术中联合胃镜测漏对预防胃癌患者术后吻合口并发症的影响

目的 对比术中联合胃镜的充气测漏和亚甲蓝测漏技术对胃癌根治术患者术后吻合口并发症的影响.方法 回顾性分析2017年9月-2019年9月南充市中心医院207例行胃癌根治术患者的临床和病理资料.根据是否使用术中测漏(IOLT),将患者分为IOLT组和无术中测漏(NIOLT)组.术中测漏包括胃镜检查、充气测漏和亚甲蓝测漏.分...     

内镜硬化剂注射术联合套扎术治疗内痔的疗效及预后影响因素分析

目的 探讨内镜硬化剂注射术联合套扎术治疗内痔的疗效及影响预后的因素。方法 前瞻性纳入2018年1月-2021年6月该院收治的内痔患者150例,采用随机数表法分为对照组（单纯内镜套扎术治疗）和观察组（内镜硬化剂注射术联合套扎术治疗）,每组75例。比较两组患者临床疗效、手术情况和术后并发症发生率。以患者预后情况为依据,分为预后良好组和预后不良组,采用多因素Logistic回归模型,筛选预后不良的影响因素,构建风险预测模型,并评价模型效能。结果 观察组总有效率明显高于对照组,手术时间明显长于对照组,术中出血量明显少于对照组,视觉模拟评分（VAS）和术后并发症总发生率明显低于对照组,愈合时间明显短于对照组,差异均有统计学意义（P <0.05）。多因素Logistic分析结果显示,年龄、病程、病情严重程度、饮食习惯、术中出血量和排便时间是内痔患者预后不良的独立危险因素（P <0.05）。构建的列线图预测模型具有较高的区分度和校准度。结论 治疗内痔时,内镜硬化剂注射术联合套扎术较单独内镜套扎术疗效更好,并发症更少。高龄、病程长、病情严重、饮食辛辣、术中出血量大和术后过早排便是内痔患者预...     

影响胃癌患者术后吻合口瘘的多因素分析

目的 探讨可能影响胃癌患者术后吻合口瘘发生的因素。方法 对2016年9月至2018年6月北京大学肿瘤医院行择期胃癌根治手术的499例患者病历资料回顾性研究。采用Logistic回归分析术后吻合口瘘的相关因素。结果 499例胃癌患者中,发生术后吻合口瘘23例(4.6%)。术后吻合口瘘相关因素有切除范围大(OR=2.633,P=0.045)、术中发生低血压(OR=4.617,P=0.007)、术后疼痛(OR=2.838,P=0.022)和饮酒史(OR=2.809, P=0.022)。结论 切除范围大、术中发生低血压、术后疼痛和饮酒史是术后吻合口瘘的危险因素。     

Anastomotic leakage and postoperative mortality in patients after esophageal cancer resection

ObjectiveEsophagectomy is a high-risk surgical procedure with significant postoperative morbidity and mortality. This study aimed to investigate the risk factors of cervical anastomotic leakage and postoperative mortality.MethodsIn this retrospective, observational study, we recruited 1010 patients with esophageal cancer. Cox regression analysis was performed to identify factors affecting anastomotic leakage and postoperative mortality. After propensity score matching, the Kaplan–Meier curve was used to evaluate the effect of leakage on postoperative mortality.ResultsThe number of patients with cervical anastomotic leakage, in-hospital mortality, 30-day postoperative mortality, and 60-day postoperative mortality was 194 (19.2%), 13 (1.3%), 12 (1.2%), and 16 (1.6%), respectively. The total length of hospital stay and hospital stay postoperatively were 29.7 ± 21.1 and 21.3 ± 20.3 days, respectively. Diabetes, stage IV, and an upper thoracic tumor were significant risk factors for leakage. Leakage and diabetes were significant risk factors for postoperative mortality. After propensity score matching, leakage also significantly affected postoperative mortality.ConclusionsPatients with tumors in the upper thoracic segment of the esophagus may be more prone to developing anastomotic leakage compared with those with tumors in the middle or lower thoracic segment. Anastomotic leakage may prolong the length of hospital stay and increase postoperative mortality.     

直肠前切除术后吻合口漏的高危因素及预防现状

吻合口漏是直肠癌患者保肛术后最严重的并发症之一，其危险因素与患者、医疗、麻醉和手术等相关。吻合口漏重在预防，主要措施为术中检查吻合情况，保证吻合肠管血供、腹/盆腔引流、保护性造口和留置肛管。鉴别相关危险因素，降低吻合口漏的发生对改善患者结局有重要的临床意义。     

Analysis of risk factors for different subtypes of acute coronary syndrome

AimsTo investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS).MethodsA total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed.ResultsUnivariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602).ConclusionDifferent subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.     

早期食管癌和高级别上皮内瘤变行内镜黏膜下剥离术后非治愈性切除的危险因素探讨

目的 探讨早期食管癌和高级别上皮内瘤变行内镜黏膜下剥离术(ESD)后非治愈性切除的危险因素.方法 回顾性分析南京医科大学附属淮安第一医院消化内科收治的153例行ESD的早期食管癌和高级别上皮内瘤变患者的临床资料,根据术后病理结果,分为治愈性切除组和非治愈性切除组,对可能影响非治愈性切除的相关因素进行多因素分析.结果 早...     

Relevant risk factors affecting time of ventilation during early postoperative period after orthotopic liver transplantation

Purpose

The aim of this study is to examine the relevant factors affecting the duration of mechanical ventilation after orthotopic liver transplantation.

Materials and Methods

The 96 patients who underwent liver transplantation were divided into 2 groups according to whether or not the duration of mechanical ventilation after operation was longer than 24 hours. Nineteen variables, including clinical and experimental variables, were analyzed by t test for continuous variables and χ² test for discrete variables. The variables with significance (P < .05) were then analyzed with stepwise logistic regression.

Results

Nine continuous preoperative clinical and experimental variables, including preoperative Child-Pugh stage, time of operation, volume of intraoperative liquid transfusion, volume of intraoperative blood loss, volume of intraoperative blood transfusion, volume of intraoperative urine, time of intraoperative hypotension, postoperative renal failure, and postoperative pulmonary edema revealed significant differences between the 2 groups. Stepwise logistic regression analysis for 9 variables indicated that volume of intraoperative blood loss, volume of intraoperative urine, and postoperative renal failure are relevant independent risk factors.

Conclusion

The relevant risks affecting the time of ventilation in patients after orthotopic liver transplantation are multiple. The volume of intraoperative blood loss, volume of intraoperative urine, and postoperative renal failure are independent risk factors.     

Factors influencing lower respiratory tract infection in older patients after general anesthesia

ObjectivePulmonary complication is common in older patients after surgery. We analyzed risk factors of lower respiratory tract infection after general anesthesia among older patients.MethodsIn this retrospective investigation, we included older patients who underwent surgery with general anesthesia. Logistic regression analyses were performed to determine risk factors of lower respiratory tract infection.ResultsA total 418 postoperative patients with general anesthesia were included; the incidence of lower respiratory tract infection was 9.33%. Ten cases were caused by gram-positive bacteria, 26 cases by gram-negative bacteria, and 2 cases by fungus. We found significant differences in age, smoking, diabetes, oral/nasal tracheal intubation, and surgery duration. Logistic regression analysis indicated that age ≥70 years (odds ratio [OR] 2.028, 95% confidence interval [CI] 1.115–3.646), smoking (OR 2.314, 95% CI 1.073–4.229), diabetes (OR 2.185, 95% CI 1.166–4.435), nasotracheal intubation (OR 3.528, 95% CI 1.104–5.074), and duration of surgery ≥180 minutes (OR 1.334, 95% CI 1.015–1.923) were independent risk factors of lower respiratory tract infections.ConclusionsOlder patients undergoing general anesthesia after tracheal intubation have a high risk of lower respiratory tract infections. Clinical interventions should be provided to prevent pulmonary infections in patients with relevant risk factors.     

Identification of independent risk factors for diabetic neuropathy progression in patients with type 2 diabetes mellitus

ObjectiveTo identify independent risk factors for diabetic neuropathy (DN) in patients with type 2 diabetes mellitus (T2DM).MethodsWe retrospectively analyzed 376 patients with T2DM at the First Affiliated Hospital of Fujian Medical University, China between January 2013 and October 2016. Multivariate logistic regression was used to explore potential risk factors for progression of DN in patients with T2DM. Effect sizes were estimated using odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe prevalence of DN in patients with T2DM was 43.1%. Multivariate logistic regression indicated that retinopathy (OR: 2.755, 95% CI: 1.599–4.746); diabetic nephropathy (OR: 2.196, 95% CI: 1.279–3.772); longer duration of T2DM (OR: 1.081, 95% CI: 1.045–1.120); use of insulin (OR: 1.091, 95% CI: 1.018–1.170); longer history of alcohol consumption (OR: 1.034, 95% CI: 1.010–1.059); and higher blood urea nitrogen (OR: 1.081, 95% CI: 1.009–1.159) were associated with increased risk of DN in patients with T2DM.ConclusionsRetinopathy, diabetic nephropathy, longer duration of T2DM, use of insulin, longer history of alcohol consumption, and higher blood urea nitrogen were independent risk factors for DN. These findings should be verified in large-scale prospective studies.     

A new oval multichannel port to facilitate reduced port distal gastrectomy

Background: This report describes the techniques and outcomes of reduced port distal gastrectomy (RPDG) using a new oval multichannel port. Material and methods: We performed reduced port distal gastrectomy through the E·Z Access? oval type device with three trocars in the umbilical incision, plus the use of additional 5 mm and 2 mm ports. All routine procedures performed in conventional laparoscopic distal gastrectomy (CLDG) were achieved in RPDG. Results: We employed this technique without the use of additional trocars or conversion to laparotomy in all 25 patients. The median length of the operation was 340 (range, 220–487) minutes, and the median estimated blood loss was 30 (range, 5–440) ml. Neither major postoperative complications, such as anastomotic leakage and stricture, nor postoperative mortality were observed. The mean length of the hospital stay was 11 days. The umbilical wound was indistinct. The patients were also highly satisfied with the cosmetic outcome. Conclusion: Reduced port surgery using the E·Z Access? oval type device was successfully applied for gastric cancer. This method is technically feasible, produces superior cosmetic results and thus could be an attractive surgical option for gastric cancer patients.     

Endoscopic salvage treatment of histoacryl after stent application on the anastomotic leak after gastrectomy: A case report

BACKGROUNDEndoscopic approach could effectively manage postoperative anastomotic leakage. Various endoscopic methods have been developed for the treatment of anastomotic leakage.CASE SUMMARYA 53-year-old woman developed anastomotic leak after laparoscopic proximal gastrectomy. Endoscopic clip closure failed due to strong wall tension; therefore, a fully covered self-expandable esophageal metal stent (fc-SEMS) was placed to cover the leak after it was filled with a mixture of fibrin glue and histoacryl. However, fluoroscopy with gastrograffin showed dye leaking out of the fc-SEMS. Using the previous fluoroscopic image for guidance, a catheter was inserted at the leakage site. The radiocontrast dye was injected and was seen spreading along the sinus tract. Thereafter, histoacryl was injected. Seven days after the last procedure, upper gastrointestinal contrast studies showed no leaks. The patient was subsequently discharged 9 d after histoacryl injection without any complications.CONCLUSIONTo seal an anastomosis leak after stent application, salvage technique using histoacryl injection at the leakage site with fluoroscopy guidance could be considered cautiously.     

Risk factors and outcomes of acute kidney injury after intracoronary stent implantation

BACKGROUND:

Acute kidney injury following percutaneous coronary intervention (PCI) is associated with a worse outcome. However, the risk factors and outcomes of acute kidney injury (AKI) in patients after intracoronary stent implantation are still unknown.

METHODS:

A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine. Those were excluded from the study if they had incomplete clinical data. The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI. The parameters of the patients included: 1) pre-operative ones: age, gender, hypertension, diabetes mellitus, cerebrovascular disease, left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate (eGFR), hyperuricemia, proteinuria, emergency operation, hydration, medications (ACEI/ARBs, statins); 2) intraoperative ones: dose of contrast media, operative time, hypotension; and 3) postoperative one: hypotension. The parameters were analyzed with univariate analysis and multivariate logistical regression analysis.

RESULTS:

Of the 325 patients, 51(15.7%) developed AKI. Hospital day and in-hospital mortality were increased significantly in the AKI-group. Univariate analysis showed that age, pre-operative parameters (left ventricular insufficiency, peripheral angiopathy, creatinine, urea nitrogen, estimated glomerular filtration rate, hyperuricemia, proteinuria, hydration), emergency operation, intraoperative parameters (operative time, hypotension) and postoperative hypotension were significantly different. However, multivariate logistic regression analysis revealed that increased age (OR=0.253, 95%CI=0.088–0.727), pre-operative proteinuria (OR=5.351, 95%CI=2.128–13.459), pre-operative left ventricular insufficiency (OR=8.704, 95%CI=3.170–23.898), eGFR≤60 ml/min/1.73 m² (OR=6.677, 95%CI=1.167–38.193), prolonged operative time, intraoperative hypotension (OR=25.245, 95%CI=1.001–1.034) were independent risk factors of AKI.

CONCLUSIONS:

AKI is a common complication and associated with ominous outcome following intracoronary stent implantation. Increased age, pre-operative proteinuria, pre-operative left ventricular insufficiency, pre-operative low estimated glomerular filtration rate, prolonged operative time, intraoperative hypotension were the significant risk factors of AKI.KEY WORDS: Intracoronary stent implantation, Acute kidney injury, Risk factor, Outcome     

肝细胞癌切除术后影响手术部位感染的危险因素

目的探讨影响肝细胞癌(简称肝癌)切除术后手术部位感染的危险因素。方法选取2012年2月至2018年2月在四川大学华西医院肝脏外科行肝癌切除术的患者1 319例作为研究对象,收集、分析患者围术期临床资料,探讨影响术后手术部位感染的独立危险因素。结果 1 319例行肝癌切除术的患者中,82例(6.2%)发生手术部位感染,其中表浅切口感染37例(2.8%),深部切口感染16例(1.2%),器官/腔隙感染29例(2.2%)。围术期空腹血糖>6.1mmol/L、手术时间、术中出血量、术后胆漏是影响手术部位感染发生的独立危险因素。肝癌切除范围明显影响手术部位感染(P<0.05),以及器官/腔隙感染(P<0.05)。手术部位感染明显影响住院时间(P<0.05)和围术期病死率(P=0.021)。结论围术期血糖控制情况、手术时间、术中失血量、术后胆漏是影响手术部位感染的独立危险因素。肝癌切除范围明显影响手术部位感染,特别是影响器官/腔隙感染的独立危险因素。手术部位感染导致住院时间延长,围术期病死率升高。     

Evaluation of the necessity of laparoscopic repair of a uterine scar defect for cesarean scar pregnancy

ObjectiveThis study aimed to determine the risk factors associated with the necessity of laparoscopic scar defect repair for cesarean scar pregnancy (CSP).MethodsWe retrospectively analyzed 237 patients with CSP who were treated by ultrasound-guided suction curettage and/or laparoscopy in our hospital from April 2012 to November 2019. A total of 199 of these patients underwent ultrasound-guided suction curettage without uterine scar defect repair, while 38 of these patients underwent laparoscopic resection and uterine scar defect repair. We analyzed various clinical variables and compared the efficacy of treatment between the two groups.ResultsGestational age, the maximum transverse diameter (MTD) of the gestational sac, myometrial thickness, the operation time, intraoperative blood loss, and the duration of the hospital stay were significantly different between the two groups. Gestational age, the MTD of the gestational sac, and myometrial thickness were independent risk factors for laparoscopic repair.ConclusionsGestational age, the MTD of the gestational sac, and myometrial thickness are important factors associated with the necessity for laparoscopic repair of a uterine scar defect.     

饮酒对血压的影响

摘要 目的：通过大样本的流行病学调查及横断面研究，进一步探讨饮酒对血压的影响；方法：资料来自2006年7月至12月开滦唐家庄矿职工查体资料。资料用Excel 2003建库，SPSS 13.0统计软件处理数据。结果：1 在调整年龄、体重指数、有无吸烟史及文化程度的差异后，男性饮酒组收缩压和舒张压均高于不饮酒组和戒酒组(P < 0.05) 。男性饮酒量与收缩压和舒张压正相关，收缩压及舒张压随饮酒量的增加呈线性增加(P<0.01)。饮酒是高血压的独立危险因素(P < 0.05)。2 高血压相关危险因素的多因素非条件回归分析结果显示年龄、BMI、 腰围、肌酐、尿素氮、血尿酸、文化程度和饮酒是高血压的危险因素。结论 :男性饮酒量与收缩压和舒张压呈正相关，收缩压及舒张压随饮酒量的增加而增加。饮酒是高血压的危险因素。     

What makes emergency department patients reduce their alcohol consumption? – A computer-based intervention study in Sweden

ObjectivesThis study investigates the effectiveness of a computerized emergency department intervention for alcohol consumption and identifies explanation factors associated with reduced alcohol consumption from risk to non-risk drinking.MethodsPatients aged 18–69 years registered at the ED triage answered alcohol-related questions on a touch-screen computer. Follow-up data were collected by means of a postal questionnaire that was mailed to the patients 6 months after their ED visit.ResultsThere were four independent explanations for reduced alcohol consumption: being motivated to reduce alcohol consumption at baseline, influenced by just visiting the emergency department, considering the alcohol-related feedback information and impact from a health care provider. 339 patients could be followed up and of these were 97 categorized as risk drinkers at baseline and 45 became non-risk drinker 6 month later.ConclusionsBeing motivated to reduce alcohol consumption at baseline, influenced by just visiting the emergency department, considering the alcohol-related feedback information and impact from a health care provider were predictors for change from risk to non-risk drinking 6 months later.     

老年膝关节单髁置换术后发生下肢深静脉血栓的危险因素分析与护理对策

目的探讨老年膝关节单髁置换术后发生下肢深静脉血栓(DVT)的危险因素与护理对策。方法选取2016年2月至2017年3月在我院行膝关节单髁置换术患者158例(158膝)为研究对象,收集其年龄、性别、体质量指数(BMI)、糖尿病史、高血压史、饮酒史、激素类药物治疗史、手术时间、术中出血量、凝血功能指标、假体类型、机械抗凝类型等资料,采用单因素分析及多因素logistic回归分析老年膝关节单踝置换术后发生DVT的相关因素。结果多因素logistic回归分析显示,年龄≥66岁、女性、BMI≥28 kg/m^2、糖尿病史、使用骨水泥型假肢、机械抗凝中未使用血液循环泵是老年膝关节单髁置换术后发生DVT的独立危险因素(P <0. 05)。结论老年膝关节单踝置换术后发生DVT的影响因素较多,应针对性实施护理对策,降低DVT发生率。     

Circular staplers in esophagojejunal and esophagogastric anastomoses

A report on 100 consecutive esophagoenteric anastomoses (EEA stapler) following total (esophagojejunostomy) or proximal gastrectomy (esophagogastrostomy) is presented. The following intraoperative problems occurred: insufficiency of the purse string suture [4], lumen of the esophagus too small [1], rupture of the esophageal wall [4], incomplete rings [4]. Fatal postoperative complications included two cases of insufficiency of the esophagojejunostomy, whilst the remaining six postoperative deaths were not linked to the use of the stapler (operative mortality 8%). Follow-up showed no recurrence at the stapler line, but two anastomotic strictures occurred. The EEA stapler is a helpful instrument to reduce leakage at the esophagoenteric anastomosis and, hence operative mortality after total and proximal gastrectomy.     

Two important factors affecting the prognosis of patients treated with sorafenib followed by regorafenib for advanced hepatocellular carcinoma

ObjectiveTo investigate the effects of hand–foot syndrome (HFS) and fatigue on disease progression and survival in patients treated with sorafenib followed by regorafenib for advanced hepatocellular carcinoma.MethodsA retrospective analysis of patients with advanced hepatocellular carcinoma treated with sorafenib in our hospital from 1 October 2018 to 31 October 2021 was performed, and clinical and pathological data and follow-up results were obtained. Patients were divided into groups according to the severity of HFS and fatigue. Survival analysis among the groups was performed using the Kaplan–Meier method, continuous variables were analyzed using the t-test, and factors associated with survival were evaluated using multivariate Cox regression analysis.ResultsThe study included 150 men and 23 women with a mean age of 60.77 years (range: 40–85 years). The median overall survival (OS), progression-free survival (PFS), and time to tumor progression (TTP) increased with increasing severity of HFS. Conversely, the median OS, PFS, and TTP decreased with increasing severity of fatigueConclusionHFS and fatigue were independent risk factors affecting TTP, PFS, and OS among patients treated with sorafenib followed by regorafenib for advanced hepatocellular carcinoma.