Visual evoked potential (VEP) is a commonly used technique in neurology and ophthalmology in the process of disease diagnosis and treatment, which refers to the electrical signal transmitted by the visual pathway and recorded in the skull or cortex after stimulating the retina. The effect of monitoring and protection of vision in surgery near the visual pathway has attracted more and more attention recently. This article summarizes the experience and problems of intraoperative monitoring of VEP in terms of anesthesiology and instrument development, monitoring technology, and application innovation, and proposes future research directions. The purpose is to provide a reference for clinical application and research of intraoperative VEP monitoring.
目的 探讨纤维胆道镜在胆道探查术中及术后的应用价值。方法 对113例在胆道探查术中及术后应用纤维胆道镜治疗患者的疗效进行回顾性分析。结果 23例胆总管扩张合并黄疸且术前未见结石的患者，其中19例术中胆道镜发现结石并于术中取净结石，2例炎性狭窄，1例胆管癌，1例未见异常。58例胆总管结石患者术中胆道镜取净结石。32例肝内、外胆管结石患者术中胆道镜取净结石21例; 2例胆道镜发现结石集中于肝左外叶合并肝内胆管狭窄, 行肝左外叶切除; 其余9例患者的结石术中未取净，于术后6～8周再经胆道镜T管窦道取净结石。113例患者术后均无严重并发症发生。术后获随访98例（86.7%），随访时间6～24个月，平均14个月，2例复发，其余96例未见结石复发。结论术中应用纤维胆道镜可明确胆管内病变，降低胆管残余结石的发生率; 术后经T管窦道取石是治疗胆管残余结石的有效方法，可避免再次手术的痛苦。
Objective To determine the independent influencing factors of intraoperative choking during painless gastrointestinal endoscopy (PGIE) after coronavirus disease 2019 (COVID-19). Methods The data of patients undergoing PGIE with COVID-19 in Northern Jiangsu People’s Hospital between December 2022 and April 2023 were retrospectively collected. Multiple logistic regression analysis was used to screen the influencing factors of intraoperative coughing events that occurred during the diagnosis and treatment process. Results A total of 948 patients were included, with 93 (9.8%) cases of choking. The results of the multiple logistic regression analysis showed that smoking and unresolved cough were independent risk factors for coughing (P<0.05), while colonoscopy and infection duration beyond 14 days between diagnosis and treatment were independent protective factors for coughing (P<0.05). ConclusionsWhen patients with COVID-19 undergoing PGIE, special attention should be paid to high-risk groups such as smoking and unresolved cough. It is necessary to strengthen intraoperative monitoring and implementation of prevention and control measures to reduce the incidence of coughing and improve the safety of diagnosis and treatment for patients.
目的 总结术中胆道造影的应用体会。方法 回顾性分析甘肃省中医院2000年5月至2007年12月期间进行术中胆道造影151例患者的临床资料。结果 所有患者术中胆道造影均顺利完成。经胆囊管造影成功者75例，其中有65例将软管直接置入胆囊管中造影，有10例经钢针穿刺胆囊管造影； 有4例直接穿刺胆总管造影； 经T管造影者72例，均直接从T管内注入造影剂。本组151例手术患者均1次完成手术，没有残余结石或术后胆管损伤的发生。结论 术中胆道造影可避免残余结石及胆管损伤的发生。
【摘要】目的探讨早期乳腺癌保乳术中电子线放射治疗(intraoperative radiotherapy with electron,ELIOT)的可行性,评价术后并发症和术后乳房外观。方法2007年6月2009年6月期间,共有26例早期乳腺癌(肿瘤直径不超过25 cm)患者接受乳腺癌保乳手术及ELIOT,放疗剂量为21 Gy(分割照射58～60 Gy)。术后1年内第1、2、3个月,第6、9、12个月,1年后每6个月评估一次,主要评估切口愈合状况、并发症、乳房外观及肿瘤复发情况。结果术后切口愈合时间14～22 d,平均17 d。随访2～25个月,平均12个月,有2例切口脂肪液化,11例切口水肿伴引流液较多,全组无切口感染或血肿。随访期间内,未发现局部复发、远处转移或对侧乳腺癌。手术切口愈合后、术后6个月,1、2年对乳房外观评价结果:优秀者分别依次为577%、667%、727%及100%;好者分别依次为346%、222%、182%及0;一般者分别依次为77%、111%、91%及0。结论乳腺癌保乳术后行ELIOT 疗效确切、安全,对早期乳腺癌患者是一种方法简便,疗效确切、安全的选择。
Objective To summarize application effect and clinical experience of multimodal intraoperative neurophysiological monitoring (IONM) technology in the surgery of neurofibromatosis type 1 (NF1) related peripheral nerve tumors. Methods A retrospective study was conducted on NF1 patients, who admitted between January 2019 and December 2023 and treated with peripheral nerve tumor resection surgery assisted by multimodal IONM technology. There were 49 males and 45 females. The age ranged from 5 to 78 years, with an average of 33.7 years. Tumor morphological classification included 71 cases of nodular type, 13 cases of diffuse type, and 10 cases of mixed type. Target tumors were distributed in craniofacial region (47 cases), neck (11 cases), trunk (12 cases), and limbs (24 cases). Preoperatively, 44 cases had no obvious neurological symptoms, while the remaining patients had neurological symptoms, including 15 cases of visual impairment, 5 cases of hearing impairment, 16 cases of somatic movement disorders, and 31 cases of somatic sensory disorders, of which 7 cases had more than one symptom. IONM plans were selected based on the relevant nerves and adjacent important structures of the target tumor, including visual evoked potential (17 cases), somatosensory evoked potential (44 cases), motor evoked potential (88 cases), and electromyogram (94 cases).Results All surgeries were successfully completed. Ninety-three patients underwent total/near total resection and 1 patient underwent palliative resection. Pathological examination showed 80 cases of neurofibroma and 14 cases of malignant peripheral nerve sheath tumors. Complications included 2 cases of hematoma and 3 cases of incision infection. All patients were followed up 3-61 months (median, 15 months). During follow-up, no significant changes in neurological symptoms or tumor recurrence were found. Among the patients with preoperative visual impairment, there were 14 cases with no improvement in symptoms and 1 with improvement after surgery. Among the patients with somatic movement disorders, there were 11 cases with no improvement in symptoms, 3 cases with improvement, 2 cases with aggravation, 4 newly onset cases, and 1 case with significant impact on daily life after surgery. Among the patients with somatic sensory disorders, there were 17 cases with no improvement in symptoms, 14 cases with improvement, and 13 newly onset cases. The patients with hearing impairment showed improvement after surgery. Conclusion The clinical manifestations of NF1 related peripheral nerve tumors are complex. Multimodal IONM technology can provide real-time detection of nerve provocation and damage. Surgical treatment with multimodal IONM technology is safe and can reduce complications.
目的 分析颅内动脉瘤弹簧圈栓塞治疗术中出血的原因和防治对策。 方法 回顾性分析2003年3月－2012年8月358例颅内动脉瘤采用弹簧圈栓塞治疗患者，7例弹簧圈栓塞过程中出血，并继续栓塞止血。2例为弹簧圈栓塞中造影仅见血流明显变慢，术后CT证实的出血。术后对症治疗6例，开颅引流减压3例。 结果 9例术中破裂者中8例致密栓塞，1例部分栓塞。5例恢复好，1例一过性动眼神经麻痹，3例死于颅内高压 结论 术中出血与手中操作、动脉瘤形态和患者血管条件、血压变化有关，继续填塞及合理术中与后续治疗可以挽救大部分患者生命。
Objective To evaluate the effect of intraoperative fluid infusion volume on postoperative pulmonary complications (PPCs) in patients after minimally invasive endoscopic esophageal carcinoma resection. Methods From June 2019 to August 2021, 486 patients undergoing elective minimally invasive endoscopic esophagectomy for esophageal cancer were retrospectively screened from the electronic medical record information management system and anesthesia surgery clinical information system of West China Hospital of Sichuan University. There were 381 males and 105 females, with a median age of 64.0 years. Taking the incidence of pulmonary complications within 7 days after operation as the primary outcome, the correlation between intraoperative fluid infusion volume and the occurrence of PPCs within 7 days was clearly analyzed by regression analysis. ResultsThe incidence of pulmonary complications within 7 days after surgery was 33.5% (163/486). Regression analysis showed that intraoperative fluid infusion volume was correlated with the occurrence of PPCs [adjusted OR=1.089, 95%CI (1.012, 1.172), P=0.023], especially pulmonary infection [adjusted OR=1.093, 95%CI (1.014, 1.178), P=0.020], and pleural effusion [adjusted OR=1.147, 95%CI (1.007, 1.306), P=0.039]. Pulmonary infection was significantly less in the low intraoperative fluid infusion group [<6.49 mL/(kg·h), n=115] compared with the high intraoperative fluid infusion group [≥6.49 mL/(kg·h), n=371] (18.3% vs. 34.5%, P=0.023). Intraoperative fluid infusion volume was positively associated with death within 30 days after surgery [adjusted OR=1.442, 95%CI (1.056, 1.968), P=0.021]. Conclusion Among patients undergoing elective minimally invasive endoscopic esophageal cancer resection, intraoperative fluid infusion volume is related with the occurrence of PPCs within 7 days after the surgery, especially pulmonary infection and pleural effusion, and may affect death within 30 days after the surgery.
目的:评估宫腔内水囊压迫治疗剖宫产术中大出血的可行性。方法:选择2005年2月至2009年3月北戴河医院及秦皇岛市妇幼保健院行子宫下段剖宫产,术中发生大出血病例106例,,常规方法处理无效后,应用宫腔内水囊压迫止血。结果:106例患者在12小时后取出水囊,阴道流血量明显减少,均无再次大出血发生。止血效率100%。结论:宫腔内水囊压迫治疗剖宫产术中大出血效果佳、操作简便、止血迅速,留置时间短、可作为治疗剖宫产术中大出血的一种简便、可行、有效的止血方法。
Transit time flow measurement (TTFM),which is independent of vessel size and shape, has been considered to be an easy, reproducible and non-invasive method to assess the hemodynamic characteristics. Moreover, current studies have shown that TTFM has clinical application in identifying the function of grafted vessel and prognosis. Researchers have proved some reliable indicators for the function of grafted vessel as follows: mean graft flow (MGF) > 15 ml/min, diastolic flow (DF) >50% and pulsatility index (PI)<3 or 5. This article focuses on the review of clinical application and research progress of TTFM in CABG.