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1.
BackgroundTo investigate perioperative complication rates at radical nephrectomy (RN) according to inferior vena cava thrombectomy (IVC-T) status and stage (metastatic vs non-metastatic) within kidney cancer patients.Materials and methodsWe ascertained perioperative complication rates within the National Inpatient Sample database (2016–2019). First, log-link linear Generalized Estimating Equation function (GEE) regression models (adjusted for hospital clustering and weighted for discharge disposition) tested complication rates in IVC-T patients, according to metastatic stage. Subsequently, a subgroup analysis relied on RN patients with or without IVC-T. Here, multivariable logistic regression models tested complication rates in RN patients according to IVC-T status, after propensity score matching including metastatic stage.ResultsOf 26,299 RN patients, 461 (2%) patients underwent IVC-T. Of those, 252 (55%) were non-metastatic vs 209 (45%) were metastatic. Rates of acute kidney injury (AKI), transfusion, cardiac, thromboembolic and other medical complications in non-metastatic vs metastatic patients were 40 vs 40%, 25 vs 22%, 21 vs 23%, 19 vs 14% and 38 vs 40%, respectively (all p ≥ 0.2). Metastatic stage in IVC-T patients did not predict differences in complications in log-link linear GEE regression models (all p > 0.1). However, in logistic regression models with propensity score matching, relying on the overall cohort of RN patients, IVC-T status was associated with higher complication rates (all p < 0.001): AKI (Odds ratio [OR]:2.60; 95%-CI [95%-Confidence interval: 1.97–3.44), transfusions (OR:2.40; 95%-CI: 1.72–3.36), cardiac (OR:2.27; 95%-CI: 1.49–3.47), thromboembolic (OR:9.07; 95%-CI: 5.21–16.58) and other medical complications (OR:2.01; 95%-CI: 1.52–2.66).ConclusionsThe current analyses indicate that presence of concomitant IVC-T is associated with higher complication rate at RN. Conversely, metastatic stage has no effect on recorded complication rates. 相似文献
2.
目的对比研究腹腔镜下外生性肾血管平滑肌脂肪瘤"蘑菇状"剜除与标准肾部分切除术的安全性及有效性,为肾血管平滑肌脂肪瘤腹腔镜下"蘑菇状"剜除术术式的建立提供临床依据。
方法选取海南医学院第二附属医院与解放军总医院2018年1月至2019年5月期间,接受腹腔镜手术的肾血管平滑肌脂肪瘤患者53例,其中25例沿肿瘤假包膜行"蘑菇状"剜除术(A组)、28例行肾部分切除术(B组)。比较两组手术患者的肾动脉阻断时间、手术时间、术中出血量、术后24 h血红蛋白、术后eGFR(estimated glomerular filtration rate,估计肾小球率过滤)的变化、术后住院时间和术后肿瘤复发率。
结果53例手术无术中转开放,无死亡病例。肾动脉阻断时间:A组(11.9±2.2)min、B组(21.5±6.5) min(P<0.001)。手术时间:A组(87.9±24.8)min、B组(114.3±38.9) min(P<0.001)。术中出血量:A组20 ml(20~40)ml、B组50 ml(50~100)ml(P<0.001)。术后24 h血红蛋白变化:A组(7.4±4.3) g/L、B组(12.4±8.8) g/L(P=0.013)。术后24 h eGFR变化:A组(6.2±7.2 )ml(min·1.73 m2),B组(12.7±12.8)ml(min·1.73 m2)(P=0.027)。术后6个月eGFR变化:A组(1.5±3.7)ml(min·1.73 m2)、B组(6.5±5.6)ml(min·1.73 m2)(P<0.001)。术后住院时间:A组4.0 d(3~4)d、B组4.5 d(3~6)d(P=0.023)。术后随访两组术后肿瘤均无复发。
结论采用腹腔镜"蘑菇状"剜除术治疗外生性肾血管平滑肌脂肪瘤在肾动脉阻断时间、术中出血量、术后24 h血红蛋白、术后eGFR变化、术后住院时间等方面均优于传统肾部分切除术,两组术后肿瘤均无复发;该方法安全、有效,适于临床推广。 相似文献
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5.
亚低温治疗重型颅脑损伤中脑组织氧分压的临床意义 总被引:1,自引:1,他引:0
目的观察亚低温治疗重型颅脑损伤过程中患者颅内压及脑组织氧分压的变化及临床意义。方法将80例急性重型颅脑损伤患者,随机分为亚低温治疗组(40例)和对照组(40例)。亚低温组入院后或术后立即给予亚低温治疗,保持肛温在32~34℃,持续24h~5d;对照组给予常规治疗。两组均观察颅内压(ICP)和脑组织氧分压(PbtO2)变化。结果亚低温组治疗后,ICP明显下降,PbtO2逐渐升高,与对照组相比有显著性差异。结论亚低温治疗能降低脑外伤后增高的ICP,提高PbtO2;伤后24h内持续PbtO2<5mmHg预示患者预后不良。 相似文献
6.
Dr. Robert L. Geggel David R. Fulton Harvey L. Chernoff Richard Cleveland Thomas J. Hougen 《Pediatric cardiology》1987,8(4):279-283
Summary An infant girl is described who had cor triatriatum and partial anomalous pulmonary venous connection of the left pulmonary
veins to the coronary sinus, the first report of this combination of lesions. The infant also had a Dandy-Walker malformation
and multiple facial and intrathoracic hemangiomas. The cardiac diagnosis was made by two-dimensional echocardiography. Cardiac
catheterization and angiography confirmed the findings and also demonstrated a persistent left superior vena cava draining
to the coronary sinus. The infant underwent successful surgical repair. Partial anomalous pulmonary venous connection and
left superior vena cava not infrequently are associated with cor triatriatum. Although two-dimensional echocardiography is
sensitive for the detection of cor triatriatum, preoperative cardiac catheterization is necessary to identify unequivocally
systemic and pulmonary venous connections. 相似文献
7.
Cocaine-treated rats acquired a preference for cocaine-associated contextual stimuli (CS) relative to saline-injected control rats. However, when animals were given repeated tests for conditioned place preference intermittent between conditioning trials, they displayed an attenuation in strength of conditioning. This attenuation was not due to pharmacologic tolerance (Experiment 1), but rather reflected a disruption in learning due to exposure to the CS alone (Experiment 2). Like other examples of classical conditioning, the strength of the conditioned response (CR) as assessed by the conditioned place preference model may be influenced by partial reinforcement. 相似文献
8.
9.
Augmentation technique with semitendinosus and gracilis tendons in chronic partial lesions of the ACL: clinical and arthrometric analysis 总被引:1,自引:0,他引:1
Roberto Buda Alberto Ferruzzi Francesca Vannini Lisa Zambelli Francesco Di Caprio 《Knee surgery, sports traumatology, arthroscopy》2006,14(11):1101-1107
Most of the techniques described in the literature for the repair of chronic partial ACL tears, don’t spare the intact portion of the ligament. The aim of this study was to perform a prospective analysis of the results of augmentation surgery using gracilis and semitendinosus tendons to treat partial sub-acute lesions of the ACL. This technique involves an “over the top” femoral passage, which enables salvage and strengthening of the intact portion of the ACL. The study included 47 patients treated consecutively at our institute from 1993 to 1998, with a mean injury-surgery interval of 18 weeks (range 12–36). The patients were followed up by clinical and instrumental assessment criteria at 3 months, 1 and 5 years after surgery. Clinical assessment was performed using the IKDC form. Subjective and functional parameters were assessed by the Tegner activity scale. Instrumental evaluation was done using the KT-2000 instrument: the 30-pound passive test and the manual maximum displacement test were performed. We obtained good or excellent results in 95.7% of cases. No recurrences in ligamentous laxity were observed. We believe that the described technique has the advantage of being compatible with ACL anatomy, and enables very rapid functional recovery. 相似文献
10.
左肝内胆管结石患者的64排CT数据集的三维重建和左肝切除可视化仿真手术的研究 总被引:4,自引:0,他引:4
目的 探讨64排螺旋cT的左肝内胆管结石的扫描数据,进行图像程序分割、三维重建和左肝切除术的可视化仿真手术.方法 利用64排cT扫描采集肝内胆管结石的数据集.运用医学图像处理系统(MIPS)对CT序列图像进行程序分割和三维重建,得到肝胆三维模型的数据以标准模板库STL格式输出,然后导入FreeForm Modeling System(FreeForm)利用自行开发的虚拟手术器械进行左肝切除的可视化仿真手术.结果 利用MIPS软件进行肝内胆管结石二维的CT图像程序分割速度快、效果满意.将分割的数据进行三维重建所获得的肝胆模型结构清晰、立体感强,形态逼真,可完成左肝切除的可视化仿真手术.结论 MIPS可以有效、快速地完成肝内胆管结石的64排螺旋CT的二维图像数据的程序分割、三维重建及在FreeForm进行左肝切除可视化仿真手术,为仿真的胆道外科手术提供思路. 相似文献