Objective To compare the effect of intravenous and epidural analgesia on postoperative complications after abdominal and thoracic surgery. Methods A literature search was conducted by using computerized database on PubMed, EBSCO, Springer, Ovid, and CNKI from 1985 to Jan 2009. Further searches for articles were conducted by checking all references describing postoperative complications with intravenous and epidural anesthesia after abdominal and thoracic surgery. All included randomized controlled trials (RCTs) were assessed and data were extracted by the standard of Cochrane systematic review. The homogeneous studies were pooled using RevMan 4.2.10 software. Results Thirteen RCTs involving 3 055 patients met the inclusion criteria. The results of meta-analyses showed that, a) pulmonary complications and lung function: patient-controlled epidural analgesia can significantly decrease the incidence of pneumonia (RR=0.66, 95%CI 0.53 to 0.83) and improve the FEV1 (WMD=0.17, 95%CI 0.05 to 0.29) and FVC (WMD=0.21, 95%CI 0.1 to 0.32) of lung function after abdominal and thoracic surgery, but no differences in decreasing postoperative respiratory failure (RR=0.77, 95%CI 0.58 to 1.02) and prolonged ventilation (RR=0.75, 95%CI 0.51 to 1.13) compared with intravenous analgesia; b) cardiovascular event: epidural analgesia could significantly decrease the incidence of myocardial infarction (RR=0.58, 95%CI 0.35 to 0.95) and arrhythmia (RR=0.64, 95%CI 0.47 to 0.88) than the control group, but could not better reduce the risk of heart failure (RR=0.79, 95%CI 0.47 to 1.34) and hypotension (RR=1.21, 95%CI 0.63 to 2.29); and c) Other complications: epidural and intravenous analgesia had no difference in decreasing the risk of postoperative renal insufficient (RR=0.78, 95%CI 0.53 to 1.14), gastrointestinal hemorrhage (RR=0.78, 95%CI 0.49 to 1.23), infection (RR=0.89, 95%CI 0.70 to 1.12) and nausea (RR=1.03, 95%CI 0.38 to 2.81). Conclusions Epidural analgesia can obviously decrease the risk of pneumonia, myocardial infarction and severe arrhythmia, and can improve the lung function after abdominal or thoracic surgery.
Objective To analyze the clinical risk factors of the occurrence of severe proliferative vitreoretinopathy (PVR) after scleral reattachment surgery. Methods A total of 4031 eyes of 4031 consecutive patients with reghmatogenous retinal detachment (RRD) and PVR (grade C1 or less), on whom the scleral buckling was performed, were retrospectively studied. Twenty-two clinical charac teristics of the patients (including the ocular tension, condition of lens and vitreous, characte ristics of retinal detachment, whether or not with choroidal detachment, et al) were recorded.In 4031 patients, 2660 were followed up for more than 3 months, and 72 (in PVR group) of the 2660 patients underwent the second surgery (vitre oretinal surgery) because of the occurrence of postoperative seve re PVR; in the other 2588 patients, 72 (72 eyes) with retinal reattachment for more than 3 months were selected randomly as the control. The data were analyzed in SPSS (10.0) software. Results Logistic regression analysis revealed that the significant risk factors for PVR were incomplete posterior vitreous detachment ( P＜0.001), intraocular pressure lt;7 mm Hg（1 mm Hg=0.133 kPa, P＜0.002）, and large retinal tear (gt;2 DD,P＜0.005). Conclusion Incomplete posterior vitreous detachment, intraocular pressure lt;7 mm Hg and large retinal tear of the patient with RRD may be the major risk factors for PVR. (Chin J Ocul Fundus Dis，2003，19：141-143)
Objective To summarize the application of different types of perineal and vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body for patients with primary or recurrent advanced rectal cancer with distal vagina or perineal body invasion， and to review the advantages and shortages and the application range of common reconstructive surgical procedures. Method The clinical data of 10 rectal cancer patients underwent extended surgery with distal vagina and perineal body resection accompanied with or without hysterectomy from October 2009 to September 2013 were summarized. Results There was no perioperative mortality. Omental flaps were used for obliteration of pelvic defect in 4 patients. The uterus was pushed backward to fill the pelvic defect after severing the round ligament in 2 patients. A reversed pedicled sigmoid flap was employed for reconstruction of the vagina in 2 patients. The reversed flap of anterior vaginal wall was used for vaginal and perineal reconstruction in 3 patients. Three cases had postoperative complications， in which included 1 patient with pelvic sepsis who underwent reoperation for drainage， 2 patients with perineal wound infection. All other patients had an uneventful healing postoperatively. Conclusions Some types of one-stage pelvic and perineal-vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body could produce an expedited wound healing with acceptable morbidity. Despite the well documented pedicled musculocutaneous flap for reconstruction， omental flap， pedicled sigmoid flap， overturn of anterior vaginal wall for reconstruction and pushing-back of the uterus for filling pelvic cavity might also result in reduced pelvic and perineal associated complications. Pedicled musculocutaneous flap is better reserved for huge pelvic and perineal defect and should be recommended among Chinese surgeons.
Complications of proliferative diabetic retinopathy have become the major indications of vitrectomy. The surgery, however, is not basically a causative therapy. The visual function after operation depends on the degree of retinal ischemia and damage induced. The surgery itself has a potential for severe complications. Therefore it is important to better understand the pathology and to master surgical strategy and techniques in order to improve surgical outcomes and reduce the surgical complications. (Chin J Ocul Fundus Dis,2007,23:234-237)
Objective To analyze the risk factors of no light perception (NLP) after vitreoretinal surgery for proliferative diabetic retinopathy (PDR). Methods Retrospectively analyzed the follow-up data of 882 patients (1000 eyes) with PDR who had undergone vitreoretinal surgery. The standard of NLP was: in a darkroom, one eye was covered, and the other one could not catch the candlelight 30 cm in front of the eye. The number of eyes with NLP was counted and the clinical data of the eyes with or without NLP were analyzed and compared. chi;2 test was used to analyze the risk factors of NLP. Results In these 1000 eyes with PDR,the postoperative visual acuity was NLP in 22 eyes (2.2%) and light perception in 978 eyes (97.8%). Comparing with the patients with light perception, the patients with NLP had severer disease condition, including ante-operative neovascular glaucoma (NVG)(36.4%), tension combined with retinal detachment 50%, and a need for lens excision during the surgery (45.5%) and for silicone oil filling at the end of the operation (63.6%). After the surgery, NVG was found in 14 eyes, un-reattached retina in 5 eyes (before the surgery was VI stage of PDR), and optic nerve atrophy and retinal vessel atresia in 3 eyes, which significantly differed from which in the patients with light perception (Plt;0.001，P=0.004, (Plt;0.001). The differences of sex, diabetes type and PDR stage between the NLP group and non-NLP group were not significant (P=0.136, P=0.681, P=0.955). Conclusions The incidence of NLP after vitreoretinal surgery for proliferative diabetic retinopathy is low. The direct causes were NVG, optic nerve atrophy, retinal vessel atresia and retinal redetachment, while the sex, type of diabetes mellitus and stage of PDR show no statistical relation to the occurrence of NLP after surgery. (Chin J Ocul Fundus Dis,2007,23:244-247)
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.
PURPOSE:To assess the effects of silicone oil removal on the complications associated with its use. METHODS:Retrospective analysis of the results of silicone oil removal after vitreous surgery for retinal detachment in 913 eyes in National Ophthalmology Centre of French. The follow-up period was at least six months and the mean duration of oil tamon- ade was 6.4 months. RESULTS :Retinal detachment recurred in 7.3%. The development of cataract continued after silicone oil removal. No patient retained a clear lens in the eye with oil remained in situ for more than 3 months. TWO of 5 eyes with keratopathy at the time of oil removal recovered after the oil removal ;but the corneas of another 4 eyes became dystrophic after the oil removal. Twelve of 15 eyes with secondary ocular hypertension incontrollable through medicinal treatment relieved after oil removal ,but another 11 eyes became hypertensive after oil removal. Persistent emulsive droplets wre found in anterior chamber angles of the above 11 hypertensive eyes and the 7 eyes with keratopathy. CONCLUSINOS:Early removal of silicone oil after retinal detachment operation might delay the development of cataract but can not avoid its occurence ,and ocular hypeitension and keratopathy can be prevented by early and complete removal of silicone oil. Chin J Ocul Fundus Dis,1997,13: 22-23）
Objective To observe the efficacy of vitreoretinal surgery on proliferative diabetic retinopathy (PDR) in patients with type 1 and type 2 diabetes mellitus (DM). Methods Retrospectively analyzed the clinical data of 451 patients with DM (71 with type 1 and 380 with type 2) who underwent PDR from June 1999 to October 2003. The follow-up period was at least 14 months with the average of 29 months. The pre-and post-operative visual acuity, progression and regression of iris neovascular (INV), neovascular glaucoma (NVG), and the reattached and being attached rate of retina were observed and compared between the two groups. The effect of different types of DM on vitreoretinal surgery for PDR were observed. Results The preoperative data showed that the number of type 1 DM patients with severe PDR was more than the type 2 DM patients: the rate of grade VI PDR, the visual acuity lower than 0.1, INV and NVG were all higher that which in type 1 DM patients. The increased ratio of postoperative visual acuity was 64.8% (46/71) in type 1 DM patients and 72.4% (275/380) in type 2 DM patients (P=0.196). There were 75.0% patients with PDR combined with rubeosis iridis in type 1 DM group and 60.0% in type 2 DM group (P＝0.678);the rate of new rubeosis iridis after surgery was 6.3% in type 1 DM group and 5.6% in type 2 DM group (P＝0.822). The intraocular pressure of NVG eyes were all controlled effectively in both type 1 and type 2 DM groups, and INV did not regressed only in one case in type 1 DM group. In the patients with preoperative retinal detachment at the grade VI of PDR, the rate of retinal reattachment after on off operation was 87.2% in type 1 DM group and 89.8% in type 2 DM (P＝0.611); the rate of retina being-attachment after one-off surgery were 90.1% in type 1 DM group and 93.4% in type 2 DM group, respectively (P＝0.323). Conclusion There was no obvious difference of surgical efficacy on the two types of DM in patients with PDR. (Chin J Ocul Fundus Dis,2007,23:248-251)
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.
Objective To analyze the reasons, methods of treatment, and effects on prognosis of vitreous hemorrhage after vitrectomy in patients with diabetic retinopathy. Methods The clinical data of 98 patients (122 eyes) with diabetic retinopathy (VI stage) who had undergone vitrectomy were retrospectively analyzed. Results Post-vitrectomy vitreous hemorrhage (gt;grade 2) was found in 25 eyes with the occurrence of 20.5%, in which the hemorrhage occurred 1 week after the surgery in 8 eyes, 1 week to 1 month in 6 eyes, and more than 1 month in 11 eyes. In the 25 eyes, C3F8 tamponade eyes occupied 31.1%, silicone oil tamponade eyes occupied 6.1%, air tamponade eyes occupied 33.3%, and infusion solution tamponade eyes occupied 26.3%. Peripheral fibrovascular proliferation was found in 9 eyes. In the 3 eyes with silicone oil tamponade, the hemorrhage was absorbed in 2, and epiretinal membrane was found in 1 which was moved when the silicon oil was taken out. In the 22 eyes without silicone oil tamponade, the hemorrhage was absorbed in 6 and aggravated in 2 without any timely treatment, neovascular glaucoma occurred in 1, and wide vitreo-retinal proliferation and retinal detachment was observed in 1 with the visual acuity of no light perception. Operations such as fluid-air exchange, vitrectomy were performed on 14 eyes 2 weeks after the hemorrhage absorption stopped. Recurrent vitreous hemorrhage was not found in 12 eyes after single operation. At the end of the follow up period, the visual acuity was no light perception in 3 eyes, hand moving in 2 eyes, counting finger-0.1 in 10 eyes, under 0.3 in 4 eyes, and over 0.3 in 6 eyes. Conclusion Most of the patients with vitreous hemorrhage after vitrectomy due to DR had peripheral fibrovascular proliferation. The visual prognosis after re-operation is good. (Chin J Ocul Fundus Dis,2007,23:241-243)