Objective To investigate the experience of operative technique of donor organ harvesting and lung transplantation in some unusual circumstance, and to improve surgical success ratio of lung transplantation. Methods Lung transplants were preformed in 65 cases, including 47 singlelung transplants and 18 double single lung transplants. All the recipients were suffered from intensive respiratory failure,and nine patients were longterm ventilatordependented of the total. The recipients included emphysema (n=23), pulmonary fibrosis (n=24), pneumosilicosis(n=5), pulmonary tuberculosis(n=2), lymphangioleiomyomatosis(n=1) and ventricular septal defect(VSD) or VSD with Eisenmenger’s syndrome(n=4),bronchiectasis (n=4), diffuse panbronchiolitis (n=1) and primary pulmonary hypertension(n=1). Retrospectively summarize clinical experience of lung transplant operation especially experience of dealing with special circumstances encountered in operation. Results 64 donor organ harvesting were achieved successfully. Inhospital death was 11cases (16.9%) after operation. Early death was due to primary lung graft dysfunction (n=3), severe infection(n=6), acute rejection(n=1), pulmonary vein embolism(n=1). Complications took place after operation in 9 cases, to exploratory thoracotomy to stop bleeding after transplantation in 3 cases, pulmonary artery anastomosis again because of stenosis in 1 case, bronchus stoma stenosis in 3 cases, pulmonary infarction in 2 cases, of which one patient accepted pulmonary lobectomy. Follow-up period was from 1.0 year to 5.6 years of 54 cases. 1year survival rate was 72.3%（47/65）.The pulmonary function was improved and the quality of life is well in most patients of the group. Conclusion To improve the technique of donor organ harvesting and lung transplantation is important to decrease the early mortality after transplantation.
Objective To determine the influence and significance of combinative assessment of 64 multi-slice spiral computed tomography (MSCT) with serum amyloid A protein (SAA) or C-reactive protein (CRP) on the selection of operative procedures of rectal cancer under the multi-disciplinary team. Methods Prospectively enrolled patients diagnosed definitely as rectal cancer at West China Hospital of Sichuan University from February to August 2009 were randomly assigned into two groups. In one group named MSCT+SAA group, both 64 MSCT and SAA combinative assessment were made for the preoperative evaluation. In another group named MSCT+CRP group, both MSCT and CRP combinative assessment were made for preoperative evaluation. Furthermore, the preoperative staging and predicted operation procedures were compared with postoperative pathologic staging and practical operation procedures, respectively, and the relationship between the choice of operation procedures and clinicopathologic factors was analyzed. Results All 165 patients were randomly assigned into MSCT+SAA group (n=83) and MSCT+CRP group (n=82). The baseline characteristics of two groups were statistically similar (Pgt;0.05). For MSCT+SAA group, the accuracies of preoperative staging T, N, M and TNM were 74.7%， 68.7%, 100% and 66.3%, respectively. For MSCT+CRP group, the accuracies of preoperative staging T, N, M and TNM were 72.0%, 86.6%, 100% and 81.7%, respectively. There were statistically significant differences in the accuracies of N staging and TNM staging between two groups (P＜0.05). However, there was no statistically significant difference of the accuracy of prediction to operative procedures between two groups (90.4% vs. 95.1%, Pgt;0.05). The pathological T staging (P＜0.001), N staging (P＜0.001), TNM staging (P＜0.001), preoperative serum level of SAA (P=0.010), serum level of CRP (P=0.042), and distance of tumor to the dentate line (P=0.011) were associated with the operative procedures. Conclusion Combinative assessment of MSCT+CRP could improve the accuracy of preoperative staging and operative procedures prediction, which may be superior to MSCT+SAA.
Objective To explore the feasibility and safety of laparoscopic cyst resection and Roux-en-Y hepatojejunostomy in treatment for adult congenital cholangiectasis and to compare the therapeutic effects of laparoscopic procedure with conventional open procedure. Methods The clinical data of 33 adult patients with congenital cholangiectasis from May 2008 to September 2011 in the department of general surgery of Shengjing Hospital of China Medical University were retrospectively analyzed. Fourteen patients received laparoscopic procedure （laparoscopic group），whereas the other 19 patients received conventional open procedure （conventional group）. Results All the operations were carried out successfully through laparoscopic procedure. The mean time of operation in the laparoscopic group was significantly longer than that in the conventional group （195min versus 130min，P＜0.01）. The average intraoperative blood loss in the laparoscopic group was significantly less than that in the conventional group （80ml versus 270ml，P＜0.01）. In contrast，the mean time of bowel peristalsis recovery and postoperative hospital stay in the laparoscopic group were significantly shorter than those in the conventional group （time of bowel motion recovery：76h versus 104 h，P＜0.01；hospital stay：6.1 d versus 9.6 d，P＜0.01）. There were no differences in the early complications between two groups （P＞0.05）. Conclusions Totally laparoscopic treatment for congenital cholangiectasis in adult is feasible and safe. It is worth to be generally applied because of its minimal invasion and fast postoperative recovery.
Objective To discuss the safety and clinical differences among elderly people being treated with neo-adjuvant chemotherapy combined with operation. Methods To analyze retrospectively the data of patients diagnosed definitely as colorectal cancer in West China Hospital of Sichuan University from June 2007 to December 2007, and to compare the clinical effect differences between elderly group (≥60 years) and non-elderly group (lt;60 years) with combined therapy. Results Among preoperative indexes, the constituent ratios of elderly group combined with cardiac vessels system diseases, endocrine system diseases or other system diseases were all obviously higher than those of non-elderly group, the differences showed statistical significance (Plt;0.05); Constituent ratio of elderly patients with hypertension or diabetes mellitus was also higher than that of non-elderly patients, there were still statistical significance (Plt;0.05), but no statistical significances among other preoperative indexes (Pgt;0.05); Differences of indexes during operation between two groups showed no statistical significance (Pgt;0.05). But during postoperative indexes, complications in elderly group were higher than those of non-elderly group, and the differences had statistical significance (Plt;0.05), and the time of removing gastric canal, urinary catheter and drainage tube between two groups showed no statistical significance (Pgt;0.05); Meanwhile, the intake time, venting time and defecation time after operation and out-of-bed activity time after operation also had no statistical significance (Pgt;0.05). As to the adverse effect relate to chemotherapy, there were no statistical significances (Pgt;0.05). Conclusion Elderly patients may have more poor physical condition and it maybe more difficult to treat them. In spite of this, the comprehensive treatment of neo-adjuvant chemotherapy combined with surgical operation will not lead to the delay of surgical therapy, in addition, operating modus during surgical intervention will not be effected and its therapeutic effect in the near future was optimistic. So the application of this combined therapy has some clinical effects and would be safety.
Ten cases of basicranial repair and reconstruction after resection of malignant tumors in nasal sinuses invading base of skull were reported. Dural repair was performed when the resected basicranial osseous lamella was less than 3 cm in diameter; when the lamella ranged from 4 to 7 cm, bone graft was not required either, the defect was repaired with either fascia lata and pericranium of pedunculated galea aponeurotica or frontal myocutaneous. No leakage of cerebrospinal fluid, cerebral hernia and intracranial infection happened postoperatively.
Objective To study the clinicopathologic features which influence the prognosis of patients with stage Ib nonsmall cell lung cancer (NSCLC) after operation, and discuss the indication of postoperative chemotherapy. Methods From January 2002 to December 2002, the clinical materials of 152 patients who underwent complete pulmonary lobectomy and were confirmed to have stage Ib NSCLC by postoperative histopathological examination were collected from Shanghai Chest Hospital. There were 82 male and 70 female cases aged from 33-80 years. The mean age was 63.0 years. KaplanMeier method was used to compare and analyze the age, gender, tumor diameter, tumor location, lymphatic or vascular carcinoma embolus, differentiation, pleural invasion and chemotherapy of patients. Cox regression model was used to do prognostic multivariate analysis to above factors. Results The 5year survival rate was 71.1%. The median survival time was 44.20 months. The results of single factor analysis showed that the tumor diameter was longer than 5 cm（χ2=4.020，P=0.042）, lymphatic or vascular carcinoma embolus existed（χ2=14670，P=0.001）, poorly differentiated tumor（χ2=8.395，P=0.004）, and those whose tumors were located on middlelower lobars had a poor prognosis（χ2=3.980，P=0.045）. The age(χ2=0.478，P=0.740), gender(χ2=0.571，P=0.450), pathological type(χ2=0.406，P=0.816), pleural invasion(χ2=0.022，P=0.882) and postoperative chemotherapy of patients (χ2=1.067，P=0.302)had no relationship with postoperative survival. The results of multivariate analysis showed that lymphatic or vascular carcinoma embolus（P=0.006，95%CI:1.491,10.524） and poorly differentiated tumor（P= 0.001,95%CI:0.116,0.578） were the main factors which influenced the survival rate of patients. Conclusion The tumor differentiation and lymphatic or vessel carcinoma embolus of patients with stage Ib NSCLC are important factors which influence prognosis and survival rate. The poorly differentiated tumor and lymphatic or vessel carcinoma embolus could be regarded as one of the indications of postoperative chemotherapy.
ObjectiveTo investigate the clinical value of neuronavigation combined with intraoperative ultrasound in the resection of glioma with epilepsy.MethodsTo review and analyze the clinical data of 47 glioma patients with epilepsy treated by intraoperative ultrasound-assisted neuronavigation during the period from June 30, 2012 to June 30, 2014, and to compare and analyze the extent of gliom resection and the control of epilepsy before and after surgery.ResultsAll the patients had no hematoma, infection or hemiplegia. MRI was reviewed 48 hours after surgery and MRI showed complete resection in 34 cases and subtotal resection in 13 cases. One year after the operation, the seizure control was evaluated. Engel’s class I, 17 cases, Engel’s class II, 20 cases, Engel’s class III, 10 cases. When the nerve function is protected, the tumor is removed and the epileptic seizure is controlled, and the clinical effect is remarkable.ConclusionsNeuronavigation is helpful to locate the lesion and brain functional area and design the surgical approach before surgery, and to guide the location and boundary of the lesion and functional area during surgery. Intraoperative ultrasound has many advantages such as noninvasive, repeatable and real-time examination. Neuronavigation combined with intraoperative ultrasound can achieve maximum resection of gliomas and epileptogenic foci and reduce the incidence of postoperative neurological dysfunction in patients.
One thousand four hundred and fifty-four cases of operations for gastric carcinoma in this hospital from 1983 to 1994 are reviewed. 121 out of 1454 patients sustained 168 occurrences of early postoperative complications. The patiets involvement rate was 8.32% and the occurrence rate of complications was 11.55%. Complications could be divided into two groups, the general complication after surery (8.25%) and complication relavent to gastrointestinal reconstruction (3.30%). Most common complications were wound infection, pulmonary infection, anastomotic obstruction or leakage. The authors stress the prevention of surgical complications that would furhter improve the therapeutic result of gastric cancer.
From Jan. 1980 to Dec. 1996, 138 cases of papillary adenocarcinoma of thyroid gland were surgically treated. To minimize the local recurrence and complication, resection of the involved lobe and the isthmus is an ideal surgical operation. Modified neck lymph node dissection should be performed, if the diameter of primary tumor is larger than 1.5 cm; whether the lymph node is palpable or not. Functional or classical radical neck lymph node excision should be taken, if the neck lymph node can be palpable.
Objective To investigate the current situations of operation management and corporate culture in the public hospital pharmacies, and to provide the evidence and suggestions for improving the performance of the public hospital pharmacies. Methods According to the principles and study methods of operation management and corporate culture, we designed the questionnaire to investigate the operation management and corporate culture among 306 managers and pharmacists working in 74 public hospital pharmacies. We used percentage and proportion for statistical description. Results (1) Over 70% participants considered that the public pharmacies lacked in consciousness of service and quality and that they cooperated as their clear responsibilities. (2) Nearly 60% considered that the public pharmacies lacked in awareness of costs and efficiency. (3)Nearly 50% thought that they could not get information in time and communicate enough. (4) About 50% considered that the working processes needed improvement. (5) About 60% realized corporate culture promoted pharmacies.Conclusion Public hospital pharmacies need to improve operation management and foster unique corporate cultures to enhance comprehensive competitive strength.