Objective To evaluate the effects of combined splenorenal shunt with portoazygos devascularization for portal hypertension. MethodsA retrospective analysis of the clinical data of combined splenorenal shunt with portoazygos devascularization for portal hypertension in 58 cases was made. They were 41 male, 17 female and average age was 42.5 and posthepatitic liver cirrhosis in 51 cases, schistosomiasis cirrhosis in 7 cases, and Child A in 26 cases, B in 28, C in 4. There was selective operation in 39 cases (Child A 20, Child B 18, Child C 1), early operation in 10 (Child A 3, Child B 6, Child C 1) and emergency operation in 9 (Child A 3, Child B 4, Child C 2).ResultsAll but two (3.4%) Child C cases died after emergency operation, the others recovered. Esophagus varicoses disappeared or had a great improvement in all cases. There were liver function damage with different degree in 19 cases and subdiaphramatic effusion or infection or pleural effusion in 23 and all were cured by conservative therapy. Followed up for 5-10 years in 48 cases, there were rebleeding in 2 cases (3.5%) and postmeal encephalopathy in 2 (3.5%).ConclusionCombined splenorenal shunt and portoazygos devascularization are the first choice for portal hypertension at present.
Objective To discuss the reconstruction of severe neck contracture by transplanting combined scapular/parascapular bilobar flaps, and the probability to reestablish three-dimensional movement of the neck. Methods From January 2003 to November 2004, 9 cases of sustained severeneck contractures were treated (aged 9-32 years). The combined scapular/parascapular bilobar flaps, pedicled on the circumflex scapular vascular bundle, were microsurgically used to cover the soft tissue defect after excision of hypertrophic scar and release of contracture. The maximum size of the combined bilobar flap was 20 cm×8 cm to 20 cm×11 cm，while the minimum one was 15 cm×4 cm to 15 cm×6 cm. Results The combined scapular/parascapular flapswere successfully used to treat 9 cases of severe neck contracture. All patients were satisfied with the final functional and aesthetic results. There was no recurrence during 3-9 months follow-up for 8 patients. The cervicomental angle was 90-105°.Conclusion The combined bilobar scapular/parscapular flap, providing a large area of tissue for coverage in three dimensions with a reliable blood supply by only one pedicle anastomosis during operation, is agood option for reconstruction of the severe neck contracture.
Objective To investigate surgical combined management of local recurrence of rectal cancer after anterior resection. Methods Relevant references about the surgical combined treatment of local recurrence of rectal cancer， which were published recently domestic and abroad were collected and reviewed. Results The surgical combined treatment for local recurrence of rectal cancer can markedly improve the survival ratio. Conclusion The surgical combined management of local recurrence of rectal cancer after anterior resection should be performed. The active and effective surgical combined management may help prolong the survival time and improve life quality.
From Jan. 1991 to Jan. 1994, 11 cases ofdifferent hip lesions with flexon contracture deformity were treated by combination of SmithPeterson and WatsonJones incisions in replacement of hip joint. All of them were followed-up for 1 to 3 years (an average of 1.9 years). According to pain, joint function, the excellent and good results were rated at 90.9%. This showed that from using the combined incisions, the hip joint was very well exposed, and release of hip flexion contracture could be acomplished in the same time. Bleeding fromoperation was reduced and the procedure was simple.
ObjectiveTo investigate the decision of combined liver and kidney transplantation (CLKT) after renal transplantation, provide surgical therapeutic experience for those patients with liver and renal insufficiencies and hepatorenal syndrome and summarize the risk factors, demerits and merits, and operative indications of CLKT. MethodsThe data of three successful CLKT cases of our centre from Feb. 2014 to Jan 2015 were retrospectively analyzed, and these three patients had kidney transplantation before. We also reviewed the latest associated literatures. ResultsThree patients got successful operations of CLKT and had very good recovery of renal function several days ofter operaton. Two of them discharged a few weeks after surgery, and one of these two patients got severe pulmonary infection of fungus two month after CLKT but recovered under proper therapy finally. The third patient died of severe mixed infection one month after CLKT. ConclusionsThe surgical techniques and rejection are not the main impact factor to the prognosis of CLKT after renal transplantation. Infection is the biggest trouble to which we should pay most of our attention. We should decide whether to do synchronous or nonsynchronous CLKT according to the situation before surgery. Moreover, the systematic therapy administration after CLKT is very necessary for the patients' long-term survival.
Objective To assess the combined management of lower limb chronic venous diseases according to the CEAP classification. Methods One hundred and twenty patients were classified according to the CEAP classification. Based on clinical presentation and image study, all patients were treated with combined management plan including oppression, medication and surgery. Results All 120 patients (135 limbs) were followed up in clinic, the local recurrence rate was 18.52%(25/135). Conclusion CEAP classification expounds the developing process of lower limb chronic venous diseases. With CEAP, we can avoid the blind spot in the treatment and expand the extent of combined therapy. Accordingly, CEAP classification is useful in the treatment and diagnosis of chronic venous diseases.
ObjectiveTo observe the clinical efficacy of ulinastatin combined with low-dose arginine vasopressin in treating severe pulmonary contusion. MethodSixty patients with severe pulmonary contusion were enrolled in our hospital between April 2012 to June 2014 year. All the patients were randomly divided into three groups. They were respectively defined as a routine treatment group (group A, n=20), an ulinastatin treatment group (group B, n=20), and a combined treatment group (group C, n=20). The respiratory frequency (RR), oxygenation index, partial pressure of carbon dioxide (PaCO2), the change of chest X-ray and the change of serum interleukin-6 (IL-6), IL-8 levels were compared among three groups before and after therapy. ResultThe respiration frequency(RR) and the concentration of serum IL-6, IL-8 levels were decreased in the group C before and after treatment with statistical differences (P=0.000, 0.000, 0.000). PaO2/FiO2 and PaCO2 were significantly increased in the group C before and after treatment (P=0.000, 0.000). After treatment for 7 d, the respiration frequency (RR) and the concentration of serum IL-6, IL-8 of patients in the group B decreased significantly compared with those in the group A (P=0.000, 0.043, 0.000). While PaO2/FiO2, PaCO 2 and the score of chest X-ray increased significantly in the group B (P=0.010, 0.000, 0.000). Compared with those in the group B, RR and the concentration of serum IL-6, IL-8 of patients in the group C decreased significantly (P=0.000, 0.045, 0.000), while PaO2/FiO2, PaCO2 and the score of chest X-ray increased significantly (P=0.043, 0.010, 0.001). ConclusionUlinastatin combined with low-dose arginine vasopressin shows obvious effects in the patients with severe pulmonary contusion. And its therapeutical effects are better than that of the other two treatment options.
ObjectiveTo evaluate the effectiveness of the combined tenodesis for proximal lesions of biceps tendon with massive rotator cuff tear by arthroscopy. MethodsBetween January 2011 and June 2013, 48 patients with massive rotator cuff tear and proximal lesions of biceps tendon underwent combined tenodesis under arthroscopy, and the clinical data were retrospectively analyzed. Of 48 cases, 22 were male and 26 were female with an average age of 46 years (range, 35-59 years); 12 cases had clear history of trauma. The disease duration ranged from 1 to 57 months (mean, 4.6 months). All cases suffered from moderate to severe shoulder pain, the strength and the range of motion (ROM) declined when compared with those of the other side. According to Goutallier classification standard, 3 cases were rated as grade 0, 18 cases as grade 1, and 27 cases as grade 2. The operation time and complication were recorded. The visual analogue scale (VAS) score, ROM, the strength of flexed elevation and elbow flexion, Constant-Murley score, University of California Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, Mayo elbow performance score (MEPS) were used to evaluate the effectiveness. ResultsThe operations were performed successfully, and incisions healed primarily. The operation time was 120-160 minutes (mean, 135 minutes). One case had shoulder joint swelling with wound bleeding, which was cured after proper treatment. All 48 patients were followed up 12-18 months (mean, 13.9 months). The results of MRI showed good healing of tendon at 6 months after operation. When compared with preoperative values, VAS score was significantly decreased (P<0.05); the ROM in forward flexion, external rotation, and internal rotation, and the strength of flexed elevation were significantly increased (P<0.05); and ASES score, Constant-Murley score, and UCLA score were significantly improved at 12 months after operation (P<0.05). No significant difference was observed in MEPS score and elbow flexion strength (P>0.05). ConclusionThe technique of combined tenodesis under arthroscopy can obtain satisfactory clinical outcomes in treating proximal lesions of biceps tendon with massive rotator cuff tear.
【Abstract】Objective To investigate the potential role of tumor necrosis factoralpha (TNFα) in apoptosis after combined liver and kidney transplantation in rats. MethodsEighty rats which had combined liver and kidney transplantation were randomly paired, were divided into study group (n=20) and control group (n=20). 40 ml of 4 ℃ sodium chloride and antiTNFα monoclonal antibody (30 ml was infused from portal veins to donated livers and 10 ml from renal arteries to donated kidneys) were infused to the study group (0.1 mg/kg weight),and the same quantity of 4 ℃ sodium chloride was infused the control group. Venous blood was drew at different phases after the transplantations to detect the function of kidney and liver. The level of TNFα and the cell apoptosis were detected in the transplanted tissues of liver and kidney by ELISA and terminal deoxynucleotidy transferase mediated dTUPbiotin nickend labeling (TUNEL). ResultsThe levels of AST, ACT, Cr and BUN in the study group were significantly lower than those of the control group at the same phases (P＜0.05). The level of TNFα in the transplanted tissues of kidney and liver was also significantly lower as compared with those of control group. The cell apoptosis index of the transplanted tissues of kidney and liver was significantly smaller in the study group （P＜0.05）. There was no dramatically pathological change in the tissues of transplanted kidney and liver, which were treated with antiTNFα monoclonal antibody, and the structures are almost normal. ConclusionAntiTNFα monoclonal antibody may reduce cell apoptosis and accelerate the restoration of function of liver and kidney after combined liver and kidney transplantation.
Objective To construct an evaluation index system of the competitiveness of private hospitals, and to provide references for guiding, supervising, and managing the high-quality development of private hospitals. Methods An index pool was constructed by the literature analysis method. Index screening was completed using the modified Delphi method. The analytic hierarchy process, entropy weight method, and combination weight method were used to determine the index weight. Results The competitiveness evaluation index system of private hospitals was constructed, which included 5 primary indexes and 36 secondary indexes. The combination weight methods were resource allocation (0.366 8), service capacity (0.470 8), service efficiency (0.033 7), quality and safety (0.121 3), and financial management (0.007 3). Conclusion The constructed evaluation index system of competitiveness of private hospitals is scientific, targeted, and operable.