Objective To investigate the surgicalmethod and perioperative treatment for senile lumbar disease accompanied by internal disease. Methods From June 2000 to December 2003,the complete neurological and physical examinations were performed on the patients before operation, as treatment of internal diseases could improve the patients’ conditions. Lumbar operations were performed on 125 patients, among whom 23 had simple lumbardisc herniation, 13 had lumbar spine stenosis, 81 had lumbar disc herniation with lumbar spine stenosis, and 8 had spondylolisthesis.The JOA score was 116±2.5. There were 3 patients undergoing fenerstration+discectomy, 16 undergoing semilaminectomy+discectomy,82 undergoing total-laminectomy+disectomy, 5 undergoing total-laminectomy+disectomy+pedicle fixation, 11 undergoing lamina decompression+nerve-root pathyway decompression, and 8 undergoing pedicle screw fixation+bone graft and fusion in spondylolisthesis. Results With an effective medical treatment, the internal disease produced little effect on the operation. Improved functions and bone fusions were observed after- operation. According to the JOA standards, the average alleviation rate was 87.9%. Conclusion Early neurological examination and proper treatment of internal diseases are the keys to the successful operation on the senile patients with lumbar disease. Radiological data are important in avoidance of mistaken diagnosis.
Objective To review the value of imaging assessment for perioperative period of liver transplantation. Methods The related literatures in recent years were reviewed, and the applications of various kinds of radiological techniques in perioperative period of liver transplantation and radiological strategies of major complications after liver transplantation were summarized. Results Transplantation has become an effective option for treatment of patients with irreversible severe liver dysfunction. Radiological assessment supplies prompt and accurate information for clinic to increase the success rate and reduce the complications. So it plays an irreplaceable role. Conclusions Radiology assessment is important for screening donors and recipients before liver transplantation， following up and monitoring the complications. The doctor of imaging department could grasp the different imaging appearance in perioperative period of liver transplantation.
Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.
Objective To determine the total blood loss and hidden blood loss associated with surgery for lumbar spinal stenosis and to identify risk factors for blood loss. Methods From September 2002 to July 2006, the cl inical data from 138 patients with lumbar spinal stenosis undergoing initial operation were analysed prospectively. There were 44 males and 94 females, aging 56-78 years (mean 66.7 years). A simple posterior lumbar spinal decompression was used in 26 cases;posterior spinal canal decompression, interbody distraction Cage, and bone graft between transverse process was used in 54 cases; pedicle screw fixation, posterior decompression and bone graft between transverse process was used in 32 cases; posterior decompression, pedicle screw fixation, interbody Cage, and graft between transverse process was used in 26 cases . Before operation, 23 patients took aspirin, and after operation 15 patients had gastrointestinal bleeding. Intraoperative blood loss was calculated by the aspirator and observed blood loss intraoperation. The whole estimated blood loss was calculated according to the level of hemoglobin, blood volume and blood transfusion at the time of admission and after 3 and 4 days of operation. Results The blood loss intraoperation was (485.51 ± 143.75) mL. The estimated blood loss was (1 218.60 ± 306.86) mL, which was significantly higher than the intraoperational blood loss (P lt; 0.001). There was significant difference between the estimated blood loss and observed blood loss during surgeries (P lt; 0.001). There were significant differences in the estimated blood loss and observed blood loss during surgery between patients treated with aspirin and without aspirin (P lt; 0.001), between patients with gastrointestinal bleeding and whiout gastrointestinal bleeding (P lt; 0.001). Conclusion The total blood loss after surgery for lumbar spinal stenosis is much greater than that of observed intra-operation. The type of surgery, treatment with aspirin and gastrointestinal bleeding or ulceration can all independently increase blood loss.
Objective To explore the effect of fast track rehabilitation in patients with gastric cancer during perioperative period. Methods Eighty patients were randomly divided into conventional method group （n=40） and fast track rehabilitation group （n=40）, and to compare the levels of total lymphocyte count （TLC） , C-reaction protein （CRP），IgG， IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ in serum on the days of 1 d before operation and 1 and 3 d after operation，and to record the duration of fever，first ventilation time of flatus， postoperative hospital stay time，and the postoperative complications. Results The first ventilation time after operation was advanced in patients of fast track rehabilitation group， and the postoperative fever time and hospital stay time after operation of patients was shorter in fast track rehabilitation group than that in conventional method group （P＜0.05）. The incidence difference of complications in two groups had not statistic significance （P＞0.05）. The TLC on 1 d after operation were lower than that on 1 d before operation in two groups, and the CRP values of 1 d after operation were higher than that of 1 d before operation in two groups （P＜0.01）. Compared with 1 d before operation, the CRP value on 3 day after operation in fast track rehabilitation group was lower than that in conventional method group, and the levels of IgG, IgM， IgA， CD3＋， CD4＋， CD8＋， and CD4＋/CD8＋ were higher than that in conventional group （P＜0.05）. Conclusions Fast track surgery applied to patients with gastric cancer during perioperative period is safe and efficient， which can mitigate the immunologic impairment of patients and accelerate postoperative rehabilitation．
Objective To explore the risk factors of postoperative anxiety in patients with pancreatic cancer undergoing total pancreatectomy. Methods A total of 31 patients who underwent total pancreatectomy for pancreatic cancer between July 2011 and December 2016 were collected and analyzed in this retrospective study. The patients’ postoperative Self-Rating Anxiety Scale scores were collected, and the exposure factors were analyzed to identify the risk factors of postoperative anxiety through univariate analysis and multiple logistic regression analysis by SPSS 21.0 statistical software. Results In the 31 patients, there were 17 males and 14 females, with an average age of (66.16±9.09) years, an average body mass index of (21.11±3.10) kg/m2, and an average postoperative hospital stay of (14.58±7.47) days. There were 23 patients (74.2%) with postoperative anxiety, and 30 patients (96.8%) with hyperglycosemia required insulin therapy. The total perioperative mortality was 3.2%. In the univariate analysis, age (P=0.012), smoking history (P=0.043), preoperative diabetes mellitus (P=0.012), postoperative bile leakage (P=0.043), and postoperative abdominal infection (P=0.026) were related factors of the postoperative anxiety. In the multiple logistic regression analysis, patients without preoperative diabetes was an independent risk factor of postoperative anxiety (P=0.013). Conclusions For patients undergoing total pancreatectomy, it is needed to pay attention to the patients’ postoperative psychological conditions and assess the postoperative anxiety, especially for those without preoperative diabetes. To improve the life quality and long-term survival of these patients, health education and psychological intervention are needed.
ObjectiveTo investigate clinical outcomes and summarize perioperative management experience of heart valve replacement (HVR)in elderly patients. MethodsWe retrospectively analyzed clinical data of 47 elderly patients undergoing HVR in Affiliated Hospital of Xuzhou Medical College from January 2011 to May 2014. There were 19 male and 28 female patients with their age of 60-79 years. There were 35 patients with rheumatic heart disease, 10 patients with degenerative valvular disease, and 2 patients with congenital bicuspid aortic valve. Preoperatively, there were 23 patients in NYHA functional class Ⅱ, 19 patients in class Ⅲ, and 5 patients in class Ⅳ. All the patients received HVR under cardiopulmonary bypass (CPB), and some patients received concomitant tricuspid valvuloplasty (TVP), left atrial thrombectomy or coronary artery bypass grafting (CABG). Postoperative mortality, morbidity and heart function improvement were evaluated. ResultsTwenty-seven patients received mitral valve replacement (MVR), 15 patients received aortic valve replacement (AVR), and 5 patients received MVR+AVR. Concomitantly, 4 patients received TVP, 3 patients received left atrial thrombectomy, and 6 patients received CABG. Operation time was 138-412 (196±52)minutes, CPB time was 48-301 (108±33)minutes, aortic cross-clamping time was 34-196 (87±21)minutes, and length of hospital stay was 12-31 (19±5)days. There was no intraoperative death, and 2 patients (4.3%)died postoperatively because of left ventricular failure and multiple organ dysfunction syndrome respectively. Twenty-three patients (51.1%)had postoperative complications including respiratory failure in 6 patients, pulmonary infection in 5 patients, arrhythmias in 5 patients, wound infection in 2 patients, pleural effusion in 2 patients, low cardiac output syndrome in 2 patients, and acute renal failure in 1 patient. Forty-five survival patients were followed up by telephone, online video and at the outpatient department for 1-32 months, and follow-up rate was 100%. There were 11 patients in NYHA functional classⅠ, 32 patients in class Ⅱ, and 2 patients in class Ⅲ. ConclusionAccording to clinical characteristics of elderly patients with valvular heart disease, meticulous surgical techniques and perioperative management can effectively reduce mortality and morbidity after HVR.
ObjectiveTo summarize the perioperative blood management strategies for joint arthroplasty. MethodsThe literature concerning preoperative, intraoperative, and postoperative blood management was reviewed and summarized. ResultsAt present, a variety of blood management and conservation strategies are available. Preoperative strategies include iron supplementation, erythropoietin (EPO), and preoperative autologous donation (PAD). Intraoperative options include acute normovolemic hemodilution (ANH), antifibrinolytics, and the use of a tourniquet. Postoperative strategies include the use of reinfusion systems and guided transfusion protocols. Preoperatively, administration of either simple EPO or a combination of EPO and PAD can be efficacious in anemic patients. Intraoperatively, tourniquet use and tranexamic acid can effectively control bleeding. Postoperatively, appropriate transfusion indications can avoid unnecessary blood transfusions. ConclusionPerioperative blood management strategies for joint arthroplasty should be integrated for the individual patient using a variety of ways to reduce perioperative blood loss and blood transfusion, and promote the rehabilitation of patients.
Objective To explore the impact of recombinant human growth hormone （rhGH） on T lymphocyte subsets in patients with rheumatic heart disease during the perioperative period of heart valve replacement. Methods A total of 65 patients with rheumatic valvular heart disease who received heart valve replacement in Department of Cardiothoracic Surgery of Xiangyang Central Hospital from June 1， 2011 to March 31， 2012 were enrolled in this double-blind randomized controlled clinical study. All the patients were divided into 2 groups by random number produced by SAS software：the trial group and the control group. There were 35 patients in the trial group including 19 males and 16 females with their average age of 50.57 years， and 30 patients in the control group including 16 males and 14 females with their average age of 49.87 years. Apart from routine cardiac glycosides， diuretics， glucose-insulin-potassium solution， and postoperative anti-infective therapy， patients in the trial group also received subcutaneously injection of rhGH 5 U （1 ml）daily from 1 day before surgery to 3 days after surgery， and patients in the control group received subcutaneously injection of normal saline 1 ml as placebo. Peripheral venous blood samples were taken in the morning 2 days before surgery and 1 st， 3 rd， 7 th day after surgery respectively. Percentages of CD3+， CD4+， CD8+ were examined timely by flow cytometry and CD4+ /CD8+ ratio was calculated. Results In the control group， percentages of CD3+， CD4+ and CD4+ /CD8+ ratio on the 1st， 3rd， 7th postoperative day were significantly lower than preoperative levels， and percentages of CD8+ on the 1st and 3rd postoperative day were significantly lower than preoperative level （P＜0.05）. In the trial group， percentages of CD3+， CD4+， and CD8+ on the 1st and 3rd postoperative day were significantly lower than preoperative levels（P＜0.05）， while percentages of CD3+， CD4+， and CD8+ on the 7th postoperative day were not statistically different from preoperative levels （P＞0.05）; CD4+ /CD8+ ratio on the 1st postoperative day was significantly lower than preoperative level （P＜0.05）， while CD4+ /CD8+ ratios on the 3rd and 7th postoperative day were not statistically different from preoperative level （P＞0.05）. There was no statistical difference in preoperative T lymphocyte subsets between the trial group and the control group （P＞0.05）. The percentages of CD4+ and CD4+/CD8+ ratio in the trial group were significantly higher than those of the control group on the 1st postoperative day （P＜0.05）， while the percentages of CD3+ and CD4+ and CD4+ /CD8+ratio in the trial group were significantly higher than those of the control group on the 3rd and 7th postoperative day（P＜0.05）. Conclusion Use of rhGH can significantly increase T lymphocyte subsets expression， enhance body cellular immunity， and improve postoperative recovery of patients with rheumatic valvular heart disease during the perioperative period of heart valve replacement.
Objective To explore the perioperative management of the coexisting diseases for the elderly patients with gastric cancer. Methods The clinical data of perioperative management for coexisting diseases in 528 patients with gastric cancer over 70 years old treated in the First Affiliated Hospital of China Medical University from March 1980 to November 2008 were analyzed retrospectively. Results The main coexisting diseases included cardiovascuclar disease (259 cases, 49.05%), respiratory disease (161 cases, 30.49%), diabetes (72 cases, 13.64%). Adjusting blood pressure and blood glucose, improving cardiopulmonary function, and hepatic and renal function were mainly given. The common postoperative complications included intestinal obstruction (10 cases), pneumonia (10 cases), reflux esophagitis (9 cases), functional evacuation disorder of gastric remnant (7 cases), and anastomotic leakage (5 cases). Ten patients died during perioperative period: 6 died of heart and lung failure, 2 of acute myocardial infarction, 1 of anastomotic leakage, 1 of intestinal obstruction. Conclusions The common coexisting diseases in the elderly patients with gastric cancer are hypertension， bronchitis and diabetes. Complete assessment of the patient’s general health before operation and intensive perioperative management of the coexisting diseases not only can decrease the risk of surgical procedures， but also decrease the incidence of complication and perioperative mortality.