Objective To systematically review the effects of enteral immunonutrition (EIN) on postoperative infection and the length of hospital stay in patients with gastrointestinal cancer after surgery, in order to provide high quality evidence for the rational perioperation nutrition plan for patients with malignant gastrointestinal tumor. Methods Randomized controlled trials (RCTs) published in English about application of EIN vs. general treatment for gastrointestinal surgery published from Jan. 1st, 1997 to Oct. 31st 2012 were retrieved in the following databases: PubMed, Ovid, and EMbase. References of the included studies were also retrieved. According to the inclusion and exclusion criteria, two reviewers independently screened studies, extracted data, and evaluated the methodological quality. Then, meta-analysis was conducted using RevMan 5.2 software. Results 19 RCTs involving 2 298 patients were included. The results of meta-analysis showed that: there was no significant difference between the postoperative EIN group and the control group in reducing the risk of postoperative infection (OR=0.91, 95%CI 0.56 to 1.47, P=0.70); But postoperative and perioperative EIN had reduced the risk of postoperative infection with a significant difference (OR=0.57, 95%CI 0.39 to 0.82, P=0.002; OR=0.52, 95%CI 0.35 to 0.76, P=0.000 9). Additionally, the results of sensitivity analysis revealed that: no matter when EIN was used (during preoperative, postoperative, or perioperative periods), it reduced the length of postoperative hospital stay with significant differences, compared to the standard nutrition group (OR= −2.39, 95%CI −3.28 to −1.49, Plt;0.000 01; OR= −2.42, 95%CI −4.07 to −0.78, P=0.004; OR= −2.76, 95%CI −3.46 to −2.06, Plt;0.000 01). Conclusion Current evidence shows that perioperative EIN can decrease postoperative infection and reduce the length of hospital stay of patients with malignant gastrointestinal tumor. Due to the limited quantity and quality of the included studies, high quality RCTs are needed to verify the above conclusion.
Objective To develope a modified surgical lavage tube to improve the efficacy of the treatment of orthopaedic postoperative infection. Methods A retrospective analysis was performed on 126 patients who received the pulsed lavage therapy with side-hole double valve lavage tube between March 2005 and March 2010. There were 98 males and28 females, aged 19-63 years (mean, 35 years). The infected sites included femur in 61 cases, tibiofibula in 46 cases, humerus in 12 cases, and patella in 7 cases. The lavage tube obstruction and defluvium, secondary infection of drainage opening, and wound heal ing were observed during treatment. Results No lavage tube defluvium occured during the lavage in all cases. Lavage tube obstruction occurred in 68 cases, edema at the peri pheral tissue was caused by obstruction in 9 cases; secondary infection at the lavage and drainage opening in 10 cases, which were cured after corresponding treatment. All cases achieved wound healing by first intention within 2 weeks. Lavage tube and drainage opening were closed within 1 month. All patients were followed up 1-5 years (mean, 18 months) with no recurrence. Conclusion Pulsed lavage therapy with side-hole double valve lavage tube can obviously improve the efficacy of the treatment of orthopaedic postoperative infection, so it is an effective modification to convention lavage.
ObjectiveTo investigate the importance of nursing observation and intervention for extrahepatic bile duct stones with gallbladder stones treated by electronic duodenoscopic sphincterotomy (EST) combined with laparoscopic cholecystectomy (LC). MethodsFrom July 2011 to February 2014, 157 patients with extrahepatic bile duct stones with gallbladder stones underwent EST and LC at the same time in our department. Combined with the surgery characteristics, we focused on the close observation and nursing of postoperative complications and drainage tubes for patients' timely recovery. ResultsOne patient with duodenal diverticulum papilla did not complete EST and LC surgery, which was then transformed to LC, bile duct incision and choledochoscopy with T tube drainage. All the remaining 156 patients completed endoscopic retrograde cholangio-pancreatography and LC with a completion rate of 99.36%. Under close observation and careful nursing care, this group of patients did not have duodenum perforation, bile leakage or other complications. No patient died. Seven to thirteen days after hospitalization, all the patients were cured and discharged from the hospital. ConclusionFor patients undergoing EST and LC at the same time, observation and timely intervention are very important in reducing serious complications, improving the quality of surgery, enhancing patients' comfort, and promoting postoperative recovery.
The aim of this paper is to explore the prevention of rabbit postoperative abdominal cavity adhesion with poly (lactic-co-glycotic acid) (PLGA) membrane and the mechanism of this prevention function. Sixty-six Japanese white rabbits were randomly divided into normal control group, model control group and PLGA membrane group. The rabbits were treated with multifactor methods to establish the postoperative abdominal cavity adhesion models except for those in the normal control group. PLGA membrane was used to cover the wounds of rabbits in the PLGA membrane group and nothing covered the wounds of rabbits in the model control group. The hematologic parameters, liver and kidney functions and fibrinogen contents were detected at different time. The rabbit were sacrificed 1, 2, 4, 6, 12 weeks after the operations, respectively. The adhesions were graded blindly, and Masson staining and immunohistochemistry methods were used to observe the proliferation of collagen fiber and the expression of transforming growth factorβ1 (TGF-β1) on the cecal tissues, respectively. The grade of abdominal cavity adhesion showed that the PLGA membrane-treated group was significant lower than that in the model control group, and it has no influence on liver and kidney function and hematologic parameters. But the fibrinogen content and the number of white blood cell in the PLGA membrane group were significant lower than those of model control group1 week and 2 weeks after operation, respectively. The density of collagen fiber and optical density of TGF-β1 in the PLGA membrane group were significant lower than those of model control group. The results demonstrated that PLGA membrane could be effective in preventing the abdominal adhesions in rabbits, and it was mostly involved in the reducing of fibrinogen exudation, and inhibited the proliferation of collagen fiber and over-expression of TGF-β1.
ObjectiveTo compare the postoperative complications following laparoscopic and open radical resection for rectal cancer. MethodsThe clinical data of 681 patients with rectal cancer from January 2011 to December 2014 in the Sixth Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively, of whom 583 patients underwent laparoscopic surgery (laparoscopic group) and 98 patients underwent open surgery (open group). The complications were compared between the two groups. Results①There were no statistically significant differences in the gender, age, total protein, albumin, and body mass index between the two groups (P > 0.05). As compared with the open group, the proportions of previous abdominal operation, Dixon operation, and TNM stageⅡandⅢwere lower (P < 0.05), while the use of neoadjuvant chemotherapy was more common (P < 0.05), the distance of the tumor lower margin from the anal verge was shorter (P < 0.05) in the laparoscopic group.②No differences were seen in terms of anastomotic leakage, pulmonary infection, urinary retention, intestinal obstruction, wound infection, abdominal sepsis, urinary tract infection, stoma complications, poor incision healing, bleeding, intestinal hemorrhage, and deep vein thrombosis between the two groups (P > 0.05). ConclusionsThe development of postoperative complications in the laparoscopic group is similar to the open group, which are both available approach to the treatment of rectal cancer. But more randomized clinical trials are warranted to confirm which one is better.
ObjectiveTo compare the outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA) for the acute appendicitis patients based on our extensive experiences. MethodsThe data of all the acute appendicitis patients who underwent appendectomy from January 2013 to December 2014 in our department were retrospectively reviewed. A total of 201 patients were enrolled and divided into LA group (n=102) and OA group (n=99). The relevant clinical indexes during and after operation of two groups were compared. ResultsThere were no significant difference in age, gender, and underlying disease between LA and OA patients (P > 0.05). And the abdominal cavity infection rate, abdominal drainage rate and 30-day readmission rate were also similar (P > 0.05). But LA group had less operative time, lower infection operative wound rate, less intestinal function recovery time, shorter inhospital days and higher hospital expenses than OA group (P < 0. 05). In addition, perforated appendix and LA could increase the rate of abdominal drainage[OR=2.710, 95% CI(1.129, 6.507), P=0.026]. ConclusionsBoth LA and OA are safe and effective methods for the treatment of acute appendicitis. But LA has several advantages over OA on less operative time and postoperative complications, earlier recovery, and shorter inhospital days. While LA have higher hospital cost than OA, it still should be considered as a prefer way to cure acute appendicitis. LA is a independent risk factor of abdominal drainage.
Objective To classify the postoperative complications (POCs) in patients receiving esophagectomy and find risk factors of different grades of complications. Methods We retrospectively analyzed the clinical data of 298 patients with esophageal cancer who underwent esophagectomy from January 2012 to August 2015 in our hospital. According to the postoperative complications, they were divided into two groups: the complication group (n=113) and the non-complication group (n=185). In the complications group, there were 86 males and 27 females with an average age of 61.42±7.81 years. There were 150 males and 35 females with an average age of 60.39±7.76 years in the non-complication group. The POCs were classified by Clavien-Dindo system. All possible factors influencing the occurrence of grade Ⅱ-Ⅴ POCs were analyzed. Univariate and multivariate analyses were used for seeking independent risk factors of POCs. Results The incidence of grade Ⅱ POCs was 29.87% (89/298), 5.37% (16/298) for grade Ⅲ and 2.68% (8/298) for grade Ⅳ and Ⅴ. The most common POC was lung infection with the incidence of 13.76%. Univariate and multivariate analyses showed the operation duration and the number of lymph node dissection were the independent risk factors of grade Ⅱ-Ⅴ POCs. Conclusion Postoperative lung infection is the major complication in patients receiving esophagectomy. The operation duration and the number of lymph node dissection are the independent risk factors of grade Ⅱ-Ⅴ POCs.
Objective To investigate the effect and safety of time of temporarily-closed wound drainage on blood loss of primary total knee arthroplasty (TKA) after intravenous and intra-articular injection of tranexamic acid (TXA). Methods Eighty female patients were selected from 102 patients who underwent primary TKA between September 2015 and July 2016, who were randomly divided into 4 groups: control group (group A), 30 minutes group (group B), 60 minutes group (group C), and 90 minutes group (group D), 20 patients each group. No significant difference was found in age, body mass index, side, pathogen, duration, and preoperative hemoglobin, albumin, and hematocrit between 4 groups (P>0.05). All the patients received intravenous injection of 1 g TXA at 10 minutes before removing the tourniquet. The patients in group A were injected with 60 mL normal saline into the articular cavity and closed drainage after surgery, while the patients in groups B, C, and D were injected with 60 mL TXA into the articular cavity and closed drainage for 30, 60, and 90 minutes respectively. The volume of drainage at 24 hours after operation, the total blood loss, the postoperative hemoglobin level, maximum hemoglobin loss, albumin loss, the volume and frequency of blood transfusion, venous thrombo embolism rate, and pulmonary embolism rate were recorded and compared between groups. Results The volume of drainage and total blood loss in groups B, C, and D were less than those of group A, showing significant difference between groups C, D and group A (P<0.05), but no significant difference between group B and group A (P>0.05). The volume of drainage at 24 hours after operation in group B was higher than that in groups C and D, showing significant difference between groups B and D (P<0.05), but no significant difference was found between groups C and D (P>0.05). There was no significant difference in the total blood loss between groups B, C, and D (P>0.05). The hemoglobin loss and albumin loss gradually decreased from groups A to D, but no significant difference was found between groups (P>0.05). No venous thrombo embolism and pulmonary embolism occurred. The hemoglobin value decreased to 28 g/L at 3 days after operation in 1 patient of group D, who received venous transfusion of 20 g human albumin. Conclusion Intravenous and topical application of TXA in TKA can significantly decrease postoperative bleeding. Topical TXA combined with 60 minutes temporarily-closed wound drainage may reduce postoperative blood loss to the greatest extent without increasing the risk of venous thrombo and pulmonary embolism event after TKA．
Objective To evaluate the effect of perioperative fluid management on postoperative pulmonary complications (PPCs) of esophagectomy, and to find out the optimal scheme for perioperative fluid administration. Methods This retrospective cohort study enrolled 75 patients with esophageal squamous cell cancer who have received esophagectomy in West China Hospital from June to December 2014. We used the Kroenke's postoperative pulmonary complications classification system to define the PPCs. Patients with PPCs of grade Ⅱ-Ⅳ were considered as PPCs group (n=13, 12 males, 1 female, age of 64.62±8.64 years), and others were considered as non-complication group (n=62, 50 males, 12 females, age of 60.55±8.73 years). Intraoperative and postoperative fluid inputs and outputs as well as clinical characteristics between groups were compared. Results Between two groups, there was a great difference in postoperative albumin infusion, intraoperative fluid administration [net input, total input, net input/kg, total input/kg, net input/(kg·h) and total input/(kg·h)] and fluid input on the first postoerative 1–3 days (total input and total input/kg). The cutoff value for total input/(kg·h) in operation and total input on the first 1–3 postoerative days was 12.07 ml/(kg·h) and 178.57 ml/kg, respectively. Conclusion The speed of fluid infusion in operation and total input on postoperative 1-3 days are most important influence factors of PPCs. The speed in operation should not exceed 12.07 ml/(kg·h) and the total input on postoperative 1-3 days should not exceed 178.57 ml/kg. Within this range, an appropriate increase in fluid volume can make patients feel better.
Objective To evaluate the postoperative effects of different thoracoscopic sympathectomy on palmar hyperhidrosis patients. Methods We searched the Wanfang Database, CNKI, Weipu, CBM, PubMed, Cochrane Library (from inception to March 2016) to identify studies about thoracoscopic sympathectomy on palmar hyperhidrosis patients. Quality of the included studies was evaluated. The meta-analysis was performed by RevMan5.3 software. Results A total of 15 studies (9 randomized controlled trials, 3 cohort studies, and 3 retrospective studies) involving 2 542 patients were included. The result of meta-analysis suggested that there was statistical difference in postoperative compensatory hyperhidrosis (OR=4.88, 95% CI 1.88 to 12.68,P=0.001) between T2 sympathectomy and T3 sympathectom. Compared with T2-4 sympathectomy patients, the risk of postoperative compensatory hyperhidrosis in T2-4 sympathectomy group was significantly lower (OR=5.13, 95% CI 2.91 to 9.02,P<0.000 01). Compared with T3 sympathectomy group, the risk of postoperative compensatory hyperhidrosis and hand dry in the T4 sympathectomy group was significantly lower (OR=2.91, 95% CI 2.06 to 4.12,P<0.000 01;OR=14.60, 95% CI 3.06 to 69.63,P=0.000 8), respectively. Conclusion The rate of postoperative compensatory hyperhidrosis or hand dry is lower on T4 sympathectomy patients and supposed to be the best segment for the treatment of palmar hyperhidrosis patients.