Clinical Effect Of Surgical Treatment Research Articles

Retraction: 'Clinical effect of surgical treatment for lung metastasis and prognostic risk factor analysis: a single-centred cohort study' by Dongge Peng, Wei Sun, ANZ Journal of Surgery 2023, 93: 1551-1558.

The above article, published online on 24 May 2023 in Wiley Online Library (https://onlinelibrary.wiley.com/doi/10.1111/ans.18491) has been retracted by agreement between the journal's Editor in Chief, Julian A. Smith, the Royal Australasian College of Surgeons and John Wiley & Sons Australia, Ltd. The retraction has been agreed due to major overlap with a previously published article from the same group of authors (DOI: 10.7507/1007-4848.202111005). The authors have been informed of the decision to retract but they did not respond.

Клиническая эффективность хирургического лечения эндометриоза I–II cтадии по rASRM

Abstract Aim. To assess the dynamics of clinical symptoms of endometriosis I–II stage (R-AFS classification) in patients with infertility before and after surgical treatment. Design. Retro-prospective cohort study. Materials and methods. The study included 55 women aged 25 to 43 years with a diagnosis of infertility and the presence of external genital endometriosis I-II stage (R-AFS classification) according to laparoscopic surgery, performed for diagnostic and therapeutic purposes. The dynamics of the pain syndrome were assessed based on the study of the pelvic pain intensity by the visual analogue scale (VAS) — from 0 to 10 points. The dynamics of clinical symptoms of the disease were assessed 12–36 months after surgical treatment using a questionnaire. A comparison was made of the data obtained during surgical treatment with the clinical manifestations of the disease. Results. Data analysis revealed a decrease in the frequency of dysmenorrhea in 16 (29.1%) women (p = 0.002) and a decrease in its intensity in 39 (70.9%) women (p < 0.001), the disappearance of chronic pelvic pain (CPP) in 10 (18.2%) women (p = 0.014) and a decrease in its intensity in 17 (30.9%) women (p = 0.011), as well as a decrease in the frequency of dyspareunia in 6 (10.9%) cases (p = 0.046). The study did not reveal a statistically significant difference in the dynamics of some menstrual cycle characteristics (regularity, abundance, presence of spotting before menstruation) before and after surgery. The relationship between CPP, dysmenorrhea and dyspareunia and the localization of endometriotic lesions has not been established. It was also not found any dependence of the surgical intervention type and the presence of pain symptoms of endometriosis. Conclusion. The surgical method is the optimal tool for treating endometriosis in the presence of objective indications: severe pain, ineffectiveness or impossibility of conservative therapy. Key words: external genital endometriosis, surgical treatment of endometriosis, laparoscopy, pain, infertility.

One-stage operation surgical efficacy observation of congenital preauricular fistula infection and static period of inflammation in children

Objective:To compare the clinical effect of surgical treatment of congenital preauricular fistulas in children during the local infection period and static inflammatory period. Methods:Forty children with congenital preauricular fistula infection treated in our hospital from January 2020 to December 2022 were selected as the experimental group, and 39 children with congenital preauricular fistula inflammation at static period were selected as the control group. The fistula of the two groups of children aged between 1-14 years old was located in front of the foot of the ear wheel or the foot of the ear wheel, and all were unilateral fistulas. The postoperative follow-up was 6 months to 2 years, and the efficacy of the two groups was compared. Results:There was no significant difference in the healing rate of stage Ⅰ and stage Ⅱ between the two groups（P>0.05）. There was no significant difference in fistula recurrence rate and satisfaction with the preauricular scar between the two groups after treatment（P>0.05）. There was no significant difference in postoperative hospital stay between the experimental group and the control group（P>0.05）. Conclusion:The effect of surgical treatment of congenital preauricular fistula in the infected period is similar to that of surgical treatment in the static period of inflammation, and it can reduce the pain of dressing change under local anesthesia in children, avoid the second operation in children, and reduce the economic cost. This treatment method is worthy of clinical promotion. Appropriate incision and resection method were designed according to the fistula and infection sites.

Clinical effect of surgical treatment for lung metastasis and prognostic risk factor analysis: a single-centred cohort study.

This study aimed to compare the clinical effects of lobectomy and sublobar resection in the treatment of lung metastasis and to analyse the factors affecting patient prognosis. A retrospective analysis was performed on the clinical data of patients with pulmonary metastasis who underwent thoracic surgery at the Affiliated Cancer Hospital of Xinjiang Medical University between March 2010 and May 2021. A total of 165 patients who underwent pulmonary metastasectomy (PM) for lung metastasis met the inclusion criteria. Compared with the lobectomy group, the sublobar resection group had shorter operation time for pulmonary metastases (P < 0.001), lower intraoperative blood loss (P < 0.001), lower drainage volume on the first day after surgery (P < 0.001), lower incidence of prolonged air leak (P = 0.004), shorter drainage tube indwelling time (P = 0.002), and shorter postoperative hospital stay (P = 0.023). Multivariate analysis showed that sex (95% confidence interval (CI), 0.390-0.974; P = 0.038), disease-free interval (DFI) (95% CI, 1.082-2.842; P = 0.023), and postoperative adjuvant therapy (95% CI, 1.352-5.147; P = 0.004) were independent influencing factors of disease-free survival of patients who underwent PM. DFI (95% CI, 1.062-3.894; P = 0.032) and preoperative carcinoembryonic antigen (CEA) level (95% CI, 1.420-5.163; P = 0.002) were independent factors influencing the overall survival of patients in this group. Sublobar resection provides a safe and effective treatment option for patients with pulmonary metastasis on the premise of ensuring resection of lung metastasis R0 . Female sex, longer DFI, the use of postoperative adjuvant therapy and a lower preoperative CEA level were all favourable prognostic factors.

Exploration of surgical approach to reconstruct smile-like lip shape in East-Asian women

BackgroundTo investigate the clinical effects of surgical treatment to improve the lip morphology for a smile-like appearance (joy and happiness) in East-Asian women. MethodsFrom October 2016 to April 2020, 63 patients who had received surgery to lift the commissure of the mouth and adjust the shape of the upper red lip to form a smile-like shape were analyzed and evaluated. ResultsThe lip shape of enrolled patients was improved to a certain extent after surgery without any obvious scar hyperplasia, and the satisfaction rate of people after the surgery was 85.71%. ConclusionFor East-Asian women with thin and flat lips, surgical approach can be used to improve the shape of lip, such that the appearance of the lip is in a smile-like shape, which can enhance affinity and also exhibit the aesthetic characteristics of East-Asian women. This treatment can be used for clinical reference. Level of EvidenceLevel IV.

Clinical effectiveness of surgical treatment after lenvatinib administration for hepatocellular carcinoma.

There is little evidence concerning survival after surgery in patients with hepatocellular carcinoma who have received lenvatinib treatment. The aim of this study was to evaluate whether post-lenvatinib surgical treatment in patients with hepatocellular carcinoma improves overall survival. The cohort of this retrospective study comprised 55 patients with hepatocellular carcinoma who had undergone lenvatinib treatment. We classified them into two groups according to post-lenvatinib surgical treatment status and compared clinicopathologic factors and prognosis between the two groups with the aim of identifying predictors of overall survival. The median duration of lenvatinib administration was 5.8months (range, 0.4-24.0months). Twelve of the 55 patients underwent surgery after receiving lenvatinib. There was no significant difference in assessed clinicopathological factors between patients who did and did not undergo surgery after being treated with lenvatinib. Multivariate analysis revealed that older age was associated with a significantly worse overall survival (hazard ratio: 2.332; 95% confidence interval 1.062-5.168; P = 0.0369) and that surgery after treatment with lenvatinib achieved better overall survival than other forms of treatment (hazard ratio: 0.121; 95% confidence interval 0.016-0.901; P = 0.0393). Surgical treatment after lenvatinib administration may be a useful therapeutic option for select patients with hepatocellular carcinoma.

Surgical treatment of acetabular fractures

Background. Acetabular fractures are severe intra-articular injuries that require anatomical reposition and early function, but they are often complicated by degenerative changes in both the acetabulum and the femoral head, leading to the development of post-traumatic coxarthrosis. The purpose was to study the clinical effectiveness of surgical treatment and postoperative management of patients using autologous platelet-rich plasma in patients with fractures of the acetabulum. Materials and methods. Twenty-eight patients with acetabular fractures of various degrees were operated at the City Emergency Hospital of Zaporizhzhia and the Municipal Clinical Hospital No 9 from 2017 to 2019. Gender composition: 22 men (78.57 %), 6 women (21.43 %), average age 46.64 ± 2.21 years, with a 95% confidence interval 42.31–50.96. Nineteen victims (67.86 %) had road traffic injuries, 7 (25 %) domestic injuries, and 2 (7.14 %) had industrial injuries. Results. In the main group of patients treated with platelet-rich plasma, radiologically visible adhesion of the injured area after 8 weeks occurred in 10 people (83.4 %). In one person (8.3 %), the adhesion occurred after 12, and in another (8.3 %) — 16 weeks after surgery. In the control group, adhesions at 8th week were registered in 14 patients (60.87 %), in 8 (34.78 %) — at 16th week. Given the general recovery of the body in the main group, the activation and social adaptation of patients occurred 2–3 weeks earlier. The assessment was performed radiologically and by the criteria of functional recovery.

Diagnosis and surgical treatment open ductus arteriosus in corgi and pomeranian dogs

The paper presents the results of a clinical and experimental study of determining the clinical effectiveness of surgical treatment of animals with patent ductus arteriosus using open ligation and endovascular occlusion using the example of dogs of the Corgi and Spitz breeds. A retrospective study, the morphofunctional state of the cardiovascular system was assessed before and after surgery. The total sample consisted of 25 animals. Diagnosis of this defect was carried out by auscultation and using echocardiography [ultrasound]. During auscultation, a systolic-diastolic murmur is heard. On ultrasound, the normalized parameters were compared before and after surgery. Animals with critical pulmonary hypertension were excluded from the study, since this complication is a contraindication for surgical treatment. In the postoperative period, the animals after open correction of the defect recovered longer and needed more prolonged analgesia than animals after endovascular treatment. After open treatment with thoracotomy, the animals were in the intensive care unit for a day, and after transcatheter surgery - 6-12 hours. After that, all animals were discharged for outpatient treatment. After closure of the duct, all dogs with a congenital defect became more active, their general condition improved, shortness of breath during physical exertion disappeared, and the respiratory rate decreased significantly. It was found that corgi are more difficult to tolerate this defect than Spitz dogs. They had a more frequent complication in the form of pulmonary hypertension. One year after the surgical treatment, when performing echocardiography, the indicators of the morphofunctional state of the heart were normalized.

Observation on the Curative Effect of Microsurgery in 154 Children with Strabismus and Analysis of Its Influencing Factors.

Strabismus is a common ophthalmic disease in the process of child body development, in which the two eyes cannot gaze at the target at the same time, and the incidence of this disease of children is higher. In children with esotropia, exotropia, and up and down strabismus and other typical symptoms, the cause is genetic, innerve, and refractive and regulated, and not receiving timely treatment may lead to stereo vision and diplopia and other phenomena, affecting their learning and life. Surgical treatment is the main treatment for strabismus at present. Traditional orthodontic surgery is performed by doctors under the naked eye, often due to improper operation or suture error and other factors, resulting in more postoperative complications, such as more tissue damage, conjunctival congestion, and muscle suture reaction, which seriously affect the clinical effect of surgical treatment. In recent years, with the continuous development of microsurgical technology, the correction of strabismus under a microscope has been widely carried out in clinic. The operation under the microscope makes the operation more delicate and accurate, overcomes the defects of traditional surgery, and highlights the advantages of minimally invasive surgery. The purpose of this study was to investigate the effect of microsurgical techniques in the treatment of strabismus in children and to analyze the factors influencing the outcome. The results showed that microsurgical strabismus correction in the treatment of strabismus children has short operation time, less intraoperative blood loss, short hospital stay, high efficiency, and less complications, which is worthy of popularization. Age, preoperative strabismus angle, refractive error, distance stereopsis injury, near stereoscopic injury, and duration of disease were all independent influencing factors of postoperative efficacy.

Analysis on the Clinical Effect of Surgical Treatment of Ankle Joint Fracture Accompanied by Triangular Ligament Injury and Its Effect on Prognosis

Analysis on the Clinical Effect of Surgical Treatment of Ankle Joint Fracture Accompanied by Triangular Ligament Injury and Its Effect on Prognosis

Оценка клинической эффективности хирургического лечения идиопатических макулярных разрывов большого и среднего диаметра с использованием модифицированной технологии инвертированного лоскута внутренней пограничной мембраны (предварительные результаты)

Purpose. To assess the clinical effectiveness of surgical treatment of medium-and large-diameter idiopathic macular ruptures (IMR) using a modified technology by inversion and fixation of a free flap of the internal limiting membrane (ILM). Methods. A prospective study was conducted in 11 patients (11 eyes), 9 women and 2 men with medium-and large-diameter IMR. Mean age - 67.3 ± 5.38 (55-80) years. Patients with penetrating IMR of 2-4 stages according to the J. Gass classification. All patients underwent optical coherence tomography (OCT) along with traditional ophthalmological methods. The scans were performed in Retina Map, Cross line, Radial line, and Angio Retina modes. The obtained images were used to measure the parameters of the macular rupture (MR) of the retina manually. All patients underwent surgical treatment of IMR according to the proposed method. Results. In all cases, 1 day after the surgery, the closure of the gap was achieved according to ophthalmoscopy. 1 month after the surgery, according to OCT, 3 patients (27.2%) had a defect in the photoreceptor layer, 4 patients (36.3%) had deformity or peripheral non-attachment of the edges of the ILM flap, and 2 patients (18.1%) had a combination of these defects. According to OCT data in the Angio Retina mode, changes in the parameters of retinal blood flow were noted: there was a significant, moderate expansion of the avascular zone, accompanied by a moderate decrease in retinal perfusion. Despite this, there was a significant increase in visual acuity in the postoperative period. Conclusion. Endovitreal intervention for medium-and large-diameter macular ruptures using a modified technology by inversion and fixation of an ILM free flap is highly effective, as well as a low-traumatic treatment method that allows achieving anatomical closure of the macular defect and improving visual functions.

Operation-effect analysis of 21 patients with ankle fracture and complete rupture of deltoid ligament

To explore short-term clinical effect of surgical treatment for ankle fracture with complete rupture of deltoid ligament in young and middle-aged patients. From January 2016 to March 2019, 21 young and middle-aged patients with ankle joint fracture and complete rupture of the deltoid ligament were treated with internal fixation and repair of the medial deltoid ligament, including 16 males and 5 females, aged from 21 to 52 years old with an average of (38.6±7.3) years old, the time from injury to operation ranged from 1 to 7 days with an average of (3.8±1.5) days. Fracture healing time and complications were observed, changes of medial malleolus clearance before and after operation were compared, American Orthopaedic Foot and Ankle Society (AOFAS) score wasused to evaluate function of ankle joint at 18 months after operation. Twenty-one patients were followed up from 18 to 26 months with an average of (21.7±1.2) months. The incisions were healed at stageⅠ, and fracture healing time ranged from 8 to 12 weeks with an average of (9.5±1.6) weeks. No wound infection, failure of internal fixation, and nerve injury occurred. Medial malleoius space decreased from (5.83±0.32) mm before operation to (2.69±0.25) mm after operation. Postoperative AOFAS score at 18 months was 91.43±4.14, 14 patients got excellent results, 6 good and 1 fair. On the basis of stable fixation of fracture, repair of deltoid ligament could help restoring the medial anatomy of ankle joint in young and middle-aged patients, and could achieve good short term clinical effect.

Clinical efficacy of surgical treatment for Pipkin fracture in 17 cases

To investigate the clinical effect of surgical treatment for femoral head fracture-dislocation (Pipkin fracture). Methods: A total of 17 patients with femoral head fracture-dislocation were retrospectively analyzed. The duration from injury to surgery was 1-30 (average 9.5) days. According to the classification of Pipkin criteria, there were 4, 6, 1, and 6 cases in Type I, Type II, Type III, and Type IV, respectively. Thirteen patients were treated with skin traction or bone traction after admission, and the postoperative traction lasted for 4 weeks. Results: All patients got a mean follow-up of 43(8-84) months. No patient suffered from infection and skin flap necrosis. X ray showed no implants loose or breakage. According to the Thompson-Epstein evaluation system, among the cases of Type I, 3 cases were excellent and 1 case was fair; among the cases of Type II, 3 cases were excellent, 2 cases were good, and 1 case was poor. The case of Type III was good. Among the cases of Type IV, 2 cases were excellent, 2 cases were good, and 2 cases were fair. The excellent and good rate was 76.47%. Conclusion: Early diagnosis of Pipkin fracture, reasonable selection of surgical approach and internal fixation according to Pipkin classification can help patients to obtain satisfactory hip function and improve their prognosis.

Latissimus Dorsi Transposition in Supraspinatus Tendon Retraction (Patte III) and Thomazeau Grade 3 Fatty Degeneration (Clinical Case)

Introduction. The proportion of injuries of the rotational cuff is from 65 to 84 % of all injuries of the shoulder joint. This pathology is more often registered in people over 60 years old. It is far from always that during initial visits, patients are given the correct diagnosis. Most patients are treated conservatively with short-term improvement or without dynamics. The main diagnostic method is an MRI of the shoulder joint, where we can see soft tissue structures. The proportion of massive rupture of the tendons of the supraspinatus muscle is 10-40 % of all ruptures of the rotator cuff. The more time passes from the moment of injury to surgical treatment, the more pronounced are the retraction and degenerative changes in tendons. A special category is occupied by patients with chronic rupture of the tendon of the supraspinatus muscle with a retraction of more than 5 cm (Patte grade III) and Thomazeau grade 3 fatty degeneration. In this category of patients, it is not possible to re-insert the tendons of the rotational cuff of the shoulder. Objective: to evaluate the clinical effectiveness of surgical treatment of a patient with retinal tendon retraction (Patte grade III) and Thomazeau grade 3 fatty degeneration. Materials and methods. The clinical case is presented: a man with a chronic total rupture of the tendon of the supraspinatus, infraspinatus muscle (Patte grade III) and Thomazeau grade 3 fatty degeneration. Secondary upper subluxation of the head of the humerus is revealed. The patient underwent surgical treatment: transposition of the latissimus dorsi muscle on the large tubercle of the humerus. Results. Six months after the operation, the patient restored the function of the upper limb, pain was stopped. Conclusion. Given the functional result, transposition of the latissimus dorsi tendon can be considered the technique of choice for inoperable tendon rupture of the supraspinatus muscle.

Clinical effects of surgical treatment of high myopic strabismus fixus by modified Yokoyama's surgery combined with medial rectus muscle recession

Objective: To analyze clinical effects of modified Yokoyama's surgery combined with medial rectus muscle recession for treatment of high myopic strabismus fixus. Methods: Retrospective analysis of records of 9 patients (14 eyes) with high myopic strabismus fixus treated from February 2013 to December 2016 in the Department of Ophthalmology, Xiangya Hospital, Central South University. All patients underwent modified Yokoyama's surgery. The temporal 1/2 of the superior rectus (SR) and the superior 1/2 of the lateral rectus (LR) were united 12 to 14 mm, combined with medial rectus muscle recession. The angle of deviation of primary position, the mobility of the affected eye, and the change of CT imaging were observed and analyzed before and 6 months after surgery. Statistical analysis was performed by Mann-Whitney U test. Results: The patients were 5 females and 4 males with an average age of (60±10) years. The duration of high myopia was (33.33±6.61) years. The refractive power was (-23.32±5.95) D, and the axial length was (33.04±2.63) mm. The recession mount of medial rectus was (7.2±2.1) mm (4.0-10.0 mm) intraoperatively. At 6 months, the median esotropia improved from 130 (80-140) prism diopter (PD) to 0 (0-10) PD, and the hypotropia from 20 (15-25) PD to 0 (0-5) PD. The median abduction limitation decreased from -3 (-4--1) to -1 (-2-0), and the median limitation of elevation decreased from -2 (-4--1) to 0 (-1-0). The angle of esotropia and hypotropia significantly improved (Z=-2.67, -2.70; P=0.008, 0.007), and the restriction of abduction and elevation decreased (Z=-3.35, -3.24; both P=0.001). Only 3 patients' CT images were enrolled in a comparative study. Preoperative orbital CT scans showed inferior LR displacement and medial SR displacement with the posterior portion of the eyeball to the superotemporal quadrant of the orbit. After surgery, the mean reduction ratio of dislocation degree of the 3 patients was 28.97%, the dislocation of LR and SR was reduced, and the posterior global part was correctly positioned within the orbit. Conclusions: The modified Yokoyama's surgery combined with medial rectus muscle recession can effectively correct high myopic strabismus fixus, recover the eyeball anatomical position, and evidently improve eye mobility. The clinical effects are satisfactory. (Chin J Ophthalmol, 2019, 55: 670-676).

Clinical effectiveness of surgical treatment with polyester tapes and temporary K-wires on complete acromioclavicular dislocation.

Ideal treatment of acute acromioclavicular joint (ACJ) dislocation remains unresolved. We evaluated ACJ reconstruction using polyester tapes and temporary Kirschner wire (KW) and presented clinical and radiological outcomes. Patients were retrospectively evaluated and classified according to Rockwood classification, clinical and sportive characteristics. Constant Score (CS) and ACJ joint instability (ACJI) score were collected. Zanca's, Alexander, axillary, standard, and stress AP views were collected. Radiographic coracoclavicular distance (CCd) of healthy and injured shoulders was measured pre-operatively, at 3months and at minimum 2-year follow-up. Heterotopic ossifications and clavicular osteolysis were evaluated. Influence of patients' characteristics and AC joint type on clinical and radiological outcomes were determined. Sixteen patients (13 type V and 3 type III ACJ dislocation) reached the end of follow-up (mean 2.4years; range 22-72months). Mean CS was 99.63 (range 96-100), while the mean ACJI score was 96.19 (range 85-100). The CCd of the treated shoulder was comparable with the healthy shoulder at 3months and at last follow-up; moreover, there was no difference in CCd scores at 3months and at 2years. CCd scores were lower in sedentary patients compared with physically active (sporty) patients. Heterotopic ossifications were observed in three patients. No osteolysis was reported. This technique provides good results with few complications and should be considered as an effective method to treat ACJ acute dislocation. CCd scores correlate with overuse factors but not with other clinical scores.

Clinical effect of surgical treatment for nodular goiter complicated with thyroid carcinoma

Objective To explore the clinical effect of surgical treatment for nodular goiter complicated with thyroid cancer, thus to provide clinical guidance. Methods From October 2011 to April 2016, 50 nodular goiter patients complicated with thyroid carcinoma in Longshan Hospital of Cixi were selected in the research, and the clinical data of the patients were retrospectively analyzed.Patients were treated with surgery, and were followed up for 1 year.The patients' quality of life scores before and after treatment, clinical efficacy and complications were analyzed. Results After sungery, the scores of mental, physical, material life, social relations, the general quality of life score were (86.71±5.51)points, (84.63±5.46)points, (85.24±5.53)points, (81.35±5.42)points, (83.56±4.58)points, which were significantly higher than those before treatment (t=10.063, 9.124, 10.683, 8.455, 10.504, all P<0.05). The patients were followed-up for 1 year, no obvious complications were observed in 50 patients, and 50 cases after treatment with surgery, 34 patients had marked effect, 13 patients were effective, 3 patients were invalid, the total effective rate was 94.00%. Conclusion The surgical treatment for nodular goiter complicated with thyroid carcinoma has significant therapeutic effect. Key words: Goiter, nodular; Thyroid neoplasms; Surgical procedures, operative; Treatment outcome; Quality of life

Effect analysis of surgical treatment for ankle osteoarthritis under arthroscopy

Objective To discuss the clinical effect of surgical treatment for ankle osteoarthritis under arthroscopy. Methods Forty-eight cases with ankle osteoarthritis patients admitted at the Orthopaedic Hospital of Zhengzhou from January 2012 to June 2014 were selected and all of them were given the treatment of focal cleaning under arthroscopy.The clinical effect of surgical treatment were judged by modified McGuire ankle rating system, the United States after ankle surgery AOFAS ankle-full score and Mazur ankle rating system respectively. Results At the time of the last follow-up, modified McGuire ankle rating system((85.64±16.52) points vs.(52.46±10.25) points, t=-8.465), the United States after ankle surgery AOFAS ankle-full score [(85.24±11.46) points vs.(53.68±9.48) points, t=-7.548) and Mazur ankle rating system((86.45±12.57) points vs.(58.49±8.64) points, t=-6.596) all increased than that of pre-operation, the differences were statistically significant(P 0.05). Conclusion The clinical effect of surgical treatment for ankle osteoarthritis under arthroscopy is remarkable and it causes light damage to the body.It is especially suitable for patients with low-grade lesions and is worth popularization and application. Key words: Ankle; Osteoarthritis; Arthroscopy; Effect

Clinical effect of surgical treatment of stricturing Crohn′s disease

Objective To explore the clinical effect of surgical treatment of stricturing Crohn′s disease (CD). Methods The retrospective cross-sectional study was conducted. The clinical data of 28 patients with stricturing CD who were admitted to the First Affiliated Hospital of Zhejiang University School of Medicine between June 2013 and April 2016 were collected. After improving the patients′ nutritional status by preoperative corresponding treatment and optimizing the risk factors of complications, patients received individualized therapy according to their conditions. The intestinal one-stage resection and anastomosis or ostomy were performed at the stenotic locus causing sypmtoms, and no treatment or angioplasty for stenosis was performed at the gentle stenotic locus. Patients received regularly postoperative outpatient reexaminations. The medication was used to prevent recurrence according to the individual conditions. Observation indicators: surgical procedures (open or laparoscopic surgery), operation time, volume of intraoperative blood loss, number of patients with intraoperative blood transfusion, length of intestine resected, anastomosis methods, angioplasty for stenosis, duration of postoperative hospital stay, postoperative complications and follow-up. Follow-up using outpatient examination, telephone interview and wechat was performed to detect the abdominal pain, diarrhea, symptoms of clinical recurrence and endoscopic recurrence situations up to July 2016. Results All the 28 patients with stricturing CD underwent the selective operations, including 8 undergoing laparoscopic surgery (3 receiving conversion to open surgery) and 20 undergoing open surgery. Of 28 patients, 2 underwent partial upper jejunum resection, 10 underwent partial terminal ileum resection, 15 underwent right hemicolectomy and 1 underwent colectomy. Operation time and volume of intraoperative blood loss were 33-288 minutes with an average time of 122 minutes and 50-650 mL with an average volume of 200 mL, respectively. One patient had intraoperative blood transfusion. Length of intestine resected of 28 patients was 10-150 cm, with an average of 54 cm and a total length of 1 510 cm. Of 28 patients, 26 received the side-to-side anastomosis using linear closures (1 received the end-to-side anastomosis using pipe stapler, 1 with multiple lesions and rectovaginal fistula received colectomy and ileostomy). Two patients with multiple stenosis of the small intestine underwent intestinal resection combined with angioplasty for stenosis in 3 loci. Duration of postoperative hospital stay was 7-45 days, with an average duration of 15 days. No patient died of surgery. Three patients had postoperative complications, including wound infection, incisional hernia and anastomotic leakage. Twenty-one patients were followed up for 3 months to 2 years, with a median time of 11 months, and there was no recurrence during the follow-up. Conclusions Surgical treatment should be performed to the patients with non-symptom, chronic and fibrous stricturing CD and anastomotic stenosis after ineffective medical treatment, with a satisfactory outcome. Meanwhile, it need follow the principle of minimally invasive . And optimizing high risk factors of complications before operation is a key point for preventing postoperative complications. Key words: Crohn′s disease, stricturing; Surgical procedures, operative; Complications

IMPROVED DOUBLE OPERATIVE APPROACHES FOR TREATMENT OF Pilon FRACTURES ACCOMPANIED WITH FIBULA FRACTURES

To investigate the clinical effect of surgical treatment of Pilon fractures accompanied with fibula fractures with the improved double operative approaches. Between January 2012 and June 2015, 19 patients with closed Pilon fractures accompanied with fibula fractures (Rüedi-Allgöwer type Ⅲ) underwent open reduction and internal fixation with improved anterior-median incision and posterior-lateral incision. There were 13 males and 6 females, aged 35 years on average (range, 23-68 years). Injury was caused by traffic accident in 11 cases, falling from height in 7 cases, and crash injury of heavy object in 1 case. According to AO/OTA classification, there were 4 cases of type C2, and 15 cases of type C3. According to Tscherne-Gotzen classification of soft tissue defect, 6 cases were rated as grade 1 and 13 cases as grade 2. The interval of injury and operation was 6-18 days (mean, 10.3 days). After operation, reduction of Pilon fracture was evaluated by the Burwell-Charnley radiological evaluation criteria, and the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. The operation time was 1.8-4.6 hours (mean, 2.4 hours); the intraoperative blood loss was 200-500 mL (mean, 310 mL). All the 19 patients were followed up for 13.7 months on average (range, 12-18 months). The fracture healing time was 3.6 months on average (range, 2.5-8.0 months). Postoperative complications included anterior-median incision necrosis in 2 cases, traumatic arthritis in 2 cases, and ankle instability in 1 case. According to Burwell-Charnley radiological evaluation criteria, anatomical reduction was obtained in 15 cases and satisfactory reduction in 4 cases. According to AOFAS score, the excellent and good rate was 84.2% (excellent in 11 cases, good in 5 cases, and fair in 3 cases). The improved anterior-median incision combined with posterior-lateral incision is a safe and effective method to treat complex Pilon fractures accompanied with fibula fractures, which has the advantages of simple operation, adequate exposure and minimal invasion.