ObjectiveTo review the advances in the diagnosis and treatment of obstetric brachial plexus palsy (OBPP). MethodsThe incidence, risk factors, classification, and imaging tests of OBPP and indication, technique, and results of surgery were reviewed and summarized. ResultsThe incidence of OBPP is not declining in recent years. Birth weight of ≥4 kg, forceps delivery, and prepregnancy body mass index of ≥21 are considered to be major risk factors, and caesarean section delivery seems to be a protective factor. Neurophysiological investigations can be applied to qualitative diagnosis of OBPP, but can not to quantitative one. Sensitivity and specificity of both CT and MRI myelography are about 0.7 and 0.97, respectively. Narakas classification is widely used:C5, 6 injury as type I, C5-7 injury as type Ⅱ, C5-T1 injury as type Ⅲ, C5-T1 injury with Horner's syndrome as type IV. It is generally considered that the brachial plexus exploration should be undertaken for infants without spontaneous recovery of elbow flexion by a maximum of 3 months old; and 10% to 30% of patients may need nerve reconstruction surgery. It is advocated that traumatic neuroma of the upper trunk should be resected with nerve reconstruction. The final evaluation for surgical results should be at minimal 4 years for upper roots and 8 years for total roots. Scales of Mallet, Gilbert, and Raimondi are mostly used for assessing shoulder function, elbow function, and hand function. ConclusionBrachial plexus exploration should be undertaken for infants without flexion of elbow at the age of 3 months. Traumatic neuroma (even neuroma-in-continuity) resection followed by microsurgical reconstruction of the brachial plexus is favored.
ObjectiveTo investigate the development and clinical application of the reverse total shoulder arthroplasty. MethodsThe relative publications on reverse total shoulder arthroplasties were extensively reviewed and analyzed. ResultsReverse total shoulder arthroplasty has extensive indications, especially for pseudoparalysis caused by irrepairable rotator cuff tears with forward or upper shift of the humeral head and intact function of deltoid. The clinical research results indicate that the short-term results are satisfactory, but there are some special complications, such as scapular nothching, instability and limities of internal and external rotation. While performing this kind of operation, the selection of the approach, the determination of the prosthetic rotation center should be considered well, and the bone graft should be paid attention to when the bony defect of the glenoid and proximal humerus exists. ConclusionThe using time of the reverse total shoulder arthroplasty is short, so the long-term results should be observed. The development of computer assisted technique is hopeful to be improve the results of the reverse total shoulder arthroplasty.
ObjectiveTo review the research progress of indication and treatment of graft in shoulder superior capsular reconstruction (SCR) for rotator cuff tear (RCT).MethodsThe literature related to shoulder SCR in recent years was extensively reviewed, and the anatomy, biomechanics, surgical indications, and treatment of graft in SCR were summarized.ResultsSuperior capsule plays a role as a functional complex with rotator cuff, ligament, and whole capsule. SCR can effectively restore the superior stability of the shoulder. The indications of SCR include the irreparable massive RCT, massive RCT combined with pseudoparalysis shoulder, medium/large RCT with severe degenerative rotator cuff tissue, and dual-layer RCT. In order to achieve a better healing of tendon-bone in graft and decrease the rate of long-term graft retearing, it is essential to select an appropriate thickness graft, fix the graft in right intensity, and get a better capsular continuity.ConclusionThe technique of SCR advanced to SCR for reinforcement and it is indicated from substantial massive RCT to severe degeneration of rotator cuff tissue. Graft treatment is the key step for a successful SCR.
ObjectiveTo summarize the procedures of the shoulder arthroplasty and the evolution of the shoulder prosthesis, and to discuss the indications and contraindications of the several common shoulder arthroplastis. MethodsThe related literature on shoulder arthroplasty was extensively reviewed, summarized, and analyzed. ResultsAt present, shoulder arthroplasties can be classified into shoulder hemiarthroplasty, total shoulder arthroplasty, resurfacing shoulder arthroplasty, stemless shoulder arthroplasty, and reserve shoulder arthroplasty, etc. Each type of the prosthesis has several special indications and contraindications. Mostly, the shoulder arthroplasties achieved the satisfied results, such as pain-relief and restoration of the elevation and adduction of shoulder. The survival rate of the most shoulder prostheses may reach 10 years or more. ConclusionMost shoulder arthroplasties are effective and satisfied to treat the shoulder traumas and diseases in pain-free and functional restoration of shoulders.
ObjectiveTo analyze the increased risks of nursing due to expansion of ophthalmic day surgery indications, and the countermeasures. MethodsWe collected the information in the last three years from January 2012 to December 2014 in the Department of Ophthalmology, including the number of operations, the proportion of cataract patients, patients aged over 70 and under 12 years old, patients with high-risk fall, the number of general anesthesia operations, adverse events, and the data from the satisfaction survey of the patients. All the data were analyzed by statistical method. ResultsDuring the last three years, the relaxation of ophthalmic day surgery indications led to an increased admission rate of high-risk patients, and caused more nursing risk factors. Through the efforts of prevention and care, during the last three years, there were no adverse events, and patients had a satisfaction rate over 90%. ConclusionAlthough the ophthalmic day surgery indication has been relaxed, through the establishment of nursing risk response system by pre-hospital guidance, admission assessment, peri-operative education and follow-up visit, with the continuous improvement of nursing management system and convenient workflow, we can not only improve the work efficiency, but also ensure nursing safety.
ObjectiveTo discuss the indications of the nonoperative management for perforated peptic ulcer. MethodsClinical data of 145 patients with perforated peptic ulcer, aged below 70 years old, with first attack and onset timelt;12 h , admitted to our hospital between January 2002 and December 2009, were analyzed respectively. Patients who were negative for fluid of abdominopelvic cavity in ultrasound examination and leakage in watersoluble contrast examination received nonoperative management, otherwise underwent operation directly (If the patients were being on medication for the ulcer, they should also go directly to surgery). Non-operative patients were converted to operation if the symptom had not relieved during the first 12 h. When admitted , the APACHE Ⅱ score was calculated for all patients. ResultsSeventy-four and 71 patients underwent non-operative management and operation directly respectively. Sex, age, onset time, perforation site and so on were comparable between the two groups （Pgt;0.05）, while APACHE Ⅱ score over 8 was 25.7% and 76.1% respectively with significant difference (P=0000). In nonoperative group, 11 (149%) patients were converted to operation. The mortality (4.1% vs 9.8%, P=0.203), mobility (16.2% vs 25.3%, P=0.175), hospital stay 〔(11.4±2.5) d vs (11.3±1.3) d, P=0.447〕, and cost 〔(11 657.3±2 826.4) yuan vs (10 013.0±1 877.4) yuan, P=0.212〕 between two groups had also no significant difference. The mean APACHE Ⅱ score was significant different between the survivors and the dead (9.3 vs 20.2, P=0.000). APACHE Ⅱ score was positively related to mortality and morbility （r=0.98, P=0.000； r=0.52, P=0.000）. ConclusionsNon-operative management is a safe and effective way in selected patients with perforated peptic ulcer, such as APACHE Ⅱ score ≤8, negative for fluid of abdominopelvic cavity in ultrasound examination, and leakage in water-soluble contrast examination. APACHE Ⅱ score is an important factor in prognosis of these patients.
Objective To introduce summarily and discuss current controversial problems in terms of necessity and methods of preoperative biliary drainage for patients with malignant biliary obstruction diseases. Method The relevant domestic and international literatures in recent years were reviewed and summarized, and the basis, pros and cons, selectable ways, and current controversy of preoperative biliary drainage were analyzed. Results With development of the research, the view of preoperative biliary drainage also has been changed continuously. At the present time, the main arguments focus on the necessity, timing, biliary decompression way of preoperative biliary drainage and corresponding surgical opportunity after biliary drainage. Incorrect patient selection and undue pursuit of preoperative biliary drainage would be completely opposite to the treatment of malignant biliary obstruction. Conclusions It is generally recommended that preoperative biliary drainage in patients with malignant biliary obstruction diseases is not needed and surgery is performed directly. For patients who have indications of preoperative biliary drainage, it could make patients spend perioperative period smoothly if a reasonable way of biliary decompression is chosen. However, it is necessary to take some large sample retrospective analyses or prospective studies for exploring existing problems of preoperative biliary drainage in future.
Objective To investigate the appropriate indication about removing abdominal drainage after pancreaticoduodenectomy. Method The clinical data of 156 patients who underwent pancreaticoduodenectomy in our hospital from January 2014 to June 2016 were analyzed retrospectively. The patients were divided into two groups, with 76 patients in the enhanced recovery after surgery (ERAS) group and 80 patients in the control group according to the type of indications about removing abdominal drainage. The time of removing abdominal drainage, hospital stay, incidence of postoperative complications, and readmission rate during 30 days after surgery were compared between the2 groups. Results Compared with the control group, the time of removing abdominal drainage 〔(6.2±2.5) dvs. (10.8±2.2) d,P<0.001〕and hospital stay〔(11.8±3.4) dvs. (15.7±3.6) d,P<0.001〕 of the ERAS group were both shorter, incidence of abdominal infection was lower〔1.3% (1/76)vs. 10.0% (8/80), P=0.020〕 , but there was no significant difference in the incidence of postoperative pancreatic fistula 〔18.4% (14/76) vs. 21.3% (17/80)〕 , delayed gastric emptying〔1.4% (1/76) vs. 7.5% (6/80)〕 , and the readmission rate during 30 days after surgery〔5.3% (4/76) vs. 3.8% (3/80)〕 , P>0.05. Conclusions Indications about removing abdominal drainage after pancreaticoduodenectomy by authors are safe.
Abstract： Surgical repair of functional tricuspid regurgitation (FTR) is often carried out concomitantly with other leftsided heart valve procedures. Though diseases of both left heart valve and tricuspid were treated during the surgery, postoperative residual or recurrent tricuspid regurgitation has been clearly associated with progressive heart failure and worsened longterm survival. To date, surgical interventions mainly address FTR at three anatomic levels: commissure, annulus and leaflets. However, a certain mid and longterm failure rate after operation still exists. High surgical mortality rates have been reported in patients with recurrent tricuspid regurgitation requiring complex reoperations. With a better understanding of tricuspid anatomical complex and valvuloplasty, significant improvements have been made in FTR surgical indications and techniques. This review article will focus on the development of surgical indications in tricuspid valve repair, while the repair techniques and their impact on longterm clinical outcome will also be compared.
This paper describes the advantages and disadvantages of radiofrequency ablation from the current situation of hepatocellular carcinoma treatment, radiofrequency ablation treatment, the efficacy of radiofrequency ablation in hepatocellular carcinoma, the shortcomings of radiofrequency ablation treatment, and the experience of the author’s treatment team. For the treatment of liver cancer, we should not blindly pursue minimally invasive and ignore the principle of radical resection, nor blindly pursue radical resection and ignore the risk of surgery. We should choose reasonable treatment methods, let the patient get the best treatment.