Objective To compare microendoscopic discectomy (MED) with open discectomy (OD) for degenerative lumbar spinal stenosis in terms of cl inical outcomes, and provide experience and therapeutic evidence for cl inical appl ication.Methods From May 2002 to October 2007, 215 patients with lumbar spinal stenosis were randomized into two groups, and underwent either MED or OD. In group A, 105 patients underwent MED, including 56 males and 49 females aged 34 to 83 years old (average 45 years old); the duration of the disease ranged from 9 months to 26 years (average 50 months); the spinal stenosis involved one segment in 76 cases, two segments in 27 cases, and three segments in 2 cases. In group B, 110 patients received OD, including 57 males and 53 females aged 35 to 85 years old (average 47 years old); the duration of the disease ranged from 8 months to 25 years (average 48 months); the spinal stenosis involved one segment in 78 cases, two segments in 29 cases, and three segments in 3 cases. No significant difference was evident between two groups in terms of the general information(P gt; 0.05). Results Operation was successfully performed in all cases. Volume of intraoperative blood loss was (82.14 ± 6.18) mL in group A and (149.24 ± 11.17) mL in group B. Length of hospital stay was (7.0 ± 2.1) days in group A and (12.0 ± 2.6) days in group B. Significant difference was noted between two groups in terms of the above parameters (P lt; 0.01). All the wounds healed by first intention. The patients were followed up for 13-54 months (average 27 months) in group A and 12-55 months (average29 months) in group B. Four patients in each group suffered from spinal dural rupture during operation and recovered after corresponding treatment. Three patients in group B had lumbar instabil ity 3 years after operation and recovered using lumbar interbody fusion combined with general spine system internal fixation. No such compl ications as wrong orientation, nerve root injury, cauda equina injury and infection occurred in each group, and radiology exam showed no relapse. Therapeutic effect was evaluated by Nakai standard, 52 cases in group A were graded as excellent, 45 as good, 7 as fair, 1 as poor, and the excellent and good rate was 92.4%; 53 cases in group B were graded as excellent, 48 as good, 8 as fair, 1 as poor, and the excellent and good rate was 91.8%; there was no significant difference between two groups (P gt; 0.05). Conclusion Two methods have the similar therapeutic effect, but MED el iminates the shortcomings of traditional OD, so it is one of ideal minimally invasive operative approaches for degenerative lumbar spinal stenosis.
Objective To compare microsurgery lumbar discectomy (MSLD) via posterior approach with traditional open discectomy by fenestration for single-level lumbar disc protrusion in terms of methodology and therapeutic effect. Methods From January 2001 to January 2008, 230 patients with single-level lumbar disc protrusion were randomized into two groups. In group A, 114 patients underwent MSLD, including 77 males and 37 females aged 15-76 years old (average 41 years old); the duration of the disease ranged from 6 months to 28 years (average 51 months); the lumbar disc protrusion involved L4,5 level in 52 cases, and L5 - S1 level in 62 cases; there were 50 cases of lumbar disc protrusion on the left side, 54 onthe right side, and 10 of the central type; preoperative JOA score was 6-18 points (average 11.8 points). In group B, 116 patients underwent traditional posterior open discectomy by fenestration, including 78 males and 38 females aged 14-78 years old (average 42 years old); the duration of the disease ranged from 8 months to 26 years (average 52 months); the lumbar disc protrusion involved L4,5 level in 56 cases, and L5 - S1 level in 60 cases; there were 53 cases of lumbar disc protrusion on the left side, 52 on the right side, and 11 of the central type; preoperative JOA score was 5-19 points (average 12.3 points). No significant difference was evident between two groups in terms of general information (P gt; 0.01). Parameters of operative time, volume of blood loss during operation, length of operative incision, length of hospital stay after operation, and total medical cost of single disease were analyzed. Therapeutic effect was assessed by postoperative JOA score during follow-up period. Results The operative time was (40 ± 9) minutes in group A and (47 ± 11) minutes in group B. The volume of blood loss during operation was (26 ± 5) mL in group A and (60 ± 6) mL in group B. The length of operative incision was (2.6 ± 0.8) cm in group A and (5.6 ± 0.5) cm in group B. The length of hospital stay after operation was (4.0 ± 2.6) days in group A and (8.0 ± 2.9) days in group B. The total medical cost of single disease was (5 500 ± 1 800) ￥ in group A and (6 300 ± 1 500) ￥ in group B. Significant difference was evident between two groups in terms of the above parameters (P lt; 0.01). The incisions in two groups all healed by first intention.No compl ications such as wrong orientation, nerve root injury, cauda equina injury, and infection occurred. The follow-upperiod was 12-37 months (average 26 months) for 102 patients of group A and 12-35 months (average 24 months) for 98 patients of group B. The JOA score 12 months after operation was 21-28 points (average 24.8 points) in group A and 22-27 points (average 25.2 points) in group B, showing a significant difference when compared with preoperative score (P lt; 0.01), and no significant difference between two groups (P gt; 0.01). Conclusion Two methods have similar cl inical outcomes, but MSLD has merits of minimal invasion, less blood loss, shorter operative time, shorter length of hospital stay, and lower medical cost. It is one of ideal minimally invasive operations for single-level lumbar disc protrusion．
Objective To observe the ability to repair bilateralradius bone defect with the composite of β-tricalciumphosphate(βTCP),hyaluronic acid(HA),type I collagen(COL-Ⅰ) and induced marrow stromal cells(MSCs), and to investigate the feasibility of the composite as a bone substitute material.Methods The MSCs of the New Zealand white rabbits were induced into ostoblasts, then combined with β-TCP, HA and COL-Ⅰ. Thirty New Zealand white rabbits were made the bilateral radius bone defects of 2 cm and divided into groups A, B and C. After 8 weeks, β-TCP-HA-COL-Ⅰ-MSCs （group A, n=27 sides）, autograft （group B, n=27 sides）andno implant（group C as control, n=6 sides）were implanted into the areas ofbilateral radius bone defects, respectively. The structure of the composite was observed by scanning electron microscope. The repairing effect was observed by gross, histomorphology, X-ray examination, and the degradation rate of inorganic substance at 4, 8 and 12 weeks. The ostogenic area and biomechanics ofgroup A were compared with those of group B at 12 weeks.Results The MSCs could stably grow in vitro, relatively rapidly proliferated, and could be induced into the ostoblasts.The composite was porous. The results of gross, histomorphology and X-ray showed that the bone defects were perfectly repaired in group A and group B, but not in group C. The ostogenic area or biomechanics had no statistically significant difference between groups A and B(Pgt;0.05). The weight of inorganic substance in group A were 75% ,57% and 42% at 4,8,12 weeks, respectively.Conclusion MSCs can be used as seedcells in the bone tissue engineering. The composite has porous structure, no reactions of toxicity to the tissue and rapid degradation, and it is an ideal carrier of seed cells.The β-TCP-HA-COL-Ⅰ-MSCs composite has the high ability of repairing bone defect and can serve as an autograft substitute material.
ObjectiveTo analyze the risk factors for neurological complications after emergency surgery of acute type A aortic dissection.MethodsThe clinical data of 51 patients with acute Stanford type A aortic dissection who were admitted to Shanghai Delta Hospital from October 2018 to May 2019 were retrospectively analyzed. There were 37 males (72.5%) and 14 females (27.5%), aged 29-85 (55.1±12.3) years. The patients were divided into two groups, including a N1 group (n=12, patients with postoperative neurological insufficiency) and a N0 group (n=39, patients without postoperative neurological insufficiency). The clinical data of the two groups were compared and analyzed.ResultsThere were statistical differences in age (62.6±11.2 years vs. 51.7±11.4 years, P=0.003), preoperative D-dimer (21.7±9.2 µg/L vs.10.8±10.7 µg/L, P=0.001), tracheal intubation time (78.7±104.0 min vs. 19.6±31.8 min, P=0.003), ICU stay time (204.1±154.8 min vs. 110.8±139.9 min, P=0.037) and preoperative coagulation factor activity R (4.0±1.5 vs. 5.1±1.6, P=0.022). Preoperative coagulation factor activity R was the independent risk factor for neurological insufficiency after emergency (OR=2.013, 95%CI 1.008-4.021, P=0.047).ConclusionFor patients with pre-emergent acute aortic dissection who are older (over 62.6-64.5 years), with reduced coagulation factor R (less than 4.0), it is recommended to take more active brain protection measures to reduce the occurrence of postoperative neurological complications in patients with acute aortic dissection, and further improve the quality of life.
Despite a wider application of robot to radical esophageal resection in recent years, the process of esophagogastrostomy is relatively complicated. Current commonly-applied clinical techniques in digestive tract reconstruction include end-to-end anastomosis, end-to-side anastomosis, and side-side anastomosis. The main methods are divided into manual and mechanical anastomosis. And the main instruments applied include circular stapler and linear stapler. Different technologies vary in advantages and restrictions and selecting the technique in esophageal operation depends on the situation of the tumor and the operator’s preference. The improved anastomosis techniques and the updated anastomosis instruments effectively lower the incidence of complications after esophagogastrostomy. However, there are still great difficulties in carrying out a safe and efficient reconstruction of the digestive tract during the operation. Scholars over the world have been working hard on it and have made modified various reconstruction techniques. Different technologies vary in advantages and restrictions and the choice of the technique depends on the situation of the tumor and the patient’s preference. There is no unified consensus on the choice of the technique. This paper introduces the research progress in robot’s assisted esophagogastrostomy from two aspects including the technique and method of anastomosis.
Objective To evaluate the effect of mediastinal drainage tube placed in the left thoracic cavity after partial resection of the mediastinum pleura in robot-assisted McKeown esophagectomy for esophageal carcinoma, and to compare it with the traditional method of mediastinal drainage tube placed in mediastinum. MethodsWe retrospectively analyzed clinical data of 96 patients who underwent robot-assisted McKeown esophagectomy for esophageal carcinoma by the surgeons in the same medical group in our department between July 2018 and March 2021. There were 78 males and 18 females, aged 52-79 years. Left mediastinum pleura around the carcinoma during operation was resected in all patients. Patients were divided into two groups according to the method of mediastinal drainage tube placement: a control group (placed in mediastinum) and an observation group (placed through the mediastinal pleura into the left thoracic cavity with several side ports distributed in the mediastinum). The incidence of left thoracentesis or catheterization after surgery, anastomotic fistula and anastomotic healing time, other complications such as pneumonia and postoperative pain score were also compared between the two groups. Results There was no statistical difference in baseline data or surgical parameters between the two groups. The percentage of patients in the observation group who needed re-thoracentesis or re-catheterization postoperatively due to massive pleural effusion in the left thoracic cavity was significantly lower than that in the control group (5.6% vs. 21.4%, P=0.020). The incidence of anastomotic leakage (3.7% vs. 7.1%, P=0.651) and the healing time of anastomosis (18.56±4.27 d vs. 24.33±5.48 d, P=0.304) were not statistically different between the two groups, and there was no statistical difference in other complications such as pulmonary infection. Moreover, the postoperative pain score was also similar between the two groups. Conclusion For patients whose mediastinal pleura is removed partially during robot-assisted McKeown esophagectomy for esophageal carcinoma, placing the drainage tube through the mediastinal pleura into the left thoracic cavity can reduce the risk of left-side thoracentesis or catheterization, which may promote the postoperative recovery of patients.
Objective To analyze influencing factors and construction of a nomogram predictive model for anastomotic leak after radical esophageal and gastroesophageal junction carcinoma. Methods The patients who underwent radical esophagectomy at Jinling Hospital affiliated to Nanjing University School of Medicine from January 2018 to June 2020 were selected. After screening for related variables using SPSS univariate and multivariate logistic regression analysis, the "nomogram" was used to predict the risk of anastomotic leak based on R language. The predicted effects were verified by the receiver operating characteristic (ROC) curves. Results A total of 468 patients with esophageal carcinoma were collected, including 354 (75.64%) males and 114 (24.35%) females with a mean age of 62.8±7.2 years. The tumor was mainly located in the middle or lower stage; 51 (10.90% ) patients had postoperative anastomotic leak. In univariate logistic regression analysis, age, BMI, tumor location, preoperative albumin, diabetes mellitus, anastomosis mode, anastomosis site, and CRP might be associated with anastomotic leak (P＜0.05). The above data suggested by multivariate logistic regression analysis illustrate that age, BMI, tumor location, diabetes mellitus, anastomosis mode, and CRP were independent risks of anastomotic leak (P＜0.05). The nomogram was constructed according to the results of multivariate logistic regression analysis. The area under the curve (AUC) of ROC curve was 0.803 showing that the actual observations agree well with the predicted results. In addition, the decision curve analysis concluded that the newly established nomogram was significant for clinical decision-making. Conclusion The predictive model of anastomotic leak after radical esophageal and gastroesophageal junction carcinoma has a good predictive effect and is critical for guiding clinical observation, early screening and prevention.