ObjectiveTo investigate the impact of primary tumor site on prognosis of colorectal cancer after radical resection in different stages.MethodsFour hundreds and twenty patients with colorectal cancer in our hospital from Jan. 2008 to Dec. 2016 were selected as study subjects, all patients were confirmed by pathology. According to the location of colorectal cancer, the patients were divided into rectum group (n=220), left colon group (n=105) and right colon group (n=95). The difference of clinicopathological features of patients with different group were compared. The risk factors affecting the prognosis of colorectal cancer patients were analyzed by single factor and multi factor unconditional Cox regression analysis, and the survival curve was drawn by Kaplan-Meier method, and the difference test was carried out by log-rank method.ResultsThere were no significant differences between the three groups in age, BMI, smoking history, alcohol history, family history, vascular tumor thrombus, N staging, tumor diameter, nerve invasion and cancer nodule (P>0.05). There were significant differences in sex, pathological type, anterior intestinal obstruction, TNM staging, T staging and M staging (P<0.05). The results of single factor Cox regression analysis showed that sex, pathological type, anterior intestinal obstruction, TNM staging, T staging, M staging, primary tumor site, nerve invasion and cancer nodule were the risk factors for the prognosis of the patients (P<0.05). Multivariate Cox regression analysis showed that TNM staging, location of primary tumor and nerve invasion were risk factors affecting prognosis of patients (P<0.05). The total 5-year survival rate of the rectal group was 80.45% (177/220), the total 5-year survival rate of the left hemicolon group was 67.62% (71/105), and the total 5-year survival rate of the right hemicolon group was 68.42% (65/95). The survival curves of Kaplan-Meier showed that the difference between the three groups was statistically significant (P<0.05).ConclusonsThe 5-year survival rate of patients with rectal cancer is significantly higher than that of patients with left colon cancer and right colon cancer. For patients with different stage of colorectal cancer after radical resection, the prognosis of colorectal cancer can be predicted by the location of primary tumor.
【摘要】 目的 探討子宮部位異位妊娠的臨床特征和處理對策。 方法 回顧分析2002年9月-2009年9月間收治的31例子宮部位異位妊娠患者的臨床資料。 結果 31例患者中，初診確診僅8例，誤診率74.2%。除5例因難以控制的大出血行經腹病灶清除術加子宮修補術或全子宮切除術外，其余26例患者均經氨甲喋呤（MTX）治療加清宮術或宮腔鏡下病灶清除術保守治療成功。 結論 子宮部位異位妊娠容易誤診，超聲檢查是診斷的主要方法。保守治療安全、有效，可保留生育能力。氨甲喋呤治療加清宮術可作為治療子宮部位異位妊娠的主要方法。【Abstract】 Objective To investigate the clinical characteristics and treatment of ectopic pregnancy in the uterus. Methods The clinical data of 31 patients diagnosed as ectopic pregnancy from September 2002 to September 2009 were analyzed retrospectively. Results During preliminary diagnosis, only eight patients were accurately diagnosed.The error rate of first diagnosis was 74.2%. Five patients suffered focal cleaning and uterus neoplasty or total hysterectomy due to uncontrollable bleeding.The other 26 patients were successfully cured by conservation treatment of methotrexate (MTX) combined with dilatation and curettage or clearance of focal lesion under hysteroscopy. Conclusion Misdiagnosis of ectopic pregnancy in the uterus is easy to make.The ultrasonography is the main method for the diagnosis of ectopic pregnancy in the uterus.Conservative treatment is proved to be safe and effective and can preserve the patients’ fertility. Administration of MTX combined with dilatation and curettage is an main therapeutic method in handling ectopic pregnancy in the uterus.
Objective To analyze the trend of standardized infection ratio (SIR) of surgical site infection (SSI) in small bowel surgery, objectively evaluate the effect of infection control, and provide evidence-based strategies for SSI prevention. Methods According to Centers for Disease Control and Prevention (CDC) / National Healthcare Safety Network (NHSN) surveillance definitions for specific types of infections and the monitoring methods of SSI events published by NHSN, the SSI and related risk factors of adult inpatients undergoing small bowel surgery in Yichang Central People’s Hospital between January 1, 2016 and December 31, 2022 were prospectively monitored. The inpatients undergoing small bowel surgery that meets the definition of International Classification of Diseases, 10th Revision Clinical Modifications/Procedure Coding System (ICD-10-CM/PCS), a multivariate binary logistic regression model was used to calculate the predicted infections in each year, the model included the risk factors for small bowel surgery in NHSN Complex Admission/Readmission (A/R) SSI Model with 7 years of surveillance data as the baseline. The SIR was calculated by dividing the number of observed SSI by the number of predicted SSI in each year. The Mid-P method was used to test the difference of SIR compared to the previous year, and the linear regression model was used to analyze the trend of SIR. Results A total of 2 436 patients were included, with 48 cases of deep incision infection and 49 cases of organ/cavity infection, and the overall incidence rate of infection was 4.0%. From 2016 to 2022, there were 151, 244, 222, 260, 320, 408, and 831 patients who underwent small bowel surgery, respectively. The Mid-P test showed that there was a significant difference in SIR from 2016 to 2019 (P<0.05), and there was an increase in 2018 compared with 2017. There was no significant difference in SIR compared to the previous year from 2019 to 2022 (P>0.05), and there was no significant difference in the trend of SIR of SSI (P=0.065). Conclusions From January 1, 2017, to December 31, 2022, advances have been made in SSI control practices of small bowel surgery in six consecutive years, except for 2018, but there was no annual downward trend from 2020 to 2022. The use of SIR provides a new approach for evaluating the quality of infection control.
It has been certificated that hip and knee arthroplasty can improve quality of life and relieving pain and discomfort for ageing population and patients with muscloskeletal disorders. However, the outcomes of prosthetic joint infections (PJI) after arthroplasty usually are disastrous. The incidence of PJI is lower, but the number of this population is huge, which makes the strong impacts on quality of life for patients and healthcare economics. This review discusses the prevention strategies of PJI based on clinical epidemiology, diagnostic definition, pathogenesis, microbiology and risk factors, combined with some guidelines for prevention surgical site infections published recently.
ObjectiveTo systematically review the effect of perioperative supplemental oxygen administration on surgical site infection (SSI) in patients underwent abdominal surgery with general anesthesia. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 2,2015), CBM, VIP, WanFang Data and CNKI were searched to collect randomized controlled trials (RCTs) about perioperative supplemental oxygen administration versus normal FiO2 in patients underwent abdominal surgery with general anesthesia from inception to March, 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was conducted using RevMan 5.3 software. ResultsA total of 13 RCTs involving 3 532 patients were included. The results of meta-analysis indicated that: the incidence of SSI in the perioperative supplemental oxygen administration group was lower than that in the control group (OR=0.68, 95%CI 0.47 to 0.99, P=0.04). There were no significiant differences between both groups in incidence of atelectasis, incidence of infection requiring reoperation and 30-day mortality after surgery (all P values >0.05). ConclusionPerioperative supplemental oxygen administration could further decrease the risk of SSI in patients underwent abdominal surgery with general anesthesia, and does not increase the risk of other adverse events. Due to the limitations of quality of included studies, more high quality studies are needed to verify the above conclusions.
ObjectiveTo analyze the current situation of antimicrobial agents using in day surgery patients to guide the rational use of antimicrobial agents in day surgery.MethodsThe day surgery performed in Day Surgery Center of Xiangya Hospital of Central South University from June 2016 to September 2017 was selected. We retrospectively collected and analyzed patients’ hospitalization data and return visit data, statistically analyzed their use of antimicrobial agents, explored whether there was an unreasonable phenomenon in the use of antimicrobial agents, and analyzed the reasons.ResultsThere were 4 054 surgeries included in this study, and 1 293 patients using antimicrobial agents, the use rate of antimicrobial agents in day surgery patients reached 31.89%. Aseptic, clean-contaminated, contaminated and dirty surgery accounted for 12.22%, 65.20%, 7.27%, and 15.31% separately. Whether the application of antimicrobial agents in aseptic surgery patients had no effect on the outcome of the incision (P=0.073). The most common type of antimicrobial agents used by patients are cephalosporins (57.50%), mainly used as single drugs (97.91%) and mostly oral used in patients’ home. Most of the sources of antimicrobial agents were purchased by patients after they were discharged from the hospital (65.43%). The antimicrobial agents more used by Stemmatological Department (23.98%), Ear/Nose/Throat Department (22.58%) and Obstetrics and Gynecology Department (22.51%). The average used time of antimicrobial agents was (5.37±1.86) days, and 7.42% of patients still had surgical site infections after the use of prophylactic antimicrobial agents, most of them from General Surgery Department.ConclusionsThe unreasonable phenomena in the use of antimicrobial agents in patients with day surgery include: a high proportion of preventive medications for clean-contamination surgery, a high level of initial medication, and most patients take oral medications at home and lack of guidance, and long medication time. There is an urgent need for scientific guidance on the use of antimicrobial agents for patients undergoing day surgery.
目的 了解醫院外科患者手術部位感染的危險因素，以采取預防與控制干預措施，降低手術部位感染率。 方法 以回顧性調查方法對2011年1月－6月外科手術患者統計手術部位感染率；以前瞻性調查的方法對2012年1月－6月外科手術部位患者進行目標性監測。 結果 2011年1月－6月手術部位感染率為1.01%，2012年1月－6月手術部位感染率為0.63%，兩者比較，差異有統計學意義（P＜0.05）。患者年齡、手術類型、手術時間、手術性質是手術部位感染的高危因素。 結論 實施目標性監測，加強危險因素管理，采取干預措施，能有效降低外科手術部位感染率。
目的 探討幕上手術后遠隔幕下部位出血的臨床特點、發病原因、影像學表現及相關干預結果。 方法 分析2009年1月－2011年1月2例經幕上手術后出現遠隔幕下部位出血的病例的臨床資料。1例患者因顱內動脈瘤經翼點入路行動脈瘤夾閉術，術后出現遠隔幕下部位出血；1例患者因硬膜下血腫行鉆孔引流術，術后出現遠隔幕下部位出血。 結果 2例幕上手術患者均在術中或（和）術后大量引流腦脊液，術后發生出血部位均位于遠隔幕下,均行積極手術干預，恢復良好，格拉斯預后評分均為4分。 結論 過度引流可能為引起幕上手術后形成遠隔幕下部位出血的主要原因，術前、術中、術后應給予高度重視，并通過少量間斷引流腦脊液可以盡量避免發生。