To investigate the causes and the cl inical treatment methods of postoperative wound compl ications following total knee arthroplasty (TKA). Methods From June 2005 to August 2008, 486 cases (576 knees, including 314 left knees and 262 right knees) underwent primary TKA using standard midl ine incision and medial parapatellar arthrotomy. There were 146 males (172 knees) and 340 females (404 knees) aged 51-86 years old (average 61.3 years old). The duration of disease was 3-35 years. Primary diseases included: 138 cases (156 knees) of rheumatoid arthritis, 282 cases (348 knees) of osteoarthritis, 46 cases (49 knees) of traumatic arthritis, 20 cases (23 knees) of pigmented villonodular synovitis. The factors of etiology, deformity correction, duration of tourniquet use and wound drainage were analyzed to determine the cause of postoperative wound compl ication. Results Postoperatively, 37 cases (43 knees) had wound compl ications and the rate of incidence was 7.5%, including 13 cases (15 knees) of aseptic exudation, 3 cases (4 knees) of fat l iquefaction, 4 cases (4 knees) of subcutaneous hematoma, 8 cases (9 knees) of flap margin necrosis, 6 cases (7 knees) of superficial infection, 3 cases (4 knees) of red swollen joint with increased skin temperature and deepinfection. All 37 patients recoveried after symptomatic treatment. Among those 37 cases, patients with rheumatoidarthritis had a higher incidence rate of wound compl ication than the patients with other primary diseases (P lt; 0.05). Theincidence rate of patients with deformity correction more than or equal to 20 degree was significantly higher than that ofother patients (P lt; 0.05). The duration of using tourniquet was (86 ± 15) minutes for patients with wound compl ication,and (78 ± 8) minutes for patients without wound compl ication, indicating there was a significant difference (P lt; 0.01).Wound compl ication occurred in 22 knees (5.1%) with autologous blood transfusion absorber, 11 knees (11.5%) withnegative pressure attraction, and 10 knees (19.2%) receiving no drainage. The incidence rate of postoperative woundcompl ication in patients without drainage was obviously higher than that in patients with drainage (P lt; 0.05). ConclusionPatients with rheumatoid arthritis are more l ikely to have wound compl ication after TKA. Postoperative wound drainage and short duration of tourniquet appl ication help decrease the incidence of compl ications. It is necessary to make early definitive diagnosis of postoperative wound compl ication, and provide proactive treatment.
In this paper, systematic reviews, randomized controlled trials and other relevant studies on surgical and adjuvant therapy following operative therapy in renal cancer were identified by searching the Guidelines International Network, ACP Journal Club, the Cochrane Library （Issue 3, 2005 ） , MEDLINE, EMBASE and CBMdisc （ from 1996 to Sept. 2005）. In operative therapy, we found no study comparing operative therapy with no treatment or adjuvant therapy alone; A meta-analysis of cytoreductive nephrectomy in patients with metastatic renal cancer showed adjuvant therapy following nephrectomy was more effective than adjuvant therapy alone; a review comparing radical nephrectomy with nephron-sparing surgery in small-volume renal tumors found similar effectiveness between the two procedures. In the adjuvant therapy following nephrectomy, ten RCTs found adjuvant cytokine therapy （Interferon and Interleukin-2 ） and 5-FU not effective in the adjuvant setting, and could increase adverse reaction; Four RCTs found adjuvant vaccine therapy effective in the adjuvant setting with only a few side effects.
Objective To investigate the cl inical outcomes of one stage debridement and closed-suction drainage for treatment of infection after lumbar instrumentation. Methods Between June 2002 and March 2008, 12 patients with infection after lumbar instrumentation were treated with one stage debridement and closed-suction drainage, including 9 males and 3females and aging 35-68 years (48.5 years on average). The disease duration varied from 7 days to 183 days (56 days on average). The segments of internal fixation included 7 cases single segment at levels of L4, 5, 4 cases of double segments at levels of L 4, 5, L5, S1 (2 cases), and L3, 4, L4, 5 (2 cases), and 1 case of three segments at levels of L3, 4, L4, 5, L5, S1. Two patients were treated with internal fixator removal. Results The bacterial culture results of intervertebral discs were positive in 8 cases for Staphylococcus aureus and in 3 cases for Enterobacter cloacae, negative in 1 case. Primary healing of incisions were achieved in all cases. Twelve patients were followed up 18-53 months (34.7 months on average). The white blood cell count, erythrocyte sedimentation rate, and C reactive protein significantly decreased after operation, showing significant differences at 15 days after operation when compared with those before operation (P lt; 0.05). No obvious low back pain was observed. Pathological-changed vertebra-space fused. No displacement and breakage of internal fixator occurred; in 2 patients who were given internal fixator removal, no removal of the instrumentation was performed again. The X-ray films showed that the average kyphosis decreased 0.8° at 18 months after operation. At last follow-up, the visual analogue scale score was 2 ± 1, showing significant difference (P lt; 0.05) when compared with that (10 ± 2) before operation. Conclusion One stage debridement and closed-suction drainage therapy is an effective method for treating infection after lumbar instrumentation. The operation is easy and can reduce hospitalization days.
ObjectiveTo analyze risk factors of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. MethodData were collected retrospectively for consecutive patients undergoing defunctioning ileostomy following sphincter preservation surgery for rectal cancer, from January 2014 to December 2014. ResultsOne hundred and thirty patients were included (median time to reversal 132 d, range 39-692 d), of whom 35 patients (26.92%) had postoperative complications after stoma reversal. The main complications included 23 cases of diarrhea, 6 cases of bowel obstruction, 9 cases of incision infection, and 4 cases of perianal eczema. The results of univariate analysis showed that the distant of tumor from anal verge <5 cm (P=0.010), postoperative adjuvant chemotherapy (P=0.002), and time to reversal (P=0.025) were related to the postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery. The result of multivariate analysis by using a logistic regression model showed that the time to reversal (OR=1.006, P=0.021) was a significant independent risk factor for it. ConclusionDelay reversal of defunctiong ileostomy might increase risk of postoperative complications associated with reversal of defunctioning ileostomy in patients with rectal cancer undergoing sphincter preservation surgery.
ObjectiveTo explore the clinical value of three early predictive scale of lung injury (ALI) in patients with high risk of acute lung injury (ALI) after lung cancer surgery.MethodsA convenient sampling method was used in this study. A retrospective analysis was performed on patients with lung cancer underwent lung surgery. The patients were divided into an ALI group and a non-ALI group according to ALI diagnostic criteria. Three kinds of lung injury predictive scoring methods were used, including lung injury prediction score (LIPS), surgical lung injury prediction (SLIP) and SLIP-2. The differences in the scores of the two groups were compared. The correlation between the three scoring methods was also analyzed. The diagnostic value was analyzed by drawing receiver operating characteristic (ROC) curves.ResultsA total of 400 patients underwent lung cancer surgery, and 38 patients (9.5%) developed ALI after operation. Among them, 2 cases progressed to acute respiratory distress syndrome and were treated in intensive care unit. There were no deaths. The predictive scores of the patients in the ALI group were higher than those in the non-ALI group, and the difference was statistically significant (all P<0.001). There was a good correlation between the three scoring methods (allP<0.001). The three scoring methods had better diagnostic value for early prediction of high risk ALI patients after lung cancer surgery and their area under ROC curve (AUC) were larger than 0.8. LIPS score performed better than others, with an AUC of 0.833, 95%CI (0.79, 0.87).ConclusionThree predictive scoring methods may be applied to early prediction of high risk ALI patients after lung cancer surgery, in which LIPS performs better than others.
Objective To summarize the application of different types of perineal and vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body for patients with primary or recurrent advanced rectal cancer with distal vagina or perineal body invasion， and to review the advantages and shortages and the application range of common reconstructive surgical procedures. Method The clinical data of 10 rectal cancer patients underwent extended surgery with distal vagina and perineal body resection accompanied with or without hysterectomy from October 2009 to September 2013 were summarized. Results There was no perioperative mortality. Omental flaps were used for obliteration of pelvic defect in 4 patients. The uterus was pushed backward to fill the pelvic defect after severing the round ligament in 2 patients. A reversed pedicled sigmoid flap was employed for reconstruction of the vagina in 2 patients. The reversed flap of anterior vaginal wall was used for vaginal and perineal reconstruction in 3 patients. Three cases had postoperative complications， in which included 1 patient with pelvic sepsis who underwent reoperation for drainage， 2 patients with perineal wound infection. All other patients had an uneventful healing postoperatively. Conclusions Some types of one-stage pelvic and perineal-vaginal reconstruction after posterior exenteration with resection of distal vagina and perineal body could produce an expedited wound healing with acceptable morbidity. Despite the well documented pedicled musculocutaneous flap for reconstruction， omental flap， pedicled sigmoid flap， overturn of anterior vaginal wall for reconstruction and pushing-back of the uterus for filling pelvic cavity might also result in reduced pelvic and perineal associated complications. Pedicled musculocutaneous flap is better reserved for huge pelvic and perineal defect and should be recommended among Chinese surgeons.
Objective To evaluate glaucoma and anterior chamber angle changes after intravitreal silicone oil injection(SOI). Methods The intraocular pressure(IOP) and anterior chamber angles of 34 e yes(33 patients)undergone pars plana vitrectomy and SOI were observed. Results Glaucoma occurred in 9 eyes(26%),in which silicone oil glaucoma(SOG) accounted for 77%(7/9).The changes of the superior part of anterior chamber angle were peripheral anterior synechiae in 11 eye(32%) and SO emulsification droplets in 22 eyes(64%) in 1～4.5 months after surgeries.Glaucoma occurred in 6 eyes of 7 eyes undergone peripheral iridectomy at the inferio r part of the iris after the closure of iridectomy holes (plt;0.05). Conclusion High incidence of glaucoma was found in this series of patients after intravitreal silicone oil injection,and the main causes of SOG were closure of the inferior iridecomy hole and silicone emulsification. (Chin J Ocul Fundus Dis, 2001,17:105-107)
Objective To explore the cause of haematoma after the cemented total hip arthroplasty (THA) and find out the way to decrease the incidence of haematoma perioperatively. Methods From March 2000 to October 2006, 103 patientswere treated with the cemented THA. Among the patients, 44 were males and 59 were females with their ages ranging from 36 to 89 years, averaged 55.3 years.The femoral neck fracture (Garden 4) was found in 49 patients, avascular necrosis of the femoral head (Ficat 4) in 26, and osteoarthritis of the hip joint (Tonnis 3) in 28. Their illness course ranged from 1 day to 8 years. The average Harris score preoperatively was 36 (range, 1948). The patients were divided into Group A (n=43) and Group B (n=60). The patients in Group A underwent the conventional surgical operations from March 2000 to December 2003; the patients in Group Bunderwent the same surgical procedures combined with additional procedures (e.g., ligation of the external rotators before incision, use of plastic bandage after the drainage tube was pulled out, prolonged stay period in bed postoperatively) from January 2004 to October 2006. Results In Group A, postoperative haematoma occurred in 9 patients and the averaged 317.8±75.3 ml(range,110-410 ml) of the accumulated blood was drained with a syringe. An average amount for the firstdrainage of the accumulated blood was 86.7±30.7 ml(range, 50-125 ml)， and an average drainage time was 4.2(range, 2-7). In Group B, postoperative haematoma occurred in 2 patients, with an amount of 110 ml and 160 ml of the accumulated blood and an amount of 40 ml and 60 ml of the drained blood at thefirst drainage. There was statistical difference in the amount of heamotoma between two groups(P＜0.05). The followup of 91 patients (39 in Group A, 52 in Group B) for 1.2-5.5 years (average, 3.7 years) revealed that the Harris scores were 78 in Group A and 85 in Group B on average.The Harris score for pain was 44 (Grade A) in 16 patients, 40 (Grade B) in 24 patients, and 30 (Grade C) in 3 patients in Group A; Grade A in 48 patients,Grade B in 12 patients, and Grade C in none of the patients in Group B. There was no statistical difference in Harris score between the two groups (P＞0.05). Conclusion Additional surgical procedures for the cemented THA, such as ligation of the external rotators before incision, use of plastic bandage afterthe drainage tube is pulled out, and prolonged stay in bed postoperatively, can greatly help to reduce the incidence of postoperative haematoma and the amount of the accumulated blood.
Objective To assess the efficacy and safety of chewing gum in promoting bowel recovery after cesarean section. Methods Such databases as The Cochrane Library, MEDLINE, EMbase and CBM were searched from their establishment to 2010 to include the randomized controlled trials (RCTs) of comparing chewing gum with other procedures for promoting postoperative bowel function after cesarean section. The risks of bias in the included studies were evaluated at randomization, allocation concealment, blinding, completeness of outcomes, and selective reporting. Meta-analyses were performed by RevMan 5.0.22 software. Results Three RCTs involving 745 participants were included. The results of meta-analyses showed chewing gum after cesarean section significantly shortened the time before getting the first postoperative flatus (MD= –6.54, 95%CI –7.82 to –5.27, Plt;0.000 01), reduced the risks of postoperative ileus (RR=0.54, 95%CI 0.34 to 0.87, P=0.01) and possibly shortened the length of hospital stay (MD= –0.21, 95%CI –0.39 to –0.03, P=0.02) compared with blank control. Currently, no adequate data supported the safety of chewing gum after cesarean section. Conclusion Chewing gum after cesarean section can promote the postoperative bowel recovery, and reduce the odds of postoperative ileus. However, more high quality RCTs are required for lack of included studies and poor quality of methodology.
ObjectiveTo evaluate the effectiveness and safety of prophylactic ondansetron for the prevention of postoperative shivering. MethodsAccording to the Cochrane Handbook, we searched such databases as Cochrane Library, PubMed, OVID, EMbase, CNKI, CBM, and VIP (From January 1999 to September 2013) to collect the literature about ondansetron for the prevention of postoperative shivering. According to the predefined inclusion and exclusion criteria, we screened randomized controlled trials (RCTs). The included studies were evaluated and analyzed by meta-analysis with RevMan 5.0 software. ResultsNine RCTs involving 655 patients were included. The results of meta-analysis showed that there was a significant difference in incidence of postoperative shivering between group ondansetron and the controls [RR=0.32, 95%CI (0.24, 0.42), P<0.05]. There was a significant difference in incidence of postoperative nausea and vomiting between the ondansetron group and the control group [RR=0.30, 95%CI (0.14, 0.63), P<0.05]. There was no significant difference in the 1 min and 5 min neonate born Apgar score between the ondansetron group and the control group [WMD=0.03, 95%CI (-0.02, 0.09), P=0.26; WMD=-0.02, 95%CI (-0.12, 0.08), P=0.68]. ConclusionIntravenous ondansetron before surgery can significantly reduce postoperative shivering without any increment of adverse effects.