ObjectiveTo summarize the surgical treatment and explore factors which influencing prognosis of hilar cholangiocarcinoma. MethodsClinical data of 189 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2000 to Dec. 2010 and clinicopathological factors that might influence survival were analyzed retrospectively. A multivariate factor analysis was performed through Cox proportional hazard model. ResultsOf 189 cases, 62 cases received radical resection, 54 cases received palliative surgery, and 73 cases received non-resection surgery. Operative procedure (RR=0.165), differentiated degree (RR=2.692), lymph node metastasis (RR=3.014), neural infiltration (RR=2.857), and vascular infiltration (RR=2.365) were found to be the statistically significant factors that influenced survival by multivariate factor analysis through the Cox proportional hazard model. ConclusionsRadical resection is the best treatment for hilar cholangiocarcinoma. Skeletonized hepatoduodenal ligament, complete excision of infiltrated nerve and blood vessel are important influence factors to improve the prognosis of hilar cholangiocarcinoma.
ObjectiveTo explore the treatment and prognostic factors of typeⅢhilar cholangiocarcinoma. MethodsThe data of 170 cases of typeⅢhilar cholangiocarcinoma treated in our hospital from Jan. 2002 to Dec. 2011 were retrospectively analyzed. ResultsAmong these 170 patients of typeⅢhilar cholangiocarcinoma, 109 patients underwent surgical exploration in which 60 patients underwent resection and the remaining 49 patients were found unresectable and underwent U-tube or metallic stent drainage. Sixty one patients were preoperatively assessed as unresectable in which 14 patients underwent percutaneous transhepatic cholangial drainage and the remaining 47 patients refused any surgical intervention. Results of Cox proportional hazard model showed that residual tumor status (HR=4.621, 95% CI:1.907-11.199, P=0.001), lymph node metastasis (HR=2.792, 95% CI:1.393-5.598, P=0.004), and hepatectomy (HR=3.003, 95% CI:1.373-6.569, P=0.006) were independent prognostic factors which associated with patients in resection group. Besides, treatmentR0 resection (HR=0.177, 95% CI:0.081-0.035, P < 0.001), no treatment (HR=5.568, 95% CI:2.733-11.342, P < 0.001)] and vascular invasion (HR=1.667, 95% CI:1.152-2.412, P=0.007) were prognostic factors associated with all patients. ConclusionsTreatment and vascular invasion are the most important predictors of prolonging survival associated with typeⅢhilar cholangiocarcinoma. Besides, R0 resection including hepatectomy without lymph nodes metastasis is feasible in the majority of patients with resectable hilar cholangiocarcinoma.
Objective To investigate the medical charge of in-patients with diabetes and its influencing factors for effective hospital costs controlling. Methods The inpatients with diabetes (the first diagnosis was diabetes; the first three ICD-10 codes of which were between E10 to E14) in Fifth Peoples' Hospital of Chengdu during January to September of 2014 were analyzed for their hospital costs with descriptive statistical method, ANOVA and multiple linear regression method. Statistical analysis was conducted by using SPSS 18.0 software. Results A total of 1 389 cases of diabetes were included. The median of total medical costs and daily costs were 4 554.45 yuan and 446.46 yuan, respectively. The differences of total medical costs and daily costs between diabetes patients with different amount of complications were statistically significant (P<0.001). The factors including age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length were proved to be significantly correlated to total medical costs of diabetes inpatients (P<0.05). Conclusion Age, the way of the medical expense, the number of complications, with acute complications, CCI score and the hospital-stay length are influence factors of medical costs of diabetes inpatients.
ObjectiveTo explore the risk factors of intraabdominal complications (IACs), pancreatic fistula (PF), and operative death after pancreatoduodenectomy (PD), and to provide a theoretical basis in reducing the rates of them. MethodsClinical data of 78 patients who underwent standard PD surgery in The Third People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from Jun. 2003 to Nov. 2011 were collected to analyze the influence factors of IACs, PF, and operative death. ResultsThere were 29 cases suffered IACs (13 cases of PF included), and 6 case died during 1 month after operation. Univariate analysis results showed that IACs and PF occurred more often in patients with soft friable pancreas, diameter of main pancreatic duct less than 3 mm, preoperative biliary drainage, no pancreatic duct stenting, and without employment of somatostatin (P < 0.05), no influence factor was found to be related to operative death. Multivariate analysis results showed that patients with no pancreatic duct stenting (OR=1.867, P=0.000), soft texture of remnant stump (OR=1.356, P=0.046), and diameter of main pancreatic duct less than 3 mm (OR=2.874, P=0.015) suffered more IACs; PF was more frequent in patient with no pancreatic duct stenting (OR=1.672, P=0.030), soft texture of remnant stump (OR=1.946, P=0.042), and diameter of main pancreatic duct less than 3 mm (OR=1.782, P=0.002);no independent factor was found to have relationship with operative death. ConclusionsSoft texture of remnant stump, diameter of main pancreatic duct less than 3 mm, and no pancreatic duct stenting are independent risk factors that should be considered in indications for PD surgery.
Objective To evaluate the results of operative treatment of complex acetabular fractures and to investigate its influence factors. Methods From June 2000 to August 2006, 54 patients with complex acetabular fractures were treated, including 44 males and 10 females aged 20-75 years old (average 39.1 years old). Fractures were due to traffic accidentin 40 cases, fall ing from high places in 8 cases and crush by heavy objects in 6 cases. All cases were fresh and close fractures and the time from injury to operation was 5-72 days. There were 5 cases of posterior column and posterior wall fracture, 25 of transverse and posterior wall fracture, 2 of T-type fracture, and 22 of double column fracture. During operation, Kocker- Lagenbach approach was used in 23 cases, anterior il ioinguinal approach was appl ied for 3 cases and the combination of anterior and posterior approaches was performed on 28 cases. AO reconstructive plate and screw internal fixation were used in all the cases. Results Fifty-two cases were followed up for 12-74 months (average 31.3 months). Anatomical reduction was achieved in 23 cases, satisfactory reduction in 19 cases, poor reduction in 10 cases, and the excellent and good rate reached 80.77%. During operation, 1 case suffered from a tear in the external il iac vein and healed after vein repair; 2 cases had sciatic nerve injury and took mecobalamin as oral administration, one of them fully recovered, and the other had incomplete recovery at 18-month follow-up. At the final follow-up, there were 6 cases of severe heterotopic ossification, one of them received heterotopic bone resection and the rest 5 patients received conservative treatment; there were 9 cases of traumatic osteoarthritis, one of them received total hip replacement and the rest 8 patients received conservative treatment; there were 5 cases of avascular necrosis of the femoral head, two of them received total hip replacement, 1 received no further treatment because the femoral head didn’ t collapse, and the rest 2 patients gave up total hip replacement; 75.00% patients were graded as excellent and good according to the modified Merled’Aubigné-Postel hip score system. Patients’ qual ity of l ife was compared with local population normsmatched for age and sex by using SF-36 scales, their overall score were below the local population norms, and their general health, vital ity, role l imitation due to emotional problems and mental health were comparable to the local population norms. Logistic regression analysis revealed the time to reduce hip dislocation, qual ity of fracture reduction nd traumatic arthritis were independent risk factors affecting postoperative functional outcomes. Conclusion Applying open reduction and internal fixation in the treatment of displaced complex acetabular fractures has a satisfying therapeutic effect. Time to reduce hip dislocation, qual ity of fracture reduction as well as traumatic arthritis are independent risk factors affecting postoperative functional outcomes.
Valvular heart disease is one of the common diseases in cardiac surgery. Surgery is the main treatment for valvular heart disease. Cardiac valve replacement surgery corrects the disordered haemodynamics, but the quality life of patients may be affected by multiple factors, such as the disease itself, treatment measures, long-term postoperative anticoagulant and follow-up. This article will provide an overview of the quality of life (origin and definition, evaluation) and the quality of life of patients after cardiac valve replacement (the purpose and significance of quality of life assessment, the quality of life of patients after cardiac valve replacement at different times and different dimensions, influencing factors of the quality of life of patients after surgery), aiming to provide clinical evidence for patients to make decisions before surgery and for clinical medical staff to take intervention measures for patients after surgery.
ObjectiveTo know the life attitude and its influence factors of nursing undergraduates in a school of nursing,so as to provide the theoretical evidence for the exploration of the way of life education. MethodsA cluster sample of 246 nursing undergraduates were asked to complete the survey,who were sampled from grade 2008 to grade 2011 in a University of Sichuan province between Nevember and December 2011.Then we used the way of questionnaire to analyze and research the life attitude and its influence factors of nursing students,and this study mainly used the Life Attitude Scale (LAS) questionnaire which was made by Taiwan scholar Manying Xie. ResultsThe total score of the investigated nursing students'attitude to life was 365.1±43.6,and the total and each level scores were higher than Taiwan college students and the differences were statistically significant (P<0.01).Female students'total score of attitude to life and the existence sense dimension were significantly higher than male students'(P<0.05).The third grade students'score of love and care level had a significant difference with the second grade and the first grade students (P<0.05).Through correlation analysis,nursing students'life attitude and self-rating interpersonal relationship (r=0.256,P=0.000),the situation of families talking about death (r=0.210,P=0.001),whether there was a Dutch act idea (r=0.172,P=0.007),family income (r=0.151,P=0.017),gender (r=0.130,P=0.042) and whether had siblings (r=-0.143,P=0.025) were positively correlated. ConclusionWe should carry out targeted life and death education for nursing students to promote them to establish positive life attitude and value.
Objective To study traits and influencing factors of coping styles in the military groups of social emergency responders for special service and provide a theoretical basis for epidemiologic intervention. Methods A cross-sectional survey on coping styles and their influencing variables was carried out among 12 special service companies from Armed Police Forces and Fire Units of Public Security stationed in Chongqing by means of cluster sampling. Then, different coping styles were compared with general military personnel, the types and maturity degree of coping behaviors were evaluated, and major influencing variables were screened. Results Of 396 subjects, 86.36% had field experience in handling emergencies. The population’s average levels of coping styles are significantly higher than the military norm (P≤0.01), and the overall type of coping behaviors is mature. Although the relevance between the performance type and the number of 6 coping styles scores reaching the military masculine norm is significant (Plt;0.001), the Pearson contingency coefficient（c=0.23）represents a relatively limited maturity in coping styles. In view of direction and extent effects of various influencing factors, lack of survival skills, disaccord on self and experience, self-inferiority as well as self-stereotypes are negative factors. In addition to social support, self-flexibility responsibility may be positive factors. Use of social support, disaccord on self and experience, self-confidence and knowledge about danger-avoiding take universal impacts, and other factors take single impact on a certain coping style. Conclusion Coping styles in military groups of social emergency responders for special service are comparatively mature and stable, but there are significantly individual differences and a wide range of influencing factors. So, it is very necessary to advance maturity in coping styles through targeted interventions.
Objective To investigate the clinical and pathological factors associated with simultaneity peritoneal metastasis of colorectal cancer. Methods Clinical data of 1 593 patients with simultaneity peritoneal metastasis of colorectal cancer who treated in Suqian People’s Hospital and Nanjing Drum Tower Hospital from 2010-2014 were collected to analyze the risk factors of simultaneity peritoneal metastasis of colorectal cancer. Results There were 40 patients (2.5%) suffered form simultaneity peritoneal metastasis of the 1 593 patients with colorectal cancer. The result of univariate analysis showed that, age, diameter of tumor, level of carcino-embryonic antigen (CEA), level of CA19-9, level of CA-125, T staging, differentiation, pathological type, and combining with diabetes were risk factors of simultaneity peritoneal metastasis of colorectal cancer, that incidence rates of simultaneity peritoneal metastasis in patients with ≥ 65 years old, diameter ≥ 5 cm, increase of CEA, CA19-9, and CA-125, later staging of T staging, poorly differentiated, signet ring cell carcinoma/mucinous adenocarcinoma, and combining with diabetes were higher (P<0.05). The result of logistic regression showed that, level of CA19-9, level of CA-125, T staging, combining with diabetes, differentiation, and pathological type were the risk factors of simultaneity peritoneal metastasis of colorectal cancer, that incidence rates of simultaneity peritoneal metastasis in patients with increase of CEA and CA-125, later staging of T staging, poorly differentiated (compared with well differentiated), mucinous adenocarcinoma (compared with adenocarcinoma), and combining with diabetes were higher (P<0.05). Conclusion Increase of CEA and CA-125, T staging, poorly differentiated, mucinous adenocarcinoma, and combining with diabetes are independent risk factors for simultaneity peritoneal metastasis of colorectal cancer.
Objective To study the influence factors of surgical site infection (SSI) after hepatobiliary and pancreatic surgery. Methods Fifty patients suffered from SSI after hepatobiliary and pancreatic surgery who treated in Feng,nan District Hospital of Tangshan City from April 2010 and April 2015 were retrospectively collected as observation group, and 102 patients who didn’t suffered from SSI after hepatobiliary and pancreatic surgery at the same time period were retrospectively collected as control group. Then logistic regression was performed to explore the influence factors of SSI. Results Results of univariate analysis showed that, the ratios of patients older than 60 years, combined with cardiovascular and cerebrovascular diseases, had abdominal surgery history, had smoking history, suffered from the increased level of preoperative blood glucose , suffered from preoperative infection, operative time was longer than 180 minutes, American Societyof Anesthesiologists (ASA) score were 3-5, indwelled drainage tube, without dressing changes within 48 hours after surgery, and new injury severity score (NISS) were 2-3 were higher in observation group (P＜0.05). Results of logistic regression analysis showed that, patients had history of abdominal surgery (OR=1.92), without dressing changes within 48 hours after surgery (OR=2.07), and NISS were 2-3 (OR=2.27) had higher incidence of SSI (P＜0.05). Conclusion We should pay more attention on the patient with abdominal surgery history and with NISS of 2-3, and give dressing changes within 48 hours after surgery, to reduce the incidence of SSI.