Objective To summarize the visual outcome of patients with severe ocular trauma treated with vitreous surgery. Methods Clinical data of 188(191 eyes) with severe ocular trauma treated with vitreous surgery in a period from November 1996 to April 1998 were analysed retrospectively. Results The study included penetrating injury in 56 eyes, foreign bodies in the posterior segment in 70 eyes, blunt injury in 41 eyes , and globe rupture in 24 eyes. Main complications included endophthalmitis in 35 eyes, choroidal bleeding in 20 eyes, retinal detachment in 60 eyes, and vitreous hemorrhage in 97 eyes. Post-opera-tively, out of 188 eyes, except for 3 of patients too young to examine, visual acuity improved in 133(70.7%), including 85(45.2%) with visal acuity 0.02-1.0, 46(24.5%) remained unchanged; and 9(4.8%) had worse vision. Among 34 with no-light-perception, 12 had light-perception or over. Conclusion A majority of severe trauma eyes can be salvaged with considerable visual recovery after adequate and timely vitreous surgery. (Chin J Ocul Fundus Dis,1999,15:4-6)
目的 探讨胰头癌侵犯肠系膜上动脉时行根治性切除的可行性。方法 采用联合将受侵犯的肠系膜上动脉一并切除的胰十二指肠切除术，肠系膜上动脉断端与腹主动脉端侧吻合方式重建。 结果 患者术后恢复顺利，已随访14个月，仍存活。 结论 肠系膜上动脉侵犯的胰头癌仍可行扩大的胰十二指肠切除术，并可延长患者的生存时间和提高生活质量。
目的 了解单纯胆囊切除术患者围手术期抗菌药物的使用情况及合理性，促进临床合理用药。 方法 对昆明医学院第二附属医院2004年7～9月期间出院的661例单纯胆囊切除术患者应用抗菌药物的合理性进行回顾性分析。结果 胆囊切除患者抗菌药物应用共涉及9大类39个品种，使用率为100%。预防用药380例（57.49%），其中单用38例(10.00%)，平均用药6.55 d，平均住院时间10.79 d； 两联281例(73.95%)，平均用药6.49 d，平均住院时间12.30 d； 三联57例(15.00%)，平均用药6.52 d，平均住院时间11.75 d； 四联4例(1.05%)，平均用药6.75 d，平均住院时间9.00 d。感染治疗281例(42.51%)，其中单用10例(3.56%)，平均用药9.60 d，平均住院时间15.10 d； 两联206例(73.31%)，平均用药11.25 d，平均住院时间15.79 d； 三联56例(19.93%)，平均用药15.23 d，平均住院时间15.23 d； 四联9例(3.20%)，平均用药13.00 d，平均住院时间21.78 d。结论 单纯胆囊切除术患者抗菌药物使用存在一些不合理现象，应按围手术期给药方案进行。加强抗菌药物使用的管理和监督，不仅减少耐药菌株及不良反应的产生，而且对降低医药费用具有积极的意义。
目的 介绍保留十二指肠乳头的胰十二指肠切除术。 方法 对2例重型十二指肠合并胰腺损伤患者行保留十二指肠乳头的胰十二指肠切除术。结果 无手术死亡,术后无胰瘘等严重并发症,均痊愈出院。结论 对胆总管完整、十二指肠乳头尚存的重型胰十二指肠损伤患者，急诊手术行保留十二指肠乳头的胰十二指肠切除是值得考虑和应用的安全手术方法。
Thirty patients with heperthyroidism were investigated for triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), thyromicrosome antibody (TMA), thyroglobulin antibody (TGA) and hydrocortisone before and after operation. The levels of serum T3, T4, TGA, TMA were markedly decreased after operation, and the level of hydrocortisone farther decreased from the preoperative low level. But only a little decrease in TSH level was found as compared with that before operation. The assay of these hormones and antibodies has very important clinical significance for judgement of the effect of operation and prevention of crisis of hyperthyroidism.
ObjectiveTo investigate the risk factors affecting the occurrence of infectious complications after radical gastrectomy for gastric cancer, and to establish a risk prediction Nomogram model. MethodsThe clinicopathologic data of 429 primary gastric cancer patients who underwent radical resection for gastric cancer at the Second Department of General Surgery of Shaanxi Provincial People’s Hospital between January 2018 and December 2020 were retrospectively collected to explore the influencing factors of infectious complications using multivariate logistic regression analyses, and to construct a prediction model based on the results of the multivariate analysis, and then to further validate the differentiation, consistency, and clinical utility of the model. ResultsOf the 429 patients, infectious complications occurred in 86 cases (20.05%), including 53 cases (12.35%) of pulmonary infections, 16 cases (3.73%) of abdominal infections, 7 cases (1.63%) of incision infections, and 10 cases (2.33%) of urinary tract infections. The results of multivariate logistic analysis showed that low prognostic nutritional index [OR=0.951, 95%CI (0.905, 0.999), P=0.044], long surgery time [OR=1.274, 95%CI (1.069, 1.518), P=0.007], American Society of Anesthesiologists physical status classification (ASA) grade Ⅲ–Ⅳ [OR=9.607, 95%CI (4.484, 20.584), P＜0.001] and alcohol use [OR=3.116, 95%CI (1.696, 5.726), P＜0.001] were independent risk factors for the occurrence of infectious complications, and a Nomogram model was established based on these factors, with an area under the ROC of 0.802 [95%CI (0.746, 0.858)]; the calibration curves showed that the probability of occurrence of infectious complications after radical gastrectomy predicted by the Nomogram was in good agreement with the actual results; the decision curve analysis showed that the Nomogram model could obtain clinical benefits in a wide range of thresholds and had good practicality.ConclusionsClinicians need to pay attention to the perioperative management of gastric cancer patients, fully assess the patients’ own conditions through the prediction model established by prognostic nutritional index, surgery time, ASA grade and alcohol use, and take targeted interventions for the patients with higher risks, in order to reduce the risk of postoperative infectious complications.
Objective To analyze the risk factors associated with prolonged length of hospital stay (PLOS) after lobectomy for lung cancer patients. Methods The clinical records of 771 lung cancer patients undergoing lobectomy between May 2012 and June 2016 in the Second Affiliated Hospital of Harbin Medical University were retrospectively analyzed. According to different length of hospital stay (LOS), 771 patients were divided into two groups, a normal LOS group and a PLOS group. In the normal LOS group, there were 551 patients including 234 females and 317 males with a median age of 59 years, whose LOS was shorter than 8.0 days. In the PLOS group, there were 220 patients including 72 females and 148 males with a median age of 60 years, whose LOS was no less than 8.0 days. Then, we analyzed the independent risk factors of PLOS by multivariate logistic regression analysis. Results Univariate analysis showed that risk factors for PLOS included male, arrhythmias and atrioventricular block, smaller FVC%, unilateral pneumonectomy, operation and anesthesia duration, intraoperative blood loss and number of lymph node dissection in the operation (P<0.05). Multivariate logistic regression analysis showed that the age ≥75 years (OR=4.100, 95%CI 1.677 to 10.026), unilateral pneumonectomy (OR=2.563, 95%CI 1.473 to 4.460), FVC% < 89.05% (OR=1.500, 95%CI 1.020 to 2.206), numbers of lymph node dissection≥ 13.5 (OR=1.826, 95%CI 1.262 to 2.642), operation duration≥126.5 min (OR=1.858, 95%CI 1.200 to 2.876) and arrhythmia (OR=2.944, 95%CI 1.380 to 6.284) were independent risk factors of PLOS (all P<0.05). Conclusion LOS is influenced by age, surgical type, FVC%, numbers of lymph node dissection, arrhythmia and operation duration. Careful assessment and appropriate management of risk factors are helpful to improve postoperative recovery after lobectomy for lung cancer patients.
目的 探讨如何预防腹腔镜胆囊切除术(LC)中的胆管损伤。方法 回顾性分析2006年1月至2008年12月期间在我院行LC的657例患者的临床资料，总结预防胆管损伤的经验。结果 651例患者完成LC，中转开腹手术6例(0.91%)，其中1例(0.15%)因Calot三角致密粘连误伤胆总管。术后胆囊床毛细胆管渗漏2例，每日经腹腔引流管引出胆汁性液体20～50 ml，7～10 d 治愈出院。术后578例（包括中转开腹6例）患者获随访,随访率为87.98%，随访时间为2～24个月, 平均14个月。23例患者剑突下隐痛, 4个月内均自行消失，其余患者均未发现并发症。结论 严格掌握手术适应证、正确仔细地处理Calot三角和适时中转开腹是预防LC术中胆管损伤的关键。
Abstract:Five eyes of acute retinal necrosis(ARN)with multiple retinal breaks and retinal detachment were treated by closed vetrectomy combined with encircling buckle,gas/fluid exchange,nolaser and cryotherapy.After operation,the detached retinas reattached in 4eyes,and among them th visual acuity was 0.2 in 1 eye,and better than 0.05 in 3 eyes.The follow-up duration in 5 eyes was from 6 to18 months and recurrent retinal detachment was found in one eys. （Chin J Ocul Fundus Dis,1996,12: 20-21)