Objective To investigate the application of transverse fascia in inguinal hernia repair. Methods In this study, 617 patients underwent inguinal hernia repair between January 1990 and December 2005 in our hospital were included, which were divided into two groups according to different operative ways: transverse fascia method group (n=337) and Bassini method group (n=280). Then intraoperative results, postoperative complications, and rehabilitated results of patients in two groups were compared. Results Compared with Bassini method group, the patients in transverse fascia method group did not show significant difference in operative time and blood loss during operation (Pgt;0.05). The differences of severe postoperative pain, testicular swelling, the time of the body’s restore for normal activities, and recurrence rate of patients between two groups were significant (Plt;0.05), while the difference of hematoma of scrotum and infection of incisional wound (Pgt;0.05). Conclusion The strengthening of posterior wall by transverse fascia and reconstruction of inner ring is a simple and effective method for inguinal hernia repair.
ObjectiveTo investigate the changes of fibrinogen and classical markers of collagen metabolism [carboxy-terminal propeptide of type Ⅰ procollagen (PICP) and carboxy-terminal cross-linked peptide of type Ⅰ collagen (ICTP)] in peripheral blood and pericardial drainage after coronary artery bypass grafting (CABG) and/or heart valve replacement (VR), and to evaluate their relationship with postoperative atrial fibrillation (POAF) after cardiac surgery. MethodsPatients who underwent CABG and/or VR in the Heart Center of Beijing Chao-Yang Hospital from March to June 2021 were included. Peripheral blood and pericardial drainage fluid samples were collected before surgery and at 0 h, 6 h, 24 h and 48 h after surgery to detect PICP, ICTP and fibrinogen levels, and preoperative, intraoperative and postoperative confounding factors were also collected. PICP, ICTP and fibrinogen levels were measured by enzyme-linked immunosorbent assay (ELISA). ResultsA total of 26 patients with 125 blood samples and 78 drainage samples were collected. There were 18 males and 8 females with an average age of 64.04±7.27 years. The incidence rate of POAF was 34.6%. Among the factors, the fibrinogen level in pericardial drainage showed two peaks within 48 h after operation (0 hand 24 h after operation) in the POAF group, while it showed a continuous downward trend in the sinus rhythm (SR) group, and the change trend of fibrinogen in pericardial drainage was significantly different over time between the two groups (P=0.022). Fibrinogen in blood, PICP and ICTP in blood and drainage showed an overall decreasing trend, and their trends over time were not significantly different between the two groups of patients (P>0.05). Univariate analysis showed that fibrinogen at 24 h and 48 h after pericardial drainage, fibrinogen in preoperative blood, PICP immediately after surgery and right atrial long axis diameter were significantly higher or longer in the POAF group than those in the SR group. Multiple regression showed that fibrinogen≥11.47 ng/mL in pericardial drainage 24 h after surgery (OR=14.911, 95%CI 1.371-162.122, P=0.026), right atrial long axis diameter≥46 mm (OR=10.801, 95%CI 1.011-115.391, P=0.049) were independent predictors of POAF. ConclusionThis study finds the regularity of changes in fibrinogen and collagen metabolic markers after CABG and/or VR surgery, and to find that fibrinogen in pericardial drainage 24 h after surgery is a potential novel and predictive factor for POAF. The results provide a new idea for exploring the mechanism of POAF, and provide a research basis for the accurate prediction and prevention of clinical POAF.
Objective To describe the situation of postoperative pain management in colorectal cancer patient in enhanced recovery after surgery (ERAS) mode, and explore its influenceing factors. Methods From March to December 2017, colorectal cancer patients in ERAS mode in Department of Gastrointestinal Surgery, West China Hospital of Sichuan University were selected. On the third day after surgery, a total of 74 patients with acute pain completed a questionnaire, which was composed of a demographic form, the Houston Pain Outcome Instrument (HPOI), Self-Rating Anxiety Scale, and Social Support Rating Scale. Mean±standard deviation and percentage were used to describe the total score of pain experience, t test, analysis of variance, Spearman correlation analysis were used for single-factor analysis, and multiple linear regression was used for multi-factor analysis. Results The mean total score of pain experience was 15.1±3.8. Single-factor analysis results showed that the affection of pain on daily life (rs=0.270, P=0.020), satisfaction of pain controlling education (rs=–0.283, P=0.015), subjective support (rs=–0.326, P=0.005), and social support utilization (rs=–0.253, P=0.029) were correlated with the total score of pain experience. Multi-factor analysis results showed that satisfaction of pain controlling education (P<0.001) and subjective support (P=0.005) were negative influencing factors of postoperative pain experience score, and severe anxiety (P=0.001) and pain expectation after surgery (P=0.016) were positive influencing factors of postoperative pain experience score. Conclusions Pain management situation is not so bad in these patients. High satisfaction of pain controlling education and high subjective social support are helpful to decrease pain. The medical staff should pay more attention to patients with severe anxiety, and help patients to establish reasonable pain expectation after surgery.
Objective To study the major postoperative complications of abdominal aortic aneurysm （AAA） repair in high-risk patients， analyze its causes， and suggest the prevention methods. Methods From January 2009 to September 2011， 57 cases of high-risk AAA patients underwent AAA repair in our hospital were analyzed retrospectively. High-risk patients were defined as age≥60 years，the American Society of Anesthesiologists grade three or four，and at least one of complications about heart， lung， and kidney. Major postoperative complications were rated， and preoperative cardiac，pulmonary， and renal condition，anesthesia and surgical impact were taken into account while evaluating the risk factors of major postoperative complications. Results Forty-one of 57 high-risk patients with AAA were repaired by endovascular repair，16 of 57 high-risk patients with AAA were repaired by traditional open surgery. The early mortality （within 30d） was 1.8% （1/57）. The major postoperative complications rate of AAA repair was 19.3% （11/57） in total，and 8.8% （5/57），8.8% （5/57），and 1.8% （1/57） for cardiac complication，pulmonary complication， and acute renal failure，respectively. The patients with coronary heart disease had a higher cardiac complication rate 〔19.0% （4/21） versus 2.8% （1/36），χ2=4.387，P＜0.05〕 ， while with hypertension had no such effect for that〔10.3% （4/39） versus 5.6% （1/18），χ2=0.340，P＞0.05〕. Patients with abnormal pulmonary function was responsible for postoperative respiratory complications 〔20.0% （4/20） versus 5.6% （1/18）， χ2=4.387， P＜0.05〕 ， while with chronic obstructive pulmonary disease history was not responsible for that 〔13.2% （5/38） versus 0 （0/19），χ2=2.740，P＞0.05〕．Patients with preoperative renal function was not related to postoperative acute renal failure 〔0 （0/4） versus 1.9% （1/53）， χ2=0.077，P＞0.05〕. Compared with traditional open surgery，endovascular repair could effectively reduce the incidence of postoperative complications 〔12.2% （5/41） versus 37.5% （6/16）， χ2=3.980，P＜0.05〕. The incidence of postoperative respiratory complications in the local anesthesia patients was less than that in the general anesthesia patients 〔0（0/20）versus 19.0% （4/21），χ2=4.221，P＜0.05〕. Conclusions Cardiac and pulmonary complications are commonly seen after AAA repair in high-risk patients．Preoperative cardiac，pulmonary condition，anesthesia and surgical aspects greatly influence the major postoperative complications. Exhaustively assessment of each system before surgery，appropriate anesthesia and surgical options，postoperative active and effective symptomatic，and supportive treatment are the key to reducing the incidence of postoperative complications.
ObjectiveTo provide references for postoperative analgesia treatment for cirrhotic patients with bone fracture. MethodsOne elderly patient with liver cirrhosis and fracture was admitted to our hospital on July 9, 2013. We obtained medical evidences by searching databases and regulated the best treatment after evaluating the patient's comprehensive conditions. And then, the whole treatment strategy was fully implemented. Finally, the consequent results were evaluated. ResultsWe identified 22 relevant articles including one clinical guideline, three cochrane reviews, five systematic reviews, seven small sample randomized controlled trials, one high quality observational study, and five quantitative reviews. We found that opioid analgesics utilization combined with non-opioid analgesics could not only reduce the occurrence of opioid drug adverse reactions, but increase analgesia safety. Cox-2 inhibitors could be used as the first choice of non-opioid drugs due to the less adverse reaction and better analgesic effectiveness. ConclusionFor femur fracture patients with liver cirrhosis, treatment decision based on evidence-based medicine is more scientific, which can ensure maximum benefit for the patients.
Objective To investigate long-term echocardiography characteristics and their clinical significance of patients after mitral valve replacement （MVR）. Methods We retrospectively analyzed clinical data of 204 patients who underwent prosthetic MVR and finished echocardiography examination at least 5 years after surgery in West China Hospital of Sichuan University. There were 44 male patients and 160 female patients with their age of 23 to 73 （50.9±10.6）years. Postoperatively， all the patients were followed up for 5-15 （7.9±2.3）years and regularly received echocardiography examination at the outpatient department. Analysis variables included left atrium （LA） dimension， left ventricle （LV） dimension，right atrium （RA） dimension， right ventricle （RV） dimension， left ventricular ejection fraction （LVEF） and effective orificearea （EOA） of the mitral valve. Results Long-term echocardiography showed that LA and LV dimensions were signifi-cantly smaller than preoperative dimensions （P＜0.05）， while RA and RV dimensions were not statistically different from preoperative dimensions （P＞0.05）. Long-term LVEF was significantly higher than preoperative value （P＜0.05）. Long-term EOA was 1.1-4.8 （2.3±0.5）cm2， including EOA of 1.1-1.4 cm2 in 7 patients （3.4%，7/204），and 1.6-1.9 cm2in 42 patients （20.6%，42/204）. During long-term follow-up， 7 patients underwent their second heart surgery， including2 patients with prosthetic valve dysfunction， 1 patient with prosthetic perivalvular leak and severe hemolytic anemia，3 patients with severe tricuspid regurgitation which were not improved after medication treatment， and 1 patient with moderateaortic valve stenosis and regurgitation. Two patients had left atrial thrombosis during follow-up， including 1 patient who died of endocarditis 7 years after surgery， and another patient who was still receiving conservative therapy and further follow-up. Conclusion Concomitant tricuspid or aortic valve disease should be actively treated during MVR， and postoperative patients need better follow-up. Many patients after MVR need long-term cardiovascular medication treatment during follow-up in order to improve their heart function and long-term survival rate.
The simple ablation of the duplicated thumb might have some residual deformities after operation that often leads to functional disorders of the hand. Since 1988, the postoperative disorders in 9 patients were treated. The plastic surgery was performed for the adduction of the thumb, lateral deviation and insufficient after plastic repair of the hand. The configuration and the function of the thumb were satisfactory.
Objective To observe the therapeutic effect of poly tetrahydrofurfuryl co-lactic acid(copolymer C4) as the biodegradable vitreous substitutes on rhegmatogenous retinal detachment.Methods Vitreoretinal surgery with copolymer C4 tamponades was performed on 32 pigmented rabbits (64eyes) with rhegmatogenous retinal detachment. The rate of reattached retina and the post operative cornplications were observed.Results Three months after the operation, reattached retina was found in 96. 4%, glaucoma in 5.5%, cataract in 10.9%, and copolymer emulsion in 10.2% of all the eyes.Conclusion copolymer C4 may withstand the retinal tear effectively for 3 months, and can be a valuable vitreous substitutes. (Chin J Ocul Fundus Dis，2004，20：27-28)
ObjectiveTo systematically evaluate the influence of posterior mediastinal and retrosternal route on the incidence of complications in patients with esophageal carcinoma after esophagectomy. MethodsA systematic literature search for studies which were published on PubMed, EMbase, CBM, VIP was performed from database establishment to April 2014. We included randomized controlled trials and case control studies related to the influence of two routes on the incidence of complications of patients with esophagectomy. We assessed the methodology quality of included researches, and extracted data. RevMan 5.2 was used for meta-analysis. ResultsA total of 23 studies including 7 randomized controlled trials and 16 case control studies were included in this study. Meta-analysis showed that there was statistically significant difference in case control studies related to anastomotic leakage between two groups[OR=0.39, 95%CI (0.30, 0.50), P < 0.01]. However, no statistical difference in anastomotic stricture was observed between the two groups[randomized controlled trials:RR=0.80, 95%CI (0.49, 1.30), P=0.36; case control studies:OR=0.64, 95%CI (0.40, 1.03), P=0.07]. And there was no statistical difference in cardiac complications[randomized controlled trials:RR=0.70, 95%CI (0.46, 1.06), P=0.09; case control studies:OR=1.13, 95%CI (0.70, 1.81), P=0.62]. There was also no statistical difference in pulmonary complications[randomized controlled trials:RR=1.27, 95%CI(0.92, 1.75), P=0.14; case control studies:OR=0.91, 95%CI (0.66, 1.27), P=0.59]. Besides, there was also no statistical difference in postoperative mortality[randomized controlled trials:RR=0.47, 95%CI (0.19, 1.16), P=0.10; case control studies:OR=0.18, 95%CI (0.03, 1.01), P=0.05]. ConclusionFor patients with esophageal carcinoma undergoing esophagectomy and reconstruction, the incidence of anastomotic leakage was significantly lower with posterior mediastinal route than that of retrosternal route.
Objective To discuss the prophylactic effect of handling inguinal nerves correctly duing Lichtenstein inguinal hernia repair on chronic pain after operation. Methods 158 patients with inguinal hernia who were treated in our hospital from February 2007 to March 2010 were given Lichtenstein hernia repair. The ilioinguinal nerves were carefully identified and preserved during the operation, the nerve excision had been carried on only in the cases of existing nerve injuried or interference with the position of the mesh. Results The identification rate of iliohypogastric nerve, ilioinguinal nerve, and genital branch of genitofemoral nerve was 87.97%（139/158）, 82.28%（130/158）, and 34.18%（54/158）, respectively. The postoperative complication rate was 5.06%（8/158）, in which subcutaneous hydrops 5 cases, scrotal hematoma 2 cases, and wound infection 1 case, all recovered by conservative management. There was not inguinal hernia recurrence in 12 months of follow-up. In 1 month after operation, there were 63（39.87%） patients suffered from mild pain and 34（21.52%） patients suffered from moderate pain in inguinal region, there was no patient with severe pain, the mean pain score was 0.83. The incidence of chronic groin pain in 6 months was 5.06% （8/158）, in which 7（4.43%） patients suffered from mild pain, and 1（1/158） patient suffered from moderate pain. In 12 months, only 4（2.53%） patients still experience occasional pain or discomfort, the mean pain score was 0.03. Multinomial logistic regression analysis indicated that neurectomy had no influence on postoperative pain（P＞0.05）and non-identification of ilioinguinal nerve was a risk factor for early（1 month） postoperative moderate pain（OR=3.373, P=0.030）. Conclusions Standard surgical procedure acted according to the Lichtenstein guidelines and handling inguinal nerves correctly can result in low incidence of chronic pain after operation, and can make the patients have a better quality of life.