Objective Enhanced recovery after surgery(ERAS)protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma....Objective Enhanced recovery after surgery(ERAS)protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma.However,the cognitive and experiential dimensions of surgical incisions under ERAS remain underexplored,particularly in non-Western populations.This study aims to explore patients’perceptions and preferences regarding laparoscopic incisions under ERAS,providing evidence to optimize incision planning and perioperative education.Methods A qualitative descriptive study was conducted at the Department of Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,between November 2022 and February 2023.The participants were adults(≥18 years)who underwent elective laparoscopic abdominal surgery under ERAS,excluding those with cognitive impairments,language barriers,or emergency procedures.Semi-structured interviews,covering physical function,social function,emotional function,self and others’acceptance,and confidence in the nature and treatment of the disease,were audio-recorded and transcribed verbatim and guided by a thematic framework co-developed by surgeons,nurses,and psychologists.The data were analyzed via the framework method to identify themes related to incision experiences.Results This qualitative study included 16 participants,8(50%)females and 6(37.5%)cancer patients,with a mean age of 41.5±12.2 years.Qualitative analysis revealed that the participants experienced minimal psychological distress and great emphasis on pain management and expressed specific concerns regarding the location,size,and cosmetic appearance of the incision.They also voiced high expectations for preventing incision complications and sought information regarding postoperative care.There was notable variation in preferences regarding the choice of incision site before surgery.Participants with cancer focused on disease cure rather than aesthetics.Conclusion Personalized preoperative discussions,incision site selection,and postoperative education are critical for increasing patient satisfaction.Laparoscopic incisions under ERAS minimally impact psychological well-being,but location-specific discomfort and aesthetic preferences require attention.展开更多
Background Prosthetic mitral valve replacement is a common surgical treatment of mitral valve disease.Complete video-assisted mitral valve replacement represents the contemporary minimally invasive cardiac surgery in ...Background Prosthetic mitral valve replacement is a common surgical treatment of mitral valve disease.Complete video-assisted mitral valve replacement represents the contemporary minimally invasive cardiac surgery in valve disease surgical therapy. In the field of minimally invasive cardiac surgery, the success of the operation is largely depending on surgical incision, it also reflects the surgeon’s technique level. Method From February 2010 to February 2013, 80 cases of cardiac patients with mitral valve pathological changes in our department who had received surgical treatment of complete video-assisted mitral valve replacement were recruited, they were divided into two groups according to the surgical incision： midclavicular group（M group,n = 50） and parasternal group（P group, n = 30）. The clinical data were recorded including： cardiopulmonary bypass time, aortic clamping time, volume of thoracic drainage after operation, ICU tracheal intubation time,postoperative days of hospital stay and time for observing the postoperative complications. The comparison between two groups was performed using t-test analysis. Result Both M Group and P Group had favorable surgical view, there were no emergency situation of redo median sternotomy during initial operative period or intraoperative death, no pericardial tamponade, no infection, and no other serious postoperative complications.Whereas, there were 2 cases of redo operation for stanch bleeding in M Group and 1 case of perivalvular leakage in P Group. Nevertheless, 3 months later, the result of reexamine showed that the perivalvular leakage had vanished. The clinical data was shown as follow（M Group vs. P Group）： cardiopulmonary bypass time（90.2 ± 28.7 vs. 87.3 ± 24.5 min, P 〉 0.05）, aortic clamping time（65.2 ± 17.4 vs. 68.6 ± 21.9 min, P 〉 0.05）,1st day volume of thoracic drainage after operation 1（75.8 ± 35.6 vs. 53.2 ± 25.6 mL, P 〉 0.05）, ICU tracheal intubation time（9.6 ± 3.4 vs. 8.4 ± 4.5 hours, P 〉 0.05）, postoperative days of hospital stay（7.3 ± 2.2 vs. 6.9± 3.2 days, P 〉 0.05）. T-test analysis of the data of each groups showed that there were no significant statistically difference. Conclusions Appropriate surgical incisions guarantee a favorable surgical view and the success of the whole process during intraoperative period. In both midclavicular and parasternal approaches, the complete video-assisted mitral valve replacement is able to be accomplished safely and successfully. Due to the current development level of thoracoscopic instruments and equipment, the surgical incision and approach for video-assisted mitral valve replacement are diversified. As a result, diversified surgical incisions can be customized according to the variegated pathological changes of cardiac patients.展开更多
BACKGROUND Pyogenic liver abscesses are insidious in the early stage.Some cases progress rapidly,and the patient’s condition can worsen and even become life-threatening if timely treatment is not provided.Surgery and...BACKGROUND Pyogenic liver abscesses are insidious in the early stage.Some cases progress rapidly,and the patient’s condition can worsen and even become life-threatening if timely treatment is not provided.Surgery and prolonged antibiotic treatment are often required if the abscess is large and liquefied and becomes separated within the lumen.CASE SUMMARY We report a case of bacterial liver abscess with a poor outcome following pharmacological treatment,review the literature related to the use of platelet-rich plasma(PRP)in the treatment of hepatic impairment and partial hepatectomy in animals,and discuss the prognostic features of surgical incision and drainage combined with PRP in the treatment of bacterial liver abscesses.This is the first case describing the use of PRP in the treatment of a bacterial liver abscess in humans,providing new ideas for the treatment of this condition.CONCLUSION This case highlights the importance of surgical treatment for bacterial liver abscesses that are well liquefied and poorly managed medically.PRP may produce antimicrobial effects and promote the regeneration and repair of liver tissue.展开更多
Background: It appeared that the conjunction inflammation and nerve damage (caused by surgery) generate the hyperalgesic component. But the probability of predicting hyperalgesia from the size of the surgical incision...Background: It appeared that the conjunction inflammation and nerve damage (caused by surgery) generate the hyperalgesic component. But the probability of predicting hyperalgesia from the size of the surgical incision and/or the resulting inflammatory reaction is not well elucidated. This survey aims to study the influence of the size of the surgical incision and the resulting inflammatory reaction (interleukin 6 levels) in the occurrence of postoperative hyperalgesia in the population of Lubumbashi. Methods: The present study was descriptive cross-sectional. The data collection was prospective over 5 months, from February 1, 2024 to June 30, 2024. This study included any patient over the age of 18 who underwent surgery under general anesthesia. We used indirect signs to define hyperalgesia: higher (ENS > 6) and prolonged pain, postoperative overconsumption of morphine. Results: During our survey, we collected 48 operated patients who had severe postoperative pain, 16 of whom had hyperalgesia, i.e. a prevalence of hyperalgesia of 33.33%. The size of the incision most represented was between ≥20 and i.e. 62.50%. The type of surgery most affected by hyperalgesia was laparotomy. We observed an elevation of IL6 in 87.50% of patients. The largest elevation was 8.91 times the preoperative value and the smallest was 1.04 times. Pre- and postoperative IL6 levels were not associated with hyperalgesia (p = 0.265). Only the size of the surgical incision was associated with hyperalgesia (p = 0.04). Incision size values between [20 - 30] cm were those associated with hyperalgesia (p = 0.027). The model shows that making an incision greater than or equal to 20 cm increases the patient’s risk of developing hyperalgesia by more than 7.222 times and this is statistically significant (p = 0.004). Conclusion: According to this survey, the size of the surgical incision was associated with postoperative hyperalgesia and a size of more than 20 cm increases the patient’s risk of developing hyperalgesia by more than 7.222 times.展开更多
Objective To study the risk factors of surgical wound infection among the patients in department of abodominal surgery. Methods The factors on surgical wound infection were investigated by retrospective study. The dia...Objective To study the risk factors of surgical wound infection among the patients in department of abodominal surgery. Methods The factors on surgical wound infection were investigated by retrospective study. The diagnosis standard was based on Diagnosis Standard of Hospital Infection published by Ministry of Health.展开更多
Objective:To explore the clinical effect of improved incision in the extraction of impacted mandibular wisdom teeth.Methods:160 patients who were treated in our hospital from October,2024 to April,2025 and had their m...Objective:To explore the clinical effect of improved incision in the extraction of impacted mandibular wisdom teeth.Methods:160 patients who were treated in our hospital from October,2024 to April,2025 and had their mandibular impacted wisdom teeth removed according to the doctor’s advice were randomly divided into observation group and control group.The observation group used modified incision,while the control group used traditional triangular incision.The operation time,intraoperative visual analogue scale(VAS)pain score,pain VAS score on the 1st,2nd and 3rd day after operation,facial swelling on the 2nd day after operation,mouth opening limitation on the 2nd day after operation and the incidence of dry socket after operation were recorded and compared between the two groups.Results:There was no significant difference in operation time between the two groups(p>0.05).The VAS score of pain in the observation group was significantly lower than that in the control group at each time point during and after operation(p<0.05).On the second day after operation,the facial swelling and mouth opening limitation in the observation group were significantly lighter than those in the control group(p<0.05).The incidence of dry socket in the observation group was 1.25%(1/80),which was significantly lower than that in the control group(8.75%,7/80),and the difference was statistically significant(p<0.05).Conclusion:The application of modified triangular incision in the extraction of impacted mandibular wisdom teeth can effectively relieve the pain during and after operation,reduce postoperative facial swelling and mouth opening limitation,and reduce the incidence of dry socket.展开更多
<strong>Background</strong><strong>:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"...<strong>Background</strong><strong>:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Nowadays we observe growing rates of obesity, mainly among women. It has a great impact on maternal and fetal morbimortality and requires a specific obstetric approach.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Aim:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> To discuss different approaches to abdominal incision in cesarean section in obese patients.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Case presentation: </span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Patient with morbid obesity submitted to an elective cesarean section due to fetal macrosomia and who underwent a cesarean section with a supraumbilical median incision evolving without any postpartum complications.</span><b><span style="font-family:Verdana;"> Conclusion:</span></b><span style="font-family:Verdana;"> It’s important to evaluate and chose </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">th</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">e best incision in morbidly obese pregnant women aiming to reduce difficulties in fetal extraction and postoperative complications. Midline supraumbilical incision is a good choice in these cases, reducing surgical time and postpartum hemorrhage.</span></span></span>展开更多
BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complic...BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.展开更多
Background:Patients with Crohn’s disease(CD)are often reported to be at a high risk for incisional surgical site infection(SSI).The aim of this study was to identify the risk factors associated with post-operative in...Background:Patients with Crohn’s disease(CD)are often reported to be at a high risk for incisional surgical site infection(SSI).The aim of this study was to identify the risk factors associated with post-operative incisional SSI in CD patients after bowel resection.Method:CD patients undergoing bowel resection between 2007 and 2015 were enrolled.Demographic and clinical features related to post-operative incisional SSI were analysed using both univariate and multivariate logistical analyses.Results:Of all eligible patients(n=159),123(77.4%)were male,with a mean age at surgery of 33.4611.8 years.A total of 35(22.0%)CD patients developed post-operative incisional SSI.Post-operative incisional SSI was more likely to happen in patients who had penetrating type of disease(P=0.018),underwent bowel resection for the indication of chronic fistula(P=0.005)and had an intra-operative finding of fistula(P=0.001).A greater proportion of patients with post-operative incisional SSI were found to have anemia(P=0.019)but elevated levels of white blood cells(P=0.027),neutrophils(P=0.006)as well as an elevated percentage of neutrophils(P=0.005).Multivariate logistic regression analysis showed that anemia(odds ratio[OR]:3.31,95%confidence interval[CI]:1.05-10.46,P=0.041),an elevated percentage of neutrophils(OR:2.85,95%CI:1.23-6.59,P=0.014)and an intra-operative finding of fistula(OR:3.76,95%CI:1.53-9.21,P=0.004)were significantly associated with the risk for post-operative incisional SSI.Conclusions:Anemia,elevated percentage of neutrophils and intra-operative finding of fistula are predictors for the development of post-operative incisional SSI in CD patients undergoing bowel resection.Favorable pre-operative nutrition status and low inflammatory status may lessen the incidence of post-operative incisional SSI.展开更多
Objective:To explore the preventive effects of anti-infective treatment on wound infection in emergency surgical trauma.Methods:180 patients in our hospital from 2019 to June to May 2020 were selected as subjects.The ...Objective:To explore the preventive effects of anti-infective treatment on wound infection in emergency surgical trauma.Methods:180 patients in our hospital from 2019 to June to May 2020 were selected as subjects.The 180 patients were randomly divided into two groups.The control group had 90 cases and adopted the conventional treatment method,and the experimental group received anti-infective treatment.The wound healing,infection status,and patient satisfaction of the two groups of patients were analyzed.Results:The wound healing,infection status,and patient satisfaction of the experimental group were better than those of the control group.Conclusion:The application of anti-infective treatment to the prevention of wound infection in emergency surgical trauma can reduce the infection rate of the patients'incision and promote the recovery of patients.It is suitable for clinical applications.展开更多
基金supported by the Applied Research Grant Program of the Academy of Social Sciences of Zhejiang University(No.2020XZA108)Medical Science and Technology Project of Zhejiang Province(No.2023KY798)Key Project in the Agricultural and Social Development Sector of the Science and Technology Bureau of Hangzhou(No.20231203A09).
文摘Objective Enhanced recovery after surgery(ERAS)protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma.However,the cognitive and experiential dimensions of surgical incisions under ERAS remain underexplored,particularly in non-Western populations.This study aims to explore patients’perceptions and preferences regarding laparoscopic incisions under ERAS,providing evidence to optimize incision planning and perioperative education.Methods A qualitative descriptive study was conducted at the Department of Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,between November 2022 and February 2023.The participants were adults(≥18 years)who underwent elective laparoscopic abdominal surgery under ERAS,excluding those with cognitive impairments,language barriers,or emergency procedures.Semi-structured interviews,covering physical function,social function,emotional function,self and others’acceptance,and confidence in the nature and treatment of the disease,were audio-recorded and transcribed verbatim and guided by a thematic framework co-developed by surgeons,nurses,and psychologists.The data were analyzed via the framework method to identify themes related to incision experiences.Results This qualitative study included 16 participants,8(50%)females and 6(37.5%)cancer patients,with a mean age of 41.5±12.2 years.Qualitative analysis revealed that the participants experienced minimal psychological distress and great emphasis on pain management and expressed specific concerns regarding the location,size,and cosmetic appearance of the incision.They also voiced high expectations for preventing incision complications and sought information regarding postoperative care.There was notable variation in preferences regarding the choice of incision site before surgery.Participants with cancer focused on disease cure rather than aesthetics.Conclusion Personalized preoperative discussions,incision site selection,and postoperative education are critical for increasing patient satisfaction.Laparoscopic incisions under ERAS minimally impact psychological well-being,but location-specific discomfort and aesthetic preferences require attention.
文摘Background Prosthetic mitral valve replacement is a common surgical treatment of mitral valve disease.Complete video-assisted mitral valve replacement represents the contemporary minimally invasive cardiac surgery in valve disease surgical therapy. In the field of minimally invasive cardiac surgery, the success of the operation is largely depending on surgical incision, it also reflects the surgeon’s technique level. Method From February 2010 to February 2013, 80 cases of cardiac patients with mitral valve pathological changes in our department who had received surgical treatment of complete video-assisted mitral valve replacement were recruited, they were divided into two groups according to the surgical incision： midclavicular group（M group,n = 50） and parasternal group（P group, n = 30）. The clinical data were recorded including： cardiopulmonary bypass time, aortic clamping time, volume of thoracic drainage after operation, ICU tracheal intubation time,postoperative days of hospital stay and time for observing the postoperative complications. The comparison between two groups was performed using t-test analysis. Result Both M Group and P Group had favorable surgical view, there were no emergency situation of redo median sternotomy during initial operative period or intraoperative death, no pericardial tamponade, no infection, and no other serious postoperative complications.Whereas, there were 2 cases of redo operation for stanch bleeding in M Group and 1 case of perivalvular leakage in P Group. Nevertheless, 3 months later, the result of reexamine showed that the perivalvular leakage had vanished. The clinical data was shown as follow（M Group vs. P Group）： cardiopulmonary bypass time（90.2 ± 28.7 vs. 87.3 ± 24.5 min, P 〉 0.05）, aortic clamping time（65.2 ± 17.4 vs. 68.6 ± 21.9 min, P 〉 0.05）,1st day volume of thoracic drainage after operation 1（75.8 ± 35.6 vs. 53.2 ± 25.6 mL, P 〉 0.05）, ICU tracheal intubation time（9.6 ± 3.4 vs. 8.4 ± 4.5 hours, P 〉 0.05）, postoperative days of hospital stay（7.3 ± 2.2 vs. 6.9± 3.2 days, P 〉 0.05）. T-test analysis of the data of each groups showed that there were no significant statistically difference. Conclusions Appropriate surgical incisions guarantee a favorable surgical view and the success of the whole process during intraoperative period. In both midclavicular and parasternal approaches, the complete video-assisted mitral valve replacement is able to be accomplished safely and successfully. Due to the current development level of thoracoscopic instruments and equipment, the surgical incision and approach for video-assisted mitral valve replacement are diversified. As a result, diversified surgical incisions can be customized according to the variegated pathological changes of cardiac patients.
基金Supported by Science and Technology Planning Project of Gansu Province,No.21CX6FD163Science and Technology Planning Project of Baiyin City,No.2021-1-18Y.
文摘BACKGROUND Pyogenic liver abscesses are insidious in the early stage.Some cases progress rapidly,and the patient’s condition can worsen and even become life-threatening if timely treatment is not provided.Surgery and prolonged antibiotic treatment are often required if the abscess is large and liquefied and becomes separated within the lumen.CASE SUMMARY We report a case of bacterial liver abscess with a poor outcome following pharmacological treatment,review the literature related to the use of platelet-rich plasma(PRP)in the treatment of hepatic impairment and partial hepatectomy in animals,and discuss the prognostic features of surgical incision and drainage combined with PRP in the treatment of bacterial liver abscesses.This is the first case describing the use of PRP in the treatment of a bacterial liver abscess in humans,providing new ideas for the treatment of this condition.CONCLUSION This case highlights the importance of surgical treatment for bacterial liver abscesses that are well liquefied and poorly managed medically.PRP may produce antimicrobial effects and promote the regeneration and repair of liver tissue.
文摘Background: It appeared that the conjunction inflammation and nerve damage (caused by surgery) generate the hyperalgesic component. But the probability of predicting hyperalgesia from the size of the surgical incision and/or the resulting inflammatory reaction is not well elucidated. This survey aims to study the influence of the size of the surgical incision and the resulting inflammatory reaction (interleukin 6 levels) in the occurrence of postoperative hyperalgesia in the population of Lubumbashi. Methods: The present study was descriptive cross-sectional. The data collection was prospective over 5 months, from February 1, 2024 to June 30, 2024. This study included any patient over the age of 18 who underwent surgery under general anesthesia. We used indirect signs to define hyperalgesia: higher (ENS > 6) and prolonged pain, postoperative overconsumption of morphine. Results: During our survey, we collected 48 operated patients who had severe postoperative pain, 16 of whom had hyperalgesia, i.e. a prevalence of hyperalgesia of 33.33%. The size of the incision most represented was between ≥20 and i.e. 62.50%. The type of surgery most affected by hyperalgesia was laparotomy. We observed an elevation of IL6 in 87.50% of patients. The largest elevation was 8.91 times the preoperative value and the smallest was 1.04 times. Pre- and postoperative IL6 levels were not associated with hyperalgesia (p = 0.265). Only the size of the surgical incision was associated with hyperalgesia (p = 0.04). Incision size values between [20 - 30] cm were those associated with hyperalgesia (p = 0.027). The model shows that making an incision greater than or equal to 20 cm increases the patient’s risk of developing hyperalgesia by more than 7.222 times and this is statistically significant (p = 0.004). Conclusion: According to this survey, the size of the surgical incision was associated with postoperative hyperalgesia and a size of more than 20 cm increases the patient’s risk of developing hyperalgesia by more than 7.222 times.
文摘Objective To study the risk factors of surgical wound infection among the patients in department of abodominal surgery. Methods The factors on surgical wound infection were investigated by retrospective study. The diagnosis standard was based on Diagnosis Standard of Hospital Infection published by Ministry of Health.
文摘Objective:To explore the clinical effect of improved incision in the extraction of impacted mandibular wisdom teeth.Methods:160 patients who were treated in our hospital from October,2024 to April,2025 and had their mandibular impacted wisdom teeth removed according to the doctor’s advice were randomly divided into observation group and control group.The observation group used modified incision,while the control group used traditional triangular incision.The operation time,intraoperative visual analogue scale(VAS)pain score,pain VAS score on the 1st,2nd and 3rd day after operation,facial swelling on the 2nd day after operation,mouth opening limitation on the 2nd day after operation and the incidence of dry socket after operation were recorded and compared between the two groups.Results:There was no significant difference in operation time between the two groups(p>0.05).The VAS score of pain in the observation group was significantly lower than that in the control group at each time point during and after operation(p<0.05).On the second day after operation,the facial swelling and mouth opening limitation in the observation group were significantly lighter than those in the control group(p<0.05).The incidence of dry socket in the observation group was 1.25%(1/80),which was significantly lower than that in the control group(8.75%,7/80),and the difference was statistically significant(p<0.05).Conclusion:The application of modified triangular incision in the extraction of impacted mandibular wisdom teeth can effectively relieve the pain during and after operation,reduce postoperative facial swelling and mouth opening limitation,and reduce the incidence of dry socket.
文摘<strong>Background</strong><strong>:</strong><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> Nowadays we observe growing rates of obesity, mainly among women. It has a great impact on maternal and fetal morbimortality and requires a specific obstetric approach.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Aim:</span></b></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;"> To discuss different approaches to abdominal incision in cesarean section in obese patients.</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><b><span style="font-family:Verdana;">Case presentation: </span></b></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">Patient with morbid obesity submitted to an elective cesarean section due to fetal macrosomia and who underwent a cesarean section with a supraumbilical median incision evolving without any postpartum complications.</span><b><span style="font-family:Verdana;"> Conclusion:</span></b><span style="font-family:Verdana;"> It’s important to evaluate and chose </span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">th</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">e best incision in morbidly obese pregnant women aiming to reduce difficulties in fetal extraction and postoperative complications. Midline supraumbilical incision is a good choice in these cases, reducing surgical time and postpartum hemorrhage.</span></span></span>
基金Supported by the Zhejiang Provincial Natural Science Foundation of China,No.LQ20H260002.
文摘BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer.Incisional surgical site infection(SSI)is a common complication after ileostomy closure.AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique(MPNPWT)in preventing incisional SSI.METHODS This was a prospective,randomized controlled clinical trial conducted at a single center.A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021.Patients were randomly allocated into an MPNPWT group and a control group.The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing.The surgical outcomes were compared between the MPNPWT(n=50)and control(n=51)groups.Risk factors for incisional SSI were identified using logistic regression.RESULTS There were no differences in baseline characteristics between the MPNPWT(n=50)and control groups(n=51).The incisional SSI rate was significantly higher in the control group than in the MPNPWT group(15.7%vs 2.0%,P=0.031).However,MPNPWT did not affect other surgical outcomes,including intra-abdominal complications,operative time,and blood loss.Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups(P=0.069 and 0.843,respectively).None of the patients experienced adverse effects of MPNPWT,including skin allergy,dermatitis,and pain.MPNPWT also helped heal the infected incision.Our study indicated that MPNPWT was an independent protective factor[odds ratio(OR)=0.005,P=0.025)]and diabetes was a risk factor(OR=26.575,P=0.029)for incisional SSI.CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.
基金supported by the National Natural Science Foundation of China(No.81400603)the Guangdong Natural Science Foundation(No.2015A030310190)the Science and Technology Planning Project of Guangdong Province(No.2015B020229001).
文摘Background:Patients with Crohn’s disease(CD)are often reported to be at a high risk for incisional surgical site infection(SSI).The aim of this study was to identify the risk factors associated with post-operative incisional SSI in CD patients after bowel resection.Method:CD patients undergoing bowel resection between 2007 and 2015 were enrolled.Demographic and clinical features related to post-operative incisional SSI were analysed using both univariate and multivariate logistical analyses.Results:Of all eligible patients(n=159),123(77.4%)were male,with a mean age at surgery of 33.4611.8 years.A total of 35(22.0%)CD patients developed post-operative incisional SSI.Post-operative incisional SSI was more likely to happen in patients who had penetrating type of disease(P=0.018),underwent bowel resection for the indication of chronic fistula(P=0.005)and had an intra-operative finding of fistula(P=0.001).A greater proportion of patients with post-operative incisional SSI were found to have anemia(P=0.019)but elevated levels of white blood cells(P=0.027),neutrophils(P=0.006)as well as an elevated percentage of neutrophils(P=0.005).Multivariate logistic regression analysis showed that anemia(odds ratio[OR]:3.31,95%confidence interval[CI]:1.05-10.46,P=0.041),an elevated percentage of neutrophils(OR:2.85,95%CI:1.23-6.59,P=0.014)and an intra-operative finding of fistula(OR:3.76,95%CI:1.53-9.21,P=0.004)were significantly associated with the risk for post-operative incisional SSI.Conclusions:Anemia,elevated percentage of neutrophils and intra-operative finding of fistula are predictors for the development of post-operative incisional SSI in CD patients undergoing bowel resection.Favorable pre-operative nutrition status and low inflammatory status may lessen the incidence of post-operative incisional SSI.
文摘Objective:To explore the preventive effects of anti-infective treatment on wound infection in emergency surgical trauma.Methods:180 patients in our hospital from 2019 to June to May 2020 were selected as subjects.The 180 patients were randomly divided into two groups.The control group had 90 cases and adopted the conventional treatment method,and the experimental group received anti-infective treatment.The wound healing,infection status,and patient satisfaction of the two groups of patients were analyzed.Results:The wound healing,infection status,and patient satisfaction of the experimental group were better than those of the control group.Conclusion:The application of anti-infective treatment to the prevention of wound infection in emergency surgical trauma can reduce the infection rate of the patients'incision and promote the recovery of patients.It is suitable for clinical applications.
