Intraoperative Bleeding Volume Research Articles

Ulinastatin reduces postoperative bleeding and red blood cell transfusion in patients undergoing cardiac surgery: A PRISMA-compliant systematic review and meta-analysis.

Ulinastatin is a type of glycoprotein and a nonspecific wide-spectrum protease inhibitor like antifibrinolytic agent aprotinin. Whether Ulinastatin has similar beneficial effects on blood conservation in cardiac surgical patients as aprotinin remains undetermined. Therefore, a systematic review and meta-analysis were performed to evaluate the effects of Ulinastatin on perioperative bleeding and transfusion in patients who underwent cardiac surgery. Electronic databases were searched to identify all clinical trials comparing Ulinastatin with placebo/blank on postoperative bleeding and transfusion in patients undergoing cardiac surgery. Primary outcomes included perioperative blood loss, blood transfusion, postoperative re-exploration for bleeding. Secondary outcomes include perioperative hemoglobin level, platelet counts and functions, coagulation tests, inflammatory cytokines level, and so on. For continuous variables, treatment effects were calculated as weighted mean difference (WMD) and 95% confidential interval (CI). For dichotomous data, treatment effects were calculated as odds ratio and 95% CI. Statistical significance was defined as P < .05. Our search yielded 21 studies including 1310 patients, and 617 patients were allocated into Ulinastatin group and 693 into Control (placebo/blank) group. There was no significant difference in intraoperative bleeding volume, postoperative re-exploration for bleeding incidence, intraoperative red blood cell transfusion units, postoperative fresh frozen plasma transfusion volumes and platelet concentrates transfusion units between the 2 groups (all P > .05). Ulinastatin reduces postoperative bleeding (WMD = -0.73, 95% CI: -1.17 to -0.28, P = .001) and red blood cell (RBC) transfusion (WMD = -0.70, 95% CI: -1.26 to -0.14, P = .01), inhibits hyperfibrinolysis as manifested by lower level of postoperative D-dimer (WMD = -0.87, 95% CI: -1.34 to -0.39, P = .0003). This meta-analysis has found some evidence showing that Ulinastatin reduces postoperative bleeding and RBC transfusion in patients undergoing cardiac surgery. However, these findings should be interpreted rigorously. Further well-conducted trials are required to assess the blood-saving effects and mechanisms of Ulinastatin.

Comparative study of percutaneous bridging plate and retrograde suprapubic intramedullary screw fixation for anterior pelvic ring fracture

To compare the effect of percutaneous bridging plate and retrograde suprapubic intramedullary screw in the treatment of anterior ring fracture of pelvis. From January 2013 to June 2017, 40 patients with unstable pelvic fractures involving anterior ring were analyzed retrospectively. According to the fixation method, they were divided into two groups, there were 20 patients in percutaneous bridging plate group (plate group) including 9 males and 11 females; according to tile classification, fractures were classified as type B1 in 1 case, type B2 in 14, type B3 in 2, type C1 in 2 and type C2 in 1. There were 20 cases in retrograde suprapubic intramedullary screw group (screw group) including 10 males and 10 females; according to tile classification, there were 1 case of type B1, 12 cases of type B2, 3 cases of type B3, 3 cases of type C1 and 1 case of type C2. The incision length, operation time, times of fluoroscopy, intraoperative bleeding volume, postoperative Matta score, postoperative complications and the last follow-up Majeed function score of the two groups were compared and analyzed. Both groups were followed up for 8 to 15 (12.25±2.24) months in the plate group and 6 to 18 (12.4±2.6) months in the screw group, there was no significant difference between the two groups. The incision length of screw group was (3.85±0.75) cm shorter than that of steel plate group (7.05±1.39) cm; the operation time of screw group was (27.70±5.36) min longer than that of steel plate group (15.10±2.07) min; the fluoroscopy times of screw group was (6.00±1.83) more than that of steel plate group (3.75±1.33) . The bleeding volume was (22.50±10.82) ml in of screw group, (25.00±9.93) ml in steel plate group, there was no significant difference between the two groups (P>0.05) . There was no significant difference in Matta evaluation and Majeed functional score in the last follow-up. One case of superficial skin infection occurred in screw group, one case of superficial skin infection and one case of transient paralysis of lateral femoral cutaneous nerve occurred in steel plate group. Percutaneous bridging plate and retrograde suprapubic intramedullary screw fixation of pelvic anterior ring fracture have the same effect. The operation time of the percutaneous plate group was shorter, the times of intraoperative fluoroscopy was less, and the learning curve was shorter, but the variation of the lateral femoral cutaneous nerve should be noted during the operation.

Is high tibial osteotomy better than proximal fibula osteotomy for treating knee osteoarthritis? A protocol for a systematic review and meta-analysis of clinical controlled trials.

Background:Knee osteoarthritis (KOA) is a common disease in the elderly, which seriously reduces the quality of life of patients and increases the social burden. proximal fibula osteotomy (PFO) and high tibial osteotomy (HTO) are effective methods to treat KOA. However, it is not entirely clear which method has the advantage. Therefore, we evaluated the efficacy and safety of HTO and PFO in the treatment of KOA.Methods:Randomized controlled trials from online databases including PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, Chinese Scientific Journal Database, Wanfang Data and Chinese Biomedical Literature Database that compared the efficacy of HTO and PFO in the treatment of KOA were retrieved. The main outcomes included hospital for special surgery (HSS) knee scores, knee society knee scoring system (KSS) score, visual analog scale (VAS) knee pain scores, western ontario and McMaster universities osteoarthritis index score, operation time, intraoperative bleeding volume, hospitalization time, complications. The Cochrane risk of bias tool was used to assess methodological quality.Results:The literature will provide a high-quality analysis of the current evidence supporting HTO for KOA based on various comprehensive assessments including HSS scores, KSS score, VAS scores, western Ontario and McMaster universities osteoarthritis index score, operation time, intraoperative bleeding volume, hospitalization time, and complications.Conclusion:This proposed systematic review will provide up-to-date evidence to assess the effect of HTO in the treatment for patients with KOA.

Needleless Contasure versus TVT-O in Women with Stress Urinary Incontinence

Objectives: The aim of this thesis is to determine the clinical effectiveness, safety and cost-effectiveness of Single Incision needleless Mini-Slings compared with tension-free Standard Mid-urethral Sling in the surgical management of female stress urinary incontinence, but with less side effects. Methods: The study will be conducted in Zagazig University Hospitals. From 2018 to Sept. 2019, 40 cases were enrolled in the study and were randomized by envelope technique at the time of surgery to either a trans-obturator vaginal tape (TOT) or Needleless anti-incontinence procedure. The patients will be divided into 2 groups: Group 1 patient treated by standard sling (TOT). Group 2 those treated by mini-sling. Parameters in perioperative period such as operating time, intraoperative hemorrhage volume, length of stay in hospital, intraoperative complications, and postoperative pain of each patient were recorded. The sample size was calculated to be 40 cases (20 cases will be treated by standard slings, 20 case will be treated by mini-sling). Results: A total of 40 patients assessed for eligibility were randomized into Needleless groups. There were no significant differences in age, body mass index, process, parity, pad test or the assessment of preoperative quality of life between the two groups. In the perioperative period, statistically significant differences between the two groups were found in operating time, intraoperative hemorrhage volume, groin pain scores at 24 h after operation and length of stay in hospital (P 0.05). Both groups registered a significant improvement in the quality of life (P 0.05). Conclusion: We conclude that compared with the TOT surgery, single-incision Needleless sling in the treatment of female stress urinary incontinence is simpler and quicker and has less hemorrhage during surgery as well as faster recovery and it also can obviously reduce the inguinal region pains after operation and shorten hospital stays. In summary, single-incision Needleless sling is a kind of convenient, safe and effective minimally invasive surgery for urinary incontinence.

Comparative Analysis of Three Internal Fixation Methods for Intertrochanteric Fracture of Femur in the Elder

As the average life span of the Chinese prolongs, the number of intertrochanteric fractures of the femur in elderly patients has increased all the time, and gradually becomes a more common type of fracture in elderly patients. From January 2011 to December 2016, 137 elderly patients with intertrochanteric fractures were treated with 3 mehhods, including locking plate, proximal femoral nail (PFNA) and artificial femoral head replacement. The mean age was 79.16±3.45 years. The mean follow-up time was 17.20±1.30 months. The operative time, intraoperative bleeding volume, postoperative complications, and Harris score of the hip joint at 1 month and 1 year after surgery were compared among the three groups. Statistical analysis by SPSS 22.0 software showed that the operation time of group C was the shortest, followed by group B and group A. The difference was statistically significant (p<0.05). There was no significant difference in operation time between group A and group B (p>0.05); There was no significant difference in bleeding volume between the three groups (p>0.05). Group A had the lowest complication rate, followed by group C and group B. But there was no significant difference between the three groups (X2=0.0618, p>0.05). All the patients were cured and discharged after active symptomatic treatment. Among the patients, the mean Harris score of group A was 38.52±6.51 at 1-month follow up postoperatively; the mean Harris score of group B was 44.28±5.97 at 1-month follow up postoperatively; the mean Harris score of group C was 70.59±6.99 at 1-month follow up postoperatively, the C group was the best and the B group was the second. There was a significant difference between the three groups (p<0.05). The mean Harris score of group A was 84.40±9.34 at 1-year follow up postoperatively; the mean Harris score of group B was 83.12±8.76 at 1-year follow up postoperatively; the mean Harris score of group C was 85.25±8.07 at 1-year follow up postoperatively. There was no significant difference between the three groups (p>0.05). During the follow-up period, there was no loosening or breakage in the internal fixation, and the fracture healed well. This study concluded that locking plate, PFNA or artificial femoral head replacement can achieve satisfactory clinical results in elderly patients with intertrochanteric fractures, but artificial femoral head replacement can achieve early functional recovery, more conducive to elderly patients.

Fully covered self-expandable metal stent with an anti-migration system vs plastic stent for distal biliary obstruction caused by borderline resectable pancreatic cancer: A protocol for systematic review.

Background and aim:Biliary obstruction can impair the effectiveness of neo-adjuvant chemotherapy. This study was designed to compare biliary stenting with covered self-expandable metal stents (FCSEMS) and plastic stents (PS) in patients with biliary obstruction caused by borderline resectable pancreatic cancer (BRPC) who were undergoing neo-adjuvant chemotherapy during preoperative biliary drainage.Methods:This single-center, comparative, randomized, superiority study was designed to compare FCSEMS with PS for drainage of biliary obstruction of BRPC. Twenty two eligible patients providing informed consent will be randomized 1:1 by computer to either FCSEMS or PS for endoscopic retrograde biliary drainage (ERBD). All subsequent clinical interventions, including crossover to alternative procedures, will be at the discretion of the treating physician based on standard clinical care. The primary outcomes will be the rates and causes of stent dysfunction during preoperative biliary drainage. Other outcomes include time required for ERBD, adverse events related to ERBD, period from ERBD to surgery, percentage of patients able to undergo surgery, operation time, intraoperative bleeding volume, postoperative adverse events, and postoperative hospitalization. Subjects, treating clinicians, and outcome assessors will not be blinded to assignment.Discussion:This study is intended to determine whether FCSEMS or PS is the better biliary stent for ERBD for management of patients with biliary obstruction of BRPC, a common clinical dilemma that has not yet been investigated in randomized trials.Trials registration:UMIN-CTR, Identifier: UMIN000030473. Registered July 10, 2017, Wakayama Medical University Hospital.

Effects of dexmedetomidine on perioperative brain protection in patients undergoing craniocerebral surgery under inhalation anesthesia with sevoflurane: a randomized controlled study

Background and objective: The inhalational anesthetic sevoflurane is often used in craniocerebral surgery for its advantages of quick onset, stable circulation, high safety, and few adverse reactions. However, it can also lead to abnormal blood pressure and heart rate, as well as restlessness and pain. Therefore, an auxiliary anesthetic is needed to help reduce adverse reactions. Dexmedetomidine is a potent and highly selective α2 adrenergic receptor agonist that has anti-anxiety, hypnotic, analgesic, sedative, and sympatholytic properties. Dexmedetomidine has been shown to reduce restlessness after sevoflurane inhalation anesthesia and minimize perioperative hemodynamic fluctuation. However, its application in craniocerebral surgery should be validated. The purpose of this study was to investigate the efficacy of dexmedetomidine in craniocerebral surgery under sevoflurane inhalation anesthesia. Subjects and methods: The prospective, single-center, randomized, controlled study will be performed in Taihe Hospital (Shiyan, China). The 1308 patients to be included in this study will be randomly divided into a trial group and control group (n = 654 patients per group) based on a table of random permutations. In both groups, sevoflurane will be used for induction of anesthesia for craniocerebral surgery. In the trial group, 1 μg/kg dexmedetomidine will be injected intravenously for 10 minutes commencing 15 minutes before anesthesia induction, and then continuously pumped at 0.3 μg/kg per hour until 30 minutes before surgery. In the control group, 0.9% sodium chloride injection will be administered in the same way and at the same injection rate. This trial was approved by the Ethics Review Committee of Taihe Hospital on December 8, 2015 (approval No. 2015GJJ-087). Protocol version: 1.0. Participants will not be blind to the study protocol or procedure, and will provide signed informed consent. Results: The primary outcome of this study is recovery time. Secondary outcomes of this study include anesthesia, recovery, and adverse events, as well as vital signs, stress index, and cerebral metabolic rate of oxygen consumption at different time points (before and after administration of the loading dose of dexmedetomidine, during anesthesia induction, at the beginning of craniocerebral surgery, during craniocerebral surgery, at the end of craniocerebral surgery, and at the time of recovery). A pilot study involving 190 patients who underwent craniocerebral surgery was performed between March 2016 and February 2017. These 190 patients randomly received either sevoflurane anesthesia (n = 95, control group) or dexmedetomidine and sevoflurane anesthesia (n = 95, trial group). Results of the pilot group showed that anesthesia time, intraoperative bleeding volume, intraoperative infusion volume, recovery time, and extubation time were similar between trial and control groups (P > 0.05). However, compared with the control group, the administered dosages of vasoactive drugs ephedrine and esmolol were significantly lower (P Conclusion: Findings from this study will help determine whether dexmedetomidine can reduce hemodynamic fluctuation, lower stress index, and protect the brain in patients who undergo craniocerebral surgery under inhalation anesthesia with sevoflurane. The results can provide evidence to support clinical application of dexmedetomidine combined with sevoflurane for craniocerebral surgery. Trial registration: This study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR2000030459).

Clinical application of percutaneous transforaminal endoscope-assisted lumbar interbody fusion

To conclude of the technical notes of percutaneous transforaminal endoscope-assisted lumbar interbody fusion (PT-Endo-LIF), and to investigate its safety and efficacy for treatment of degenerative lumbar disease. Twenty-four patients were treated by PT-Endo-LIF combined with posterior percutaneous pedicle screws fixation from October 2017 to April 2018. There were 16 males and 8 females, ranging in age from 39 to 72 years old, with a mean of (59.6±9.5) years old. There were 15 cases diagnosed with lumbar intervertebral disc herniation combined with degenerative disc, the other 9 cases were diagnosed as low level lumbar spondylolistheses w/o segmental instability. Single segmental fusion was performed for 22 cases(one for L₂,₃, 3 for L₃,₄ and 18 for L₄,₅) and 2 segmental fusion was performed for the other 2 cases (both for L₃,₄ and L₄,₅). PT-Endo-LIF was performed under local anesthesia with conscious sedation, followed by decompression through endoscopic technics. After that, end-plate preparation and autogenous bone and expandable cage implantation were performed. Finally, percutaneous screws and rod instrumentation were used. The visual analogue scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the clinical efficacy. The operation time, intraoperative bleeding volume, intraoperative and postoperative complications were recorded. All patients underwent X-ray, CT plain scan, three-dimensional reconstruction and MRI examination to evaluate the stability of the implants and fusion rate before 3 days and 1, 3, 6, 12 and 18 months after operation. All patients were followed up, and the duration ranged from 12 to 18 months. The operation time of single-segment fusion was (192.3±22.7) min, and that of double-segment fusion was (272.5±24.7) min. The estimated intraoperative bleeding volume was less than 50 ml per segment, and no blood transfusion was performed in all patients. The VAS improved from preoperative 7.4±1.1 to postoperative 2.3±0.8 (t=-19.65, P<0.000 5). The ODI improved from preoperative (41.2±3.3)% to the final follow-up (12.3±2.5)%(t=-35.76, P<0.000 5). Postoperative complications occurred in 4 cases, and contralateral radicular symptoms occurred in 2 cases. After contralateral foraminoscopic decompression, the symptoms were completely alleviated. One case had neurological symptoms related to percutaneous screw placement, and the symptoms were alleviated after removal of the lateral screw rod internal fixation. The other cases had surgical incision infection and improved after debridement and suture. At the latest follow-up, no displacement or loosening of the fusion cage and screw rod system occurred in all patients, and 14 cases showed signs of fusion. PT-Endo-LIF is a minimal invasive, safe and efficient surgical procedure for treatment of degenerative lumbar disease. Nevertheless, the long-term results still need to be confirmed by a multi-center and lagre sample follow-up study.

Long term outcome of posterior lumbar pedicle screw fixation combined with isthmic bone graft fusion in the treatment of lumbar spondylolysis in young patients

To investigate the long-term effect of posterior lumbar pedicle screw fixation combined with isthmus bone grafting and fusion in young patients with spondylolysis. A retrospective study was carried out, consisting of 16 young patients with lumbar spondylolysis without spondylolisthesis treated by lumbar posterior pedicle screw fixation combined with isthmic bone grafting fusion from January 2006 to July 2014. There were 11 males and 5 females, aged from 18 to 21 years old, with an average age of 19.3 years old, and the course of disease ranged from 12 to 26 months, with an average of 22 months. All the patients suffered from lumbar pain and difficulty in getting out of bed. Preoperative CT confirmed 12 cases of L₅ isthmus fissure and 4 cases of L₄ isthmus fissure. Bone graft fusion was confirmed and internal fixation was removed after operation. Lumbar spondylolysis was evaluated by lumbago visual analogue scoring method at preoperative and postoperative time points. Lumbar isthmic fusion was evaluated by lumbar CT, and degeneration of fixed and adjacent segments of lumbar intervertebral disc was evaluated by lumbar MRI. Of the 16 patients, 13 patients (26 sides) were followed up, with a mean duration of 96 months. The operation time ranged from 80 to 105 minutes, with an average of 95 minutes. The intraoperative bleeding volume ranged from 150 to 300 ml, with an average of 225 ml. All the patients were successfully operated without any complications related to the operation. VAS scores at each time point after operation were improved compared with those before operation(P<0.01). Postoperative CT scans of lumbar spine showed osseous fusion at 6 to 14 months, with an average of 12 months. There were no changes of adjacent segment degeneration, fixed segment disc degeneration and protrusion on lumbar spine MRI, and no symptomatic recurrence or recurrent spondylolysis in the long term. The posterior lumbar pedicle screw fixation combined with isthmic bone grafting and fusion is safe and effective in the treatment of young spondylolysis. The fusion rate is high and the interference of normal physiological range is reduced. The long-term effect is satisfactory.

Gastrointestinal endoscopy in early diagnosis and treatment of gastrointestinal tumors.

Objective:To explore the value of gastrointestinal endoscopy in the early diagnosis and treatment of gastrointestinal tumors and lay a foundation for the diagnosis and treatment of gastrointestinal tumors.Methods:One hundred and eight patients with gastrointestinal tumors who were admitted to our hospital from August 2016 to April 2018 were retrospectively analyzed and divided into observation group and control group according to different diagnostic methods, 54 cases in each group. The control group was treated with traditional endoscopy (white light imaging) and traditional surgery, while the observation group underwent narrow band imaging (NBI) based on endoscopic examination and endoscopic mucosal resection. The image quality scores (morphological image, gastric pit image and capillary image), diagnostic accuracy, surgery related clinical indicators (operation time, intraoperative bleeding volume, hospitalization days) and complications were observed and compared between the two groups.Results:The morphological image, gastric pit image and capillary image scores of the observation group were higher than those of the control group (P<0.05). The diagnostic accuracy rate of the observation group was 96.30%, which was significantly higher than 75.93% (P<0.05). The operation time and hospitalization days of the observation group were shorter than those of the control group, and the intraoperative bleeding volume of the observation group was less than that of the control group; the differences were statistically significant (P<0.05). The incidence of complications of the observation group was lower than that of the control group, and the difference was statistically significant (P<0.05).Conclusion:Gastrointestinal endoscopy can accurately identify the pathological changes of tumors in the early diagnosis and treatment of gastrointestinal tumors, improve the diagnostic accuracy rate, and guide the implementation of treatment measures to improve clinical indicators. Moreover the incidence of postoperative complications is low. It is worth clinical promotion.

A comparative study of all-arthroscopic technique and modified open Broström technique in repair of anterior talofibular ligament with anchors

To compare the effectiveness of all-arthroscopic technique and modified open Broström technique in repair of anterior talofibular ligament (ATFL) for lateral instability of the ankle (LIA). A retrospective analysis was made on 65 patients who underwent ATFL repair with anchors for LIA between January 2014 and January 2017. The ATFL was repaired by all-arthroscopic technique in 35 patients (arthroscopic group) and modified open Broström technique in 30 patients (open group). There was no significant difference in age, gender, the side of injured ankle, the time from injury to operation, and preoperative anterior displacement of talus, tilt angle of talus, the Karlsson Ankle Functional (KAF) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Japanese Society for Surgery of the foot ankle-hindfoot (JSSF) scale score between the two groups (P>0.05). The operation time, the intraoperative bleeding volume, and the length of time for surgery recovery were recorded. The anterior displacement of talus, the tilt angle of talus, KAF score, AOFAS score, and JSSF scale score were evaluated at 2 weeks, 3 months, and the last follow-up. All patients were followed up 24-30 months, with an average of 26 months. The operation time, intraoperative bleeding volume, and the length of time for surgery recovery of arthroscopic group were superior to open group (P<0.05). There were 2 cases of temporary ankle and dorsum numbness and 1 case of thread reaction in arthroscopic group; and there were 2 cases of temporary ankle and dorsum numbness and 2 cases of thread reaction in open group. The AOFAS score, KAF score, and JSSF scale score in arthroscopic group were significantly higher than those in open group (P<0.05) at 2 weeks after operation; there was no significant difference between the two groups at 3 months and the last follow-up (P>0.05). There was no significant difference in the anterior displacement of talus and the tilt angle of talus between the two groups at 2 weeks, 3 months, and last follow-up (P>0.05). Compared with the modified open Broström technique, the all-arthroscopic technique, as a minimally invasive technique, can achieve the same effectiveness, and has the advantages of shorter operation time, less intraoperative bleeding, and less pain in the early stage.

Short-term effectiveness of acetabular reconstruction with three-dimensional printed trabecular metal pads in hip revision

To investigate the short-term effectiveness of three-dimensional (3D) printed trabecular metal pads for Paprosky type Ⅲ acetabular defect in hip revision. Between August 2014 and December 2015, the 3D printed trabecular metal pads were used to repair Paprosky type Ⅲ acetabular defects and reconstruct the annular structure of the acetabulums in 5 cases of primary hip revision. There were 3 males and 2 females, aged from 50 to 72 years, with an average age of 66 years. The time from initial replacement to revision was 10 to 18 years, with an average of 14.4 years. The types of prostheses in primary replacement were non-cemented in 3 cases and cemented in 2 cases. The types of acetabular bone defects were Paprosky type ⅢA in 3 cases and Paprosky type ⅢB in 2 cases. The preoperative Harris score was 34.23±11.67. The height of rotation center of affected hip was (38.17±8.87) mm and the horizontal position was (35.62±9.12) mm. The operation time was 120-180 minutes, with an average of 142 minutes. The intraoperative bleeding volume was 800-1 700 mL, with an average of 1 100 mL. Five patients were followed up 18-24 months (mean, 21 months). At last follow-up, the Harris score was 79.82±8.70, which was significantly higher than that before operation (t=16.991, P=0.000). At 1 week after operation, the abduction angle of acetabular cup was 38-42° (mean, 39.4 °) and the anteversion angle was 13-18 ° (mean, 14.6°). The height and horizontal position of rotation center of affected hip were (22.08±8.33) mm and (29.03±6.28) mm, respectively, showing significant differences when compared with those before operation (P<0.05); there was no significant difference when compared with those of healthy hip [(28.62±7.73), (27.29±4.22) mm] (P>0.05). During the follow-up, there was no complication such as prosthesis loosening, dislocation, or periprosthetic fracture. In hip revision, 3D printed trabecular metal pads can repair Paprosky type Ⅲ acetabular defect, reconstruct the structure of acetabulum, provide a stable supporting structure for the acetabular cup, reconstruct the relatively normal rotation center of the hip joint, avoid iatrogenic bone loss, and achieve satisfactory functional recovery of the hip. The long-term effectiveness needs further follow-up.

Open reduction and internal fixation via modified Stoppa approach for pelvic fractures of Tile type C combined with acetabular both-column fractures

Objective To evaluate the clinical efficacy of the modified Stoppa approach in the surgical treatment of pelvic fractures of Tile type C combined with acetabular both-column fractures. Methods Between April 2014 and April 2017, a total of 14 patients were treated by open reduction and internal fixation (ORIF) through the modified Stoppa approach at Department of Orthopaedics, Foshan Gaoming Hospital for pelvic fractures of Tile type C combined with acetabular both-column fractures. They were 10 men and 4 women, with an average age of 36.4 years (from 23 to 57 years). The modified Stoppa approach was used exclusively in 4 cases, in combination with the iliac fossa approach in 3 ones, in combination with the Kocher-Langenbeck approach in 4 ones and in combination with the Kocher-Langenbeck and iliac fossa approaches in 3 ones. In all the patients, the pelvic reconstructive plate and screws and lag screws were used. The operation time, intraoperative bleeding volume, postoperative fracture reduction, fracture union time, efficacy and complications were recorded. Results The operation time averaged 170 min (from 110 to 330 min) and the intraoperative bleeding 420 mL (from 240 to 1 100 mL). There were no operative complications. By the Matta evaluation, the postoperative reduction was rated as excellent in the 14 pelvic fractures and 9 acetabular both-column fractures and as good in 5 acetabular both-column fractures. Of this series, 13 patients were followed up for an average of 19 months (from 12 to 29 months) and one was lost to the follow-up. The fractures got united after an average time of 3.4 months (from 2.7 to 4.6 months). Screw loosening was observed in one case and mild limitation to hip flexion in one. Follow-ups found no lateral ventral syndrome or femoral head necrosis. Their Harris hip scores at the last follow-up ranged from 70 to 94 points, averaging 84 points. The function of the affected hip was excellent in 6 cases, good in 5 and fair in 2. Conclusion The modified Stoppa approach may be used exclusively or in combination with other approaches to treat effectively the pelvic fractures of Tile type C combined with acetabular both-column fractures, leading to good short-term clinical outcomes. Key words: Pelvis; Acetabulum; Fractures, bone; Fracture fixation, internal; Surgical approach

Minimally Invasive Decompression and Intracorporeal Bone Grafting Combined with Temporary Percutaneous Short-Segment Pedicle Screw Fixation for Treatment of Thoracolumbar Burst Fracture with Neurological Deficits

We evaluated the clinical and radiographic outcomes of patients with thoracolumbar burst fractures and neurological deficits treated with minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment stabilization. Patients with thoracolumbar burst fractures and neurological deficits underwent minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment stabilization. Instrumentation was removed approximately 1 year after vertebral fracture union. The clinical and radiographic outcomes were analyzed. The mean operative duration and intraoperative bleeding volume were 135 ± 63 minutes and 120 ± 200 mL, respectively. The average American Spinal Injury Association impairment scale scores had significantly improved at the final follow-up examination. The visual analog scale score had decreased from 7.8 ± 1.1 preoperatively to <2.9 ± 1.3 (P < 0.05) at 1 week postoperatively. The Oswestry disability index had decreased from 86.1 ± 8.8 preoperatively to 15.9 ± 6.4 (P < 0.05) at 1 year postoperatively. The canal stenosis index had improved from 43.4% ± 12.0% to 93.8% ± 4.8% (P < 0.05). The sagittal Cobb angle had been corrected from 17.8° ± 7.5° to 4.0° ± 1.9° (P < 0.05) and remained at 4.9° ± 2.0° (P > 0.05) at 1 year postoperatively. The sagittal index had been corrected from 16.6° ± 6.1° to 0.3° ± 4.6° (P < 0.05) and remained at 1.5°+ 4.5° (P > 0.05) at 1 year postoperatively. The anterior vertebral height had increased from 49.3% ± 11.1% to 97.6% ± 6.5% (P < 0.05) and remained at 95.7% ± 6.0% (P > 0.05) at 1 year postoperatively. After implant removal, the total kyphosis correction losses were 1.5° ± 0.8° for the Cobb angle, 2.0° ± 1.1° for the sagittal index, and 3.4% ± 2.1% for the anterior vertebral height. One pullout screw and one broken rod were found in 1 patient each. Minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment fixation yielded satisfactory results in decompression and immediate kyphosis correction. Additionally, this procedure resulted in maintenance of the vertebral height and prevented late correction loss after implant removal.

Clinical application of three-dimensional computed tomography bronchography and angiography in thoracoscopic segmentectomy

Objective To explore the clinical value of three-dimensional computed tomography bronchography and angiography (3D-CTBA) in thoracoscopic dissection or combined segmentectomy. Methods The clinical data of 30 patients with isolated or multiple pulmonary nodules from September 2017 to August 2019 were retrospectively analyzed. All cases were treated with 3D-CTBA to locate the nodules accurately before operations, in order to explicit the courses of bronchi and vessels, and to observe the variations. The target bronchi, arteries and veins were resected accurately during the operations, and the intersegmental plane was determined by expansion-collapse method. Results 13 patients underwent segmentectomy and 17 patients underwent combined segmentectomy. The diameter of the nodule was (11.56±3.79)mm; the depth of the nodule (the shortest distance from the visceral pleura) was (13.88±3.96)mm; the operation time was (134.94±18.68)min, and the intraoperative bleeding volume was (94.38±37.94)ml. No cancer metastasis was found by rapid pathological examination of lymph nodes during operations. No conversion to thoracotomy. The indwelling time of thoracic tube was (3.69±1.30)days, and the hospitalization days after operations was (4.81±1.47)days. No serious complications or death during the perioperative period. Conclusions Preoperative 3D-CTBA has advantages in pulmonary segmentectomy, which is a safe and effective method for accurate segmentectomy. Key words: Imaging, three-dimensional; Bronchography; Thoracoscopy; Pneumonectomy

Comparison of sun's tip-flexible ureterorenoscopy and minimally invasive percutaneous nephrolithotomy in the treatment for senile upper ureteral incarcerated calculi

Objective To compare the efficacy of Sun's tip-flexible ureterorenoscopy and minimally invasive percutaneous nephroscopy in the treatment of incarcerated upper ureteral calculi in elderly patients. Methods From July 2016 to December 2017, 60 elderly patients with upper ureteral incarcerated calculi were selected from the department of urology of the Huaian hospital affiliated to Xuzhou medical university. According to the order of hospitalization, it was divided into the Sun's tip-flexible ureterorenoscopy (30 cases) and the minimally invasive percutaneous nephroscope (30 cases), respectively, with Sun's tip-flexible ureterorenoscopy and minimally invasive percutaneous nephrolithotomy. The one-time success rate, stone clearance rate, intraoperative bleeding volume, postoperative hospital stay, postoperative complications, postoperative comfort, pain and trauma index (TNF-a, IL-6 and CRP) were compared between the two groups. Results The two groups were successful in the first stage operation, and there was no significant difference between the two groups after 1 month of operation (P>0.05). The intraoperative bleeding volume, postoperative hospitalization time and incidence of postoperative complications in the Sun's tip-flexible ureterorenoscopy group were significantly lower than those in the minimally invasive percutaneous nephrolithotomy group (P<0.05), and the pain scores in the Sun's tip-flexible ureterorenoscopy group were significantly lower than those in the minimally invasive percutaneous nephrolithotomy group (P<0.05), while the comfort scores were significantly higher than those in the minimally invasive percutaneous nephrolithotomy group (P<0.05). The levels of serum TNF-α, IL-6 and CRP in both groups increased 24 hours after operation, but decreased 72 hours later. The levels of TNF-α, IL-6 and CRP in percutaneous nephroscopy group were significantly higher than those in Sun's tip-flexible ureterorenoscopy group at different time points (P<0.05). Conclusions Sun's tip-flexible ureterorenoscopy and minimally invasive percutaneous nephroscope both have high lithotripsy efficiency in the treatment of incarcerated upper ureteral calculi in the elderly, but Sun's tip-flexible ureterorenoscopy has the advantages of small trauma, low complications and high comfort, which is worthy of wide clinical application. Key words: Ureteral Calculi; Ureteroscopy; Nephrostomy, Percutaneous

Comparison of ureteral soft endoscopy and pneumatic lithotripsy in the treatment of renal calculi and its effect on serum NGAL, WBC level

Objective To investigate the effect of ureteral soft endoscopy and pneumatic lithotripsy in patients with renal calculi and its effect on serum NGAL, WBC level. Methods From September 2015 to September 2016, 216 patients with renal calculi were randomly divided into two groups: control group (n=108) and observation group (n=108). The observation group was treated with ureteral soft lithotripsy and the control group with pneumatic lithotripsy.The success rate of lithotripsy, the incidence of adverse reactions, the time of hospitalization, the time of operation, the amount of intraoperative bleeding and the level of NGAL were compared between the two groups. Results There was no significant difference in the success rate of lithotripsy between the observation group (79.31%) and the control group (72.41%). The incidence of adverse reactions in the observation group was 5.17%, which was significantly lower than that in the control group (17.24%). The postoperative hospitalization time, operation time and intraoperative bleeding volume in the observation group were significantly lower than those in the control group(t=10.166, P=0.000; t=18.245, P=0.000; t=25.296, P=0.000). Before operation, there was no significant difference in WBC, CRP, NGAL and Scr between the observation group and the control group(P>0.05). The levels of NGAL in the observation group were significantly lower than those in the control group at 24, 48 and 72 h after operation(t=5.316, P=0.000; t=4.969, P=0.000; t=3.319, P=0.000). Twenty-four hours after operation, the levels of WBC, CRP and Scr in the observation group were lower than those in the control group(t=5.127, P=0.000; t=3.280, P=0.001; t=3.687, P=0.000). Conclusions Compared with pneumatic lithotripsy, soft ureteroscopic lithotripsy has the advantages of less adverse reaction, shorter operation time, less bleeding and less damage to renal function. Key words: Kidney Calculi; Ureteroscopy; Lithotripsy; Lipocalins; Leukocytes

Clinical characteristics during the perioperative period of pheochromocytomas in the elderly

Objective To investigate the clinical characteristics during the perioperative period of pheochromocytoma in patients aged 60 years and over. Methods Data of age, sex, tumor size, anesthesia time, intraoperative bleeding volume, intraoperative blood pressure, complications and hospitalization time from patients with pheochromocytoma in our hospital treated by the retroperitoneal laparoscopic adrenalectomy from January 2008 to October 2018 were retrospectively analyzed.The relationships of age with the intraoperative hemodynamic instability and postoperative complications were analyzed. Results A total of 203 patients with pheochromocytoma met the inclusion criteria were enrolled.Age over 60 years(OR1.771, 95%CI=1.015-3.089, P=0.044)was an independent risk factor for intraoperative hemodynamic instability. Conclusions Laparoscopic retroperitoneal adrenalectomy is a safe surgical method for pheochromocytoma patients aged 60 years and over.For elderly patients with pheochromocytoma, especially those with a tumor diameter of more than 5 cm, special attention should be paid to the prevention of intraoperative hypertension crisis. Key words: Pheochromocytoma; Perioperative period

231.2: Advantages of extrahepatic Glissonean approach in the donor operation in living donor liver transplantation.

Background: In the donor operation for living donor liver transplantation (LDLT), it is required to preserve the appropriate length and sufficient blood supply of bile ducts for both the remnant liver and the graft. We introduced the extrahepatic Glissonean approach combined with liver hanging maneuver in the living donor operation since 2016 to preserve blood supply of the hilar plate and secure the maximum length of the bile duct. We report the beneficial effect of the technique comparing the outcomes before and after the introduction. Methods: Surgical procedures are as follow. The first step is extrahepatic Glissonean pedicle isolation and the second one is liver transection with liver hanging maneuver. Prior to liver transection, we secure the extrahepatic Glissonean pedicle at the donation side approaching the gap between the Glissonean pedicle and Laennec’s capsule. Then, we introduce a hanging tape from the encircle point of Glissonean pedicle to the groove between the middle hepatic vein and right hepatic vein. Liver transection was initiated from the demarcation line and performed with the hanging maneuver. After the completion of transection, hepatic artery and portal vein of the donation side were isolated in the hilar part. The encircled pedicle without hepatic artery and portal vein was recognized as bile ducts. We compared surgical and clinical outcomes (operation time, intraoperative bleeding volume, postoperative stay, incidences of bile duct leakage and bile duct stenosis in donors and 1-year survival in recipients) of Glissonean approach group (2016-) with those of conventional technique group (2005-2015). Results: We performed 149 (lateral segment graft in 36, left lobe graft in 72, and right lobe graft in 41) and 42 (lat. seg. in 7, left in 24, and right in 11) of living donor operations before and after the introduction, respectively. There were no statistically significant differences in operation time, bleeding amount, postoperative stay between the groups. Bile duct stenosis was observed in 2 cases (1.3%) in conventional technique group but was not observed in Glissonean approach group. In conventional technique group, the incidence of bile leakage was higher in the left lobe graft than in right lobe graft (0.7% vs 6.0%). The incidence of bile leakage did not differ between the groups in lateral segment donor (0% vs 0%) and right lobe graft donor (0.7% vs 0%), but was markedly reduced in Glissonean approach group compared to conventional technique group in left lobe graft donor (4.2% vs 13.0%). One-year survival of recipients did not differ between the groups (90.6% vs 87.2%). Conclusions: The proposed procedures with extrahepatic Glissonean approach and pedicle guided liver transection enable minimum dissection of hilar part, preservation of blood supply for bile ducts, and dissection of bile ducts at the ideal point. The introduction was beneficial for reducing the incidence of bile duct complications.

Application of 3D printed osteotomy guide plate-assisted total knee arthroplasty in treatment of valgus knee deformity

IntroductionTo analyze the application of 3D printed osteotomy guide plate-assisted total knee arthroplasty (TKA) for valgus knee deformity.MethodsThe clinical data of 20 patients with valgus knee deformity admitted to our hospital from April 2012 to April 2017 were collected and analyzed. According to the treatment method, these patients were divided into two groups: 3D printed osteotomy guide plate-assisted TKA (combined treatment group, n = 10) and TKA (treatment group, n = 10). The operation time, intraoperative bleeding volume, postoperative mean femorotibial angle (MFTA), and Knee Society Score (KSS) of the two groups were statistically analyzed.ResultsCompared with the treatment group, the operation time was significantly shorter (P < 0.05), the intraoperative blood loss and postoperative MFTA were significantly decreased (P < 0.05), and the clinical and functional scores were significantly increased (P < 0.05) in the combined treatment group.Conclusion3D printed osteotomy guide plate-assisted TKA for valgus knee deformity is more effective than TKA alone.