In this editorial,the authors of this paper comment on the article by Bokov et al published in the recent issue of World Journal of Orthopedics.We reviewed a general overview of oblique lumbar interbody fusions(OLIF)a...In this editorial,the authors of this paper comment on the article by Bokov et al published in the recent issue of World Journal of Orthopedics.We reviewed a general overview of oblique lumbar interbody fusions(OLIF)and lateral lumbar interbody fusions(LLIF),their indications and complications as an increasingly popular minimally invasive technique to address several lumbar pathologies.This editorial thoroughly discusses and reviews the literature regarding factors affecting outcomes of indirect decompression utilized through OLIF and LLIF procedures.Several parameters play a critical role in patient outcomes including restoration of disc height,foraminal height,central canal squared,and foraminal area.The indirect decompression allows for unbuckling of the ligamentum flavum which can significantly decompress the neural elements as well as aid in reduction of spondylolisthesis.However,the authors further highlight the limitations of indirect decompression and factors that may predict unsuccessful outcomes including bony foraminal stenosis,severe central canal stenosis,and osteoporosis.As a result,failure of indirect decompression can lead to persistent pain,radiculopathy and unsatisfied patients.Spinal surgeons may be left to reimage patients and consider additional procedures with direct decompression.展开更多
Objective:Microvascular decompression(MVD)is the gold standard for treating drug-resistant classic trigeminal neuralgia(dcTN),with endoscopy enhancing surgical precision through improved visualization.This study evalu...Objective:Microvascular decompression(MVD)is the gold standard for treating drug-resistant classic trigeminal neuralgia(dcTN),with endoscopy enhancing surgical precision through improved visualization.This study evaluates the efficacy of fully endoscopic MVD for dcTN and presents our early experience.Methods:This retrospective study included patients with dcTN who underwent fully endoscopic MVD in the Department of Neurosurgery,the First Affiliated Hospital,Zhejiang University School of Medicine from November 2020 to February 2023.We recorded basic patient clinical information,clinical outcomes,offending vessels,complications,and recurrences,and assessed outcomes via the Barrow Neurological Institute(BNI)pain intensity score and the numeric rating scale(NRS)score.Results:All 42 patients had dcTN with preoperative BNI scores of V and NRS scores of 8e10.Endoscopic visualization enabled the precise identification of neurovascular conflicts,including small and deeply located vessels.Immediately after surgery,90.5%of patients achieved complete pain relief(BNI score of I,NRS score of 0).At the final follow-up,85.7%of patients had complete pain relief.All patients’pain was significantly relieved at immediate after surgery(0 vs.9,p<0.001)and at the final follow-up(0 vs.9,p<0.001),with lower NRS scores.Complications,including vertigo,headache,and transient facial numbness,occurred in 14.4%of patients and were manageable.展开更多
BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of con...BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.AIM To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.METHODS A search was conducted in MEDLINE,EMBASE,and Scopus from inception to August 2024.Studies reporting the clinical success,perforation,recurrence,and need for surgery after colonoscopic decompression in ACPO were included.A random-effects inverse-variance model was used to calculate the pooled proportion.RESULTS Sixteen studies were included in the final analysis.The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8%(95%CI:72.0-85.6)and 91.5%(95%CI:87.0-96.0),respectively.The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85(95%CI:2.00-7.42).The pooled incidence of perforation was 0.9%(95%CI:0.0-2.0),while recurrence was observed in 17.1%(95%CI:12.9-21.3)of the patients after clinical success.The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5%(95%CI:5.0-15.9)and 3.7%(95%CI:0.3-7.1),respectively.Subgroup analysis,excluding the low-quality studies,did not significantly change the event rates.CONCLUSION Colonoscopic decompression for ACPO is associated with a clinical success rate of>90%with a perforation rate of<1%,demonstrating high efficacy and safety.展开更多
Endoscopic transnasal optic nerve decompression surgery plays a crucial role in minimal invasive treatment of complex traumatic optic neuropathy.However,a major challenge faced during the procedure is the inability to...Endoscopic transnasal optic nerve decompression surgery plays a crucial role in minimal invasive treatment of complex traumatic optic neuropathy.However,a major challenge faced during the procedure is the inability to visualize the optic nerve intraoperatively.To address this issue,an endoscopic image-based augmented reality surgical navigation system is developed in this study.The system aims to virtually fuse the optic nerve onto the endoscopic images,assisting surgeons in determining the optic nerve’s position and reducing surgical risks.First,a calibration algorithm based on a checkerboard grid of immobile points is proposed,building upon existing calibration methods.Additionally,to tackle accuracy issues associated with augmented reality technology,an optical navigation and visual fusion compensation algorithm is proposed to improve the intraoperative tracking accuracy.To evaluate the system’s performance,model experiments were meticulously designed and conducted.The results confirm the accuracy and stability of the proposed system,with an average tracking error of(0.99±0.46)mm.This outcome demonstrates the effectiveness of the proposed algorithm in improving the augmented reality surgical navigation system’s accuracy.Furthermore,the system successfully displays hidden optic nerves and other deep tissues,thus showcasing the promising potential for future applications in orbital and maxillofacial surgery.展开更多
Ternary hydrides, with their superior chemical and structural flexibility over binary systems, open up new avenues for advancing high-performance superconductor research. The Y-Ca-H system is a promising candidate for...Ternary hydrides, with their superior chemical and structural flexibility over binary systems, open up new avenues for advancing high-performance superconductor research. The Y-Ca-H system is a promising candidate for high-temperature superconductors, as both Im3m YH_(6) and Im3m CaH_(6) exhibit similar structures and excellent superconducting properties, while Y and Ca atoms possess close atomic radii and electronegativities.Here, we report the successful synthesis of Im3m(Y, Ca)H_(6) achieving a maximum superconducting transition temperature(T_(c)) approximately 224 K at 155 GPa through five independent high-temperature and high-pressure experiments. Remarkably, the T_(c) of Im3m(Y, Ca)H_(6) remains highly stable(ΔT_(c) ≤ 1 K) during decompression between 148 and 165 GPa, significantly outperforming binary Im3m CaH_(6) and Im3m YH_(6). The enhanced superconducting properties may stem from the cooperative chemical template effect of Y and Ca atoms near the s-d border, which significantly reinforces H lattice stability and thus maintains superior superconductivity.This study highlights the potential of multicomponent cooperative effects in designing hydride superconductors,offering new insights for achieving high-T_(c) hydrides at lower pressures in the future.展开更多
Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to...Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.展开更多
Objective:To observe the effect of recombinant human bone morphogenetic protein 2/polylactide-co-glycolic acid(rhBMP-2/PLGA) with core decompression on repair of rabbit femoral head necrosis.Methods:Bilateral femoral ...Objective:To observe the effect of recombinant human bone morphogenetic protein 2/polylactide-co-glycolic acid(rhBMP-2/PLGA) with core decompression on repair of rabbit femoral head necrosis.Methods:Bilateral femoral head necrosis models of rabbit were established by steroid injection.A total of 48 rabbits(96 femoral head necrosis) were randomly divided into 4groups:Group A,control group with12 rabbits,24 femoral head necrosis;Group B,treated with rhBMP-2/PLCA implantation after core depression,with 12 rabbits,24 femoral head necrosis;Group C,treated with rhBMP-2 implantation after core depression,with 12 rabbits,24 femoral head necrosis;Croup D treated with core depression group without implantation,with 12 rabbits,24 femoral head necrosis.All animals were sacrificed after 12 weeks.The ability of repairing bone defect was evaluated by X-ray radiograph.Bone mineral density analysis of the defect regions were used to evaluate the level of ossification.The morphologic change and bone formation was assessed by HE staining.The angiogenesis was evaluated by VEGF immunohistochemistry.Results:The osteogenetic ability and quality of femoral head necrosis in group B were better than those of other groups after 12 weeks by X-ray radiograph and morphologic investigation.And the angiogenesis in group B was better than other groups.Group C had similar osteogenetic quality of femoral head necrosis and angiogenesis with group D.Conclusions:The treatment of rhBMP-2/PLCA implantation after core depression can promote the repair of rabbit femoral head necrosis.It is a promising and efficient synthetic bone material to treat the femoral head necrosis.展开更多
AIM: To report the effects of intravenous high-dose glucocorticoids(iv GC) and orbital decompression(OD) surgery for treatment of sight-threatening thyroid-associated ophthalmopathy(TAO).METHODS: A retrospective revie...AIM: To report the effects of intravenous high-dose glucocorticoids(iv GC) and orbital decompression(OD) surgery for treatment of sight-threatening thyroid-associated ophthalmopathy(TAO).METHODS: A retrospective review of medical records from patients with sight-threatening TAO [definite or highly suspected dysthyroid optic neuropathy(DON)] treated with iv GC(60 cases) and OD(25 cases) was conducted at the Zhongshan Ophthalmic Center between January 2001 and January 2009. Patients were initially treated with iv GC(iv GC group). If no significant improvement in visual function was obtained, they then received OD surgery(OD group). The pre-versus post-treatment efficacies of either iv GC or OD in these patients were assessed using several indices, including visual acuity, intraocular pressure, ocular alignment, ocular motility, and exophthalmos. RESULTS: Nighty-one eyes had definite DON while 79 were considered to have highly suspected DON. In the iv GC group, 51 individuals(85.0%) eventually demonstrated normal vision, while 10 patients(16.7%) demonstrated a reduction in deviation(P<0.01), and 35 cases(58.3%) showed slight improvements in ocular motility(P<0.01). In OD group, visual acuity improved in 24 cases(96.0%, P<0.01) and all patients showed varying reductions of exophthalmos(mean: 4.35±1.13 mm, P<0.01). Eight cases(32.0%) experienced an 8-15 PD reduction of deviation and ocular motility improved in 12 cases(48.0%), while 3 patients(12.0%) developed new-onset strabismus with diplopia post-surgically(P<0.01). Patients were followed up at an average of 1.55±1.07 y. CONCLUSION: Both iv GC and OD show good therapeutic efficacy in the treatment of sight-threatening TAO. Thepresence of extremely poor eyesight(≥0.5 log MAR) was corrected in some patients with iv GC alone, thus sparing these patients from subsequent OD surgery. In patients who were refractory to steroids, subsequent OD surgery often provided satisfactory outcomes, however, new-onset strabismus with diplopia was observed in 12.0% of these cases.展开更多
AIM： To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS： Three hundred and...AIM： To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS： Three hundred and sixteen patients submitted to operations associated with colorectostorny from January 2004 to September 2005 were randomized to two groups： In experimental group （n = 161）, the nasogastric tube was removed after the operation from 12 to 24 hours and was promised immediately oral feeding; In control group （n = 155）, the nasogastric tube was maintained until the passage of flatus per rectum. Variables assessed included the time to first passage of flatus, the time to first passage of stool, the time elapsed postoperative stay, and postoperative complications such as anastornotic leakage, acute dilation of stomach, wound infection and dehiscense, fever, pulmonary infection and pharyngolaryngitis. RESULTS： The median and average days to the first passage of flatus （3.0±0.9 vs 3.6±1.2, P〈0.001）, the first passage of stool （4.1± 1.1 vs 4.8±1.4 P〈0.001） and the length of postoperative stay （8.4±3.4 vs 9.6±5.0, P〈0.05） were shorter in the experimental group than in the control group. The postoperative complications such as anastomotic leakage （1.24% vs 2.58%）, acute dilation of stomach （1.86% vs 0.06%） and wound complications （2.48% vs 1.94%） were similar in the groups, but fever （3.73% vs 9.68%, P〈0.05）, pulmonary infection （0.62% vs 4.52%, P〈0.05） and pharyngolaryngitis （3.11% vs 23.23%, P〈0.001） were much more in the control group than in the experimental group. CONCLUSION： The present study shows that applicationof gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications. On the contrary, it may increase the incidence rate of fever, pharyngolaryngitis and pulmonary infection. These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation.展开更多
BACKGROUND:Excessive hepatocyte apoptosis and bile lakes in severe obstructive jaundice might impair liver functions.Although decompression of the bile duct has been reported to improve liver functions in animal studi...BACKGROUND:Excessive hepatocyte apoptosis and bile lakes in severe obstructive jaundice might impair liver functions.Although decompression of the bile duct has been reported to improve liver functions in animal studies,the mechanism of obstruction differs from that in humans.This study aimed to determine the profiles of hepatocyte apoptosis and bile lakes following bile duct decompression in patients with severe obstructive jaundice in the clinical setting.METHODS:We conducted a 'before and after study' on severe obstructive jaundice patients as a model of inhibition of the excessive process by bile duct decompression.Specimens of liver biopsies were taken before and after decompression of the bile duct and then stained by terminal deoxynucleotide transferase-mediated dUTP nick end-labeling(TUNEL) to identify hepatocyte apoptosis and by hematoxilin-eosin(HE) to identify bile lakes.All measurements were independently done by 2 observers.RESULTS:Twenty-one severe obstructive jaundice patients were included.In all patients,excessive hepatocyte apoptosis and bile lakes were apparent.After decompression,the hepatocyte apoptosis index decreased from 53.1(SD 105) to 11.7(SD 13.6)(P<0.05),and the bile lakes from 23.6(SD 14.8) to 10.9(SD 6.9)(P<0.05).CONCLUSION:Bile duct decompression improves hepatocyte apoptosis and bile lakes in cases of severe obstructive jaundice,similar to the findings in animal studies.展开更多
U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently c...U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or （and） sacral decompression. EQ-5d score was applied to evaluate the patients＇ quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years （range： 15-55 years） at the time of injury. There were 6 females and 9 males. The mean follow- up time was 22.7 months （range： 9-47 months） and mean full weight-bearing time was 9.9 weeks （range： 8-14 weeks）. Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle （mean 27.87°, and range： 8°-90°） of the sacrum was smaller than that pre-operation （mean 35.67; range： 15-90） with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score （VAS） was reduced from preoperative 7.07 （range： 5-9） to postoperetive 1.93 （range： 1-3）. All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work full time. In conclusion, lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed. Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery. Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.展开更多
文摘In this editorial,the authors of this paper comment on the article by Bokov et al published in the recent issue of World Journal of Orthopedics.We reviewed a general overview of oblique lumbar interbody fusions(OLIF)and lateral lumbar interbody fusions(LLIF),their indications and complications as an increasingly popular minimally invasive technique to address several lumbar pathologies.This editorial thoroughly discusses and reviews the literature regarding factors affecting outcomes of indirect decompression utilized through OLIF and LLIF procedures.Several parameters play a critical role in patient outcomes including restoration of disc height,foraminal height,central canal squared,and foraminal area.The indirect decompression allows for unbuckling of the ligamentum flavum which can significantly decompress the neural elements as well as aid in reduction of spondylolisthesis.However,the authors further highlight the limitations of indirect decompression and factors that may predict unsuccessful outcomes including bony foraminal stenosis,severe central canal stenosis,and osteoporosis.As a result,failure of indirect decompression can lead to persistent pain,radiculopathy and unsatisfied patients.Spinal surgeons may be left to reimage patients and consider additional procedures with direct decompression.
基金supported by financial assistance from the Zhejiang Provincial Natural Science Foundation of China under Grant No.LY18H160020.
文摘Objective:Microvascular decompression(MVD)is the gold standard for treating drug-resistant classic trigeminal neuralgia(dcTN),with endoscopy enhancing surgical precision through improved visualization.This study evaluates the efficacy of fully endoscopic MVD for dcTN and presents our early experience.Methods:This retrospective study included patients with dcTN who underwent fully endoscopic MVD in the Department of Neurosurgery,the First Affiliated Hospital,Zhejiang University School of Medicine from November 2020 to February 2023.We recorded basic patient clinical information,clinical outcomes,offending vessels,complications,and recurrences,and assessed outcomes via the Barrow Neurological Institute(BNI)pain intensity score and the numeric rating scale(NRS)score.Results:All 42 patients had dcTN with preoperative BNI scores of V and NRS scores of 8e10.Endoscopic visualization enabled the precise identification of neurovascular conflicts,including small and deeply located vessels.Immediately after surgery,90.5%of patients achieved complete pain relief(BNI score of I,NRS score of 0).At the final follow-up,85.7%of patients had complete pain relief.All patients’pain was significantly relieved at immediate after surgery(0 vs.9,p<0.001)and at the final follow-up(0 vs.9,p<0.001),with lower NRS scores.Complications,including vertigo,headache,and transient facial numbness,occurred in 14.4%of patients and were manageable.
文摘BACKGROUND Acute colonic pseudo-obstruction(ACPO)is defined as colonic obstruction without a mechanical or extrinsic inflammatory factor.Colonic decompression is advised for patients with ACPO after the failure of conservative and medical management.AIM To systematically review and analyze the efficacy and safety of colonoscopic decompression in ACPO.METHODS A search was conducted in MEDLINE,EMBASE,and Scopus from inception to August 2024.Studies reporting the clinical success,perforation,recurrence,and need for surgery after colonoscopic decompression in ACPO were included.A random-effects inverse-variance model was used to calculate the pooled proportion.RESULTS Sixteen studies were included in the final analysis.The pooled rates of success after the first session of colonoscopic decompression and overall success were 78.8%(95%CI:72.0-85.6)and 91.5%(95%CI:87.0-96.0),respectively.The first session of colonoscopic decompression had a significantly higher success than the first dose of neostigmine with OR 3.85(95%CI:2.00-7.42).The pooled incidence of perforation was 0.9%(95%CI:0.0-2.0),while recurrence was observed in 17.1%(95%CI:12.9-21.3)of the patients after clinical success.The pooled rates of surgery in all cases undergoing colonoscopic decompression and those who had a successful procedure were 10.5%(95%CI:5.0-15.9)and 3.7%(95%CI:0.3-7.1),respectively.Subgroup analysis,excluding the low-quality studies,did not significantly change the event rates.CONCLUSION Colonoscopic decompression for ACPO is associated with a clinical success rate of>90%with a perforation rate of<1%,demonstrating high efficacy and safety.
基金the National Natural Science Foundation of China(Nos.82330063 and M-0019)the Interdisciplinary Program of Shanghai Jiao Tong University(Nos.YG2022QN056,YG2023ZD19,and YG2023ZD15)+2 种基金the Cross Disciplinary Research Fund of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(No.JYJC202115)the Translation Clinical R&D Project of Medical Robot of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(No.IMR-NPH202002)the Shanghai Key Clinical Specialty,Shanghai Eye Disease Research Center(No.2022ZZ01003)。
文摘Endoscopic transnasal optic nerve decompression surgery plays a crucial role in minimal invasive treatment of complex traumatic optic neuropathy.However,a major challenge faced during the procedure is the inability to visualize the optic nerve intraoperatively.To address this issue,an endoscopic image-based augmented reality surgical navigation system is developed in this study.The system aims to virtually fuse the optic nerve onto the endoscopic images,assisting surgeons in determining the optic nerve’s position and reducing surgical risks.First,a calibration algorithm based on a checkerboard grid of immobile points is proposed,building upon existing calibration methods.Additionally,to tackle accuracy issues associated with augmented reality technology,an optical navigation and visual fusion compensation algorithm is proposed to improve the intraoperative tracking accuracy.To evaluate the system’s performance,model experiments were meticulously designed and conducted.The results confirm the accuracy and stability of the proposed system,with an average tracking error of(0.99±0.46)mm.This outcome demonstrates the effectiveness of the proposed algorithm in improving the augmented reality surgical navigation system’s accuracy.Furthermore,the system successfully displays hidden optic nerves and other deep tissues,thus showcasing the promising potential for future applications in orbital and maxillofacial surgery.
基金supported by the National Key R&D Program of China (Grant No.2022YFA1405500)the National Natural Science Foundation of China (Grant No.52372257)。
文摘Ternary hydrides, with their superior chemical and structural flexibility over binary systems, open up new avenues for advancing high-performance superconductor research. The Y-Ca-H system is a promising candidate for high-temperature superconductors, as both Im3m YH_(6) and Im3m CaH_(6) exhibit similar structures and excellent superconducting properties, while Y and Ca atoms possess close atomic radii and electronegativities.Here, we report the successful synthesis of Im3m(Y, Ca)H_(6) achieving a maximum superconducting transition temperature(T_(c)) approximately 224 K at 155 GPa through five independent high-temperature and high-pressure experiments. Remarkably, the T_(c) of Im3m(Y, Ca)H_(6) remains highly stable(ΔT_(c) ≤ 1 K) during decompression between 148 and 165 GPa, significantly outperforming binary Im3m CaH_(6) and Im3m YH_(6). The enhanced superconducting properties may stem from the cooperative chemical template effect of Y and Ca atoms near the s-d border, which significantly reinforces H lattice stability and thus maintains superior superconductivity.This study highlights the potential of multicomponent cooperative effects in designing hydride superconductors,offering new insights for achieving high-T_(c) hydrides at lower pressures in the future.
文摘Objective: Thorough, prompt enteral decompression technique without contamination was de- veloped to ensure safety for emergent colon resection and primary anastomosis. Methods: After isolating the mesentery, the “to be resected colon segment” was cut at its lower end, then the proximal cut end was put into a plastic bag which was adhered to one side of the operating table. After releasing the clamp, the content could ?ow into this bag. The operator could squeeze the bowel with two hands by turns, from proximal to farness, and from small bowel to large bowel, until the entire bowel content was fully discharged. Then the upper end of this “to be resected colon segment” was cut, and was removed together with the plastic bag. Results: 31 cases of left colon cancer with acute obstruction were decompressed with this technique. They all recovered smoothly, without anastomosis ?stula. Another 6 cases of hepatic seg- mentectomy with incidental colonectomy were decompressed with this technique and had the same results. This technique was also used in di?erent kinds of acute small intestinal obstruction and gained satisfactory results. Conclusion: This technique could be considered as the preferable choice for intraoperative enteral decompression.
基金supported by Shandong Province Natural Science Foundation of China:sd2018762872
文摘Objective:To observe the effect of recombinant human bone morphogenetic protein 2/polylactide-co-glycolic acid(rhBMP-2/PLGA) with core decompression on repair of rabbit femoral head necrosis.Methods:Bilateral femoral head necrosis models of rabbit were established by steroid injection.A total of 48 rabbits(96 femoral head necrosis) were randomly divided into 4groups:Group A,control group with12 rabbits,24 femoral head necrosis;Group B,treated with rhBMP-2/PLCA implantation after core depression,with 12 rabbits,24 femoral head necrosis;Group C,treated with rhBMP-2 implantation after core depression,with 12 rabbits,24 femoral head necrosis;Croup D treated with core depression group without implantation,with 12 rabbits,24 femoral head necrosis.All animals were sacrificed after 12 weeks.The ability of repairing bone defect was evaluated by X-ray radiograph.Bone mineral density analysis of the defect regions were used to evaluate the level of ossification.The morphologic change and bone formation was assessed by HE staining.The angiogenesis was evaluated by VEGF immunohistochemistry.Results:The osteogenetic ability and quality of femoral head necrosis in group B were better than those of other groups after 12 weeks by X-ray radiograph and morphologic investigation.And the angiogenesis in group B was better than other groups.Group C had similar osteogenetic quality of femoral head necrosis and angiogenesis with group D.Conclusions:The treatment of rhBMP-2/PLCA implantation after core depression can promote the repair of rabbit femoral head necrosis.It is a promising and efficient synthetic bone material to treat the femoral head necrosis.
基金Supported by the National Natural Science Foundation of China (No.81670885)the Science and Technology Program of Guangdong Province, China (No.2013B020400003)the Science and Technology Program of Guangzhou, China (No.15570001)
文摘AIM: To report the effects of intravenous high-dose glucocorticoids(iv GC) and orbital decompression(OD) surgery for treatment of sight-threatening thyroid-associated ophthalmopathy(TAO).METHODS: A retrospective review of medical records from patients with sight-threatening TAO [definite or highly suspected dysthyroid optic neuropathy(DON)] treated with iv GC(60 cases) and OD(25 cases) was conducted at the Zhongshan Ophthalmic Center between January 2001 and January 2009. Patients were initially treated with iv GC(iv GC group). If no significant improvement in visual function was obtained, they then received OD surgery(OD group). The pre-versus post-treatment efficacies of either iv GC or OD in these patients were assessed using several indices, including visual acuity, intraocular pressure, ocular alignment, ocular motility, and exophthalmos. RESULTS: Nighty-one eyes had definite DON while 79 were considered to have highly suspected DON. In the iv GC group, 51 individuals(85.0%) eventually demonstrated normal vision, while 10 patients(16.7%) demonstrated a reduction in deviation(P<0.01), and 35 cases(58.3%) showed slight improvements in ocular motility(P<0.01). In OD group, visual acuity improved in 24 cases(96.0%, P<0.01) and all patients showed varying reductions of exophthalmos(mean: 4.35±1.13 mm, P<0.01). Eight cases(32.0%) experienced an 8-15 PD reduction of deviation and ocular motility improved in 12 cases(48.0%), while 3 patients(12.0%) developed new-onset strabismus with diplopia post-surgically(P<0.01). Patients were followed up at an average of 1.55±1.07 y. CONCLUSION: Both iv GC and OD show good therapeutic efficacy in the treatment of sight-threatening TAO. Thepresence of extremely poor eyesight(≥0.5 log MAR) was corrected in some patients with iv GC alone, thus sparing these patients from subsequent OD surgery. In patients who were refractory to steroids, subsequent OD surgery often provided satisfactory outcomes, however, new-onset strabismus with diplopia was observed in 12.0% of these cases.
文摘AIM： To evaluate the feasibility, safety, and tolerance of early removing gastrointestinal decompression and early oral feeding in the patients undergoing surgery for colorectal carcinoma. METHODS： Three hundred and sixteen patients submitted to operations associated with colorectostorny from January 2004 to September 2005 were randomized to two groups： In experimental group （n = 161）, the nasogastric tube was removed after the operation from 12 to 24 hours and was promised immediately oral feeding; In control group （n = 155）, the nasogastric tube was maintained until the passage of flatus per rectum. Variables assessed included the time to first passage of flatus, the time to first passage of stool, the time elapsed postoperative stay, and postoperative complications such as anastornotic leakage, acute dilation of stomach, wound infection and dehiscense, fever, pulmonary infection and pharyngolaryngitis. RESULTS： The median and average days to the first passage of flatus （3.0±0.9 vs 3.6±1.2, P〈0.001）, the first passage of stool （4.1± 1.1 vs 4.8±1.4 P〈0.001） and the length of postoperative stay （8.4±3.4 vs 9.6±5.0, P〈0.05） were shorter in the experimental group than in the control group. The postoperative complications such as anastomotic leakage （1.24% vs 2.58%）, acute dilation of stomach （1.86% vs 0.06%） and wound complications （2.48% vs 1.94%） were similar in the groups, but fever （3.73% vs 9.68%, P〈0.05）, pulmonary infection （0.62% vs 4.52%, P〈0.05） and pharyngolaryngitis （3.11% vs 23.23%, P〈0.001） were much more in the control group than in the experimental group. CONCLUSION： The present study shows that applicationof gastrointestinal decompression after colorectostomy can not effectively reduce postoperative complications. On the contrary, it may increase the incidence rate of fever, pharyngolaryngitis and pulmonary infection. These strategies of early removing gastrointestinal decompression and early oral feeding in the patients undergoing colorectostomy are feasible and safe and associated with reduced postoperative discomfort and can accelerate the return of bowel function and improve rehabilitation.
文摘BACKGROUND:Excessive hepatocyte apoptosis and bile lakes in severe obstructive jaundice might impair liver functions.Although decompression of the bile duct has been reported to improve liver functions in animal studies,the mechanism of obstruction differs from that in humans.This study aimed to determine the profiles of hepatocyte apoptosis and bile lakes following bile duct decompression in patients with severe obstructive jaundice in the clinical setting.METHODS:We conducted a 'before and after study' on severe obstructive jaundice patients as a model of inhibition of the excessive process by bile duct decompression.Specimens of liver biopsies were taken before and after decompression of the bile duct and then stained by terminal deoxynucleotide transferase-mediated dUTP nick end-labeling(TUNEL) to identify hepatocyte apoptosis and by hematoxilin-eosin(HE) to identify bile lakes.All measurements were independently done by 2 observers.RESULTS:Twenty-one severe obstructive jaundice patients were included.In all patients,excessive hepatocyte apoptosis and bile lakes were apparent.After decompression,the hepatocyte apoptosis index decreased from 53.1(SD 105) to 11.7(SD 13.6)(P<0.05),and the bile lakes from 23.6(SD 14.8) to 10.9(SD 6.9)(P<0.05).CONCLUSION:Bile duct decompression improves hepatocyte apoptosis and bile lakes in cases of severe obstructive jaundice,similar to the findings in animal studies.
文摘U-shaped sacral fractures are rare and often difficult to diagnose primarily due to the difficulty in obtaining adequate imaging and the severe associated injuries. These fractures are highly unstable and frequently cause neurological deficits. The majority of surgeons have limited experience in management of U-shaped sacral fractures. No standard treatment protocol for U-shaped sacral fractures has been available till now. This study aimed to examine the management of U-shaped sacral fractures and the early outcomes. Clinical data of 15 consecutive patients with U-shaped sacral fracture who were admitted to our trauma center between 2009 and 2014 were retrospectively analyzed. Demographics, fracture classification, mechanism of injury and operative treatment and deformity angle were assessed. All the patients were treated with lumbopelvic fixation or （and） sacral decompression. EQ-5d score was applied to evaluate the patients＇ quality of life. Of the 15 consecutive patients with U-shaped sacral fracture, the mean age was 28.8 years （range： 15-55 years） at the time of injury. There were 6 females and 9 males. The mean follow- up time was 22.7 months （range： 9-47 months） and mean full weight-bearing time was 9.9 weeks （range： 8-14 weeks）. Ten patients received lumbopelvic fixation and sacral decompression, one lombosacral fixation, and 4 merely sacral decompression due to delayed diagnosis or surgery. The post-operation deformity angle （mean 27.87°, and range： 8°-90°） of the sacrum was smaller than that pre-operation （mean 35.67; range： 15-90） with no significance difference noted. At the latest follow-up, all patients obtained neurological recovery with different extents. Visual analogue score （VAS） was reduced from preoperative 7.07 （range： 5-9） to postoperetive 1.93 （range： 1-3）. All patients could walk without any aid after treatment. Eight patients were able to care for themselves and undertook some daily activities. Five patients had returned to work full time. In conclusion, lumbopelvic fixation is an effective method for stabilization of U-shaped sacral fractures with fewer complications developed. Effective reduction and firm fixation are the prerequisite of early mobilization and neurological recovery. Sacral decompression effectively promotes neurological recovery even in patients with old U-shaped sacral fractures.
