ObjectiveTo determine the influence of high BMI on postoperative complications in a cohort of squamous esophageal cancer patients. MethodsWe retrospectively analyzed the clinical data of 450 consecutive esophageal cancer patients who underwent esophagectomy in our hospital from September 2010 through November 2012 year. The patients were divided into three groups. Forty-five patients were classified as a low BMI group (BMI < 18.5 kg/m2), 304 patients were classified as a normal BMI group (18.5≤BMI < 25.0 kg/m2), and 101 patients as a high BMI group (BMI≥25.0 kg/m2). Patients' demographics, tumor characteristics, and postoperative complications were compared among the three groups. ResultsThe comorbidity of diabetes was higher in the high BMI group compared with the other two groups (P=0.025). Longer operative time, wound infection or delayed healing were more frequent in the high BMI group (P=0.010 and P=0.039, respectively). Pneumonia and length of hospital stay had a tendency to increase in the high BMI group (P=0.052 and P=0.081, respectively). However, the differences did not reach statistical significance. There was no statistical difference in pulmonary embolism, respiratory failure, anastomotic leakage, vocal code paresis, chylothorax, other organ damage, reoperation, arrhythmia, or in-hospital mortality among the three groups. ConclusionsHigh BMI has a negative impact on postoperative morbidity after esophagectomy. However, overweight is not a postoperative complications which should always be paid attention to.
Objective To evaluate the characteristics and reasons of complications in the patients with thoracoscopic esophagectomy. Methods We retrospectively analyzed the clinical data of 165 patients with thoracoscopic esophagectomy in our hospital from January 2013 through January 2015. There were 102 males and 63 females at average age of 67.9±8.3 years. Results The operation time was 275.3±50.2 min. The intraoperative blood loss was 230.0±110.5 ml. The number of lymph node dissection was 18.1±6.5. The volume of drainage in thoracic cavity was 750±550 ml on the third day after operation. Thoracoscopic esophagectomy surgeries were successful except that 13 patients (7.8%) converted to open operation including 6 patients (4.2%) with severe pleural adhesion, 2 patients (1.2%) with hemorrhage, 2 patients (1.2%) with arrhythmia, and 3 patients (1.8%) with abnormal oxygenation. There were 17 patients (10.8%) were with intraoperative complications including 2 patients (1.2%) with arrhythmia, 3 patients (1.8%) with abnormal oxygenation, 7 patients (4.2%) with hemorrhage caused by vascular injury, 4 patients (2.4%) with thoracic duct injury, 1 patient (0.6%) with recurrent laryngeal nerve injury. Moreover, 46 patients (27.8%) experienced postoperative complications including 23 patients (13.9%) with pulmonary infection, 6 patients (3.6%) with hoarseness, 4 patients (2.4%) with anastomotic leakage, 3 patients (1.8%) with incision infection, 2 patients (1.2%) with tracheoesophageal fistula, and 2 patients (1.2%) with pneumothorax. Unexpectedly, five patients underwent re-operation due to chylothorax (n=3, 1.8%) and hemorrhage (n=2, 1.2%). One patient (0.06%) died of acute pulmonary embolism. Conclusion Serious adhesion in abdominal cavity, abnormal of lung and heart. And bleeding are the main reasons caused transferring open thoracic surgery operation in patients with thoracoscopic esophagectomy. Lung infection, hoarseness, and anastomotic leakage of neck are the most common postoperative complications. And acute pulmonary embolism is the main cause of postoperative death. Proper precautions to decrease the morbidity of complication are necessary.
Objective To evaluate the diagnostic value and safety of surgical lung biopsies ( SLB)in patients with interstitial lung disease ( ILD) . Methods A retrospective analysis was performed on patients undergoing SLB, who were obtained from Chinese literatures through searching PubMed, CBM,Wanfang database, VIP information and CHKD from 2000 to 2010. The data from Affiliated Drum Tower Hospital, Nanjing University Medical College from2000 to 2010 was also reviewed. Results A total of 398cases underwent SLB, including open lung biopsy ( OLB) in 221 cases and video-assisted thoracoscopic lung biopsy ( VATLB) in 177 cases. SLB yielded a specific diagnosis for 386 cases. The total postoperative complication rate was 12. 1% and mortality rate was 2. 0% . The diagnostic yield, post-operative complication rate, and mortality rate between VATLB and OLB had no significant difference. Conclusion SLB is a useful and relatively safe procedure for diagnosis of ILD.
Objective To investigate the risk factors and preventions of functional delayed gastric emptying (FDGE) after pylorus-preserving pancreatoduodenectomy (PPPD). Methods The clinical data of 41 patients after undergoing PPPD between 2003 and 2009 in this hospital were analyzed retrospectively.Results In all 41 cases, postoperative complications developed in 13 patients (31.7%), in which 7 patients developed FDGE (17.1%). The complications excluding FDGE (P=0.010) and diabetes (P=0.024) had remarkable relations with the FDGE in the univariate analysis; Compared with the non-FDGE patients, the albumin was declined obviously (P=0.020) while the serum direct bilirubin increased significantly (P=0.036) in the FDGE patients, while the development of FDGE had relation only with the albumin (P=0.039) and the complication of diabete (P=0.047) by the binary logistic regression analysis. Conclusion In the patients undergoing PPPD, preoperative control of the blood glucose, preoperative correction of hypoproteinemia and hyperbilirubinemia, and centralizing PPPD in high-volume have possibly positive significance for the prevention of FDGE.
Objective To evaluate the complication rate of CT-guided percutaneous lung biopsy and determine the risk factors. Methods A retrospective investigation of patients with CT-guided percutaneous lung biopsy in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between2002 and 2009 was performed. The risk factors for complications were determined by multivariate analysis of variables related to patients’demographics, lung lesions, biopsy procedures, and individual radiological features. Results 281 biopsy procedures were enrolled. The total complication rate was 55. 9% with pneumothorax 32. 4% ( 91/281) , hemoptysis 34. 5% ( 97 /281) , and cutaneous emphysema2. 1% ( 6 /281) , and with no mortality.The pneumothorax rate was correlated with lesion location, lesion depth, and number of pleural passes. The bleeding risk was correlated with lesion size, lesion depth, and age. Prediction models for pneumothorax and bleeding were deduced by logistic regression. The pneumothorax model had a sensitivity of 80. 0% and a specificity of 62. 4% . And the bleeding model had a sensitivity of 67. 4% and a specificity of 88. 8% .Conclusions Lesion location, lesion depth, and number of pleural passes were independent risk factors for pneumothorax. Lesion size, lesion depth, and age were independent risk factors for bleeding. The prediction models for pneumothorax and bleeding will helpfully reduce the complication of CT-guided lung biopsy.
Objective To investigate the value of magnetic resonance (MR) imaging for diagnosing typeⅠ congenital choledochocele and its complications. Methods The MR imaging data of 13 cases with proved typeⅠ congenital choledochocele associated with complications were retrospectively reviewed and compared with operative findings. MR imaging sequences included axial T2W and T1W plain scan, true-FISP coronal images, 2D-MRCP, and Gd-enhanced T1W images. Results All patients had cystic dilatation of the common bile ducts to various degrees. In 6 patients complicated with stone and infection, the bile duct showed uniform wall thickening with marked enhancement, and calculus were depicted within the duct lumen with dilatation of the proximal biliary duct. In 7 cases complicated with carcinoma of biliary duct, a polypoid soft tissue mass or nodule was seen inside the ductal lumen in 3 cases, or the duct wall was irregularly thickened in 4 patients. Six cases received curative operation, but one patient with extensive local infiltration, vascular encasement and lymphadenopathy had only palliative treatment. MR imaging observations were verified by surgery findings in all 13 patients.Conclusion MR imaging is very valuable not only in diagnosing typeⅠ congenital choledochocele, but also in revealing its complications.
ObjectiveTo explore the clinical effect of the whole-course integrated care and traditional nursing in perioperative period of percutaneous needle biopsy. MethodsA total of 198 patients treated between May 2012 and March 2013 were randomly divided into the traditional care group (control group) and the whole-process integrated care group (experimental group). Then, we compared between the two groups in terms of pain and anxiety levels, qualified rate of specimen and incidence of postoperative complications. ResultsQualified rate of specimen in the experimental group (97.94%) was significantly higher than that in the control group (85.15%) (χ2=10.312, P=0.001). After surgery, the rates of pneumothorax and bleeding were 3.09% and 4.12% in the experimental group, and 11.88% and 14.85% in the control group; the pain score of the experimental group was 4.25±1.38, and 6.12±1.87 in the control group. One hour before and 8 hours after surgery, the anxiety scores were 11.16±3.29, 8.47±2.52 in the experimental group, respectively, and were 16.26±3.17, 12.12±3.26 in the control group, respectively. There were significant differences between the two groups in all the above indexes (P<0.05). ConclusionWhole-course integrated care can significantly reduce pain and anxiety levels and the incidence of postoperative complications and improve the success rate of percutaneous needle biopsy.
ObjectiveTo analyze the cause of complications for patients with advanced malignant biliary obstruc-tion treated with percutaneous transhepatic implantation of biliary stent (PTBS) and summarize the experiences of comp-lications of the treatment. MethodThe complications of 59 patients firstly treated with percutaneous transhepatic cholangial drainage (PTCD) then with PTBS in 156 cases of advanced malignant biliary obstruction from January 2010 to January 2013 in this hospital were analyzed retrospectively. ResultsFifty-nine cases of complications were occurred in 156 cases of advanced malignant biliary obstruction, the incidence was 37.8%, including biliary infection in 26 cases, bile duct bleeding in 17 cases, liver failure in 5 cases, renal failure in 4 cases, acute pancreatitis in 4 cases, stent displa-cement in 2 cases, bile duct perforation in 1 case.Three cases died in 59 patients with complications, 56 cases were improved after symptomatic treatment. ConclusionPTCD combined with PTBS is a safe and effective treatment of advanced malignant biliary obstruction, the reasonable perioperative management is very important to reduce the occurrence of complications.
ObjectiveTo investigate the value of central lymph node dissection in patients with cN0 papillary thyroid carcinoma. MethodThe clinical data of 128 patients with cN0 papillary thyroid carcinoma who had been performed central lymph node dissection during their hospitalization from December 2010 to July 2012 in Chinese PLA General Hospital were analyzed retrospectively. ResultsThe central neck lymph node metastasis rate was 35.94%(46/128) in 128 patients with cN0 papillary thyroid carcinoma, which in the patients with aged less than 45 years, with the tumor diameter larger than 1 cm, and with capsule or extrathyroidal invasion were significantly higher than those in the patients with aged larger than 45 years, with the tumor diameter less than 1 cm, and without capsule or extrathyroidal invasion (P < 0.05). After the operation, there were 22(17.19%) patients with temporary hypoparathyroidism as well as 3(2.34%) patients with temporary recurrent laryngeal nerve injury. However, no permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism occurred. During the 14-32 months follow-up with an average 23.4 months, 2 cases of lateral neck lymph node metastases were observed. ConclusionAs an essential, effective, and safe operation to the patients with cN0 papillary thyroid carcinoma, central lymph node dissection should be performed by experienced hands.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive approach to treat symptomatic severe aortic stenosis with surgical taboos or high risk. With the update of the guidelines, the indication of TAVR has been extended to the intermediate-risk aortic stenosis population, and even has a tendency to further expand to the low-risk population. This review highlights the research progress and new evidence of TAVR in respects of patient selection, valve and approach selection, ethnic differences, and surgical complications such as perivalvular leakage, cardiac conduction block, vascular complications, stroke, acute kidney injury, and coronary artery occlusion.