腹腔镜手术与开放手术治疗精索静脉曲张的对比性研究(附273例分析)

目的:对比研究腹腔镜和开放手术精索静脉高位结扎术治疗精索静脉曲张的疗效。方法:回顾分析121例腹腔镜和152例开放手术精索静脉高位结扎术的临床资料,比较两种方法在手术时间、术后住院天数及综合治疗费用及术后止痛药应用等的差异。结果:两组在手术时间、术后住院天数及止痛药应用等方面差异均有高度显著性(P<0.01),腹腔镜组均优于开放手术组;综合治疗费用两组差异无显著性(P>0.05)。结论:腹腔镜治疗精索静脉曲张较开放手术具有创伤小、康复快,术后住院时间短及美容效果好等优点。     

CT成像Pin-point激光导航系统引导下行椎体成形术的临床观察

目的:探讨CT成像Pin-point激光导航系统引导下行椎体成形术治疗椎体压缩骨折的疗效及优缺点。方法:在CT成像Pin-point激光导航系统引导下行经皮椎体成形术25例,观察手术疗效和并发症发生情况,同时以疼痛分级和Dallas评分的形式记录患者术前、术后的相应得分,通过量化后的数据应用统计学软件进行统计分析,评价手术后的疼痛缓解情况。结果:1例骨水泥轻度渗漏,所有患者术后疼痛分级和Dallas评分均较术前明显减低(P<0.01),均恢复了因疼痛所影响的活动能力。结论:CT成像Pin-point激光导航引导下的椎体成形术手术操作精度高,并发症少,近期疗效好。     

Laparoscopic and open gastric resections for malignant lesions: A prospective comparative study

Background Whereas laparoscopy for benign diseases provides clear advantages over traditional surgery, the benefits of laparoscopic gastric resection for malignant diseases are less clear. The objectives of this study were to compare prospectively the clinical outcomes between completely laparoscopic and open total and partial gastrectomies for malignant diseases and to assess whether laparoscopic gastrectomies obtain adequate margins and follow oncologic principles.Methods Between April 1995 and March 2004, a prospective comparative study was performed comparing eight patients who underwent laparoscopic total gastrectomy with 11 patients who underwent open total gastrectomy, and 16 patients who underwent laparoscopic partial gastrectomy with 17 who patients underwent open partial gastrectomy. Stage, extent of lymphadenectomy, and long-term follow-up were examined. The intraoperative and postoperative details of the two groups were compared.Results The laparoscopic group patients had fewer intraoperative complications while the operative time was similar to that of the open group. Both ambulation and hospital stay were significantly shorter in the laparoscopic groups than in the open groups. The short-term morbidity was lower in the laparoscopic groups and there were no cases of death, whereas one case of postoperative death occurred after an open total gastrectomy. There was no need to convert to open surgery. The number of lymph nodes obtained in the laparoscopic and open procedures was not significantly different. In addition, all resected margins were tumor free in the laparoscopic group, whereas tumor involvement was presented in the margin of one specimen in the open group.Conclusions The totally laparoscopic approach to total and partial gastrectomies had good results and was proven to be a feasible and safe procedure. In addition, the laparoscopic procedures are superior to open surgeries in terms of faster postoperative recovery, shorter hospital stay, and better cosmetic outcomes. A totally laparoscopic approach for early and advanced gastric cancer can obtain adequate margins and follow oncologic principles.     

新生儿复杂先天性心脏病的外科治疗

目的总结29例新生儿复杂先天性心脏病的外科治疗经验。方法29例患先天性心脏病的新生儿,年龄3～28d,其中室间隔缺损3例,完全性大动脉错位10例,肺动脉闭锁1例,三尖瓣闭锁3例,单心室1例,法洛四联症6例,完全性房室管畸形4例,永存动脉干1例,所有患者合并房间隔缺损和动脉导管未闭。29例患者均在深低温低流量体外循环下行一期矫治术。结果术后死亡4例(13.8%),其中1例完全性大动脉错位和1例肺动脉闭锁患者死于低心排血量综合征,2例死于灌注肺、低氧血症,其余25例患者均治愈出院。随访19例,随访时间1～31个月,体重及各项发育指标与正常同龄儿基本相同。结论新生儿心脏手术麻醉、体外循环应平稳,手术操作要精细,手术成功的关键是畸形矫正满意及良好的心肌保护和肺保护。     

舒筋壮骨汤结合经皮椎体成形术治疗骨质疏松压缩性脊柱骨折对患者腰椎功能和骨代谢水平的影响

目的：观察舒筋壮骨汤结合经皮椎体成形术（PVP）治疗骨质疏松压缩性脊柱骨折对患者腰椎功能和骨代谢水平的影响。方法：选取我院2018年8月—2020年8月收治的骨质疏松压缩性脊柱骨折患者114例,根据入院顺序采用随机数字法分为两组,每组57例。对照组给予PVP治疗,观察组给予舒筋壮骨汤结合PVP治疗。统计两组总有效率,应用视觉模拟（VAS）评分法和Oswestry功能障碍指数（ODI）评价疼痛程度和腰椎功能障碍程度,检测两组骨代谢相关因子及腰椎骨密度（BMD）的变化,随访6个月,记录并比较两组邻近椎体骨折再发生率。结果：观察组临床痊愈24例,显效和有效共29例,总有效率92.98%,高于对照组（78.95%）,差异有统计学意义（P<0.05）。与治疗前比较,两组治疗2周、12周后VAS评分、ODI评分下降（P<0.05）,观察组治疗2周、12周后VAS评分、ODI评分低于对照组（P<0.05）。与治疗前比较,两组治疗2周、12周后血钙、骨钙素升高（P<0.05）,骨碱性磷酸酶下降（P<0.05）,观察组治疗2周、12周后血钙、骨钙素高于对照组（P<0....     

Perioperative and long-term outcomes after open conversion of endovascular aneurysm repair versus primary open aortic repair

BackgroundThe use of endovascular abdominal aortic aneurysm repair (EVAR) has superseded that of open aneurysm repair (OAR) as the procedure of choice for abdominal aortic aneurysm repair. However, significant rates of late reintervention and aneurysm rupture have been reported after EVAR, resulting in the need for conversion to OAR (C-OAR). To assess the relative effects of C-OAR on patients, we compared the outcomes of these patients to those of patients who had undergone P-OAR.MethodsThe data from all patients who had undergone C-OAR and P-OAR in the Vascular Quality Initiative Vascular Implant Surveillance and Interventional Outcomes Network database from 2003 to 2018 were queried. Multivariable logistic regression and Kaplan-Meier survival and Cox proportional hazard regression analyses were used to assess the perioperative long-term outcomes.ResultsA total of 4763 patients were included (91.4%, P-OAR; 8.6%, C-OAR). C-OAR was associated with a significant increase in the odds of perioperative mortality (odds ratio, 1.7; 95% confidence interval [CI], 1.1-2.7; P = .027) and renal complications (odds ratio, 1.5; 95% CI, 1.1-2; P = .004) vs P-OAR. At 5 years, conversion was associated with a higher risk of mortality (hazard ratio [HR], 1.5; 95% CI, 1.3-1.9; P < .001), aneurysmal rupture (HR, 1.9; 95% CI, 1.2-3.1; P = .007), and reintervention (HR, 1.4; 95% CI, 1.05-1.97; P = .022) compared with P-OAR. These results also persisted at 10 years, with conversion associated with a higher risk of mortality (HR, 1.5; 95% CI, 1.2-1.8; P < .001), rupture (HR, 1.8; 95% CI, 1.1-2.8; P = .018), and reintervention (HR, 1.5; 95% CI, 1.1-2.1; P = .010).ConclusionsThe results from the present study have demonstrated that C-OAR is associated with a significantly higher risk of perioperative morbidity and mortality compared with P-OAR. We found a significant increase in mortality, aneurysm rupture, and reintervention at 5 and 10 years of follow-up.     

Treatment of Umbilical Granuloma in Infants With Topical Application of Common Salt: A Scoping Review

BackgroundCommon salt is a safe, effective and cheap home-made remedy for umbilical granuloma. The aim of this scoping review is to identify and summarize the available evidence and examine the research conducted on salt treatment for umbilical granuloma.MethodsA literature search was performed in the second week of September, 2022 using Google scholar, PubMed, MEDLINE and EMBASE databases using the keywords ‘umbilical granuloma’ and ‘salt treatment’ to identify all English articles pertaining to salt treatment for umbilical granuloma. Tables were made to summarize the methodological characteristics, results and the dosage regimens of salt used by different authors. The Cochrane Collaboration's tool was used for assessing risk of bias in RCTs. The indexing statuses of the journals publishing these studies were also noted. The overall efficacy with the use of common salt was calculated by adding the success rates mentioned in each study.ResultsTwenty-four articles (2 systematic reviews, 6 Randomized Controlled Trials, 11 prospective cohort studies, 1 case control study, 3 retrospective case series and 1 case report) were included. An overall 93.91% success rate (1033/1100) was seen with common salt application, without any reports of complications/recurrences.ConclusionTopical application of common salt for umbilical granulomas is simple, effective and inexpensive. This scoping review provides a broader outlook at the existing level of evidence and may help in planning interventional comparative studies, so that recommendations can be formulated. It also highlights a lack of properly designed randomized controlled trials on this topic.Level of EvidenceI.     

A Novel Surgical Technique for Neglected Volar Dislocation of the Lunate: Cases Report and Literature Review

Background

Treatments for chronic perilunate or lunate dislocations are very difficult and associated with poor prognoses. There is no established treatment method and are still many controversies.

Case Presentation

We reported three cases of chronic neglected lunate volar dislocation treated with a novel surgical technique. All three cases were males with wrist pain and tingling sensation. Radiographs confirmed chronic volar dislocation of the lunate. Open reduction was performed by combined volar and dorsal approaches. After anatomical reduction, scapholunate and lunotriquetral interosseous ligament reconstructions were performed with the palmaris longus tendon and synthetic tape. The patients had an uneventful postoperative period with satisfactory functional outcomes at the last follow-up.

Conclusions

We believe that open reduction and interosseous ligament reconstruction using the autogenous tendon and synthetic tape may be a valuable option for treating chronic volar dislocation of the lunate.     

Underutilization of laparoscopy for ovarian surgeries in the pediatric population: A nationwide analysis

PurposeOophorectomy and ovarian detorsion are some of the most frequent operations performed in the female pediatric population. Despite the advent of laparoscopy, many surgeons continue to utilize open surgical approaches in these patients. This study sought to compare nationwide trends and postoperative outcomes in laparoscopic and open ovarian operations in the pediatric population.MethodsFemales less than 21 years old who underwent ovarian operations (oophorectomy, detorsion, and/or drainage) from 2016 to 2017 were identified from the Nationwide Readmissions Database. Patients were stratified by surgical approach (laparoscopic or open). Hospital characteristics and outcomes were compared using standard statistical tests.ResultsThere were 13,202 females (age 17 [14–20] years) who underwent open (59%) or laparoscopic (41%) ovarian operations. The most common indications for surgery were ovarian mass (48%), cyst (36%), and/or torsion (19%) for which oophorectomy (88%), detorsion (26%), and drainage (13%) were performed most frequently. The open approach was utilized more frequently for oophorectomy (95% vs. 77% laparoscopic) and detorsion (33% vs. 16% laparoscopic), both p < 0.001. A greater proportion of laparoscopic procedures were performed at large (67% vs. 61% open), teaching (82% vs. 76% open) hospitals in patients with private insurance (47% vs. 42% open), all p < 0.001. Patients undergoing open procedures had significantly higher index length of stay (LOS) and rates of wound infections. Thirty-day and overall readmission rates, as well as overall readmission costs, were higher in patients who received open surgeries.ConclusionsDespite fewer overall complications, decreased cost, fewer readmissions, and shorter LOS, laparoscopic approaches are underutilized for pediatric ovarian procedures.Type of StudyRetrospective Comparative.Level of EvidenceLevel III.