目的:探討早期采用益活清下法治療重癥急性胰腺炎(severe acute pancreatitis,SAP)并腎功能不全的療效。方法:35 例符合病例選擇標準并接受益活清下法治療的SAP并發腎功能不全患者,按發病后入院時間分為早期組(3d 內入院接受治療,24例)和晚期組(3～7 d 內入院接受治療,11例),比較治療過程中兩組患者各并發癥的持續時間、病程、手術中轉率及病死率。結果:兩組入院48小時Ranson 評分、急性生理和慢性健康評價指標Ⅱ(APACHE Ⅱ )評分及CT 評分比較差異無顯著性(Pgt; 0.05);早期組急性呼吸窘迫綜合征、腎功能不全的持續時間低于晚期組(Plt; 0.05);早期組和晚期組中轉手術率分別12.5%(3/24例)和 18.18%(2/11例),差異無統計學意義(Pgt; 0.05);病死率早期組和晚期組分別為 8.33%(2/24例)和9.09%(1/11例),差異無統計學意義(Pgt; 0.05);早期組和晚期組住院病程分別為(20.40±18.25)d 和(34.92±12.62)d,兩組比較有統計學意義(Plt; 0.05)。結論:早期使用益活清下法對SAP合并腎功能不全可以取得更好療效。
ObjectivesTo systematically review the prophylactic efficacy of lidocaine administrated intravenously in advance on rocuronium associated injection pain/withdrawal movement in patients under general anesthesia.MethodsPubMed, The Cochrane Library, Web of Science, EMbase, CNKI, WanFang Data and VIP databases were electronically searched to collect relevant randomized controlled trials (RCTs) on pretreatment with lidocaine intravenously to prevent injection pain /withdraw movement from rocuronium from inception to September 30th, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software.ResultsA total of 30 RCTs involving 2 518 patients were included. The results of meta-analysis showed that, compared to the control group, pretreating with intravenous lidocaine could significantly reduced the occurrence of total pain/withdrawal movement associated with rocuronium injection (RR=0.43, 95%CI 0.36 to 0.51, P<0.000 01), and whether with (RR=0.39, 95%CI 0.29 to 0.52, P<0.000 01) or without (RR=0.45, 95%CI 0.36 to 0.57, P<0.000 01) occluding the vein, intravenous lidocaine could prevent pain/withdrawal movement associated with rocuronium injection. In addition, the incidence of lidocaine group igniting moderate (RR=0.38, 95%CI 0.31 to 0.46, P<0.000 01) or severe (RR=0.23, 95%CI 0.18 to 0.30, P<0.000 01) pain/ withdrawal movement were less likely to occur. However, there was no difference between the lidocaine and control group in the incidence of mild injection pain/withdrawal movement induced by rocuronium (RR=0.89, 95%CI 0.75 to 1.06, P=0.19).ConclusionsCurrent evidence shows that pre-intravenous lidocaine can reduce the occurrence of injection pain/withdrawal movement associated with rocuronium injection patients, especially in the prevention of moderate and severe injection pain/withdrawal movement.
ObjectiveTo systematically evaluate the efficacy and safety of simultaneous transurethral resection of bladder cancer and prostate (TURBT+TURP) in the treatment of bladder cancer with benign prostatic hyperplasia (BPH). MethodsWe searched PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, WanFang Data and VIP from inception to January 2015, to collect randomized controlled trials (RCTs) and cohort studies investigating the efficacy and safety of TURBT with TURP in the treatment of bladder cancer with BPH. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies, and then meta-analysis was performed using RevMan 5.3 software. Results3 A total of 3 RCTs (n=137) and 10 retrospective cohort studies (n=998) were included. The results of meta-analysis showed that there were no significant differences between the simultaneous resection group and the control group in the overall recurrence rate (RCT:OR=0.55, 95% CI:0.24 to 1.24, P=0.15; retrospective cohort study:OR=0.78, 95% CI:0.60 to 1.01, P=0.06), postoperative recurrence rate in the prostatic fossa/urethra (RCT:OR=1.40, 95% CI:0.28 to 7.60, P=0.68; retrospective cohort study:OR=1.36, 95% CI:0.49 to 3.74, P=0.55), progression rate (OR=0.93, 95% CI:0.53 to 1.61, P=0.79) and overall perioperative complication rate (RCT:OR=0.35, 95% CI:0.08 to 1.55, P=0.17; retrospective cohort study:OR=0.1.75, 95% CI:0.44 to 6.98, P=0.43). ConclusionCompared with only TURBT or sequential TURBT and TURP, simultaneous TURBT and TURP do not increase the overall recurrence rate, postoperative recurrence rate in the prostatic fossa/urethra, progression rate and overall postoperative complication rate. However, due to the limited quality and quantity of included studies, larger sample size and higher quality RCTs are needed to verify the above conclusion.
ObjectivesThe present network meta-analysis was conducted to evaluate the potential efficacy and safety of various surgical approaches in the treatment of benign prostatic hyperplasia with enlarged prostate.MethodsPubMed, EMbase, The Cochrane Library, Clinicaltrials.gov and CNKI databases were electronically searched to identify eligible studies. Two reviewers independently screened literature, extracted data and evaluated risk of bias and the ADDIS 1.16.8 software was used to conduct meta-analysis.ResultsA total of 23 studies involving 2 849 patients with 5 approaches including open prostatectomy (OP), holmium laser enucleation of the prostate (HoLEP), plasmakinetic/bipolar plasmakinetic enucleation of the prostate (PK/BPEP), transurethral vaporization of the prostate (TUVP), and laparoscopic prostatectomy (LSP) were included. HoLEP, PK/BPEP and OP were superior to the other methods in improving the objective indicators and subjective feelings of patients during both short and medium-term follow-up. However, compared with OP, HoLEP and PK/BPEP were observed to result in a significantly lower hemoglobin level (MD=1.65, 95%CI 0.35 to 4.41; MD=2.62, 95%CI 0.64 to 2.90), longer postoperative irrigation time (MD=4.67, 95%CI 1.29 to 10.66; MD=2.67, 95%CI 1.32 to 6.63), as well as indwelling catheter after operation (MD=1.64, 95%CI 0.48 to 4.15; MD=2.52, 95%CI 0.60 to 3.78). In terms of short-term complications, PK/BPEP (RR=0.45, 95%CI 0.13 to 1.29) was found to be significantly lower than that of OP.ConclusionsHoLEP and PK/BPEP can be probably used as a superior treatment option for large volume benign prostatic hyperplasia because of its better curative effect, higher safety and quick postoperative recovery.
ObjectiveTo explore the impact of different tracts on the effectiveness and safety of percutaneous nephrolithotomy (PCNL) on complete staghorn calculus.MethodsPatients with complete staghorn calculus who underwent single channel PCNL by the same surgeon in West China Hospital of Sichuan University from October 2009 to August 2019 were included. The removing time, the rate of immediate stone removal, the average extubating time, and the incidences of postoperate complications such as fever and bleeding were analyzed statistically.ResultsA total of 379 patients were included. There were 146 cases in the upper tract group, 170 cases in the lower tract group and 63 cases in the middle tract group. Compared with the upper and middle tract groups, the lower tract group had shorter stone removing time [(50.34±18.52) vs. (53.41±22.75) vs. (41.79±17.45) min, P<0.001], shorter average extubating time [(5.53±1.83) vs. (6.17±1.44) vs. (4.96±1.91) d, P=0.007]. The rate of immediate stone removal was higher in the the upper tract group (40.56% vs. 32.79% vs. 34.71% ), but there was no statistical difference among the three groups (P=0.447). There was no significant difference among the three groups in the fever incidence (25.44% vs. 24.24% vs. 26.85%, P=0.938) or bleeding incidence (3.54% vs. 3.03% vs. 4.03%, P=1.000). In addition, there were 8 cases of pleural injury in the upper tract group.ConclusionsCompared with the lower and middle tract, PCNL with upper tract has a higher rate of removing stones for complete staghorn calculus, but there was no significant difference among the three groups. The incidences of bleeding and fever after surgery are similar in the three groups, but the risk of pleural injury may be increased in the upper tract group.
Objective To assess the efficacy and safety of the tubeless approach with a ureteral stent versus nephrostomy tube for postoperative drainage following percutaneous nephrolithotomy, and to provide guidance for clinical practice. Methods Randomized controlled trials (RCTs) were identified from PubMed (1966 to August 2008), Ovid (1966 to August 2008), Embase (1966 to August 2008), The Cochrane Library (Issue 3, 2008) and CBM (1978 to 2008). We also handsearched for relevant published and unpublished reports and check their references. The quality of the included trials was evaluated by two reviewers. We used The Cochrane Collaboration’s RevMan 5.0.16 software for meta-analysis. Results Eight studies involving 507 patients were included. We divided the patients into three groups: small (8~9 Fr), medium (16~18 Fr) and large (20~24 Fr) according to the diameter of nephrostomy tube for the analysis. Our meta-analyses showed: ①Hospital stay (hours): There was no statistically significant difference between tubeless and small bore tubes, but a difference was found in the comparison of tubeless versus medium and large bore tubes [WMD (95%CI) –32.4 (–33.64, –31.16) and –39.07 (–67.75, –10.39), respectively]; ② Puncture site urinary leakage: No statistically significant difference was found between tubeless and small bore tubes, of between tubeless versus medium tubes [RR= 0.07, 95%CI (0.00, 1.15), P=0.06]; ③ Visual analogue scale scores for postoperative pain on Day 1: There was no statistically significant difference between tubeless and small bore tubes, but there was a difference in tubeless versus medium and large bore tubes [MD (95%CI) –2.80 (–2.94, –2.66) and –2.04 (–2.29, –1.79), respectively];④No statistically significant difference was found in transfusion, fever or infection and operating time between tubeless and any size of nephrostomy tube. Conclusion No statistically significant difference between tubeless versus small bore tubes is found for any of the outcome measurements we analysed. Compared with medium and large bore tubes, tubeless PCNL of ureteral stent could reduce hospital stay, urine leakage and postoperative pain without an increase in complications. There is a moderate possibility of selection bias, performance bias and publication bias in this review, because of the small number of the included studies, which weakens the strength of the evidence of our results. Better evidence from more high-quality randomized controlled trials is needed.
Objective To study the effect of hypoxia on the prol iferation of hBMSCs and human placental decidua basal is-MSCs (hPDB-MSCs), and to provide the theoretical basis for discovering the new seed cells source for tissue engineering. Methods Density gradient centrifugation method was adopted to isolate and culture hBMSCs and hPDB-MSCs,flow cytometry (FCM) was appl ied to detect cell surface marker. After establ ishing the experimental model of CoC12 chemical hypoxia, MTT method was appl ied to evaluate the prol iferation of hBMSCs and hPDB-MSCs at different time points (6, 12, 24, 48, 72, 96 hours) with various CoC12 concentration (0, 50, 75, 100, 125, 150, 175, 200 μmol/L). Results FCM analysis revealed that hPDB-MSCs and hBMSCs expressed CD9, CD29, CD44, CD105, CD106 and human leucocyte antigen ABC (HLA-ABC), but both were absent for CD34, CD40L and HLA-DR. Compared with hBMSCs, hPDB-MSCs expressed stage-specific embryonic antigen 1 (SSEA-1), SSEA-3, SSEA-4, TRA-1-60 and TRA-1-81 better. The prol iferations of hPDB-MSCs and hBMSCs were inhibited within the first 12 hours under hypoxia condition, but promoted after 12 hours of hypoxia. Compared with the control group, the hBMSCs were remarkably prol iferated 24 hours after hypoxia with CoC12 concentration of 150 μmol/L (P lt; 0.05), while hPDB-MSCs were significantly prol iferated 12 hours after hypoxia with CoC12 concentration of 75 μmol/L (P lt; 0.05). Conclusion Compared with hBMSCs, hPDB-MSCs express more specific surface antigens of embryonic stem cells and are more sensitive to the prol iferation effects of chemical hypoxia, indicating it may be a new seed cells source for tissue engineering.