ObjectiveTo explain the advantage of laparoscopic endoscopic rendezvous procedures used to treat rectal carcinoma, and predict the future direction of the surgery methods for rectal carcinoma. MethodsA review and summary based on the clinical experience of our hospital and the published researches about the laparoscopic endoscopic rendezvous procedures over the past years in home and abroad were performed. ResultsLaparoscopy can monitor the situation of the abdominal cavity.Endoscopy can detect the location of rectal carcinoma.Laparoscopic endoscopic rendezvous procedures used to treat rectal carcinoma can combine the advantage of each other.And the purpose of "less invasion, less pain, and faster recovery" will be achieved.The effect of "1+1 > 2" will be realized. ConclusionLaparoscopy and transanal endoscopic microsurgery hybrid could be a naive form of nature orifice transluminal endoscopic surgery to treat rectal carcinoma.
ObjectiveTo investigate the adequate surgical procedures for well-differentiated thyroid cancer (WDTC) located in the isthmus.MethodsNineteen patients with WDTC located in the isthmus were identified with WDTC and managed by surgery in Department of General Surgery in Xuanwu Hospital of Capital University from Jun. 2013 to May. 2018.ResultsAmong the nineteen cases, fifteen patients had a solitary malignant nodule confined to the isthmus, four patients had malignant nodules located separately in the isthmus and unilateral lobe. One patient received extended isthmusectomy as well as relaryngeal and pretracheal lymphectomy; six patients received isthmusectomy with unilateral lobectomy and central compartment lymph node dissection of unilateral lobe; four patients received isthmusectomy with unilateral lobectomy and subtotal thyroidectomy on the other lobe as well as central compartment lymph node dissection of unilateral lobe; seven patients received total thyroidectomy or isthmusectomy with unilateral lobectomy and nearly total thyroidectomy on the other lobe, as well as central compartment lymph node dissection of both sides; one patient received total thyroidectomy and central compartment lymph node dissection of both sides, as well as lateral thyroid lymph node dissection of both sides. The median operative time was 126 minutes (67–313 minutes), the median intraoperative blood loss was 30 mL (10–85 mL), and the median hospital stay was 6 days (4–11 days). Hypocalcemia occurred in 12 patients. There were no complications of recurrent laryngeal nerve palsy or laryngeal nerve palsy occurred. All the nineteen patients were well followed. During the follow up period (14–69 months with median of 26 months), there were no complications of permanent hypoparathyroidism occurred, as well as the 5-year disease-specific survival rate and survival rate were both 100%.ConclusionsFor patients with well-differentiated thyroid cancer located in the isthmus with different diameters and sentinel node status, individualized surgical procedures should be adopted.
Objective To investigate the safety, efficacy and morbidity of onestage urethroplasty by using bladder mucosa for treatment of hypospadias. Methods From August 1991 to August 2003, 38 cases of congenital hypospadias were given bladder mucosa flap procedure and one stage urethroplasty. Results Thirty-eight cases of hypospadias treated with one stageurethroplasty by using bladder mucosa were followed up 6 months-9 years afterthe procedure. The success rate of the operation was 95%. Three cases of urethral fistula after the procedure were surgically repaired again, 2 cases of urethral stricture recovered after distension. The complication markedly lessened, micturation became normal with the reconstructed meatussituated at the proper site on the glands. Conclusion one stage urethroplastyby using bladder mucosa for treatment of hypospadias is a simple, effective andsafe surgery.
Objective To summarize mid-term effectiveness of modified arthroscopic suture button fixation Latarjet procedure for treatment of recurrent anterior shoulder dislocations. Methods Between January 2018 and October 2020, 30 patients with recurrent anterior shoulder dislocations were treated with modified arthroscopic suture button fixation Latarjet procedure. There were 19 males and 11 females with an average age of 27.3 years (range, 18-41 years). The shoulder dislocation occurred 3-7 times, with an average of 4.9 times. The time from the last dislocation to operation was 3-10 days, with an average of 4.1 days. Glenoid defects exceeded 20% in all cases. There were 27 cases of Hill-Sachs lesions. The joint pain and function were estimated by visual analogue scale (VAS) score, University of California, Los Angeles (UCLA) score, Rowe score, American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction of shoulder before operation and at 1 month, 6 months, and last follow-up. The X-ray film, CT scan and three-dimensional reconstruction were reviewed to observe the position, healing, and absorption of the coracoid graft, correction of glenoid defect, and joint degeneration.Results The operation time ranged from 51 to 79 minutes, with an average of 68.4 minutes. All incisions healed without complications such as nerve or blood vessel injury. All patients were followed up 36-60 months with an average of 44.6 months. The VAS score, UCLA score, Rowe score, ASES score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction after operation significantly improved when compared with preoperative values (P<0.05). All indicators further improved with time, and the differences between different time points after operation were significant (P<0.05). Imaging review showed that the coracoid graft was located in the anteroinferior glenoid at 1 day after operation, and no occurrence of shoulder osteoarthritis was found during follow-up. The anatomical structure of the glenoid was normal, and no delayed healing or non-union of the coracoid graft occurred. At 20 months after operation, arthroscopic re-exploration was performed in 1 case due to fracutre caused by falling injury revealed the good shaping of the coracoid graft, smooth glenoid, and no bone resorption or osteoarthritis. ConclusionFor recurrent anterior shoulder dislocations, the modified arthroscopic suture button fixation Latarjet procedure can obtain good recovery of shoulder function and low incidence of complications and has a good mid-term effectiveness.
Objective To analyze the strategy and skill of resection for lung cancer invading the superior vena cava (SVC) and improve the surgical treatment results. Methods An analysis of 35 patients who underwent surgery for lung cancer invading the SVC was performed. The pressure of SVC before and during operation, and the time of clamping the SVC were recorded. The conjunctival oedema was observed. 14 mm or 16 mm diameter terylene or expanded polytetrafluoroethylene graft artificial vessel were used to replace SVC.The continuous everted suture was applied with 4-0 Prolene. The embolism of artificial vessel and stomal hemorrhage were observed after operation. Results The SVC replacement with prothesis were performed in 20 patients in which the SVC hadn’t clamped in 5 patients. The clamping time was 8-35 mins for another 15 patients with SVC clamped.The clamping time were 1735 mins and 8-20mins respectively for patients with or without conjunctival oedema.The pressure of SVC was 20-45cmH2O before operation and the maximal pressure was 37-56cmH2O during operation for patients with clamping SVC. The maximal pressure during operation was 48-56cmH2O and 37-47cmH2O for patients with or without conjunctival edema, the difference was significant (P=0.000).No mortality or embolism of artificial vessel,but the stomal hemorrhage was found for one patients cured by reoperation. Thirtytwo patients was followed up for 4-130 months,the median survival time was 35 months. Conclusion No clamping of SVC or short time clamping with some operative skill can avoid the occurrence of cerebral edema. Selecting suitable length and roughness of the expanded polytetrafluoroethylene artificial vessel and continuous everted suture with suitable slide suture is important for avoiding the occurrence of embolism and the stomal hemorrhage.
ObjectiveTo compare clinical outcomes between modified and traditional Morrow procedures for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). MethodsForty-two HOCM patients undergoing surgical correction in Beijing Anzhen Hospital between January 2005 and July 2011 were recruited in this study. According to different surgical techniques, all the patients were divided into 2 groups. In traditional Morrow procedure group, there were 16 patients including 13 males and 3 females with their age of 49±15 years. In modified Morrow procedure group, there were 26 patients including 14 males and 12 females with their age of 40±18 years. Preoperative and postoperative echocardiography were performed to compare ventricular septal thickness (VST), left ventricular outflow tract velocity (LVOTV)and left ventricular outflow gradient (LVOG)between the 2 groups. ResultsVST, LVOTV and LVOG of HOCM patients were significantly reduced after both traditional and modified Morrow procedure. There was statistical difference in preoperative and postoperative VST (23.10±3.64 mm vs. 17.38±4.39 mm), LVOTV (433.08±101.68 mm/s vs. 248.46±101.88 mm/s)and LVOG (78.57±40.16 mm Hg vs. 4.29±21.52 mm Hg)in traditional Morrow procedure group (P < 0.05). There was statistical difference in preoperative and postoperative VST (25.04±47.05 mm vs. 18.38±6.55 mm, P < 0.05), LVOTV (414.83±83.33 mm/s vs. 159.72±60.84 mm/s, P < 0.05)and LVOG (77.94±29.16 mm Hg vs. 17.56±9.39 mm Hg, P < 0.05)in modified Morrow procedure group (P < 0.05). Preoperative and postoperative difference in LVOG of modified Morrow procedure group was more significant than that of traditional Morrow procedure group (74.25±27.91 mm Hg vs. 34.63±30.66 mm Hg, P < 0.05). ConclusionModified Morrow procedure is superior to traditional Morrow procedure in reducing postoperative LVOG for HOCM patients.
Objective To analyze pathologic features and surgical procedures for patients with unroofed coronary sinus syndrome (UCSS) associated with endocardial cushion defect (ECD). Methods The clinical data of 44 patients with UCSS and ECD from May 1998 to July 2016 were retrospectively reviewed. There were 18 males and 26 females with a mean age of 10.4±12.1 years (range: 5.0 months to 44.0 years) and mean weight of 25.2±20.9 kg (range 5.2-80.0 kg). According to the Kirklin and Barratt-Boyes classification, 28 patients were categorized into type Ⅰ, 5 typeⅡ , 4 type Ⅲ and 7 type Ⅳ. Among them 25 patients suffered partial ECD, 10 complete ECD, 9 transitional ECD, and 27 were associated with single atrium, 34 involved persistent left superior vena cava (PLSVC), and in 27 of the 34 patients PLSVC directly drained into the left atrium (LA). Among the 44 patients, 1 patient associated with complex anomalies underwent palliative operation, and other cardiac malformations were corrected simultaneously by surgical correction. PLSVC was ligated in 2 patients, and the intracardiac tunnels or baffles to drain PLSVC to right atrium (RA) were reconstructed in 25 patients. The associated cardiac lesions were corrected concomitantly. Results In-hospital death occurred in 2 patients, among whom 1 died of low cardiac output syndrome on postoperative day 8 and the other pulmonary infection on postoperative day 21. Thirty-one were followed up from 1 month to 10 years, and there was no death or severe complications. Conclusion When ECD is associated with PLSVC and a single atrium, UCSS may develop. Repair according to the type of UCSS is effective.
Objective To observe the effect of vitrectomy (PPV) combined with silicone oil filling on the stability of the tear film. Methods A total of 72 eyes of 36 patients with vitreous hemorrhage and retinal detachment were enrolled in the study with PPV combined with silicone oil filling. The operation and contralateral eyes were set up in the operation group and the control group respectively, each had 36 eyes. The tear film rupture time (BUT), the base tear secretion test or Schirmer Ⅰ test (SⅠT) and corneal fluorescein staining (CFS) were performed at 7, 30, 60, and 90 days after operation. The difference of BUT, SⅠT and CFS at different time points after the operation of the two groups were compared. Results After operation 7, 30 days, SⅠT and CFS increased, BUT staining is shortened in the surgery group, the differences were statistically significant (t=1.78, P＜0.05); after operation 60, 90 days, SⅠT, CFS, BUT were same between the surgery group and the contralateral eyes (t=12.39, P＞0.05). Conclusion PPV combined with silicone oil filling can affect the stability of the tear film, which can be recovered to the preoperative level at postoperative 60 days.
ObjectiveTo evaluate the advantages and disadvantages of parasternal minimally incision surgery over median sternotomy to treat atrial septal defect (ASD) patients. MethodsWe retrospectively analyzed the clinical data of 55 ASD patients received ASD closure under cardiopulmonary bypass (CPB) in Department of Cardiovascular Surgery, West China Hospital from November 2010 through March 2014. There were 16 males and 39 females with an average age of 25.8 (range, 9-56 years). All the patients were divided into two groups depending on different surgical approach:a median sternotomy group (a MS group, 15 patients)and a parasternal minimally incision group (a PMI group, 40 patients). There was no statistical difference in age, gender, weight, cardiac function classification (NYHA), and atrial septal defect diameter between the two groups (P>0.05). We analyzed the clinical data of the patients and followed up for 6 months. ResultsAfter operation, no death occurred in the two groups. One patient in the MS group prolonged hospitalization due to poor postoperative heart function. One patient in the PMI group prolonged hospitalization because of pulmonary infection. Patients in the PMI group had longer operation time (P=0.007) and cardiopulmonary bypass (CPB) time (P < 0.001), higher cost in hospital (P=0.040), less intraoperative blood loss, less postoperative drainage volume on the first day (both P < 0.001). There was no statistical difference in aortic clamp time (P=0.500) mean hospital stay (P=0.290) after operation between the two groups. To eliminate the interference of the learning curve, there was no statistical difference in operation time (P=0.275) and hospitalization cost (P=0.188) between the two groups. While there was a statistical difference in CPB time between the two groups (P=0.007). There was no remnant shunts or wound complications in the two groups at the end of following up for 6 months. More patients in the PMI group could engage in non-strenuous activities with a statistical difference (P < 0.001). ConclusionParasternal minimally incision in the treatment of atrial septal defect is safe, effective, minimally invasive, with easy operation and shorter learning curve. It can be used as an important part of minimally invasive treatment procedure of congenital heart disease.
Objective To explore the effect of Frey procedure on patients with chronic pancreatitis, and evaluate pain control as well as the quality of life (QOL) after Frey procedure. Methods The clinical data of 81 patients with chronic pancreatitis who underwent Frey procedure in West China Hospital of Sichuan University from January 2010 to January 2015 were retrospectively analyzed. Izbicki pain score and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30) were used to assess pain and QOL respectively. Results The mean value of operative time were (252±70) minutes (180-430 minutes), the mean value of blood loss were (220±142) mL (100-550 mL), and the mean value of hospital stay were (14.1±4.9) days (8-36 days). After Frey procedure, delayed gastric emptying occurred in 4 patients, hemorrhage occurred in 1 patient, wound infection or fat liquefaction occurred in 6 patients, abdominal infection and pyoperitoneum occurred in 4 patients, and pancreatic fistula occurred in 3 patients. All of the patients were followed up for 4-60 months, and the median time were 28 months. During the follow up period, 11 patients developed diabetes and 10 patients developed steatorrhea, respectively. In addition, the pain related score, including frequency of pain attacks, visual analogue scale of pain, analgetic medication, inability to work, and total pain score, were significantly reduced after Frey procedure (P＜0.001). Moreover, all the functional scales of EORTC -QLQ-C30, except for cognitive function, were improved postoperatively (P ＜0.001). Regarding to the symptom scales, the score of fatigue, pain, loss of appetite, and loss of body weight were significantly lower after surgery (P＜0.050). The scores of QOL after surgery were higher than before surgery (P＜0.001). Conclusion Frey procedure results in good post-operative pain control and significant improvement in qol.