Objective To evaluate the safety and ascendancy of small caliber stapler application for anterior resection in ultra-low rectal cancer with anal sphincter preservation. Methods A retrospective analysis of the data of 60 cases of ultra-low rectal cancer treated by anterior resection with anal sphincter preservation by double stapling technique according to TME principle between June 2006 and June 2009 were undertaken. The 60 patients were divided into two groups, each group included 30 cases. One group adopted 33 mm stapler and another group adopted 29 mm stapler, and then the profiles of medi-operation, post-operation, and prognosis were assessed. Results Time of simple anastomose in operation was (9.0±3.3) min in 33 mm stapler group and (6.0±2.6) min in 29 mm stapler group, and there was significant difference between them (P=0.022 5). There were 6 cases needed to be restored because of lesion during operation or dys-anastomosis in 33 mm stapler group, while 2 cases in 29 mm stapler group, there was significant difference between them (P=0.030 1). No significant differences were observed between the two groups in terms of the time for operation, leakage, bleeding, stenosis, anastomotic recurrence, and fecal incontinence after operation or length of stay. Conclusion The application of 29 mm stapler not only can shorten time for anastomose and step down the degree of difficulty, but also dosen’t increase stenostomia and other complications.
Vitrectomy is an important treatment for vitreoretinal diseases. After half a century of innovation and development, it has made a breakthrough from open type to micro-incision surgery. Minimally invasive vitrectomy has the advantages of wide indications and high cutting efficiency, which greatly improves the safety and efficacy of surgery, and minimizes the occurrence of trauma and complications during surgery. At present, with the development of surgical microscope system, ophthalmic microsurgery robot and other equipment, and the development and application of new artificial vitreous materials, vitrectomy is developing toward minimally invasive, accurate and intelligent development. The further development of vitrectomy innovative technology in the field of ophthalmology is hopeful in the future, so that clinicians can achieve the best surgical results with the minimum damage, and bring better light to patients.
ObjectiveTo create a new scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination for the treatment of rhegmatogenous retinal detachment (RRD), and to evaluate its safety and effectiveness. MethodsA scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination was performed in 6 eyes of 6 patients with RRD, including 2 males and 4 females. The mean age was 51 years old with a range from 23 to 66 years old. Proliferative vitreoretinopathy (PVR) were diagnosed of grade B in all 6 eyes. Duration of retinal detachments until surgery was 5.8 days with a range from 2 to 13 days. The mean preoperative intraocular pressure (IOP) was 12 mmHg with a range from 9 to 15 mmHg (1 mmHg=0.133 kPa). A 23-gauge optic fiber was used to provide an intraocular illumination. Fully examination of the ocular fundus and cryoretinopexy of retinal breaks was performed under a noncontact wide-angle viewing system. Subretinal fluid drainage through the sclerotomy and buckling procedure were performed under the operating microscope. Intravitreal injection of sterile air bubble was performed in 4 eyes. Antibiotic eye drops was applied in all eyes postoperatively, and all the eyes were followed up for at least 6 months. ResultsRetinal reattachment was achieved in all eyes, and the conjunctiva healed well. The best corrected visual acuity (BCVA) increased in all eyes. The mean postoperative IOP was 15 mmHg with a range from 12 to 19 mmHg. No complications were found intra and postoperatively. ConclusionsThis new scleral buckling surgery using noncontact wide-angle viewing system and 23-gauge intraocular illumination for RRD is safe and effective. Advantages such as higher successful rate, less complication, shorter operating time, and less discomfort of patients were showed comparing with the previous scleral buckling surgery using indirect ophthalmoscope.
Objective To evaluate the clinical characteristics of end oscopically guided thorough vitrectomy in managing exogenous endophthalmitis with cloudy cornea. Methods The clinical data of 20 patients (20 eyes) suffered from exogenous endophthalmitis with cloudy cornea and underwent endoscopically guided total vitrectomy were retrospectively analyzed. The patients (18 males and 2 females) aged from 5 to 79 years with the average age of 35.9 years. There were 16 post-trauma and 4 post-cataract endophthalmitis. The cornea was cloudy with the visual acuity of not better than counting fingers in all eyes. During the operation, posterior vitreous detachment was induced, vitreous at the base and bands over the ciliary body was removed, and membrane at the anterior or posterior surface of the iris was also removed after lensectomy. The median of the duration of hospita lization to operation was 1.5 days, and the follow-up period was 6～42 months (mean=23 months). Results Positive cultures were obtained in 9 (45%) cases. Seven intraocular foreign bodies were extracted from 6 eyes. Ora serrata was separated at one place in 2 cases, iatrogenic retinal tear at one, two place in 1 case respectively. Vitrectomy and intravitreal injection were underway again in 2 cases respectively after surgery. Ten eyes (50%) retained useful vision (ge;0.05). The visual acuity was decreased, maintained and improved in 1, 3 and 16 eyes, respectively, and 4 cases over than 0.08. Cornea was clear in 11 (55%) eyes after operation; 9 cases with silicon oil in; ocular pressure was slanting low in 2 cases , but more than 5 mm Hg（1 mm Hg=0.133 kPa）; intraocular hypertension in 1 case , controlled by medicine; local and questionable retinal detachment in 1 case respectively, without surgery again. The visual acuity of none of the 9 eyes with silicon oil in was lower than counting fingers, only one eye in 11 eyes without silicon oil in was lower than 0.05 and no eye lost at the end of follow-up. Conclusion Endoscopically guided total vitrectomy is useful, safe and reliable for the management of exogenous endophthalmitis with cloudy cornea in time. （Chin J Ocul Fundus Dis，2008，24：202-205）
Objective To observe the related complications of 23G pars plana vitrectomy (PPV). Methods One hundred and fifteen patients who underwent 23G PPV were enrolled in this study. There were 98 patients (65.3%) with macular diseases, 46 patients (30.7%) with proliferative diabetic retinopathy, four patients (2.7%) with vitreous hemorrhage, one patient (0.7%) with rhegmatogenous retinal detachment, and lens nucleus falling off in cataract surgery in one patient (0.7%). Among 98 patients with macular diseases, 21 patients (21.4%) underwent topical anesthesia, 77 patients (78.6%) underwent retrobulbar anesthesia. DORC "twostep method" was performed in three patients, and Alcon 23G PPV "onestep method" was performed in 147 patients. The operation times ranged from 20 to 100 minutes, with a mean of (51.1±18.9) minutes. The follow-up ranged from three to 12 months. The intraoperative and postoperative complications were observed. Results Intraoperative complications was found in seven patients (4.7%), which included iatrogenic retinal breaks in one patient (0.7%), macular damage in one patient (0.7%), suprachoroidal perfusion in one patient (0.7%), puncture leakage and closure incision in two patients (1.3%), vitreous hemorrhage in one patient (0.7%) and stopper broken off in cannula in one patient (0.7%). Postoperative complications was found in 34 patients (22.7%), which including retinal detachment in one patient (0.7%), vitreous hemorrhage in three patients (2.0%), cataract in three patient (2.0%), intraocular pressure ＜10 mm Hg（1 mm Hg=0.133 kPa） in 20 patient (13.3%), and transient ocular hypertension in seven patients (4.7%). After treatment there was no complication associated with surgery. Conclusion Intraoperative complications related to incision and transient hypotony are mainly complications of 23G PPV.
Objective To investigate the influence of preoperative assessment by transrectal ultrasound (TRUS) on the development of operative procedures for rectal cancer. Methods A total of 110 patients with pathologically proven rectal cancer and distance between tumor to dentate line ≤10 cm were enrolled and randomized into group A (n=55) and group B (n=55) according to a computer-generated random sequence. Both TRUS staging and Clinical Staging System (CS staging) were performed preoperatively in group A, while only CS staging was conducted in group B. Preoperative TRUS stage, CS stage, and proposed operative procedures were recorded to compare with the postoperative pathological stage and practical operative procedures. Results A total of 99 patients were assessed. They were randomized into group A (n=49) and B (n=50), and there were no significant differences in baseline characteristics between the two groups. The difference in staging accuracy was statistically significant (P=0.000) between group A (91.8%) and group B (48.0%). Statistically significant improvement (P=0.013) in the accuracy of proposing operative procedures for rectal cancer was observed in group A (93.9%) compared with group B (76.0%). Conclusion TRUS is evidently superior to CS staging in preoperative assessment for rectal cancer, and may remarkably enhance the accuracy of proposing operative procedures. Therefore, TRUS is valuable in preoperative assessment which may help to guide the selection of operative procedures for rectal cancer surgery.
ObjectiveTo compare the outcomes of 23G and 25G plus (25G+) vitrectomy in treatment of proliferative diabetic retinopathy (PDR). MethodsThis is a prospective randomized study. Fifty-seven PDR patients (75 eyes) with symptoms requiring vitrectomy were randomly divided into 23G vitrectomy group (30 patients, 39 eyes) and 25G+ vitrectomy group (27 patients, 36 eyes). Visual acuity, intraocular pressures, ophthalmoscopy, B-scan ultrasound was examined before surgery. The follow-up period was 10.0 (23G group) and 8.5 months (25G+ group) respectively. Intraoperative complications, operation time, postoperative visual acuity, intraocular pressure, postoperative complications and postoperative ocular conditions were analyzed. ResultsThe mean surgical times were (53.35±7.42) minutes and (49.16±5.17) minutes in 23G and 25G+ group respectively, and the difference was significant (t=4.37, P < 0.05). Iatrogenic injuries occurred in 11 eyes (28.21%) and 5 (13.89%) eyes in 23G and 25G+ group respectively, and the difference was significant (χ2=4.93, P < 0.05). The postoperative visual acuity of 23G and 25G+ group were improved compared to before surgery (χ2=16.81, 18.29; P < 0.05). At last follow-up, there was 25 eyes and 24 eyes with visual acuity≥0.05 in 23G and 25G+ groups respectively, and the difference was not significant (χ2=0.13, P > 0.05). Hypotony was detected in 7 and 3 eyes at the third postoperative day in 23G and 25G+ group respectively, and the difference was significant (χ2=5.67, P < 0.05). Conclusion25G+ vitrectomy is a safe and effective treatment for PDR with shorter surgery time and fewer surgical complications.
Objective To analyze the strategy and skill of resection for lung cancer invading the superior vena cava (SVC) and improve the surgical treatment results. Methods An analysis of 35 patients who underwent surgery for lung cancer invading the SVC was performed. The pressure of SVC before and during operation, and the time of clamping the SVC were recorded. The conjunctival oedema was observed. 14 mm or 16 mm diameter terylene or expanded polytetrafluoroethylene graft artificial vessel were used to replace SVC.The continuous everted suture was applied with 4-0 Prolene. The embolism of artificial vessel and stomal hemorrhage were observed after operation. Results The SVC replacement with prothesis were performed in 20 patients in which the SVC hadn’t clamped in 5 patients. The clamping time was 8-35 mins for another 15 patients with SVC clamped.The clamping time were 1735 mins and 8-20mins respectively for patients with or without conjunctival oedema.The pressure of SVC was 20-45cmH2O before operation and the maximal pressure was 37-56cmH2O during operation for patients with clamping SVC. The maximal pressure during operation was 48-56cmH2O and 37-47cmH2O for patients with or without conjunctival edema, the difference was significant (P=0.000).No mortality or embolism of artificial vessel,but the stomal hemorrhage was found for one patients cured by reoperation. Thirtytwo patients was followed up for 4-130 months,the median survival time was 35 months. Conclusion No clamping of SVC or short time clamping with some operative skill can avoid the occurrence of cerebral edema. Selecting suitable length and roughness of the expanded polytetrafluoroethylene artificial vessel and continuous everted suture with suitable slide suture is important for avoiding the occurrence of embolism and the stomal hemorrhage.
ObjectiveTo compare the safety and efficacy of a modified 23G with suturing incision and traditional 23G vitrectomy for silicone oil removal. MethodsA total of 177 patients (180 eyes) who underwent silicon oil removal (the average tamponade period was 4.5 months) were enrolled in this prospective study. The patients included 112 males (113) and 65 female (67). The mean age was (43.8±10.3) years. The corrected vision, indirect ophthalmoscopy, intraocular pressure, B-ultrasound and optical coherence tomography were measured for all patients. All patients had no complete retinal detachment. The patients were randomly divided into modified 23G with suturing incision group (group A, 88 eyes) and traditional 23G vitrectomy (group B, 92 eyes). The differences of sex (χ2=1.596), age, corrected vision (t=0.785), intraocular pressure (t=0.352), primary disease (χ2=1.982) and lens condition (χ2=2.605) were not significant (P>0.05). The operation time, intraocular pressure, silicon oil retention, choroidal detachment, retinal redetachment and endoophthalmitis were recorded at the end of the operation. ResultsThe difference of mean operation time was not significant between group A and B (t=1.950,P>0.05). The differences of mean visual acuity 1 day, 1 week and 3 months after operation were not significant between group A and B (t=0.873, 1.115, 0.141; P>0.05). There was difference of mean intraocular pressure at 1 day after operation (t=2.550,P<0.05), but not at 1 week and 3 months after operation (t=1.451,1.062; P>0.05) between group A and B. There were 25 eyes (28.4%) with intraocular hypotension, 8 eyes (9.1%) with choroidal detachment, 5 eyes (5.7%) with vitreous hemorrhage, 9 eyes (10.2%) with retinal redetachment, and 7 eyes (8.0%) with silicon oil retention in group A. There were 5 eyes (5.4%) with intraocular hypotension, 2 eyes (2.2%) with choroidal detachment, 2 eyes (2.2%) with vitreous hemorrhage, 8 eyes (8.7%) with retinal redetachment, and 1 eye (1.1%) with silicon oil retention in group B. The differences of incidence of intraocular hypotension, choroidal detachment and silicon oil retention were significant (P<0.05). No endoophthalmitis occurred. ConclusionThe safety of modified 23G with suturing incision is better than traditional 23G vitrectomy for silicone oil removal, with decreased incidence of intraocular hypotension, choroidal detachment and silicon oil retention.
Objective To analyze symptoms, associated anomalies, diagnostic approach, and surgical procedures in patients with unroofed coronary sinus syndrome (UCSS), a rare congenital disorder. Methods The clinical, echocardiographic, operative, and followup data on 44 patients with unroofed coronary sinus syndrome (typeⅠin 15，typeⅡin 9，type Ⅲ in 5 and type Ⅳ in 15) between May 1998 and January 2008 were reviewed retrospectively. The initial diagnosis of unroofed coronary sinus syndrome was made by echocardiography in 12 patients, by the surgeon at repair of other congenital cardiac anomalies in 32 patients. The patients underwent cardiovascular surgery at Fu Wai hospital. Left superior vena cava(LSVC) directly drains into the left atrium (LA) were found in 15 cases, LSVC was ligated in 1 case, the intracardiac tunnel to drain LSVC to right atrium (RA) were reconstructed in 14 cases. The associated cardiac lesions were corrected concomitantly. Results There were 3 hospital deaths. One patient died of low cardiac output syndrome and 2 patients died of pulmonary infection. One case was applied diaphragm plication because of right diaphragm paralysis after the heart operation and the hospital stay was 70 days.The other 40 cases had good surgical result. The average time of extubation was 11.7±12.1 h and hospital stay was 8.1±2.8 d. In the 32 cases, who have been followed up from 4 months to 10 years, there was no death and severe complications. Conclusion Unroofed coronary sinus syndromes are often missed in the preoperative evaluation of congenitally malformed hearts. When associated with LSVC, unroofed coronary sinus syndrome should be considered as a possible additional finding.We performed different surgical approaches to deal with the different kinds of LSVC with a good result.