Abstract Aim To prospectively study the role of three-dimensional visualization (3DV) technology in preoperative planning of complex abdominal wall defect repair and reconstruction. Methods 210 patients with complex abdominal wall defects who underwent reconstruction surgery were enrolled. Preoperative planning was performed by CT imaging (CT group) or 3DV technology (3DV group). Results The methods of repair and reconstruction of abdominal wall defects included single or double patch, three-layer bridging (mesh+greater omental flap+mesh), CST+mesh, CST+mesh+omental flap, mesh+tissue flap repair. There was no significant difference in the clinical cure rates of abdominal wall defect observed between the CT group and 3DV group (82.61% vs.91.30%, P > 0.05). The clinical cure rates of abdominal wall defect caused by primary and secondary abdominal wall tumors were 96.23% and 89.66% in the 3DV group, respectively, which were significantly higher than those in the CT imaging group (84.91% and 68.97%, both P < 0.05). Conclusion 3D visualization technology can accurately evaluate the indicators of complex abdominal wall defects before surgery, helping clinicians to make an improved individualized surgical planning.
Background:Cross-field ventilation is used as a conventional choice during carinal resection and anastomosis, but may interfere with surgical procedures. High-frequency jet ventilation (HFJV) allows for control of oxygenation in the open airways; nevertheless, there is a paucity of data to support its benefits versus cross-field ventilation. Herein, we aimed to investigate the efficacy of HFJV on intraoperative oxygen saturation compared with cross-field ventilation in patients undergoing carinal surgeries. Methods:We conducted a retrospective analysis of 82 adults who underwent carinal resection and reconstruction (CRR) for benign or malignant diseases and received cross-field ventilation or HFJV at Shanghai Chest Hospital between January 2018 and September 2021. Patients were excluded when they had emergency surgeries or critical airway stenosis requiring extracorporeal life support, or limited resection without the need for cross-field ventilation or HFJV. Patients were classified into two groups based on the airway approach: cross-field ventilation group and HFJV group. The primary outcome was the area under the curve (AUC) of intraoperative hypoxemia defined as peripheral oxygen saturation (SpO2) below 90% lasting at least 1 minute. The secondary outcomes included cumulative time of SpO2 below 90%, AUC and cumulative time of severe intraoperative hypoxemia (defined as SpO2 below 80% lasting at least 1 minute), and AUC and cumulative time of suboptimal SpO2 (defined as SpO2 below 95% lasting at least 1 minute). Results:Thirty-two patients were included in the final analysis, with 22 patients in cross-field ventilation group and 10 patients in HFJV group. The two groups did not differ in the severity and duration of intraoperative hypoxemia (P=0.366). The median (IQR) AUC of SpO2 below 90% was 21.92 (4.28, 54.48) min in cross-field ventilation group and 28.93 (10.78, 199.89) min in HFJV group. The cumulative time of SpO2 <90% was 16.67 (4.46, 37.11) min in cross-field ventilation group and 19.32 (7.50, 121.24) min in HFJV group, without statistical difference between groups (P>0.05). Severe intraoperative hypoxemia did not occur in either group. Conclusions:This retrospective case series demonstrates that HFJV can be adopted to maintain oxygenation in CRR, without the interruption of surgical procedure.
目的 探讨运用麻醉科PDCA[P(计划,Plan)、D(实施,Do)、C(检查,Check)、A(处理,Action)]循环管理模式提高术中自体血输注率的效果.方法 选择2018年7-9月在复旦大学附属闵行医院行手术治疗,术中输血的患者31例,作为对照组;之后9个月实施PDCA循环管理加以改进,分别收集2018年10-12月、2019年1-3月和4-6月术中输血的患者作为改进1组(28例)、改进2组(31例)和改进3组(39例).比较各组患者的性别构成、年龄、术前和术后血红蛋白水平、术中失血量、手术种类,以及术中自体血输注率.结果 4组间患者的性别构成、年龄、术前及术后血红蛋白水平,以及术中失血量、手术种类的差异均无统计学意义(P值均＞0.05).改进1组、改进2组、改进3组患者自体血输注率分别为21.4％(6/28)、41.9％(13/31)、48.7％(19/39),均显著高于对照组的 19.4％(6/31,P值均＜0.05);且改进2组和改进3组的自体血输注率均＞35％的目标值.结论 运用麻醉科PDCA循环管理模式可显著提高术中自体血输注率.
目的 探讨腹腔镜联合胆道镜经胆囊管治疗胆总管结石的有效性与安全性.方法 回顾分析2015年1月—2019年12月间在泰州市中医院行手术治疗的55例慢性结石性胆囊炎合并胆总管结石患者的临床资料,根据不同的手术方式,分为腹腔镜下胆囊切除术+经胆囊管行胆总管取石术(LTCBDE)组(26例)和腹腔镜下胆囊切除术+胆总管切开探查术(LCCBDE)组(29例).比较两组患者手术相关的临床指标和术后消化道症状分级评分,以及术后并发症发生情况.结果 LTCBDE组术中出血量显著少于LCCBDE组(P＜0.05),术后首次排气时间、腹腔引流时间、术后住院时间均显著短于LCCBDE组(P值均＜0.05).两组间手术时间的差异无统计学意义(P＞0.05).LTCBDE组术后消化道症状分级评分总分为(2.65±1.41)分,显著低于LCCBDE组的(4.24±2.06)分(P＜0.05).LTCBDE组食欲差、便秘、硬粪的评分均显著低于LCCBDE组(P值均＜0.05),两组间腹泻、脐周痛、下腹胀、排气增多评分的差异均无统计学意义(P值均＞0.05).LCCBDE组术后发生胆漏1例,予以保守治疗后好转出院,两组患者术后并发症发生率的差异无统计学意义(P＞0.05).两组患者术中均无中转行开腹手术,LTCBDE组有1例患者因取石困难而改行LCCBDE术.所有患者均痊愈出院,出院后随访3个月,无相关并发症发生.结论 LTCBDE治疗胆总管结石具有创伤小、安全、患者痛苦小、术后胃肠道功能恢复快等优点,且保留了胆道系统的完整性,使微创外科的优势最大化,从而提高患者的生活质量.
目的 探究心肌桥患者焦虑-抑郁与社会压力-支持度的关系.方法 纳入2017年8月-2018年6月经选择性冠状动脉造影或冠状动脉CTA确诊的200例心肌桥患者的临床资料.采用汉密尔顿焦虑(HAMA)量表、汉密尔顿抑郁(HAMD-17)量表、简单自测焦虑(GAD-7)量表、9项患者健康问卷(PHQ-9)、生活事件量表(LES)和社会支持评定量表(SSRS),分析不同性别和心肌桥收缩期压缩程度患者的焦虑、抑郁和社会压力的支持情况.结果 女性心肌桥患者HAMA量表评分显著高于男性(P＜0.05).不同严重程度的心肌桥患者HAMA、HAMD-17、GAD-7、PHQ-9、LES和SSRS的差异均无统计学意义(P值均＞0.05).简单线性相关分析表明,焦虑与社会压力呈正相关(r=0.274,P＜0.001),与社会支持呈负相关(r=-0.174,P=0.014);抑郁与社会压力呈正相关(r=0.320,P＜0.001),与社会支持呈负相关(r=-0.213,P=0.003).结论 女性心肌桥患者焦虑程度高于男性心肌桥患者,减轻心肌桥患者的生活压力和增强社会支持度可改善其焦虑-抑郁的心理状况.
