Objective To explore clinical efficacy and independent risk factors related to the recurrence of primary spontaneous pneumothorax (PSP) after video-assisted thoracoscopic surgery (VATS). Method We retrospectively anal- yzed the clinical data of 566 PSP patients by VATS in our hospital between December 2011 and June 2014 year. The patients were divided into a triple-port group(110 patients with 88 males and 22 females, aged 31.34±15.62 years) and a double-port group (456 patients with 383 males and 73 females, aged 31.46±15.65 years) by operation methods. We tried to find out the independent risk factors related to the recurrence. Results There was no statistical difference in intraoperative blood loss, postoperative drainage, drain removal, postoperative complications, postoperative length of hospital stay and rate of postoperative recurrence between the two groups (P>0.05) . However, the operation time (P<0.001) and the drainage of postoperative 48 hours (P<0.05) in the double-port group was shorter or less than that in the triple-port group. The overall recurrence rate was 1.41% (8/566) . The minors (OR=14.75, P=0.045) , no bulla type (OR=32.76, P=0.019) , and multiple bulla type (OR=15.48, P=0.013) were the independent risk factors for postoperative recurrence. Conclusions The double- port VATS technique has similar effect with triple-port VATS technique on spontaneous pneumothorax patients under- gone pulmonary bullae ligation and pleurodesis. Bulla ligation and whole mechanical pleurodesis can get better clinical efficacy and lower rate of recurrence. The minor, no bulla type, and multiple bulla type are the independent recurrence risk factors of PSP after surgery.
ObjectiveTo systematically review the clinical effectiveness of continuous lumbar drainage for CSF leakage. MethodsA comprehensive literature search was conducted in PubMed, The Cochrane Library (Issue 1, 2014), EMbase, CNKI, CBM, VIP and WanFang Data from January 1994 to January 2014 for randomized or non-randomized controlled trials on the comparison between lumbar drainage and conventional treatment in the effectiveness of CSF leakage treatment. According to the inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. ResultsSeven non-randomized controlled trials were finally included, involving 465 patients. The results of meta-analysis showed that:compared with conventional treatment, lumbar drainage was better in effectiveness (RR=3.78, 95%CI 1.91 to 7.50, P=0.000 1), CNS infection rates (RR=0.48, 95%CI 0.24 to 0.95, P=0.04), and hospital stay (MD=-6.66, 95%CI-10.09 to-3.23, P=0.000 1). However, no significant difference was found in the incidence of headache caused by hypotensive cranial pressure (RR=1.32, 95%CI 0.65 to 2.69, P=0.45). ConclusionCurrent evidence suggests that continuous lumbar drainage is superior to conventional treatment in total effectiveness rates, prevention of CNS infection and in reducing hospital stay, which is an effective treatment intervention of CSF leakage. Due to the limited quantity and quality of the included studies, the above conclusion still needs to be verified by carrying out more high-quality studies.
ObjectiveTo summarize the types of difficult cases and complications during interventional therapy for Budd-Chiari syndrome, and to propose solutions to these problems and complications. MethodsClinical data of 1 859 cases of Budd-Chiari syndrome (2 214 times) who underwent interventional diagnosis and therapy from Jan. 1990 to Sep. 2014 in our hospital were retrospectively analyzed. ResultsOf the 2 214 times, complications happened in 31 times, which were related to the interventional therapy, and the incidence of complication was 1.40% (31/2 214). Of the 31 times who suffered from complications, 25 times were successfully treated, and the successful rate was 80.65%. Three hundreds and seventy two times had been successful treated in 396 times with difficult situation (there were 9 times without treatment), and the successful rate was 96.12% (372/387). Seven patients abandoned inteventional therapy. Six cases died during the operation and hospital stay period, and the mortality was 0.32% (6/1 852). There were 1 553 cases were followed-up for 10-284 months (average of 100.9 months). During the follow-up period, 209 cases suffered from restenosis, and the restenosis rate was 13.46% (209/1 553). ConclusionInterventional therapy for Budd-Chiari syndrome has entered a mature stage, discover timely and correct handling of intraoperative complications are important to improve the successful rate and curative effect.