糖尿病对冠状动脉旁路移植术围手术期影响的临床研究

目的探讨糖尿病对冠状动脉旁路移植术(CABG)的影响.方法1512例患者接受CABG,其中糖尿病患者(DM组)328例,非糖尿病患者(NDM组)1184例.单变量统计分析两组术前危险因素和术后并发症.结果两组患者住院费用[DM组(6.11±2.4)万元;NDM组(5.63±2.2)万元;P＞0.05]、切口并发症(DM组:10.1%;NDM组8.9%;P＞0.05)、输血量[DM组(807.6±654.3)ml;NDM组(814.6±662.2)ml;P＞0.05]等方面差异无显著意义.两组患者术后严重并发病:低心排(DM组:1.5%;NDM组1.9%;P＞0.05)、心律失常(DM组:14.6%;NDM组15.2%;P＞0.05)、围术期心肌缺血(PMI)(DM组:1.2%;NDM组1.5%;P＞0.05)以及死亡率(DM组:1.52%;NDM组0.84%;P＞0.05)差异无显著意义.结论糖尿病患者经适当控制病情以后,CABG可以如同非糖尿病患者一样安全地实施.     

Postoperative 30-day Mortality Following Surgical Resection for Colorectal Cancer in Veterans: Changes in the Right Direction

Temporal changes in short-term mortality following surgery for colorectal cancer (CRC) are unknown. We examined temporal changes in 30-day postoperative mortality, as well as changes in preoperative and postoperative disorders that could contribute to 30-day mortality. Using national Veterans Administration (VA) administrative data, we identified patients with CRC during 1987–2000 who received surgical resection. Cox proportional hazards models were used to evaluate the association between the risk of 30-day mortality and year of surgical resection, while adjusting for several preoperative disorders, disease comorbidity, as well as hospital surgical volume. A total of 32,621 patients were identified. The 30-day postoperative mortality declined from 4.7% during 1987–1988 to 3.9% during 1998–2000. Patients who received surgical resection during 1992–1994, 1995–1997, and 1998–2000 had a 14, 14, and 27% lower adjusted risk of 30-day mortality, respectively, compared with those resected in 1987–1988. Preoperative disorders associated with increased mortality included chronic pulmonary disease, congestive heart failure, diabetes, hemiplegia/paraplegia, moderate/severe liver disease, and renal disease. Significant declines were observed in several postoperative disorders including anesthesia complications and thromboembolism. An improvement in 30-day postoperative mortality following surgical resection for CRC was observed. Declining preoperative and postoperative disorders, as well as improvements in surgical care, could partly explain these findings.     

Anastomotic strictures and delayed gastric emptying after esophagectomy: incidence,risk factors and management

The aim of this study was to report the incidence, risk factors, and management of gastric conduit dysfunction after esophagectomy in 177 patients over a 3‐year period in a single center. Patients with anastomotic strictures or delayed gastric emptying (DGE) were identified from a prospective database. Anastomotic strictures occurred in 48 patients (27%). Eighty‐three percent of early anastomotic strictures (<1 year) were benign, and all late strictures (>1 year) were malignant. Dilatation was effective in 98% of benign and 64% of malignant strictures. DGE occurred in 21 patients (12%), and was associated with both anastomotic leak (P = 0.001) and anastomotic stricture (P = 0.001). 4/8 patients with late DGE (>3 months postesophagectomy) were tumor‐related. Pyloric dilatation was effective in 92% of early and 63% of late DGE. Pyloric stents were inserted in 3 patients with tumor‐related DGE. After esophagectomy, early anastomotic strictures (within 1 year) and early delayed gastric emptying (within 3 months) are usually benign and respond to dilatation. However, patients presenting later with tumor‐related obstruction are unlikely to respond to anastomotic or pyloric dilatation and should be stented.     

Mast cell degranulation during abdominal surgery initiates postoperative ileus in mice

BACKGROUND & AIMS: Inflammation of the intestinal muscularis following manipulation during surgery plays a crucial role in the pathogenesis of postoperative ileus. Here, we evaluate the role of mast cell activation in the recruitment of infiltrates in a murine model. METHODS: Twenty-four hours after control laparotomy or intestinal manipulation, gastric emptying was determined. Mast cell degranulation was determined by measurement of mast cell protease-I in peritoneal fluid. Intestinal inflammation was assessed by determination of tissue myeloperoxidase activity and histochemical staining. RESULTS: Intestinal manipulation elicited a significant increase in mast cell protease-I levels in peritoneal fluid and resulted in recruitment of inflammatory infiltrates to the intestinal muscularis. This infiltrate was associated with a delay in gastric emptying 24 hours after surgery. Pretreatment with mast cell stabilizers ketotifen (1 mg/kg, p.o.) or doxantrazole (5 mg/kg, i.p.) prevented both manipulation-induced inflammation and gastroparesis. Reciprocally, in vivo exposure of an ileal loop to the mast cell secretagogue compound 48/80 (0.2 mg/mL for 1 minute) induced muscular inflammation and delayed gastric emptying. The manipulation-induced inflammation was dependent on the presence of mast cells because intestinal manipulation in mast cell-deficient Kit/Kitv mice did not elicit significant leukocyte recruitment. Reconstitution of Kit/Kitv mice with cultured bone marrow-derived mast cells from congenic wild types restored the manipulation-induced inflammation. CONCLUSIONS: Our results show that degranulation of connective tissue mast cells is a key event for the establishment of the intestinal infiltrate that mediates postoperative ileus following abdominal surgery.     

普胸术后肺栓塞23例临床分析

目的探讨普胸术后肺栓塞的临床特点、诊断方法和治疗措施及预后。方法对我院2000年1月～2010年10月普胸术后的肺栓塞患者23例进行临床分析。结果23例肺栓塞患者,出现呼吸困难18例,胸痛15例,咯血4例,发热5例,晕厥3例;17例经肺增强CT或CT肺动脉造影明确诊断,23例均行99MTC肺灌注扫描,表现为段性或叶性放射性稀疏或缺损。结论肺栓塞临床表现多样,诊断需结合易患因素,CT肺动脉造影、99MTC肺灌注扫描可帮助明确诊断。早期正确治疗PE,可减少死亡率。     

老年房间隔缺损患者介入封堵治疗疗效分析

目的总结老年房间隔缺损(ASD)患者介入封堵治疗临床经验和疗效,探讨其适应证和操作原则。方法选择老年ASD患者38例,经超声心动图检查测量ASD大小、类型、边缘残端条件、分流方向,确定适应证。选12～32 mmASD封堵器,在放射线导引下封堵ASD。术后1、3、6、12个月复查。结果介入封堵成功37例,占97.4%,封堵失败1例,无死亡,无心包填塞等严重并发症发生。发生残余分流1例,术后早期发生阵发性房性心动过速1例,频发房性期前收缩2例,偶发房性期前收缩6例。随访期间患者右心室内径明显减小,三尖瓣反流面积明显缩小,肺动脉收缩压、平均压明显降低,心功能明显改善(P<0.01)。结论老年ASD患者介入封堵治疗安全可靠、疗效确切,但需严格掌握适应证,同时综合治疗各种合并症。     

Effect of topically applied hyaluronic acid on pain and palatal epithelial wound healing: An examiner‐masked,randomized, controlled clinical trial

1 Background

This study aims to evaluate the effects of two different concentrations of topical hyaluronic acid (HA) on postoperative patient discomfort and wound healing of palatal donor sites after free gingival graft (FGG) surgery.

2 Methods

Thirty‐six patients requiring FGG were randomly assigned into three groups in an examiner‐masked, randomized, controlled clinical trial. After harvesting palatal grafts, 0.2% and 0.8% HA gels were used in test groups 1 and 2, respectively. Gels were applied on donor sites and protected with periodontal dressing in the test groups, whereas the wound was covered only with periodontal dressing in the control group. On days 3, 7, 14, and 21, pain and burning sensation were recorded using a visual analog scale (VAS) as well as other parameters such as complete epithelization (CE) and color match on days 3, 7, 14, 21, and 42.

3 Results

Test groups experienced less pain than the control group on days 3 and 7 (P <0.001 and P <0.001, respectively). Mean VAS score for burning sensation was higher in the control group on day 3 compared with test groups 1 and 2 (P = 0.03 and P = 0.02, respectively). CE in all patients was achieved on day 21 in both test groups, whereas it was achieved on day 42 in the control group. The test groups showed higher color match scores than the control group on days 21 (P <0.001 and P <0.001, respectively) and 42 (P = 0.004 and P = 0.002, respectively).

4 Conclusion

Topical application of HA exhibits positive impact on postoperative pain and burning sensation, and accelerates palatal wound healing in terms of epithelization and color match.     

Risk factors for bleeding after dental extractions in patients over 60 years of age who are taking antiplatelet drugs

The aim of this retrospective, single-centre study was to identify the risk factors for bleeding after dental extractions in patients aged over 60 who were being treated with antiplatelet drugs. A total of 338 patients who fulfilled the inclusion criteria were enrolled, and their personal and clinical details, and complications with bleeding after extraction, were retrieved and recorded. There were 182 men and 156 women (mean (SD) age 72 (8) years). A total of 469 teeth were extracted, with a mean (SD) of 1.4 (0.6) teeth/patient. Seventy-seven patients (23%) developed mild, and 55 (16%) severe, bleeding postoperatively. No patient developed a major cardiovascular or cerebrovascular event. We calculated the significance of the association of different variables with the occurrence of postoperative haemorrhage using a multivariate stepwise logistic regression model. The presence of three or more coexisting conditions, a complicated tooth extraction, and the use of two antiplatelet drugs were independent risk factors, while discontinuation of antiplatelet treatment four or more days before the tooth was extracted was a protective factor. This suggests that clinicians should assess the thrombotic risk associated with the interruption of antiplatelet drugs as well as the risk of bleeding for each patient before dental extraction. Strong and effective measures for haemostasis may be preferred over blind discontinuation of antiplatelet drugs. This study is registered in the Chinese Clinical Trial Registry (No. ChiCTR1800014355).     

Effect of Resin-based and Bioceramic Root Canal Sealers on Postoperative Pain: A Split-mouth Randomized Controlled Trial

Introduction

The aim of this study was to compare the effect of resin-based and bioceramic root canal sealers on the occurrence and intensity of postoperative pain in patients with asymptomatic apical periodontitis (AAP).

Laparoscopic cholecystectomy: Imaging of complications and normal postoperative CT appearance

Six patients underwent imaging studies to evaluate complications related to laparoscopic cholecystectomy. In addition, computed tomography (CT) of the abdomen and pelvis was performed on six patients 3–5 days after uncomplicated laparoscopic cholecystectomy in order to further clarify the normal postoperative CT appearance in these patients. Complications included ureteral laceration with periureteric hematoma and ureteroperitoneal fistula, hepatic artery pseudoaneurysm, hepatic laceration, retained common bile duct stone, bile leak, and biloma of the abdominal wall. At 3–5 days following uncomplicated laparoscopic cholecystectomy, typical CT findings include fluid density in the gallbladder fossa, a very small amount of pelvic fluid, and small densities within the subcutaneous fat at the expected sites of trocar insertion.