ObjectiveTo analyze the effect of anal fistula clip (AFC) in the treatment of anal fistula, and to evaluate its safety. MethodsA historical cohort study method was conducted. Eighty-three patients with glandular transsphincteric anal fistula in the Xuzhou Central Hospital from September 2018 to May 2021 were collected, of which 42 patients underwent the AFC treatment (AFC group), 41 patients underwent the endorectal advancement flap (ERAF) treatment (ERAF group). The operation time, intraoperative blood loss, visual analogue scale (VAS) score of anus pain on postoperative day 1, 3, and 7, wound healing time, Wexner incontinence score of anal function on postoperative month 6, and clinical efficacy (healing and failure) were compared between the two groups. ResultsThe operation was successfully completed in both groups. The operation time and intraoperative blood loss in the AFC group were shorter or less than those in the ERAF group (P<0.05). No complications such as internal opening infection and bleeding occurred in the two groups. There were no statistical differences in the VAS score of postoperative anus pain at all time point between the two groups (P>0.05). The median follow-up time was 22 months. There was no statistical difference in the wound healing time between the two groups (P>0.05). The Wexner score of anal function in the AFC group was lower than that in the ERAF group (P<0.05), and there was no statistical difference between after operation and before operation (Z=–1.751, P=0.089) in the AFC group, while that in the ERAF group after operation was higher than before operation (Z=–1.859, P=0.014). The healing rate had no statistical difference between the AFC group and ERAF group (85.7% versus 77.5%, χ2=0.925, P=0.336). Conclusion From the results of this study, the AFC is safe and effective in treatment of anal fistula, with the advantages of relatively simple operation, less bleeding during operation, lighter postoperative pain, and good protection of anal function.
目的 探讨急性重症胰腺炎不同时期的治疗方式，观察治疗效果以及治疗前后的临床表现。 方法 回顾性分析2006年1月-2009年1月收治的34例急性重症胰腺炎患者的临床资料，患者给予内科规范化治疗，并对比治疗前、后的APACHEⅡ评分、主要的实验室检查指标以及CT检查表现。 结果 31例治愈，2例中途转外科治疗，1例死亡。所有患者治疗后APACHEⅡ评分较治疗前减小（Plt;0.01），治疗后血清淀粉酶和白细胞计数较治疗前明显降低（Plt;0.05），而治疗后短期内CT检查表现无明显变化。 结论 内科规范化治疗能有效地治疗急性重症胰腺炎，适当的肠内外营养和预防性使用抗生素可有效地减少急性重症胰腺炎并发症的发生。APACHE-Ⅱ评分可作为判断急性重症胰腺炎患者预后的指标。
Objective To compare perioperative results between transventricular and transatrialtransventricular approaches in repairing tetralogy of Fallot (TOF), and to improve the surgical results. Methods The data of 1 423 consecutive patients who underwent complete repair of TOF between January 1998 and December 2007 were reviewed. 736 patients were repaired by the transventricular approach,and 687 patients by the transatrialtransventricular approach. Results Patients repaired by transventricular approach decreased from 100% in 1998 to 65% in 2002, and by transatrialtransventricular approach increased from 35% in 2002 to 79% in 2007. Aortic clamping time, cardiopulmonary bypass (CPB) time,mechanical ventilation time,and intensive care unit (ICU) stay in patients repaired by transatrialtransventricular approach had less than those in patients repaired by transventricular approach. No difference in transvalve patch ratio.There was lower morbidity in patients repaired by transatrialtransventricular approach in one to two organ systems dysfunction than that in patients repaired by transventricular approach. No difference in three or more organ systems dysfunction between them. Rate of residual ventricular septal defect(VSD), right ventricule to mean pulmonary artery (MPA) pressure gradient, tricuspid regurgitation, pulmonary artery regurgitation and arrhythmia in patients repaired by transatrialtransventricular approach were less than those in patients repaired by transventricular approach. Reoperative rate and mortality in patients repaired by transatrialtransventricular approach were less than those in patients repaired by transventricular approach. Conclusion TOF repair by the transatrialtransventricular approach fits to the actual conditions in China.
Objective A meta-analysis was performed for a comparison of outcomes between surgery and balloon angioplasty (BA) for native coarctation of the aorta (NCA) in pediatric patients. Methods Electronic databases, including PubMed, EMbase, Medline, Cochrane Library, Weipu Data, Wanfang Data and CNKI were searched systematically for the literature aimed mainly at comparing the therapeutic effects for NCA administrated by surgery and BA. Corresponding data sets were extracted and two reviewers independently assessed the methodological quality. Results Ten studies meeting the inclusion criteria were included, involving a total of 723 subjects. It was observed that compared with BA, surgery was significantly associated with a lower incidence of recoarctation (OR, 0.43; 95%CI, 0.30–0.63; P<0.001), repeat intervention due to recoarctation (OR, 0.40; 95%CI, 0.27–0.61;P<0.001) and lower residual transcoarctation gradient in mid to long term follow up (WMD –0.85; 95%CI, –12.34 to –3.76;P<0.001). Compared with BA, surgery was significantly associated with a longer hospitalization time (WMD, 19.40; 95%CI, 15.82–22.99;P<0.001). Incidence of aneurysm formation (OR, 0.64; 95%CI, 0.26–1.57;P=0.33), complications(OR, 1.77; 95%CI, 0.95–3.28; P=0.07), perioperative mortality (OR, 2.57; 95%CI, 0.87–7.61, P=0.09) and immediate transcoarctation residual gradient (WMD –1.66; 95%CI, –4.23–0.90; P=0.2) were not statistically different between surgery and BA. Conclusions Compared with BA, surgery was significantly associated with a lower incidence of recoarctation, repeat intervention due to re-CoA and residual transcoarctation gradient in mid to long term follow up. On the contrary, BA was significantly associated with a shorter hospitalization time. Incidence of aneurysm formation, perioperative mortality, complications and immediate transcoarctation residual gradient were similar between surgery and BA.
ObjectiveTo investigate the value of proton magnetic resonance spectroscopy (1H-MRS), gradient dual-echo, and triple-echo sequences in the quantitative evaluation of treatment effect of fatty liver at 3.0T MR.MethodsThirty patients with fatty liver diagnosed by CT or ultrasound who admitted in Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital between August 2017 and May 2018, were enrolled and undergone gradient dual-echo, triple-echo, and 1H-MRS examination before and 3 months after treatment. The fat index (FI) and relative lipid content (RLC) were measured. Fatty liver index (FLI) was calculated from blood biochemical indicators, waist circumference, and BMI at the same time. With the reference standard of FLI, the results before and after treatment measured from MRI were analyzed.ResultsThere were significantly differences of FLI, FIdual, FItriple, and RLC before and after treatment (t=5.281, P<0.001; Z=–3.651, P<0.001; Z=–3.630, P<0.001; Z=–4.762, P<0.001), all indexes decreased after treatment. FIdual and FItriple were positively correlated with FLI before (rs=0.413, P=0.023; rs=0.396, P=0.030) and after treatment (rs=0.395, P=0.031; rs=0.519, P=0.003), the highest correlation factor was FItriple to FLI after treatment. There were no significant correlation between RLC and FLI before and after treatment (P>0.05).ConclusionsIt is feasible to quantitatively evaluate the treatment effect of fatty liver by using 1H-MRS, gradient dual-echo, and triple-echo sequences. Gradient triple-echo sequences has better accuracy, which is technically easy to implement and more suitable for clinical development.
Objective To observe the therapeutic effects of transpupillary thermal therapy (TTT) on exudative agerelated macular degeneration (AMD) accompanied with subfoveal choroidal neovascularization (CNV).Methods The clinical data of 44 eyes of 41 patients with exudative AMD diagnosed by fundus fluorescein angiography (FFA) who had undergone 810 nmdiode laser were retrospectively analyzed. In the 44 eyes of 41 patients, there were 26 eyes of 24 patients had occult CNV,12 eyes of 12 patients had classic CNV,and 5 eyes of 5 patients had small classic CNV. According to the focus sizes, the diameters of beam spot was 1.2-3.0 mm,the power of laser was 160-400 mW,and the duration was 60 s.The frequency of photocoagulation was once to thrice with the mean of 1.48.The followup duration was 3-24 months with the mean of 10.8 months.Visual acuity, haemorrhage in ocular fundus,absorption of exudation, and the closure of CNV were examined in the followup examination.Results A total of 42 eyes of 40 patients were examined at the last time in the followup duration,in which the visual acuity kept still or improved in 35 eyes of 33 patients (83.34%) and reduced in 7 eyes of 7 patients (16.67%). The results of OCT revealed that 1 and 3 months after the treatment and at the last time of followup duration, the decrease rate of exudative liquid at the macular area was 79.5%,86.4%,and 88.1%, respectively. Three months after the treatment,the macular volume decreased significantly than that before the treatment (P=0.01).The results of FFA demonstrated that at the last time in the folowup duration,the closure rate of occult CNV,classic CNV,and small classic CNV was 79.16%,46.15%,and 60%,respectively.The exudates increased in 6 eyes of 5 paitnets,including 5 eyes of 4 patients with classic CNV and 1 eye of 1 patient with small classic CNV.Conclusion TTT is effective for AMD accompanied with occult CNV,classic CNV, and small classic CNV.
Objective To evaluate the efficacy and safety of the silicone stent for treatment of three common benign central airway stenosis. Methods We retrospectively reviewed 40 patients with benign airway stenosis who were treated with a Dumon silicone stent at Affiliated Hospital of Guizhou Medical University between November 2019 to October 2023, including 14 cases of tracheobronchial tuberculosis (TBTB) stenosis, 14 cases of stenosis after tracheal intubation,and 12 cases of stenosis after tracheotomy. The clinical data and information on bronchoscopic interventional procedures and related complications were collected and analyzed, for evaluating the short-term efficacy, long-term efficacy and stent-related complications. Results The 40 patients were successfully implanted of silicone stents for 48 times totally. The mMRC score, KPS score, blood oxygen saturation and the diameter of the narrowest airway were significantly improved (P<0.05) after the implantation of silicone stents in all patients. Patients in TBTB group achieved inferior efficacy than those in the other two groups (P<0.05), while there was no significant therapeutic effect between tracheal intubation and tracheotomy groups (P>0.05). The main complications after the implantation of silicone stents were granulation hyperplasia, sputum retention and stent displacement. There were higher incidence rates of granulation hyperplasia and sputum retention in the TBTB group compared with the tracheal intubation and tracheotomy groups (P<0.05 ), while there was no statistically significant difference in incidence rates of granulation hyperplasia and sputum retention between the last two groups. Meanwhile, there was no significant difference in the proportion of stent displacement among the three groups.Conclusions The efficacy and safety were satisfied in the treatment of the three common benign central airway stenosis,with a recommendation for the treatment of refractory benign airway stenosis. However, the treatment effect of the TBTB group is inferior to that of the tracheal intubation and tracheotomy groups, with higher rates of obvious granulation hyperplasia and sputum retention simultaneously. More detailed follow-up management was recommended for TBTB patients implanted with silicone stents to avoid the development of stent-related minor complications into serious complications with a worse prognosis.
Objective To evaluate therapeutic effect of tile shape perineal stapled prolapse resection in treatment of rectal prolapse. Methods The clinical data of 31 patients with rectal prolapse underwent tile shape perineal stapled prolapse resection in the Renmin Hospital of Wuhan University from December 2013 to August 2015 were retrospectively analyzed. All the patients with rectal prolapse were performed the tile shape perineal stapled prolapse resection with general anesthesia and (or) epidural anesthesia. The prolapse was completely pulled out and then axially cut open with a linear stapler in the lithotomy position. Finally, the prolapse was resected stepwise with the curved stapler at the prolapse’s uptake. Results There were 8 males and 23 females in the 31 patients. The age was (65.8±3.2) years old. There were 14 patients with Ⅱ degree and 17 patients with Ⅲ degree prolapses. The median course was 5.8 years. The 31 patients were followed up for 0.5–7.0 months. Of 31 cases, the 24 cases were cured and 7 cases were better. It was found out that there was a significant difference between the number of axially cut open with a linear stapler and the weight of specimen (P<0.05). And there was a significant difference between the number of axially cut open with a linear stapler and the recurrence (P<0.05) too. When the number of axially cut open with a linear stapler were 4 for Ⅱ degree and 3 for Ⅲ degree, the treatment had been proved to be the highest efficacy. Conclusions Preliminary results of limited cases in this study show that tile shape perineal stapled prolapse resection is safe and effective in treatment of rectal prolapsed. Key of operation is that prolapse is completely pulled out and then axially cut open with a linear stapler at some o’clock for 2–4 points and rectal valves are formed. Prolapsed is resected stepwise with curved stapler at prolapse’s uptake. When number of axially cut open with a linear stapler are 4 for Ⅱ degree and 3 for Ⅲ degree, it could achieve the best therapeutic effect.
ObjectiveTo evaluate the surgical outcomes of 25G+ vitrectomy with air tamponade and 1-day prone positioning for idiopathic macular hole (IMH).MethodsA prospective analysis was performed on 39 patients (39 eyes) underwent 25G+ pars plana vitrectomy (PPV) combined with the internal limiting membrane (ILM) removal and fluid-air exchange for IMH from July 2012 to December 2013. After vitrectomy, patients were instructed to keep prone positioning for only 1 day (the air group). These patients were compared to 30 consecutive patients from July 2010 to July 2012, who were conducted 25G+ PPV with 25% SF6 tamponade. They remained in the same face-down position for 3 days postoperatively (SF6 group). Age, gender, logMAR BCVA, macular thickness, macular hole diameter, axial length, macular hole stages and pseudophakic status were collected as baseline characteristics in both groups. The initial hole-closure rate, visual outcome and intra-operative & post-operative complications were evaluated for 6 months. Group comparisons of numeric variables were made by using two sample t -test. Group difference of categorical variables was determined by using standard chi-square test or rank sum test.ResultsThirty nine patients (39 eyes) and 30 patients (30 eyes) were respectively enrolled in air group and SF6 group. The distribution of age (t=－1.63), gender (χ2=0.03), logMAR BCVA (t=0.39), macular thickness (t=－0.93), macular hole diameter (t=－0.70), axial length (t=－0.56), macular hole stages (Z=－0.47) and pseudophakic status (χ2=0.13) was similar in both groups. Anatomical closure of macular holes was achieved in 35 (89.7%) of the 39 eyes in the air group and in 27 eyes (90.0%) in the SF6 group. There was no significant difference of closure rate between the two groups (χ2=0.001, P=0.970). The postoperative visual acuity of gaining, stability and decreasing 2 or more 2 lines was achieved in 23 eyes,10 eyes and 6 eyes in air group and 18 eyes, 6 eyes and 6 eyes in SF6 group. The proportion of visual acuity improvement in air group was lower than that in SF6 group without the statistical significance (Z=－0.08, P=0.93). The gas bubble was absorbed sooner in the air group (mean 8.54±1.74 days) than in the SF6 group (mean 31.10±3.20 days). No retinal break, retinal detachment or endophthalmitis occurred in either group. Postoperatively intraocular pressure was elevated temporarily in 2 eyes of the air group and 3 eyes in the SF6 group. All returned to normal limit after local medication.ConclusionCompared to SF6 group, air group has similar anatomical macular hole closure rate and visual acuity rehabilitation.
目的 总结 14 例原位心脏移植的治疗经验。 方法 回顾性分析 2006 年 1 月至 2015 年 9 月我院行原位心脏移植术终末期心脏病患者的临床资料，其中男 11 例、女 3 例，年龄 22～62（46.7±10.1）岁。4 例使用抗 Tac 单克隆抗体诱导治疗，10 例使用巴利昔单克隆抗体诱导治疗。采用 4℃ 组氨酸-色氨酸-酮戊二酸（HTK）液保护供心。2 例采用经典式原位心脏移植，12 例采用双腔静脉法行心脏移植。术后采用环孢素或他克莫司+吗替麦考酚酯+激素三联抗排斥方案。 结果 术后早期 1 例因多器官功能衰竭合并严重感染死亡。早期并发症有：败血症 1 例，硬膜外血肿 1 例，急性肾功能不全 1 例，移植物右心功能不全 2 例，低心排血量并需要体外膜肺氧合支持 1 例。术后长期随访：截至 2016 年 6 月，2 例失访，1 例于术后 30 个月因自行停服抗排斥药物死于急性排斥，1 例于术后 36 个月死于肺癌。余 9 例存活 9～121 个月，生活质量良好。 结论 心脏移植是治疗终末期心脏病的有效方法，熟练的手术技巧、合理的免疫抑制治疗，围术期管理经验、密切监测和治疗感染和排斥及患者依从性均影响着心脏移植的效果。