左半结肠恶性肿瘤并发肠梗阻切除一期吻合的临床效果观察

目的探讨分析左半结肠恶性肿瘤并发肠梗阻切除一期吻合的临床效果。方法选取2008年10月~2010年11月因左半结肠恶性肿瘤并发肠梗阻就诊于本院进行治疗的120例患者为研究对象,随机分为治疗组(采用一期吻合手术治疗)60例患者,对照组(采用全结肠切除吻合术治疗)60例患者,统计两组患者术后出现并发症的情况及近期治疗效果。结果治疗组并发症总发生率为28.3%,明显低于对照组,一期吻合手术治疗组总有效率为56.7%,明显高于对照组,P0.05,差异存在显著性。结论一期切除吻合术治疗结肠癌并发肠梗阻治疗效果显著,并发症少。     

糖尿病视网膜病变前期视盘周围神经纤维层厚度的动态变化

目的 探究糖尿病视网膜病变前期（NDR）视盘周围视网膜神经纤维层（RNFL）厚度的动态变化。 方法 选取 NDR 患者 24 例和健康对照者 30 例，用光学相干断层扫描仪测量两组视盘周围 RNFL 厚度，每间隔 6 个月复查 1 次，共检测 5 次；比较两 组视盘全周及各象限 RNFL 厚度的动态变化。 结果 NDR 组与对照组视盘周围 RNFL 均值为 （104.42±15.75）、（114.28±6.69）滋m， NDR 组视盘全周、上方、下方和颞侧象限 RNFL 厚度均小于对照组（P＜0.05）；NDR 组每次测量（共 5 次）的视盘全周 RNFL 厚度均小 于对照组（P＜0.05）。上方与鼻侧、上方与颞侧、下方与鼻侧、下方与颞侧象限 RNFL 厚度两两比较，差异均有统计学意义（均 P＜ 0.05）。 结论 NDR 患者 RNFL 变薄，且随病程发展持续存在，以视盘上方、下方象限尤为显著。     

Inter-ocular asymmetry of retinal parameters in Caucasian healthy children and young adults measured with optical coherence tomography

AIM: To evaluate retinal parameters in a sample of healthy young Caucasian adults to define the normal or physiological range of inter-ocular asymmetry in this particular age and ethnic group. METHODS: Study sample consisted of 37 Caucasian children and young adults aged between 12 and 23y (spherical equivalent from -3.00 D to +4.00 D, anisometropia <0.5 D and axial length differences <0.3 mm). Normal inter-ocular asymmetry values were determined and 95% inter-ocular difference tolerance values were obtained. RESULTS: Statistically significant inter-ocular differences were found in mean (P=0.003) and superior (P=0.008) retinal nerve fiber layer (RNFL) thickness, as well as in central macular thickness (P=0.039), with larger values in the left eye in all instances, and with tolerance limits of inter-ocular asymmetry of -9.00 μm to 6.00 μm, -28.00 μm to 9 μm and -39.00 μm to 29.00 μm, respectively. In addition, statistically significant differences were found between males and females in mean thickness of the RNFL in the right eye (P=0.020). CONCLUSION: The exploration of the normal asymmetries of the retina may be an effective approach to further understand myopia onset and progression, which is particularly relevant in this age group. Differences in instrumentation and sample characteristics compromise direct comparison with published research and warrant the need for further studies.     

Use of the Covera Stent Graft for the Treatment of Dysfunctional or Thrombosed Arteriovenous Grafts: A Retrospective Analysis of 64 Patients

PurposeTo retrospectively evaluate the safety and effectiveness of the Covera stent graft (SG) for the treatment of dysfunctional or thrombosed arteriovenous grafts (AVGs).Materials and MethodsWithin 29 months (February 2016–August 2018), 79 patients underwent Covera SG placement in the authors’ department for the treatment of dysfunctional AVGs. Data were available for 64 patients who underwent 64 procedures, using 64 devices. Minimum follow-up was 6 months, unless reintervention occurred. Mean follow-up was 277 days (6–923 days). Treatment characteristics were 51 cases with venous-graft anastomosis (VGA) stenosis (79.7%), 13 cases of puncture zone stenosis (20.3%), 14 cases of in SG stenosis (21.9%), 8 cases of pseudoaneurysm treatment (12.5%) (1 treatment area might have had more than 1 characteristic). Thirty-six patients presented with thrombosis (56.2%), and 31 of 64 case were de novo treatment areas (48.4%). Primary outcome measurements were technical success and post-intervention primary patency (PIPP) at 6 months, whereas secondary outcome measurements included factors influencing primary outcome.ResultsTechnical success was 100%. Median PIPP was 336 days, and 73.6% of treatment areas were patent at 6 months. There were no significant differences in terms of PIPP when de novo treatment areas were compared with restenotic areas (519 vs. 320 days, respectively; P = .1); patients who presented with versus those who presented without thrombosis (320 vs. 583 days, respectively; P = .07); puncture zone stenosis or elsewhere (329 vs. 686 days, respectively; P = .52); and VGA stenosis or elsewhere (336 vs. 335 days, respectively; P = .9).ConclusionsUse of the Covera SG for AVG treatment was safe and effective in every type of treatment area presented in this retrospective analysis.     

食管癌切除食管胃T形吻合与圆形吻合安全性的meta分析

目的比较食管癌切除食管胃吻合术中T形吻合与圆形吻合的安全性。 方法计算机检索PubMed、EMbase、The Cochrane Library、中国知网、万方数据库及维普数据库中收录的有关食管癌切除食管胃T形吻合与圆形吻合的比较研究，检索时间为数据库建库至2020年2月1日，采用Stata12.0软件进行meta分析。 结果11篇文献共纳入987例食管癌手术患者，其中T形吻合组551例，圆形吻合组436例。Meta分析结果显示：相比较于圆形吻合组，T形吻合组的吻合口瘘[OR(95%CI)＝0.48(0.27～0.87)，P＝0.015]，吻合口狭窄[OR(95%CI)＝0.14(0.08～0.23)，P<0.001]及胃食管反流[OR(95%CI)＝0.54(0.35～0.84)，P＝0.006]的发生风险较低。 结论食管癌手术使用T形吻合方式可以降低术后吻合口瘘、吻合口狭窄及胃食管反流的发生率。     

Risk factors and management of stoma-related obstruction after laparoscopic colorectal surgery with diverting ileostomy

BackgroundStoma-related obstruction (SRO) is defined as small bowel obstruction occurring around the limbs of diverting ileostomy (DI). This study was aimed to investigate the incidence, risk factors, and management of SRO after laparoscopic colorectal surgery with DI creation.MethodsThis study included 155 patients who underwent laparoscopic colorectal surgery with DI creation for rectal cancer (n = 138), ulcerative colitis (UC) (n = 14), and familial adenomatous polyposis (FAP) (n = 3) between 2011 and 2019. Univariate and multivariate analyses were performed to identify the risk factors of SRO.ResultsThe incidence of SRO was 7.7% (n = 12), and it was significantly lower (P < 0.01) in patients with lower anterior resection or intersphincteric resection (4.3%) than in those with ileal-pouch anal anastomosis (IPAA) (35.2%). The multivariate analysis revealed that IPAA was independently associated with the development of SRO (P = 0.001; odds ratio, 9.4; 95% confidence interval, 2.5–35.4). Eleven of 12 patients (92%) with SRO required trans-stomal tube decompression, and 8 of those (67%) underwent early stoma closure.ConclusionIPAA was an independent risk factor of SRO in laparoscopic colorectal surgery with DI creation. Early stoma closure was needed in most cases of SRO.     

Prophylactic intra-abdominal drainage following colorectal anastomoses. A systematic review and meta-analysis of randomized controlled trials

BackgroundClinically evident Anastomotic Leakage (AL) remains one of the most feared complications after colorectal resections with primary anastomosis. The primary aim of this systematic review and meta-analysis was to determine whether Prophylactic Drainage (PD) after colorectal anastomoses confers any advantage in the prevention and management of AL.MethodsSystematic literature search was performed using MEDLINE, the Cochrane Central Register of Controlled Trials, and EMBASE databases for randomized studies comparing clinical outcomes of patients with Drained (D) or Undrained (UD) colorectal anastomoses performed for any cause.ResultsFour randomized controlled trials comparing D and UD patients undergoing colorectal resections with primary anastomosis were included for quantitative synthesis. In total, 1120 patients were allocated to group D (n = 566) or group UD (n = 554). The clinical AL rate was 8.5% in the D group and 7.6% in the UD group, with no statistically significant difference (P = 0.57). Rates of radiological AL (D: 4.2% versus UD: 5.6%; P = 0.42), mortality (D: 3.6% versus UD: 4.4%; P = 0.63), overall morbidity (D: 16.6% versus UD: 18.6%, P = 0.38), wound infection (D: 5.4% versus UD: 5.3%, P = 0.95), pelvic sepsis (D: 9.7% versus UD: 10.5%, P = 0.75), postoperative bowel obstruction (D: 9.9% versus UD: 6.9%, P = 0.07), and reintervention for abdominal complication (D: 9.1% versus UD: 7.9%, P = 0.48) were equivalent between the two groups.ConclusionsThe present meta-analysis of randomized controlled trials investigating the value of PD following colorectal anastomoses does not support the routine use of prophylactic drains.