ObjectiveTo evaluate clinical efficacy of the modified Sugiura procedure with cardia transection in treatment of recurrent portal hypertension with upper gastrointestinal bleeding. MethodsFrom January 2007 to January 2015, there were 28 cases of recurrent portal hypertension with upper gastrointestinal bleeding were treated by the modified Sugiura procedure with cardia transection in The Second People's Hospital of Yichang and The Zigui County People's Hospital, collecting the clinical data of them and then summarizing the therapeutic effect. ResultsAll cases underwent surgery successfully with no operative death. The operative time was 120-300 minutes with an average of 160 minutes. About surgical blood loss was 100-500 mL, with an average of 210 mL. Two cases suffered from postoperative gastrointestinal bleeding, 6 cases suffered from postoperative gastric dysfunction, and no one suffered from anastomotic leakage, anastomotic stenosis, and portal vein thrombosis. Three cases died in reason of liver failure and hepatic coma. There were 24 cases were followed up for 6-60 months, with the median of 33 months. No recurrence of gastrointestinal bleeding happened during the follow-up period. Sixteen cases underwent gastroscopy in 6 months after surgery, according to the results, the clinical effect was fine. For grade of varicose veinsm, there were 14 cases of grade GⅠ and 2 cases of grade GⅡ. For shape of varicose veins, there were 11 cases of grade F1 and 5 cases of grade F2. ConclusionThe modified Sugiura procedure with cardia transection is a safe and thorough operation for recurrent portal hypertension with bleeding.
The modified "seagull flap" for creating a new web in treated congenital syndactyly is deseribed. The technique is easy and this method can produce a web that is wide enough to allow adequate digital separation when fingers are abducted. The contour is satisfaction.
Objective To modify orthotopic liver transplantation method with two-cuff technique. Methods On the basis of cuff technique, the donor liver was perfused through the abdominal aorta with 20 ml cold perfusate. The anastomosis of the suprahepatic vena cave(SVC) was sutured end-to-end with 8/0 nylon line,and the continuity of infrahepatic vena cave(IVC) and portal vein(PV) were established by means of cuff method respectively.The bile duct anastomosis was performed by internal stent. Results Orthotopic liver transplantations were performed in 360 rats. The time for donor operation and liver preparation was (31.2±5.0) min and (12.0±3.0)min，and the recipient operative and anhepatic time was (45.0±5.5) min and (20.0±2.5) min, respectively. The two-day survival rate was 91.4%.In nonintervention group, one-week survival rate was 86.5%. Conclusion The modified model is easily available and highly reproducible which provides a practical and stable experimental model for the study of liver 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.
Objective To compare the therapeutic effects between endoscopic thyroidectomy by anterior chest approach and modified Miccoli thyroidectomy. Methods Sixty patients with thyroid goiter were performed endoscopic thyroidectomy by anterior chest approach (endoscopic thyroidectomy by anterior chest approach group, n=30) and modified Miccoli thyroidectomy (modified Miccoli group, n=30) respectively. The operative time, the drainage volume, cosmetic benefit, the postoperative hospitalization time, the expenses of hospitalization and postoperative complications of two groups were compared. Results The operative time and the drainage volume after operation of endoscopic thyoidectomy by anterior chest approach group were significantly more than modified Miccoli group 〔(99.9±23.4) min vs. (74.0±29.6) min; (68.6±8.7) ml vs. (40.9±6.1) ml, respectively〕, Plt;0.05. The cosmetic benefit score of endoscopic thyoidectomy by anterior chest approach group was higher than that of modified Miccoli group 〔(4.7±0.2) points vs. (3.7±0.1) points〕, Plt;0.05. The postoperative hospitalization time and expenses of hospitalization were no significant differences between the two groups 〔(6.5±1.7) d vs. (5.5±0.9) d; (9 328.3±1 107.1) yuan vs. (8 568.2±1 032.3) yuan, respectively〕, Pgt;0.05. One case had transient hoarseness in 2 groups respectively, no other complications happened. Conclusions Modified Miccoli operation is both minimally invasive and cosmetic, but endoscopic thyroidectomy by anterior chest approach has better cosmetic benefit, which can release patients’ psychological trauma. The patients with specific cosmetic demand may choose endoscopic thyroidectomy by anterior chest approach.
ObjectiveTo investigate the effectiveness of modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering in the treatment of diabetic foot (DF). MethodsThe clinical data of 22 DF patients treated with modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering between October 2019 and December 2021 were retrospectively analyzed. There were 13 males and 9 females with an average age of 61.3 years (range, 41-74 years). The duration of diabetes mellitus was 8-30 years, with an average of 12.5 years, and the duration of DF was 10-42 days, with an average of 28.2 days. There were 2 cases of grade 3 and 20 cases of grade 4 according to Wagner classification. CT angiography was performed on both lower extremities of the patients, and the blood vessels of the affected extremities were narrowed to varying degrees and the blood supply was poor. The preoperative skin temperature of affected foot was (28.27±0.91)°C, the ankle brachial index (ABI) was 0.42±0.11, and the visual analogue scale (VAS) score was 7.7±0.6. Preoperative size of DF ulcer ranged from 2.5 cm×2.0 cm to 3.5 cm×3.0 cm. The skin temperature of affected foot, ABI, VAS score, and skin wound healing of the affected foot were recorded and compared between before operation and at 3 months after operation. ResultsAll patients were followed up 3-18 months, with an average of 10.5 months. The infection of 1 patient with Wagner grade 4 did not improve significantly after operation, and there was a trend of further deterioration, and the amputation of the left leg was finally performed at 22 days after operation.The remaining 21 patients recovered well after operation, the external fixator was removed at 1 month after operation, the wound healed at 3 months after operation, and there was no recurrence of ulcer in situ or other sites during follow-up. At 3 months after operation, the skin temperature of affected foot was (31.76±0.34)°C, the ABI was 0.94±0.08, and the VAS score was 2.1±0.3, which significantly improved when compared with those before operation (t=25.060, P<0.001; t=32.412, P<0.001; t=–51.746, P<0.001). ConclusionModified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering for DF patients can effectively improve the blood supply of the affected limb, promote wound healing, and improve effectiveness.
Objective To investigate the effect of new type ultrafiltration technique in preventing and relieving the main organ injury that may follow open heart surgery with cardiopulmonary bypass (CPB),and improve the operative effects and decrease the postoperative complications. Methods Thirty patients with congenital heart diseases were randomly divided into two groups. Modified ultrafiltration group: modified ultrafiltration was used after CPB; new type ultrafiltration group: new type ultrafiltration technique was used throughout CPB. The serum concentrations of nflammatory mediators,hematocrit,serum albumin concentrations, pulmonary function, operative duration time and main organ function parameters were measured in both groups. Results Ultrafiltration time after CPB in new type ultrafiltration group was significantly shorted as compared with modified ultrafiltration group（6.35±1.28 min vs. 12.45±4.52 min，P=0.000）; serum concentrations of interleukin6(IL-6)and tumor necrosis factor α(TNF-α) after CPB were significantly decreased as compared with modified ultrafiltration group（292.84±58.23 μg/L vs. 383.79±66.24 μg/L,P=0.000; 13.32±2.31 μg/L vs. 16.41±2.65 μg/L,P=0.000）; the hematocrit and serum albumin concentrations at the ten minutes after CPB were increased as compared with modified ultrafiltration group (0.39±0.04 vs. 0.35±0.03,P=0.003; 38.32±4.26 g/L vs. 34.04±2.83 g/L, P=0.003); the mechanical ventilation support time and ICU time after operation was shorted as compared with modified ultrafiltration group (Plt;0.05); main organ function was improved as compared with the modified ultrafiltration group. Conclusion The clinical application of new type ultrafiltration throughout CPB can effectively exclude some harmful inflammatory mediators, concentrate blood,short operation time,attenuate the main organ edema and injury.
Objective To analyze the effect of myocardial protection between modified Del Nido cardioplegia and St. Thomas Hospital Cardioplegia in adult patients with aortic valve and mitral valve replacement. Methods From January 2014 to June 2016, 140 patients underwent aortic valve and mitral valve replacement in our hospital. According to different cardioplegia, the patients were divided into two groups including a modified Del Nido cardioplegia group (70 patients, 37 males, 33 females at mean age of 53.13±9.52 years) and a St. Thomas cardioplegia group (70 patients, 32 males, 38 females, at age of 50.71±9.29 years). We collected clinical data of the patients before operation (T1), 2 h after aortic unclamping (T2), 24 h after operation (T3) and 48 h after operation (T4). Indexes of muscle enzymes including blood center creatine kinase (CK), creatine kinase isoenzyme (CK-MB) concentration and liver function indexes including urea nitrogen (BUN), creatinine (Cr), alanine aminotransferase (ALT), aspartate aminotransferase (AST) concentrations, and compared the postoperative and follow-up clinical data. Results There was no statistical difference in age, weight, gender, ejection fraction baseline data between the two groups (P>0.05). All patients were successfully completed combined valve replacement under cardiopulmonary bypass. The cardiopulmonary time was no statistical difference between the two groups (P>0.05). However, compared with St. Thomas cardioplegia group, modified Del Nido group was less in perfusion (1.19±0.39vs. 2.99±0.75, P<0.001), shorter in aortic clamping time (P=0.003). No statistical difference was found in defibrillation rate after resuscitation between the two groups (P=0.779). Biochemical indicators were not statistically different at different time points between the two groups (P>0.05). Conclusion Modified Del Nido cardioplegia has the same effect on myocardial protection with St. Thomas cardioplegia in adult patients. It reduces the frequency of reperfusion, and shortens the clamping time. There is no additional injury in the important organs such as liver, kidney. Modified Del Nido cardioplegia myocardial protection ability in adult heart valve surgery is feasible.
ObjectiveTo evaluate the application of modified perineal stapled prolapse resection in treatment of external rectal prolapse, and to assess the preliminary efficacy. MethodsClinical data of 11 patients with external rectal prolapse underwent modified perineal stapled prolapse resection in The First Affiliated Hospital of Guangzhou University of Chinese Medicine between December 2013 and August 2015 were collected for retrospectively analysis. ResultsAll patients with external rectal prolapse were performed modified perineal stapled prolapse resection with general anesthesia and (or) epidural anesthesia. The average operation time was (53.6±6.1) min (40-85 min) and the average blood loss was (35.3±10.1) mL (20-60 mL). The time of the first flatus was less than 24 h after operation, the time of the first defecation was (44.6±3.3) h (40-52 h) after operation. The average hospital stay was (9.7±1.8) d (7-12 d) and average cost was (34 635.8±1 268.8) RMB (31 796-36 212 RMB). None of them occurred serious complications such as uncontrollable anastomotic stoma bleeding, anastomotic leakage, pelvic abscess, bowel obstruction, and anastomotic straitness. All of the 11 patients were followed up for (4.7±0.8) months (3-7 months), and all patients did not suffered from recurrence and fecal incontinence during follow-up period. ConclusionsThe essential procedure for modified perineal stapled prolapse resection is cutting the prolapse open at 3 and 9 clock directly at the same time by linear staplers, and dissecting mesorectum before using the contour satpler. Modified perineal stapled prolapse resection is a safe and effective operation technique for the external rectal prolapse.
Objective To increase the success rate of vaginal reconstruction with pudendal-thigh flap, reduce the chance of hemocirculatory disorder and rel ieve the deformity of greater l ip of pudendum and vaginal orifice. Methods FromJune 1998 to May 2004, 15 patients, 2 males with transsexual ism and 13 females with vaginal absence, aged 23-31 years old (26.2 on average), received vaginal reconstruction. Arterial perforator was detected at 3 cm laterally away from the mid-point between the vaginal orifice and the anus. The flap of 12.0 cm × 5.5 cm was designed at the lateral of the greater l ip of pudendum, with the groin as the axis. After the flap was elevated beneath the deep fascia, the fascial pedicle was partially severed from lateral to medium, keeping the perforator intact into the flap. Then the flap was transferred through the tunnel to the socket. The inner layer and the orifice were formed. Results All flaps survived, and the contour of the vulva was satisfactory. Among the 15 patients, 14 patients’ incisions obtained heal ing by first intention, and only 1 male with transsexual ism was discovered to suffer from rectovaginal fistula at the remote juncture of the two flaps at 7 days after the operation. By taking out all the gauze and cleaning the feces, the fistula healed automatically. All patients were followed up for 6 months-3 years. The reconstructed vagina was about 10 cm deep and 2 fingers wide. One female’s vagina was found pilous at 20 months after the operation, and no special treatment was given. The other patients’ vaginal inner walls were smooth and complete. Two female patients had the experienceof sexual intercourse and felt satisfied after using lubricant. Conclusion The modified pudendal-thigh flap has rel iable blood supply and makes the transferring during vaginal reconstruction more convenient and the contour of the vulva more satisfactory.