (PSS-4) were scored. The higher score, the higher need, the better recovery, and the more serious anxiety and stress.ResultsIn this study, 382 questionnaires were distributed, which of 351 were returned and of 349 were valid, the valid callback rate was 99.4% (349/351). ① Follow-up needs. Follow-up form: Online platform was the preferred follow-up method (72.2%), the most patients hoped that the follow-up would be conducted by a doctor (82.5%) and hoped to start the follow-up at 1 month after the operation (67.6%) and in the afternoon (50.7%), the duration of each follow-up was 10–15 min (47.3%), and accepted the follow-up frequency of 1 times per month (41.3%) and the lifetime follow-up (69.9%). Needs degree of follow-up contents: There were 13 follow-up items requiring more than 80% of patients. The top 5 items with the higher follow-up needs score were the question on test results, returning visit guidance, knowledges of metastasis and recurrence, medication guidance, and issuance of inspection orders, and their scores were 4.78±0.47, 4.70±0.51, 4.70±0.57, 4.65±0.59, 4.57±0.64, respectively. The results of multiple linear regression analysis were found that the age (young), marital status (unmarried), medical payment method (with medical insurance), and postoperative interval (<1 month) were closely related to the follow-up needs score (P<0.05). ② Recovery, anxiety, and stress statuses: The total QoR-15 score of patients was 79.87±29.95, which was positively correlated with the total score of follow-up needs (72.93±8.52, r=0.131, P=0.014). No significant correlation was found between the total score of GAD-7 (4.77±3.59) or PSS-4 (6.51±3.10) and the total score of follow-up needs (r=0.068, P=0.207; r=0.008, P=0.881).ConclusionsYoung, unmarried, medically insured, and early postoperative patients with thyroid cancer have higher follow-up needs. Patients with better recovery after surgery have a higher follow-up needs. Medical staff should pay attention to follow-up services after discharge, rationally arrange content, frequency, and time period of follow-up according to follow-up needs of patients, so as to improve quality of medical services.
Objective To investigate the factors influencing the occurrence of postoperative pulmonary complications (PPCs) in liver transplant recipients and to construct Nomogram model to identify high-risk patients. Methods The clinical data of 189 recipients who underwent liver transplantation at the General Hospital of Eastern Theater Command from November 1, 2019 to November 1, 2022 were retrospective collected, and divided into PPCs group (n=61) and non-PPCs group (n=128) based on the occurrence of PPCs. Univariate and multivariate logistic regression analyses were used to determine the risk factors for PPCs, and the predictive effect of the Nomogram model was evaluated by receiver operator characteristic curve (ROC) and calibration curve. Results Sixty-one of 189 liver transplant patients developed PPCs, with an incidence of 32.28%. Univariate analysis results showed that PPCs were significantly associated with age, smoking, Child-Pugh score, combined chronic obstructive pulmonary disease (COPD), combined diabetes mellitus, prognostic nutritional index (PNI), time to surgery, amount of bleeding during surgery, and whether or not to diuretic intraoperatively (P<0.05). Multivariate logistic regression analysis showed that age [OR=1.092, 95%CI (1.034, 1.153), P=0.002], Child-Pugh score [OR=1.575, 95%CI (1.215, 2.041), P=0.001], combined COPD [OR=4.578, 95%CI (1.832, 11.442), P=0.001], combined diabetes mellitus [OR=2.548, 95%CI (1.024, 6.342), P=0.044], preoperative platelet count (PLT) [OR=1.076, 95%CI (1.017, 1.138), P=0.011], and operative time [OR=1.061, 95%CI (1.012, 1.113), P=0.014] were independent risk factors for PPCs. The prediction model for PPCs which constructed by using the above six independent risk factors in Nomogram had an area under the ROC curve of 0.806. Hosmer and Lemeshow goodness of fit test (P=0.129), calibration curve, and decision curve analysis showed good agreement with Nomogram model. Conclusion The Nomogram model constructed based on age, Child-Pugh score, combined COPD, combined diabetes mellitus, preoperative PLT, and time of surgery can better identify patients at high risk of developing PPCs after liver transplantation.
Objective To investigate the effects of different ventilation modes on postoperative pulmonary complications in elderly patients undergoing abdominal surgery. Methods The patients who underwent upper abdominal surgery under general anesthesia in Chengdu Office Hospital of the People’s Government of Tibet Autonomous Region between February 2020 and February 2021 were selected. Patients were randomly divided into volume controlled ventilation (VCV) group, pressure controlled ventilation (PCV) group, and pressure controlled ventilation-volume guarantee (PCV-VG) group according to the random number table method. All the three groups adopted the internationally recognized lung protective ventilation strategy. The transcutaneous arterial oxygen saturation and respiratory mechanics indicators of three different time periods, as well as pulmonary symptoms and signs and laboratory imaging examinations 7 days after surgery were recorded. The incidence of postoperative pulmonary complications in the three groups of patients were evaluated using the Melbourne Group Scale Version 2. Results A total of 120 patients were included, with 40 in each group. There was no statistically significant difference in the general situation of the three groups of patients (P>0.05). The platform pressure and compliance of three different time periods all changed over time (P<0.05). There were statistically significant differences in the occurrence of pulmonary complications and hospital stay among the three groups 7 days after surgery (P<0.05). Conclusion Under the internationally recognized lung protective ventilation strategy, PCV-VG mode can significantly reduce the incidence of pulmonary complications 7 days after abdominal surgery, shorten the length of hospital stay, and improve the quality of life in elderly patients.
Objective To analyze the influencing factors of delirium after endovascular aortic repair, and to provide a basis for clinical nursing and prevention of this condition. Methods Patients who underwent endovascular aortic repair at Fuwai Hospital, Chinese Academy of Medical Sciences from 2018 to 2019 were selected. The Chinese version of the Nursing Delirium Screening Scale (Nu-DESC) was used to assess whether postoperative delirium occurred. Patients with a Nu-DESC score ≥ 3 were assigned to the delirium group. Non-delirium patients who had the same surgeon and adjacent surgical order were selected at a 1 : 4 ratio to form the non-delirium group. Univariate analysis was performed on the clinical data of the two groups. Factors with P<0.1 in the univariate analysis and those considered clinically significant were included in a multivariate logistic regression analysis to identify the influencing factors of postoperative delirium. Stratified analysis was conducted based on thoracic endovascular aortic repair (TEVAR) and endovascular abdominal aortic repair (EVAR). Results A total of 213 patients were included, comprising 46 in the delirium group and 167 in the non-delirium group. The overall mean age was (60.3±12.0) years, and 183 (85.9%) were male. Univariate analysis showed that emergency admission, preoperative neutrophil percentage, lymphocyte percentage, operative duration, intubation time, and ICU stay might be associated with postoperative delirium. Multivariate analysis revealed that longer operative and intubation times were associated with a higher likelihood of delirium. In the stratified analysis, the results for the TEVAR group were consistent with the overall findings, whereas no significant differences were observed in the EVAR group. Conclusion Longer operative and intubation times are associated with a higher risk of delirium in patients undergoing TEVAR, while no significant association was found in patients undergoing EVAR.
As a novel analgesic method, erector spinae plane block is increasingly widely used during perioperative period. This technique mainly injects local anesthetic drugs into the connective tissue between the deep fascia of the erector muscle and the transverse process of the vertebral body to achieve a blocking effect. Its role in postoperative analgesia in adult patients has been verified. Currently, case reports have shown that it also has a certain analgesic effect in pediatric patients, which can reduce postoperative pain scores and opioid consumption. Therefore, this article explores the application of erector spinae plane block in pediatric patients from various aspects, summarizes existing research results, and aims to provide more evidence for clinicians to reasonably use this block technique in the pediatric population.
ObjectiveTo analyze the current version of the West China Database from Colorectal Cancer (DACCA) and explore how the occupational background of colorectal cancer patients affects the complexity of surgical difficulty and postoperative complications. MethodsWhen using the updated version of DACCA data on May 28, 2023 for analysis, the data items concerned covered occupation, operative duration, anatomical difficulty, pelvic stenosis, abdominal obesity, adhesion in surgical area, abnormal mesenteric status, tissue or organ hypertrophy, intestinal quality in surgical area, postoperative complications in hospital, short-term postoperative complications and long-term postoperative complications. According to the “Occupational Classification Code of the People’s Republic of China”, the occupations of patients were divided into professional and technical personnel, staff, service personal, production personnel, manufacturing personnel and retirees according to different occupations. The operative difficulty and postoperative complications of 6 groups were analyzed. ResultsAccording to the screening conditions, 5 734 valid data rows were obtained from DACCA. The results of occupation analysis showed that there were significant difference in operative duration (H=11.609, P=0.041), anatomical difficulty (H=29.166, P<0.001), pelvic stenosis (H=16.412, P=0.006), abdominal obesity (H=44.622, P<0.001), adhesion in surgical area (H=23.695, P<0.001), abnormal mesenteric status (χ2=39.252, P=0.035), tissue or organ hypertrophy (χ2=58.284, P<0.001) and intestinal quality in surgical area (H=21.041, P=0.001) between different groups. There were no significant differences in the occurrence of complications in hospital, near and short-term and long-term after operation among different occupations (P>0.05). Further subgroup analysis showed that only the difference of fever (χ2=10.969, P=0.041) and intestinal obstruction (χ2=12.025, P=0.021) were statistically significant among different occupations. ConclusionThe occupation of patients may affect the difficulty of colon cancer surgery, and the occurrence of postoperative complications is nothing to do with the occupation of patients, but the occurrence of postoperative fever and postoperative intestinal obstruction is related to occupations, and the possible causes need to be further explored.
The aim of this paper is to explore the prevention of rabbit postoperative abdominal cavity adhesion with poly (lactic-co-glycotic acid) (PLGA) membrane and the mechanism of this prevention function. Sixty-six Japanese white rabbits were randomly divided into normal control group, model control group and PLGA membrane group. The rabbits were treated with multifactor methods to establish the postoperative abdominal cavity adhesion models except for those in the normal control group. PLGA membrane was used to cover the wounds of rabbits in the PLGA membrane group and nothing covered the wounds of rabbits in the model control group. The hematologic parameters, liver and kidney functions and fibrinogen contents were detected at different time. The rabbit were sacrificed 1, 2, 4, 6, 12 weeks after the operations, respectively. The adhesions were graded blindly, and Masson staining and immunohistochemistry methods were used to observe the proliferation of collagen fiber and the expression of transforming growth factorβ1 (TGF-β1) on the cecal tissues, respectively. The grade of abdominal cavity adhesion showed that the PLGA membrane-treated group was significant lower than that in the model control group, and it has no influence on liver and kidney function and hematologic parameters. But the fibrinogen content and the number of white blood cell in the PLGA membrane group were significant lower than those of model control group1 week and 2 weeks after operation, respectively. The density of collagen fiber and optical density of TGF-β1 in the PLGA membrane group were significant lower than those of model control group. The results demonstrated that PLGA membrane could be effective in preventing the abdominal adhesions in rabbits, and it was mostly involved in the reducing of fibrinogen exudation, and inhibited the proliferation of collagen fiber and over-expression of TGF-β1.
Objective To compare and analyze the occurrence of acute and chronic pain after subxiphoid and transcostal thoracoscopic extended thymectomy. MethodsA retrospective analysis was performed on 150 patients who underwent thoracoscopic extended thymectomy in our hospital from July 2020 to June 2022, among whome 30 patients received subxiphoid video-assisted thoracic surgery, and 120 patients received transcostal video-assisted thoracic surgery. The patients were matched by the propensity score matching method. Postoperative pain was evaluated by numeric rating scale (NRS). The intraoperative conditions and postoperative pain incidence were compared between the two groups. ResultsAfter matching, 60 patients were enrolled, 30 in each group, including 30 males and 30 females with an average age of 50.78±12.13 years. There was no difference in the general clinical data between the two groups (P>0.05), and no perioperative death. There were statistical differences in the intraoperative blood loss, postoperative drainage volume, postoperative catheter duration, postoperative hospital stay, postoperative pain on 1 d, 2 d, 3 d, 7 d, 3 months and 6 months after the surgery (P<0.05), but there was no statistical difference in the operation time or the postoperative 14 d NRS score (P>0.05). Further univariate and multivariate analyses for postoperative chronic pain showed that surgical method and postoperative 14 d NRS score were risk factors for chronic pain at the 3 months and 6 months after the surgery (P<0.05). Conclusion The subxiphoid thoracoscopic extended thymectomy has advantages over transcostal thoracoscopic surgery in the postoperative acute and chronic pain.
ObjectiveTo evaluate the effect of pathological portal vein (PV)/superior mesenteric vein (SMV) invasion during pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma and the clinical significance of PD with PV/SMV resection in patients without pathological evidence of venous invasion.MethodsFrom January 1, 2013 to December 31, 2017, data of 183 patients who had PD for pancreatic adenocarcinoma were collected. Eighty-one patients had PD with PV/SMV resection for pancreatic adenocarcinoma, among them, 42 cases (51.9%) had pathological PV/SMV invasion (PD+P/S+ group) and 39 patients (48.1%) didn’t have pathological PV/SMV invasion (PD+P/S− group). One hundred and two patients had a standard PD without PV/SMV resection (control group). Multivariate analysis was used to identify predictive variables which influencing survival and the Kaplan-Meier method to estimate patients’ survival.ResultsThere were no differences in gender, age, preoperative serum CA19-9 level, blood loss, tumor size, tumor TNM stage, positive lymph nodes, ratio of positive lymph nodes, degree of tumor differentiation, perineural invasion, postoperative adjuvant chemotherapy, type of operation, and margin status among 3 groups (P>0.05). And moreover, no significant differences were found between the PD combined PV/SMV resection group and the control group in the incidence of complications and mortality (P>0.05) and all no reoperation happened. Univariate analysis revealed a significant difference in overall survival (OS) among the PD+P/S+ group, PD+P/S– group and control group (P<0.001), median survival time were 10, 19 and 20 months, respectivly. Moreover, depth of PV/SMV invasion, use of postoperative adjuvant chemotherapy and tumor differentiation were independent prognostic factors by multivariate survival analysis.ConclusionsOS of patients with PV/SMV invasion is significantly worse than that of patients without PV/SMV invasion, no matter underwent PV/SMV resection or not. The cause of that maybe invade to the tunica intima by tumor limits OS of patients with pancreatic adenocarcinoma. OS of PV/SMV-resected patients without pathological PV/SMV invasion is similar to that of patients who had standard PD without PV/SMV resection. Whether the patients can benefit from routine resection of PV/SMV is still controversial.