目的 讨论甲状腺患者围手术期护理措施及经验。 方法 对2004年6月－2012年12月收治的171例甲状腺手术患者的围手术期护理方法进行回顾性分析，并就护理要点进行经验总结。 结果 171例甲状腺手术患者均获治愈。术后并发症发生率1.8%～9.9%，包括切口内出血16例（9.9%），甲状腺机能减退11例（6.4%），单侧喉返神经损伤5例（2.9%），术后呼吸困难和窒息4例（2.3%），甲状腺危象4例（2.3%），喉上神经损伤3例（1.8%）。经及时对症处理，并发症得到有效控制，预后良好。 结论 术前细致的准备、术中积极的配合、术后密切观察并及早发现并发症、恰当处置，同时强化对患者的健康教育，对提高甲状腺围手术期护理质量与改善患者预后具有重要意义。
ObjectiveTo investigate the clinical effect and the incidence of postoperative complications of Milligan-Morgan hemorrhoids combined with reducing tension of alary incision in the treatment of annular mixed hemorrhoids.MethodsProspectively collected 120 patients with annular mixed hemorrhoids who received treatment from the Department of Colorectal Surgery of Bazhong Hospital of Traditional Chinese Medicinel during the April, 2016 to October, 2018. All of the 120 patients with annular mixed hemorrhoids were randomly divided into the experimental group and the control group, with 60 patients in each one group. Patients in the experimental group was treated with Milligan-Morgan hemorrhoids combined with reducing tension of alary incision, while patients in the control group with conventional Milligan-Morgan hemorrhoid.ResultsIn the experimental group, 49 cases were cured, 11 cases showed obvious effect; in the control group, 39 cases were cured, 20 cases showed obvious effect, and 1 case was effective. The curative effect in experimental groups was better than that of the control group (Z=–2.090, P=0.037), and the effective rates of these two group were both 100% in total. The mean healing time was (19±3) d (14–21 d) in the experimental group and (21±3) d (14–24 d) in the control group, respectively, which was better in the experimental group (Z=–13.636, P<0.001). Experimental group with lower score of wound pain, hemafecia, and anal margin edema, which were much better than control group on 1 d and 3 d after operation (P<0.05). There was no statistically significant differences on incidence of uroschesis and recurrence rate between the two groups (P>0.05).ConclusionsMilligan-Morgan hemorrhoids combined with reducing tension of alary incision in the treatment of annular mixed hemorrhoids has good clinical effect and deserves clinical application.
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.
Objective To explore the operative safety of HIV-infected patients with colorectal cancer in different degrees of immunodeficiency. Methods A total of 56 patients, including 26 cases of HIV positive (HIV-positive group) and 28 cases of HIV negative (HIV-negative group), who underwent radical operation for colorectal cancer between January 2012 and December 2015, were enrolled in our study. We divided HIV-positive patients into three groups according to CD4+ T cells count in peripheral venous blood before 1 day (D0) of the surgery (HIV-positive Ⅰgroup with CD4+ T cells count >500/μL, HIV-positive Ⅱgroup with CD 4+ T cells count among 200–500/μL, and HIV-positive Ⅲ group with CD4+ T cells count <200/μL). Non-infective patients were enrolled in HIV-negative group. Leukocyte count, neutrophil percentage, lymphocyte percentage, CD 4+ T cells subsets count, and CD8+ T cells subsets count of the 4 groups in different time points were tested. In addition, we compared postoperative complications, carcinoembryonic antigen (CEA), and postoperative survival rate between the HIV-positive group and the HIV-negative group. Results In 56 cases, there were 26 cases of HIV-positive patients (including 10 cases of HIV-positive Ⅰ group, 8 cases of HIV-positive Ⅱ group and 10 cases of HIV-positive Ⅲ group). Variance results about repeated measurement data showed that, variation of leukocyte count, neutrophil percentage, lymphocyte percentage, and CD8+ T cells count among 4 groups after surgery had no statistical significance (P>0.05), in addition there was no significant on time effect and interactive effect of time and group (P>0.05). CD4+ T cells count in the 4 groups showed a trend from decline to rising with time going, and the time effect had statistical significance (P<0.05). The speed and amplitude of decline and recovery of CD4+ T cells count were different among groups, and the group effect had statistical significance (P<0.05). CEA showed a trend of decline after surgery in both HIV-positive group and HIV-negative group, and the time effect had statistical significance (P<0.05), but the group effect and interactive effect of time and group had no statistical significance (P>0.05). No statistically significant differences in amount of blood loss, duration of surgery, postoperative stay, nor complication rate (including incision infection, pulmonary infection, and opportunistic infections after surgery) were found between the HIV-positive group and the HIV-negative group (P>0.05). The overall survival situation of the HIV-positive group and the HIV-negative group had no statistical significance (P>0.05). Conclusions Radical operation for HIV-infected patients with colorectal cancer has an impact of " first inhibition and recovery” on cellular immunity over a period of time. Incidence of postoperative complications and survival rates are similar in HIV-positive patients and HIV-negative patients. In a word, it’s safe to have radical operation for colorectal cancer in HIV-positive patients under the proper perioperative treatment.
ObjectiveTo investigate the occurrence and treatment of postoperative complications after laparoscopic laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD) or pancreaticoduodenectomy (LPD). MethodThe clinical data of 130 patients undergoing LPD from October 2010 to December 2015 in West China Hospital of Sichuan University were analyzed retrospectively. ResultsOf 130 patients, postoperative complications occurred in 55 cases, including 24 cases of pancreatic fistula, 14 cases of gastric emptying disorder, 3 cases of anastomotic bleeding, 6 cases of peritoneal infection, 1 case of bile leakage, 1 case of venous thrombosis, 1 case of chylous leakage, 5 cases of peritoneal effusion, without the occurrence of stress ulcer and incision complications. There were significant difference in the incidence of pancreatic fistula (P=0.025), gastric emptying disorder (P=0.034), anastomotic bleeding (P=0.020), and peritoneal infection (P=0.016) among prophase group, metaphase group, and the later stage group. ConclusionsThe most common complication after LPD is pancreatic fistula. With the improvement of surgical techniques and procedures, incidences of some postoperative complications decreases gradually.