Objective This experiment is to compare the effect of two operations “disconnection” and “ligation” of separation of gastroesophageal peripharal blood vessel in portal hypertension and provide base of rational for selecting reasonable method of separation of gastroesophageal peripheral blood vessel in portal hypertension.MethodsFortyeight SD rats were induced to model of liver cirrhosis and portal hypertension by CCL4 . They were divided at random into 3 groups (16 rats each): disconnection group, ligation group and pseudooperation group. There was also a normal comparison group with 6 normal SD rats (laparotomy only). Thirty days and 100 days after the operation, 8 rats were killed respectively in every group except for the normal comparison group. Thirty days after the operation, the rats of normal comparison group were killed. The adhesion around gastric cardia and fundus with the building of new branch blood vessels, and the relative average blood vessel amounts and average vein caliber changes in submucosa layer and lamina propria layer of esophagus inferior segment were observed. ResultsIn the observation of adhesion around gastroesophageal and the building of new branch blood vessels after the operations, disconnection group was more marked than ligation group. In the observation of relative average blood vessel amounts and average vein calibers changes in submucosa layer and lamina propria layer of esophagus inferior segment, pseudooperation group was more marked than in normal comparison group in different time（P＜0.05）,and 30 days after the operations, disconnection and ligation groups were less serious than pseudooperation group（P＜0.05）. One hundred days after the operation, the two observation indexes of all the groups were more serious than before, and result of disconnection group was nearly close to pseudooperation group（Pgt;0.05）, but ligation group was still less serious than pseudooperation group(P＜0.05).Conclusion Both the “disconnection” and “ligation” operation have the same rank effect of separation of gastroesophageal peripharal blood vessel in short time. But the “ligation” operation makes less trauma, postoperative adhesion and vascularizition, then the separation effect of the “ligation” operation may sustain a relatively long time.
Objective To summarize the experiences of surgical intervention for tetralogy of Fallot(TOF) in early infancy and to discuss the relevant issues about primary treatment procedures in the period. Methods We retrospectively analyzed the clinical operative information of 21 patients in their early infancy (less than 6 months) with TOF treated in Children’s Hospital of Shanghai from June 2008 to August 2010. There were 14 males and 7 females with a mean age of 4.86±1.15 months and a mean body weight of 6.84±1.33 kg. All patients were diagnosed by heart color Doppler ultrasound. Four patients underwent CT or magnetic resonance imaging（MRI） or right heart catheter arteriography examination. The McGoon ratio was 1.86±0.41 and the pulmonary artery index（PAI） was 142.54±59.46 mm2/m2. The ventricular septal defect (VSD) was closed with autologous pericardium using continuous sutures through right atrium (19 cases) or right ventricle (2 cases). Transannular repair was performed when pulmonary valve annulus was one standard deviation less than the normal Z value (18 cases). If the annulus diameter approached or reached the normal Z value, the valve annulus was preserved and pericardium was used to enlarge the right ventricular outflow tract(RVOT) and the main pulmonary artery (3 cases). Results There was one death due to heart failure on the 15th day after operation, one patient had acute laryngeal edema after removal of endotracheal intubation on the second day after operation, and received reintubation and assisted ventilation for three days. All the other patients recovered well. Eighteen patients were followed up for 9.89±6.47 months. Their heart functions were in modified Ross class I or II. Echocardiography during the followup showed that RVOT pressure was 21.20±12.27 mm Hg (8.10-45.14 mm Hg); pulmonary incompetence (PI) was mild in 10 cases, moderate in 5 cases, and no severe PI occurred. Two cases of residual VSD were spontaneously closed. Compared with the early postoperative period, RVOT pressure and PI levels were not significantly different (Pgt;0.05). Right heart function was good.onclusion Early complete repair of TOF yields good surgical results. Transatrial repair of intracardiac pathology and retaining pulmonary valve annulus can be safely applied to yield good postoperative right ventricular function.
Objective To discuss the operative technique and curative effect of minor-incision cholecystectomy. Methods The clinical data of 672 patients with application of mini-cholecystectomy from June 2001 to June 2009 were analyzed. Perioperative management and operative technique were emphasized. Results Six hundred and fifty-two cases (97.0%) were cured with mini-cholecystectomy and 20 cases (3.0%) with incision lengthened. Operation time was （40.0±10.0） min. One case with hemorrhoea during operation was cured by interventional embolotherapy. Bile duct injury was found in 1 case during operation， and adopted suture with T tube. There were no infection of incisional wound or death in this study. Conclusion On the basis of skillful conventional cholecystectomy, by controlling indication and improving operative technique, it is an economical and safe way to perform minor-incision cholecystectomy.
Spinal cord injuries (SCI) seriously impair the quality of life, functional status, and social independence of the patients. Since the last century, a series of basic research on spinal cord injury has made us a deep understanding of its mechanisms and pathophysiology. But so far, how to repair damaged nerve functions after SCI is still a neurological problem. There are still controversies surrounding some treatment strategies for SCI, including the use of magnetic resonance imaging, type and timing of anticoagulant prevention, the timing of surgical intervention, the use of corticosteroids such as methylprednisolone sodium, as well as the type and timing of rehabilitation. For patients with SCI, early surgical intervention and neuroprotective therapy may be the best treatment. At the same time, rehabilitation and psychological intervention are equally important.
ObjectiveTo overview the systematic reviews on the timing of different surgical interventions for severe multidrug-resistant pulmonary tuberculosis patients.MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data and CNKI databases were searched for systematic reviews about the timing of different surgical interventions for severe multidrug-resistant pulmonary tuberculosis patients from inception to December, 2018. Two reviewers independently screened literature, extracted data, evaluated the reporting and methodological qualities using the PRISMA checklist and the AMSTAR tool. After re-extraction of individual RCT data from included systematic reviews, meta-analysis was performed by Stata10.0 software.ResultsA total of 11 systematic reviews were included. The average methodological quality score was 8.13 in AMSTAR , the reporting quality score was from 19.5 to 25 in PRISMA. Re-performed meta-analysis showed that, the total success rate of operation was 93.3% (95%CI 92.9 to 93.8), the failure rate was 3.7% (95%CI 3.3 to 4.0), the mortality rate was 2.0% (95%CI 1.8 to 2.2), and the loss rate was 1.0% (95%CI 0.8 to 1.2). The cure rates of different surgical methods were all over 80%, among which single lobectomy (98.47%) and compound lobectomy (98.94%) had the higher cure rates than others. For the time of different surgical interventions, cure rate could be improved obviously in patients receiving surgery treatment after 1 months (OR=1.58, 95%CI 1.29 to 1.94, P=0.000 12), 1-8months (OR=1.66, 95%CI 1.30 to 2.12, P=0.000 05) and 9-24 months (OR=1.48, 95%CI 1.15 to 1.90, P=0.002) of anti-tuberculosis therapy compared with 0 month.There were significant differences between two groups.ConclusionCurrent evidence shows that operation is an effective way for severe multidrug-resistant pulmonary tuberculosis. Operative opportunity should be selected after 1-24 months of anti-tuberculosis drug treatment when the operation time depending on whether the tuberculosis has turned negative or not. Operative mode should be decided by the location and the scope of the lesion, which ensures the maximum excision of lesions and retention of lung function.