Objective To summarize the methods andskills of anterior cervical locking plate systems in clinical application and to analyze the causes of some complications as well as give some preventive or remedial countermeasures. Methods From 1998 to 2002, 159 patients with cervical spondylotic myelopathy,fracturedislocation,tumor or tuberculosis of the cervical spine were treated with anterior locking plate systems. The complications were reviewed and analyzed. Results Ten kinds of complications related to anterior locking plate systems occurred in 21 patients. Most of the complications were caused by improperly-selecting implants, experience and technique deficiency. Conclusio The important preventive or remedial countermeasures are correctly-selecting patients, meticulous preoperative preparation, properly-selecting implants, standard and skillful manipulation and rational postoperative protection.
Objective To investigate the value of magnetic resonance (MR) imaging for diagnosing typeⅠ congenital choledochocele and its complications. Methods The MR imaging data of 13 cases with proved typeⅠ congenital choledochocele associated with complications were retrospectively reviewed and compared with operative findings. MR imaging sequences included axial T2W and T1W plain scan, true-FISP coronal images, 2D-MRCP, and Gd-enhanced T1W images. Results All patients had cystic dilatation of the common bile ducts to various degrees. In 6 patients complicated with stone and infection, the bile duct showed uniform wall thickening with marked enhancement, and calculus were depicted within the duct lumen with dilatation of the proximal biliary duct. In 7 cases complicated with carcinoma of biliary duct, a polypoid soft tissue mass or nodule was seen inside the ductal lumen in 3 cases, or the duct wall was irregularly thickened in 4 patients. Six cases received curative operation, but one patient with extensive local infiltration, vascular encasement and lymphadenopathy had only palliative treatment. MR imaging observations were verified by surgery findings in all 13 patients.Conclusion MR imaging is very valuable not only in diagnosing typeⅠ congenital choledochocele, but also in revealing its complications.
Objective To investigate the security and efficiency of endovascular repair for Stanford type B aortic dissection (AD) with severe complications. Methods Between January 2003 and December 2009, 60 patients having Stanford type B AD with severe compl ications were treated, including 39 males and 21 females with an average age of 43.7 years (range, 34-71 years). Severe compl ications included 27 cases of huge hemothorax, 1 case of paraplegia, 7 cases of acute renal failure,10 cases of cel iac trunk ischemia, 10 cases of superior mesenteric artery ischemia, and 5 cases of severe limb schemia. Emergency stent-graft deployment were appl ied in all patients, and 64 stent-grafts were successfully implanted. Results All patients survived and were followed up 3-86 months. Hemothorax disappeared after 28 days to 3 months of operation in all hemothorax patients; renal function returned normal after 1 to 9 days; l imb and visceral ischemia disappeared gradually after 1 to 14 days; and muscular strength of lower limb in the paraplegia patient began to recover after 4 hours of operation. The postoperative CT angiography showed enlarged true lumen and thrombosis in the false lumen. Conclusion Emergency endovascular repair is a safe and effective method to treat Stanford type B AD with severe complications.
Conduit failure and conduit airway fistula are rare complications after esophagectomy, however they can be catastrophic resulting in high mortality. Survivors can expect a prolonged hospital course with multiple interventions and an extended period of time prior to being able to resume oral nutrition. High index of suspicion can aid in early diagnosis. Conduit failure usually requires a period of proximal esophageal diversion and staged reconstruction. Conduit airway fistulas may be amenable to endoscopic repair but this has a high failure rate and many patients will require surgical repair with closure of the fistula and interposition of vascularized tissue to minimize recurrence.
ObjectiveTo investigate the value of central lymph node dissection in patients with cN0 papillary thyroid carcinoma. MethodThe clinical data of 128 patients with cN0 papillary thyroid carcinoma who had been performed central lymph node dissection during their hospitalization from December 2010 to July 2012 in Chinese PLA General Hospital were analyzed retrospectively. ResultsThe central neck lymph node metastasis rate was 35.94%(46/128) in 128 patients with cN0 papillary thyroid carcinoma, which in the patients with aged less than 45 years, with the tumor diameter larger than 1 cm, and with capsule or extrathyroidal invasion were significantly higher than those in the patients with aged larger than 45 years, with the tumor diameter less than 1 cm, and without capsule or extrathyroidal invasion (P < 0.05). After the operation, there were 22(17.19%) patients with temporary hypoparathyroidism as well as 3(2.34%) patients with temporary recurrent laryngeal nerve injury. However, no permanent recurrent laryngeal nerve injury and permanent hypoparathyroidism occurred. During the 14-32 months follow-up with an average 23.4 months, 2 cases of lateral neck lymph node metastases were observed. ConclusionAs an essential, effective, and safe operation to the patients with cN0 papillary thyroid carcinoma, central lymph node dissection should be performed by experienced hands.
Objective To investigate the clinical value and complication factors of percutaneous transthoracic needle biopsy (PTNB) guided by multislice computed tomography (MSCT). Methods From January 2013 to December 2016, 179 patients treated with MSCT-guided lung biopsy in the Affiliated Hospital of North Sichuan Medical College and Dianjiang People’s Hospital were reviewed. Occurrence rate and the influencing factors of complications were analyzed. Meanwhile, biopsy findings and diagnostic accuracy rate were summarized. Results A total of 129 cases of lung cancer were detected under MSCT-guided percutaneous biopsy in 179 patients with a diagnostic accuracy of 93.30%. The correct rate of malignant tumor diagnosis was 92.14%. The main complications were pneumothorax, pulmonary hemorrhage, dyspnea and hemoptysis. Major risk factors of MSCT-guided PTNB complications included lesion size ≤ 2 cm, the shortest distance to the diaphragm ≤ 5 cm, puncture depth > 5 cm, pleural puncture angle > 50°, the puncture times ≥ 2, puncture time ≥ 20 minutes, age of patients > 60 years, and existence of pulmonary disease (P<0.05). Conclusions The clinical application value of MSCT-guided PTNB is high. Skilled puncture technique and appropriate puncture procedure are helpful to reduce complications.
Objective To evaluate the efficiency and safety of combinative use of radiofrequency and transilluminated powered phlebectomy for treatment of varicose veins of lower extremity. Methods Three hundred and twenty-one cases of varicose veins of lower extremity were randomly divided into three groups: group A (102 cases)： endovenouser whole range closure in situ for great saphenous vein by radiofrequency and transilluminated powered phlebectomy for varicose veins of leg; group B (97 cases)： endovenouser whole range closure in situ for upper leg part of great saphenous vein by radiofrequency and transilluminated powered phlebectomy for varicose veins of leg; 122 conventional treatment cases, which high ligation and stripping of great saphenous vein, blood vessel branches and communicating branches resection and ligation were used, were selected as controlled group (group C). Consequences and complications of operation were checked. Results In all cases, the symptoms of swelling in lower extremity, soreness and infirmity disappeared within one month after operation, skin pigmentation was alleviated within one month after operation, and disappeared gradually within three months. Contrasting three groups in complications of skin numbness of legs, ecchymosis of upper leg, wound hematoma, and swelling below ankle, there was no statistical difference between group A and B, and there was statistical difference between group A and C, and B and C. There were more complications in conventional group than those in mini-invasive groups. There was no statistical difference in leg ecchymosisa between group B and C. No deep vein thrombosis of lower extremity and incision infection was detected in all cases. Conclusion It is simple and definitely efficient to combine radiofrequency with transilluminated powered phlebectomy for treatment of varicose veins of lower extremity. Powered phlebectomy is efficient in removal of varicose vein, but not suitable for phlebectomy for trunk of great saphenous vein.
ObjectiveTo evaluate nutritional risk of patients with esophagus cancer before operation using nutritional risk screening 2002 (NRS2002), and explore the relationship between nutritional risk score and postoperative results. MethodsWe prospectively evaluated the nutritional risk of 225 patients with esophagus carcinoma patients who were admitted in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between March 2012 and March 2013 using NRS2002, in accordance with disease severity score, nutritional status score and age score(age≥70 years old score was 1 point, < 70 years old for 0 point). There were 136 males and 89 females with age of 64.0±8.2 years (ranged from 41 to 85 years). Postoperative results include postoperative complications, mortality, and length of hospital stay. ResultsThe number of patients with preoperative score≥3 points was 75 (33.3%), < 3 points was 150 (66.7%). The incidence rate of postoperative complications was 26.7% in the patients with NRS2002 score≥3 points, and was 12.0% in those with NRS2002 score < 3 points(P < 0.05). And the total hospital stay time was longer in the patients with NRS2002 score≥3 points than that with NRS2002 score < 3 points(29.80±7.94 d vs. 15.30±2.05 d, P < 0.05). Logistic regression analysis showed that the preoperative NRS2002, the underlying diseases, and surgical method were risk factors for postoperative complications. ConclusionsPreoperative NRS2002 score≥3 points can predict more postoperative complications and longer hospital stay time in patients with esophagus carcinoma. It indicates that scientific nutrition support is necessary for esophagus carcinoma patients with NRS2002 score≥3 points. NRS2002 can be used as a predictive index of nutritional risk after operation of esophagus carcinoma.
Objective To evaluate the complication rate of CT-guided percutaneous lung biopsy and determine the risk factors. Methods A retrospective investigation of patients with CT-guided percutaneous lung biopsy in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine between2002 and 2009 was performed. The risk factors for complications were determined by multivariate analysis of variables related to patients’demographics, lung lesions, biopsy procedures, and individual radiological features. Results 281 biopsy procedures were enrolled. The total complication rate was 55. 9% with pneumothorax 32. 4% ( 91/281) , hemoptysis 34. 5% ( 97 /281) , and cutaneous emphysema2. 1% ( 6 /281) , and with no mortality.The pneumothorax rate was correlated with lesion location, lesion depth, and number of pleural passes. The bleeding risk was correlated with lesion size, lesion depth, and age. Prediction models for pneumothorax and bleeding were deduced by logistic regression. The pneumothorax model had a sensitivity of 80. 0% and a specificity of 62. 4% . And the bleeding model had a sensitivity of 67. 4% and a specificity of 88. 8% .Conclusions Lesion location, lesion depth, and number of pleural passes were independent risk factors for pneumothorax. Lesion size, lesion depth, and age were independent risk factors for bleeding. The prediction models for pneumothorax and bleeding will helpfully reduce the complication of CT-guided lung biopsy.
Objective To explore the correlation between gender and long-term prognosis of patients with type-B acute aortic dissection (AAD) after endovascular therapy (EVT). Methods From January to December 2012, all patients with type-B AAD undergoing EVT were enrolled by retrospective and observational study. They were divided into male and female groups. Kaplan-Meier analysis was used to analyze the correlation between gender and the cumulative survival rate. Results A total of 131 tyep-B AAD patients who had undergone EVT were selected, including 97 males (74.0%), and 34 females (26.0%). The medium follow-up duration was 2.1 years. Smoking history, cholesterol, white blood cell count, hemoglobin, creatinine and uric acid of the patients in males were higher than those in females (P<0.05); while the difference in other indexes were not significant (P>0.05). The inhospital mortality of male patients was 10 (10.3%), and was 3 (8.8%) in female patients; there was no significant difference between the two groups (P=0.803). Kaplan-Meier analysis showed that there was no significant difference in cumulative survival rate between the two groups (84.5% vs. 82.4%; Logrank test χ2=0.023, P=0.880). Conclusion No correlation between gender and long-term prognosis in patients with type-B AAD after EVT is found.