Objective To compare the mean operative time and complications between the LigaSure device and Harmonic Scalpel during video-assisted endoscopic approaches thyroidectomy. Methods The clinical data of 684 cases performed Miccoli thyroidectomy by the same operation team from January 2007 to December 2011 in the department of general surgery，Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University were analyzed. Three hundred and forty-nine patients were used Harmonic Scalpel，335 patients were used LigaSure device. The mean operative time and complications （such as hematoma，transient hoarseness，permanent recurrent laryngeal nerve injury，and hypocalcemia） were compared between two groups. Results A total of 684 patients were included in the study，of whom 263 underwent total thyroidectomy and 421 underwent lobectomy. There were not significant differences of the operative time and the complications in both thyroidectomy and lobectomy between the LigaSure device and Harmonic Scalpel（P＞0.05）. Conclusions The uses of the LigaSure device and Harmonic Scalpel in thyroid surgery are safe and reliable，surgeons may choose surgical instruments by habits and medical equipments.
ObjectiveTo summarize the experience of applying extracorporeal membrane oxygenation (ECMO) after cardiac surgery in adult patient. MethodsWe retrospectively analyzed the clinical data of 27 patients underwent ECMO from December 2011 to October 2013. There were 15 males and 12 females at the mean age of 51±11 years ranging from 41 to 73 years. Vein-artery perfusion was performed in all 27 patients. ResultsAll 27 patients underwent ECMO. The mean time of using ECMO was 81.2±36.4 hours ranging from 48.0-192.0 hours. The mean time of hospital stay was 307.8±97.0 hours ranging from 168.0-480.0 hours. The rate of weaning from ECMO was 77.8% (21/27). The rate of discharge was 51.9% (14/27). The rate of perioperative mortality was 44.4% (12/27). ConclusionEffective monitoring with other supportive equipments is helpful to promote the result of ECMO.
【Abstract】Objective To study the clinical application of laparoscopic operation. Methods The clinical findings from 13 840 cases of laparoscopic surgery in this hospital from 1992 to 2005 were reviewed retrospectively.Results Laparoscopic operation were performed successfully in 13 653（98.6%）,187 cases were transferred to open operation. Complications were occurred in 115 cases, including common bile duct injury in 3 cases. Combined treatment with laparoscope and endoscope were performed in 162 cases. Eleven thousand three hundred and fiftytwo patients had been succeeded in followup survey. Over 90.0 percent of patients recovered smoothly. Conclusion Laparoscopic operation may be applied in a more extensive scope. The major complications can be reduced by strict procedures of laparoscopic operation. The combined treatment of laparoscope and endoscope should be further studied and widely used.
ObjectiveTo discuss the treatment of retroperitoneal tumors infiltrating celiac trunk. MethodFifteen cases of retroperitoneal tumors who underwent surgery in our hospital between December 2014 to December 2015 were reviewed and analyzed. ResultsAll of the 15 cases had underwent operation, and the blood loss was 300-2200 mL (mean of 600 mL), operation time was 125-600 minutes (mean of 240 minutes). Length of stay in cases of celiac trunk resected was 10-23 days (mean of 15.1 days), and length of stay in cases of celiac trunk nonresected was 15-132 days (mean of 35.2 days). Thirty cases of them were complete resection, and 2 cases were mostly resection. Eight cases of them did not injure celiac trunk, 1 case suffered from complication, 7 cases injured celiac trunk and all of them suffered from complication. There were significant statistical difference in incidence of complications (χ2=8.14, P=0.01) in cases of celiac trunk injury or not. All the cases were followed up for 3-13 months (mean of 6.3 months), 2 cases recurred during the follow-up period, 1 case was leiomyosarcoma, and another 1 was malignant fibrous histiocytoma who underwent celiac trunk resection. ConclusionsWhen retroperitoneal tumors infiltrates celiac trunk, we can resect the celiac trunk, but we must follow a certain principle.
Objective To analysis the safety of high-intensity focused ultrasound (HIFU) in the treatment of uterine fibroids and provide references for clinical practice and prevention of complications of gynecological diseases. Methods Databases including PubMed, The Cochrane Library (Issue 2, 2016), EMbase, CBM, CNKI, and VIP were searched to collect studies concerning the complications of HIFU for uterine fibroids from March 1st 2005 to February 15th 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using R software. Results A total of twenty studies involving 2 405 patients were included. The results of meta-analysis showed that complications rate of gynecological system induced by HIFU was 6.63% (95%CI 3.58% to 12.28%); among them, the incidence of vaginal bleeding was 5.82% (95%CI 3.22% to 10.53%), and the incidence of abdominal pain was 10.02% (95%CI 4.77% to 21.05%). Conclusion The current evidence shows that there is a certain amount of complications of HIFU for uterine fibroids. Due to the limited quantity and quality of included studies, the above results are needed to be validated by more studies.
Objective To summarize the advantages and complications of implantation of venous access port via axillary vein in the operation of breast cancer, and to explore the countermeasures against the complications. Methods A total of 40 female patients with breast cancer were enrolled in this observational study between January 2011 and September 2014. They were aged from 32 to 62 years with a mean of 49.3 years. The time for implantation, catheter life, reasons for port removal and complications were evaluated. Results The average time for implantation was 23.3 minutes. The catheter life ranged from 142 to 917 days with a mean of 395 days. Four patients (10%) had port-related complications including 2 cases of pocket infection and 2 of catheter dysfunction. Thirty-one ports were removed for termination of chemotherapy, and four were removed for complications. Conclusions It is simple and time-saving to implant venous access port via axillary vein in the operation of breast cancer. The incidence of pocket infection is high, and is expected to be reduced by choosing appropriate cases and taking strict aseptic norms.
Objective To explore the effectiveness of neoadjuvant chemotherapy on postoperative risk of colorectal cancer by use of estimation of physiologic ability and surgical stress （E-PASS）. Methods A total of 161 patients with colorectal cancer according to the inclusion criteria from January 2009 to December 2009 in West China Hospital of Sichuan University were analyzed retrospectively，who were assigned to neoadjuvant chemotherapy group （NC group, 78 patients） and non-NC group （83 patients）. The postoperative risk of each group was assessed by the E-PASS scale including preoperative risk score （PRS），surgical stress score （SSS），and comprehensive risk score （CRS）. Results The baseline of two groups had no significant difference （P＞0.05）. The postoperative complication incidence of two groups had no significant difference either （P＞0.05）， which was 10.26% （8/78） in the NC group，and 7.23% （6/83） in the non-NC group. The PRS was 78.42 in the NC group and 83.42 in the non-NC group （P=0.497）. The SSS was 80.77 in the NC group and 81.22 in the non-NC group （P=0.951）. The CRS was 80.74 in the NC group and 81.24 in the non-NC group （P=0.976）. The accuracy of the postoperative risk assessment was 70 cases and 78 cases in the NC group and non-NC group，respectively. There was no significant difference of accuracy between two groups （P=0.325）. Conclusions Neoadjuvant chemotherapy does not increase the risk of patients with colorectal cancer after operation，and the results suggest that E-PASS scale can provide a more accurate assessment of neoadjuvant chemotherapy in patients with surgical risk.
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.
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 analyze the cause of complications for patients with advanced malignant biliary obstruc-tion treated with percutaneous transhepatic implantation of biliary stent (PTBS) and summarize the experiences of comp-lications of the treatment. MethodThe complications of 59 patients firstly treated with percutaneous transhepatic cholangial drainage (PTCD) then with PTBS in 156 cases of advanced malignant biliary obstruction from January 2010 to January 2013 in this hospital were analyzed retrospectively. ResultsFifty-nine cases of complications were occurred in 156 cases of advanced malignant biliary obstruction, the incidence was 37.8%, including biliary infection in 26 cases, bile duct bleeding in 17 cases, liver failure in 5 cases, renal failure in 4 cases, acute pancreatitis in 4 cases, stent displa-cement in 2 cases, bile duct perforation in 1 case.Three cases died in 59 patients with complications, 56 cases were improved after symptomatic treatment. ConclusionPTCD combined with PTBS is a safe and effective treatment of advanced malignant biliary obstruction, the reasonable perioperative management is very important to reduce the occurrence of complications.