Occurrence Rate Of Postoperative Complications Research Articles

Effect of sinus resection combined with vacuum-assisted closure on sacrococcygeal pilonidal sinus.

This study was aimed at investigating the effect of sinus removal combined with vacuum-assisted closure in the treatment of sacrococcygeal pilonidal sinus. From January 2019 to May 2022, 62 patients with sacrococcygeal pilonidal sinus were treated and their information was collected at our hospital. These patients were randomly divided into two groups: an observation group (n = 32) and a control group (n = 30). The control group underwent a simple sinus resection and suture, while the observation group received a sinus resection combined with closed negative pressure drainage of the wound. A retrospective analysis of the data obtained was conducted. Perioperative indicators, clinical efficacy, postoperative pain, complications, aesthetic effects, and satisfaction scores at six months after the operation were compared between the two groups, and the recurrence rate at six months after the operation was recorded. Through this study, we found that the observation group had significantly shorter surgery time, hospital stay, and return time compared with the control group (P < 0.05). Additionally, the observation group had a higher overall recurrence rate (ORR) of 100.00%, which was significantly better than the control group's ORR of 86.67% (P < 0.05). The visual analog scale (VAS) score at 6, 12, and 24 h after the operation was significantly lower in the observation group compared with the control group (P < 0.05). Although the differences were not significant (P > 0.05), the observation group had decreased white blood cell, neutrophil, and C-reactive protein levels after the operation. Moreover, the total occurrence rate of postoperative complications in the observation group was significantly lower (6.25%) than that of the control group (26.67%; P < 0.05). The observation group also had significantly lower scores on the postoperative scar scale and higher satisfaction scores than the control group (P < 0.05). However, there was no significant difference in the postoperative recurrence rate between the two groups (P > 0.05). Our study demonstrated that sinus resection combined with vacuum-assisted closure was more effective in treating sacrococcygeal pilonidal sinus compared with simple sinus resection and suture. This approach significantly reduced surgery time, hospital stay, and return time. It also effectively relieved postoperative pain, reduced the occurrence of postoperative complications, resulted in smaller postoperative scars, and yielded better aesthetic outcomes and higher patient satisfaction.

Surgical Outcomes of Laparoscopic versus Open Hepatectomy for Left Hepatocellular Carcinoma: Propensity Score Analyses Using Retrospective Japanese and Korean Individual Patient Data

Introduction: This study aimed to compare the prognostic impact of laparoscopic left hepatectomy (LLH) with that of open left hepatectomy (OLH) on patient survival after resection of left hepatocellular carcinoma (HCC). Methods: Among the 953 patients who received initial treatment for primary HCC that was resectable by either LLH or OLH from 2013 to 2017 in Japan and Korea, 146 patients underwent LLH and 807 underwent OLH. The inverse probability of treatment weighting approach based on propensity scoring was used to address the potential selection bias inherent in the recurrence and survival outcomes between the LLH and OLH groups. Results: The occurrence rate of postoperative complications and hepatic decompensation was significantly lower in the LLH group than in the OLH group. Recurrence-free survival (RFS) was better in the LLH group than in the OLH group (hazard ratio, 1.33; 95% confidence interval, 1.03–1.71; p = 0.029), whereas overall survival (OS) was not significantly different. Subgroup analyses of RFS and OS revealed an almost consistent trend in favor of LLH over OLH. In patients with tumor sizes of ≥4.0 cm or those with single tumors, both RFS and OS were significantly better in the LLH group than in the OLH group. Conclusions: LLH decreases the risk of tumor recurrence and improves OS in patients with primary HCC located in the left liver.

Primary Suture of the Common Bile Duct: Continuous or Interrupted?

Objective: To compare the effectiveness and safety of continuous suture and interrupted suture in Laparoscopic Common Bile Duct Exploration (LCBDE) for choledocholithiasis. Materials and Methods: The data of 125 patients with choledocholithiasis treated with LCBDE in our department from January 2017 to January 2019 were retrospectively collected and divided into two subgroups: the continuous suture group (n = 56) and the interrupted suture group (n = 69). The operation duration, time to suture, intraoperative blood loss, extubation time, hospital stay, total hospitalization expenses, preoperative and postoperative diameters of the common bile duct (CBD), and the occurrence rate of postoperative complications were all compared between the two groups. Results: The operative duration, time to suture, and intraoperative blood loss in the continuous suture group were less compared with those in the interrupted suture group (P < .05). There was no statistical significance between the 2 groups considering extubation time, hospital stay, total hospitalization expenses, and the occurrence rate of postoperative complications (P > .05). The postoperative CBD diameters in both groups were significantly larger than the preoperative CBD diameters (P < .05). Conclusions: The continuous suture technique shortened the operative duration, time to suture, and reduced intraoperative blood loss. It proves to be an effective and safe method in patients diagnosed with CBD stones.

Surgical Treatment for Cervical Spine Fracture in Patients With Ankylosing Spondylitis: Single Posterior Approach or Combined Anterior-posterior Approach?

A retrospective single-center study. We aimed to compare the clinical outcomes of cervical spine fracture accompanied with ankylosing spondylitis (ASCSF) treated by single posterior approach (PA) and combined anterior-posterior approach (CA) for patients who were followed up for >1 year. For ASCSF patients, surgical treatment has been widely accepted as a recommendable therapeutic option. But the optimal surgical approach is still under controversy, and few studies have focused on the comparison between PA and CA. From February 2007 to March 2019, 53 patients were enrolled and divided into the PA group (34 cases) and CA group (19 cases). Their general characteristics and clinical materials were recorded. From the aspects of reduction distance, bone fusion, neurological functional restoration, and postoperative complications, patients' surgical outcomes were evaluated qualitatively and quantitatively. The reduction degree of dislocation (mean PA=2.05 mm, mean CA=2.36 mm, P=0.94) was close between the 2 groups. Besides, with a similar follow-up period (P=0.10), the rate of bone fusion (both 100%) and neurological functional restoration (PA=31.03%, CA=35.29%, P=0.77) were also without significant difference. The occurrence rate of postoperative complications tended to be higher in the CA group (31.58% vs. 23.53%) but with no significant difference (P=0.52). Nevertheless, the surgical duration time (mean=209.15 min) and blood loss (average=388.91 mL) of PA group were significantly less than CA group (mean duration time=285.34 min, mean blood loss=579.27 mL) (P<0.01). Compared with to the CA approach and with the equally significant outcome, surgery by single PA was feasible and should be positively recommended for ASCSF patients, especially for those accompanying with a severe chin-on-chest deformity or poor physical conditions which restrain patients from tolerating a long surgery or major surgical trauma.

The Role of X and CT Image Measurement in Hip Arthroplasty in Patients with Parkinson's Disease

Objective: The study aims at evaluating if X-ray and spiral CT imaging is efficient in patients with Parkinson's disease after total hip arthroplasty (THA). Method: 76 patients with Parkinson combined with hip disease were selected as the study subjects, and grouped into the control group and the experimental group. Before surgery, X-ray and spiral CT were used to detect the data of abduction angle and the front rake of the healthy side of the patient, so as to perform THA as the reference value. In addition, Harris score was adopted to evaluate hip function 3 months after surgery in both groups. Also, the progression of Parkinson after operation was evaluated by Hoehn-Yahr grading method, and the complications were analyzed. Results: The results showed that the abduction angle measured by X-ray was 48.39 ± 4.15°, and the front rake was 13.83 ± 6.27°. In the experimental group, the abduction angle obtained by spiral CT measurement was 46.26 ± 3.92°, and the front rake was 12.44 ± 4.52°. The unequal length of limb was 1.10 ± 0.42 cm in the control group and 0.42 ± 0.21 cm in the experimental group. Moreover, the unequal length of limb in the two groups was significantly smaller than that before surgery (P &lt; 0.01). The hip joint score of the two groups after surgery was apparently higher (P &lt; 0.01), and the experimental group had significantly higher hip joint score (P &lt; 0.05). Additionally, the experimental group had obviously higher Harris score of Parkinson's disease progression (P &lt; 0.05). The occurrence rate of postoperative complications in the control group and the experimental group was 9.09% and 7.69%, respectively, which was not greatly different (P &gt; 0.05). Conclusion: THA based on the data of spiral CT image measurement can achieve better postoperative results, which is conducive to recovering hip joint function and treating Parkinson's disease, and provides experimental basis for the diagnosis and treatment of Parkinson's disease in later clinical.

Comparative analysis of the clinical effect and safety of Laparoscopic Radical Cystectomy + Orthotopic Ileal Neobladder and Open Surgery.

Objectives:To explore the clinical effect and safety of laparoscopic radical cystectomy + orthotopic ileal neobladder and open surgery.Methods:The study was conducted at Jingzhou First People’s Hospital from January 2017 to July 2018. In this study 87 patients undergoing radical cystectomy + orthotopic ileal neobladder were chosen and classified into an observation group (48 cases) and a control group (39 cases) according to the surgical methods. The observation group underwent laparoscopic surgery, while the control group underwent open surgery. Perioperative period and prognostic conditions were compared in both groups.Results:The intraoperative bleeding amount obviously decreased. The recovery time of gastroenteric function and postoperative hospitalization time were significantly shortened. Postoperative pain was significantly alleviated. Compared with the control group, the observation group showed significant differences (P<0.05). The time, amount and difference in pelvic lymph node dissection in both groups were not significantly different (P>0.05). The differences in both groups in terms of the daytime/nighttime urinary continence rate, maximum urinary flow rate, internal bladder pressure, maximum bladder pressure during urination, internal urethral pressure, bladder capacity, and residual urine volume six months after the operation were not statistically significant (P>0.05). There was no significant difference in postoperative complications, including urinary fistula, bleeding, urinary tract infection, pulmonary infection, dysuria, lymphatic leakage, ureterostenosis, or relapse (P>0.05). The ileus incidence rate in the observation group was obviously lower than that in the control group, and the difference was statistically significant (P<0.05).Conclusion:Laparoscopic radical cystectomy + orthotopic ileal neobladder has the characteristics of limited trauma, a minimal amount of bleeding and a fast recovery. The functions of orthotopic neobladders are good, and the occurrence rate of postoperative complications is low. In addition, body immunity is protected. Hence, this procedure deserves to be promoted clinically.

Prognostic factors for postoperative complications after K-wire fixation for paediatric forearm fractures: a multivariate analysis.

Although osteosynthesis using K-wires is a commonly performed procedure, the outcome is not always preferable. We aimed to identify the prognostic factors for postoperative complications in paediatric patients with both-bone forearm fractures. We reviewed 160 paediatric patients who underwent K-wire osteosynthesis for either distal or diaphyseal forearm fractures. We defined the occurrence rate of postoperative complications as the primary outcome and performed a multivariate logistic regression analysis. Variables such as age, sex, mechanism of injury, presence of an open fracture, ulnar or radial fracture and the associated procedure, the K-wire tip procedure and operation time, the duration from injury to operation and operation to implant removal, and duration of casting were included into the model as possible prognostic factors. The mean follow-up period was 51.2 weeks. The total number of complications was 43 (26.2%). Results of the logistic regression analysis indicated that a shorter duration from surgery to K-wire removal caused a significantly higher rate of postoperative complications [odds ratio (OR), 0.99; 95% confidence interval (CI), 0.97-1.0]. The subgroup analyses revealed that intramedullary K-wire fixation for radial fractures (OR, 1.07 × 10-5; 95% CI, 5.46 × 10-10 to 0.211) and a longer casting duration (OR, 0.84; 95% CI, 0.72-0.99) resulted in fewer postoperative infections. An exposed wire tip in the ulna contributed to more postoperative displacement (OR, 6.87; 95% CI, 1.76-26.9). To decrease the risk of postoperative complications, surgeons should bury the wire tip beneath the skin to facilitate a longer duration of K-wire placement.

Impact of Curative Effect of Laparoscopic and Open Partial Nephrectomy for Complex Renal Tumours on Renal Function.

To explore the effect and safety of laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in the treatment of complex renal tumours and to compare renal function in the perioperative period. Comparative study. Departments of Urology and Cardiovascular Medicine, Affiliated Hospital of Hebei University, from July 2016 to June 2018. A total of 168 complex renal tumour patients with renal tumour scoring system scores (R.E.N.A.L) <7 and tumour stages of T1aN0M0~TlbN0M0 (diameter of tumour <7 cm without metastasis) were chosen. The patients were classified into the retroperitoneal laparoscopic partial nephrectomy (RLPN) group and open partial nephrectomy (OPN) group, comprising 84 patients in each group. Intraoperative and postoperative characteristics of both groups were compared. Statistical analysis of the occurrence rate of postoperative complications was conducted. Renal function indicators, including serum urea (UREA), creatinine (Cr), uric acid (UA) and glomerular filtration rate (GFR), were evaluated one day before the operation and one week after the operation. The differences between the two groups in intraoperative renal warm ischaemia time (WIT) and postoperative drainage time were not statistically significant. Compared with OPN group, RLPN group had shorter recovery time of gastrointestinal function, less use of analgesics and longer hospital stay. The difference in the recent occurrence rate of complications was not statistically significant. The differences between the two groups in UREA, Cr, UA and GFR one day before the operation and one week after the operation were not statistically significant (p>0.05). The Cr and UA levels of both groups improved significantly after the operation, and the GFR level declined significantly. The differences were statistically significant compared with preoperation levels (p<0.05). The effect and safety of RLPN in the treatment of complex renal tumours are equal to those of open operations. Laparoscopic surgery involves a small operative wound and contributes to renal function recovery, allowing patients to recover quickly; however, laparoscopic surgery has high technical requirements for its operators.

Application of a novel embeddedness-like pancreaticojejunostomy anastomosis technique used in pancreaticoduodenectomy.

Optimized pancreaticojejunostomy anastomosis was used to investigate the effects on the incidence rate of postoperative complications in pancreaticoduodenectomy. The data of 250 patients who underwent pancreaticoduodenectomy between August 2011 and December 2015 were analyzed; all surgery was performed by a single team. The first 100 surgeries were performed using traditional pancreaticojejunostomy anastomosis, whereas the next 150 patients underwent novel pancreaticojejunostomy anastomosis (the experimental group). General information, disease status and the occurrence rate of postoperative complications [postoperative pancreatic fistula (POPF), biliary leakage, delayed gastric emptying, bleeding and mortality] within 30 days of surgery were observed. In the first group, 56 patients had POPF (56%), the proportion of grades A, B and C was 44% (n=44), 9% (n=9) and 3% (n=3), respectively; in the experimental group, 30 patients had POPF (20%), the proportion of grades A, B and C was 14.67% (n=22), 5.33% (n=8) and 0%, respectively. Furthermore, in the experimental group, none of the patients exhibited postoperative bleeding or succumbed during surgery. The application of the novel embeddedness-like pancreaticojejunostomy anastomosis technique in pancreaticoduodenectomy was safe and effective, and may reduce the incidence of POPF in future.

Safety and efficacy of the perioperative administration of recombinant human brain natriuretic peptide (rhBNP): a systematic review and meta-analysis.

ObjectiveRetrospective studies and a meta-analysis were performed to evaluate the safety and effectiveness of the perioperative administration of recombinant human brain natriuretic peptide (rhBNP) during cardiac surgery under extracorporeal circulation.MethodsComputerized literature searches were performed in Medline, Embase, The Cochrane Library, CNKI, CBM, and WANFANG to find randomized controlled trials (RCTs) related to the perioperative administration of rhBNP during cardiac surgery starting from the database inception until December 2016. Two researchers independently performed study screening, information extraction, and quality evaluation according to the inclusion/exclusion criteria, and a meta-analysis was performed using RevMan 5.2 software.ResultsA total of 12 studies were analyzed, including 12 RCTs and 727 patients. The meta-analysis results indicated that the perioperative administration of rhBNP could reduce the occurrence rate of postoperative complications, length of intensive care unit (ICU) stay, length of hospital stay, and serum creatinine (Scr) levels, and increase the 24-hour urine volume; however, it did not affect the postoperative mortality rate.ConclusionThe perioperative administration of rhBNP during cardiac surgery was safe and effective, and could improve the prognosis of the patients.

Comparison of short-term therapeutic effects between laparoscopic surgery and laparotomy combined with new adjuvant radiochemotherapy in progressive stage-rectal carcinoma

Objective: This study aimed to discuss the short-term therapeutic effects of laparoscopic surgery and laparotomy with new adjuvant radiochemotherapy on rectal carcinoma in the progressive stage. Methods: A total of 120 patients with rectal carcinoma in our hospital from May 2014 to February 2016 were selected and categorized into the control group (n=60) and treatment group (n=60) by random number table method. All respondents were simultaneously treated by new adjuvant radiochemotherapy. The control group was treated by laparotomy, whereas the treatment group received laparoscopic surgery. Operation mode, intraoperative conditions, post-operative rehabilitation effect, and occurrence rate of complications in the near future were compared between the two groups. Results: No significant difference of operation mode (e.g., Dixon operation, Miles operation, and Hartmann operation) was observed between the treatment group and control group (P>0.05). The operation time of the control group was shorter than that of the treatment group, but the intraoperative blood loss of the treatment group was far higher (P 0.05). The time of exhaustion, time of defecation, and time of feeding after operation and Length of Stay (LOS) of the treatment group were shorter than that of the control group (P<0.05). The control group and treatment group presented no statistically significant difference in view of the occurrence rate of post-operative complications (P<0.05). Conclusions: Laparoscopic surgery combined with new adjuvant radiochemotherapy has outstanding therapeutic effect on rectal carcinoma in the progressive stage and high safety. It can be promoted as the first clinical therapy for rectal carcinoma in the progressive stage.

Application of Multimodal Navigation together with Fluorescein Angiography in Microsurgical Treatment of Cerebral Arteriovenous Malformations

This study aimed to explore the clinical applications of multimodal navigation combined with indocyanine green (ICG) fluorescein angiography in microsurgical treatment of cerebral arteriovenous malformations (AVMs). We retrospectively collected 52 patients with AVMs. Assisted by anatomic image, we reestablished three-dimensional structure using preoperative functional magnetic resonance imaging (fMRI) and Diffusion tensor imaging (DTI). The operation for lesion resection was finished under the assistance of neuro-navigation. ICG fluorescein angiography was performed for 16 of the study subjects, meanwhile, FLOW800 was used to rebuild blood vessel color visual image. Brain angiography was performed 1 week after the operation to check residual malformations. The patients’ status was estimated by Modified Rankin Scale score. Of the AVMs, 92.3% (48/52) were totally removed, without severe side events. Among the patients, fluorescein angiography was carried out up to 58 times for 16 cases. All of these 16 cases were confirmed with malformations and 14 of them had draining vein. The total resection rate of these 16 cases reached 100%, and the occurrence rate of postoperative complications was not significantly increased. During the operation of lesion resection, the application of multimodal navigation could effectively protect functional cortex and conduction pathway.

Psychoanalysis and intervention effect on unstable angina pectoris patients in perioperative period

Objective The corresponding psychological care and intervention method are designed to prevent and reduce postoperative complications to occur and promote patients to get recovered by means of investigating and analyzing the anxiety condition of unstable angina pectoris patients in perioperative period. Methods A total of 348 patients diagnosed as unstable angina pectoris were selected and optional interventional therapy was implemented. By means of self-rating anxiety scale testing investigation, the patients were divided into SAS<50 scores group and SAS≥50 score group. In addition, two groups of patients were divided into two subgroups randomly, of which psychological care intervention was conducted two one group and usual care was conducted to the other group to analyze the influence of psychological care intervention on the occurrence rate of postoperative complications. Results Compared with male, SAS sores of female were higher(61.1±10.9 vs 53.1±12.8, P=0.038), and it was easy to have anxiety disorder. With regard to SAS≥50 scores patients, the occurrence rate of postoperative complications was higher than the patients of SAS 0.05). However, psychological care intervention conducted to the patients of SAS≥50 scores could significantly reduce the occurrence rate of postoperative complications(13.3% vs 37.1%, P<0.01). Conclusion The anxiety state during perioperative period of interventional therapy can significantly influence the prognosis for the unstable angina pectoris patients. Psychological care should be strengthened for the anxiety patients, which is very effective to prevent and reduce the occurrence of postoperative complications. Key words: Unstable angina pectoris; Anxiety; Psychological care

Analysis on application effect of strengthened pulmonary rehabilitation exercise in lung cancer patients with severe pulmonary ventilation dysfunction in perioperative period

Objective To explore the application effect of strengthened pulmonary rehabilitation exercise in lung cancer patients with severe pulmonary ventilation dysfunction during perioperative period. Methods A total of 96 patients receiving lung cancer radical treatment under thoracoscope in our hospital during March 2013 to April 2015 were collected, and for all these patients, pulmonary function test before treatment showed that there was severe pulmonary ventilation dysfunction. The patients were divided into the routine group and the intervention group by random digital table method, with 48 patients in each group; patients in the routine group received routine perioperative nursing, and those in the intervention group received the strengthened pulmonary rehabilitation intervention plan; change in pulmonary function before treatment, duration of mechanical ventilation, time of oxygen therapy, retaining time of chest tube, length of hospital stay and occurrence of complications after treatment were compared between the two groups. Results After strengthened pulmonary rehabilitation intervention in the intervention group, the FVC was (2.63±0.47)L, the MVV was (53.14±9.40)L, the DLCO was (19.26±2.63)ml·min-1·mmHg-1, the VO2 was (23.15±4.36)ml/kg and the O2Pulse was (10.98±2.52)ml·min-1·times-1, Which were significantly improved compared with those before treatment, (2.41±0.40)L,(46.98±8.91)L,(17.56±2.83)ml·min-1·mmHg-1, (20.17±4.35) ml/kg and (9.82±2.07)ml·min-1·times-1,t=2.521, 3.512, 3.112, 3.421, 2.515,P<0.01 or 0.05. While there was no obvious change in the above-mentioned indexes of those in the routine group. After treatment of patients in the intervention group the duration of mechanical ventilation was (9.42±3.17) hours, time of oxygen therapy was (76.23±21.18)hours, retaining time of chest tube was (3.58±1.44)days and length of hospital stay was (6.62±2.14)days, which were significantly shorter than those in the routine group, (17.29±4.79)hours,(92.14±24.29)hours, (4.73±2.15)days and (8.68±2.96)days. The occurrence rates of complications such as pulmonary infection, pulmonary atelectasis and respiratory failure were 12.50% (6/48),10.42%(5/48)and 4.17%(2/48) in the intervention group, significantly lower than those in the routine group, 41.67%(20/48),29.17%(14/48)and 18.75%(9/48),χ2=10.338, 5.315, 5.031,P <0.01 or 0.05. Conclusions Strengthened pulmonary rehabilitation intervention can improve pulmonary function of lung cancer patients with severe pulmonary ventilation dysfunction before treatment, reduce the occurrence rate of post-operative complications and enhance safety during the perioperative period; it is worth of being further promoted clinically. Key words: Lung neoplasms; Perioperative nursing; Severe pulmonary ventilation dysfunction; Pulmonary rehabilitation

Clinical application of enhanced recovery after surgery in thoracoscopic and laparoscopic esophagectomy for esophageal cancer

Objective To investigate the application value and feasibility of enhanced recovery after surgery (ERAS) in thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Methods The clinical data of 304 patients with esophageal cancer who were admitted to the Affiliated Cancer Hospital of Zhengzhou University from December 2013 and July 2014 were retrospectively analyzed. All the patients underwent esophagogastric partial resection, esophagogastric cervical anastomosis and 2-field lymph node dissection under general anesthesia. The management of 195 patients guided by ERAS were allocated to the ERAS group and 109 patients receiving perioperative traditional treatments were allocated to the control group. Observing indicators included: (1) enteral and parenteral nutritional support treatments; (2) nutrient indexs: levels of serum albumin (Alb) and prealbumin; (3) the recovery of gastrointestinal function: time to anal exsufflation and defecation; (4) postoperative complications and the grading according to Clavien standard; (5) duration of postoperative hospital stay and treatment expenses; (6) risk factors affecting postoperative complications by multivariate analysis; (7) independent risk factors affecting occurrence rate of postoperative complications by univariate analysis. Measurement data with normal distribution were presented as ±s and analyzed using the t test. Non-normal distribution data were analyzed by the Wilcoxon rank sum test. Comparison of repeated data was analyzed by the repeated measures ANOVA. Categorical variables were analyzed using the chi-square test or Fisher's exact probability. The multiple linear regression analysis and Logistic regression were used to measure the multivariate analysis of continuous variables and binary variable, respectively. Results (1) During the enteral and parenteral nutritional support treatments, 11 patients with surgery-related complications in the ERAS group didn't receive oral intake at postoperative day 1, 26 proceeded the intravenous rehydration at postoperative day 4 due to calorie intake less than 80% of calorie requirement, and enteral nutritional support treatment was well-tolerated in the control group. (2) Comparison of nutrient indexs: the levels of serum Alb and prealbumin at postoperative day 1, 3 and 5 were (37.2±3.9)g/L, (39.1±3.5)g/L, (38.5±3.0)g/L and (0.20±0.06)g/L, (0.13±0.04)g/L, (0.13±0.04)g/L in the ERAS group, (37.7±2.8)g/L, (39.0±3.6)g/L, (38.4±3.8)g/L and (0.18±0.06)g/L, (0.13±0.04)g/L, (0.13±0.04)g/L in the control group, respectively, showing no significant difference in the postoperative changing trends between the 2 groups (F=0.357, 0.453, P>0.05). (3) The recovery of gastrointestinal function: time to first anal exsufflation and first defecation were (2.1±0.8)days and (3.4±1.2)days in the ERAS group, (3.2±0.9)days and (5.5±1.5)days in the control group, respectively, showing significant differences between the 2 groups (t=-10.505, -13.174, P 0.05). Eight and 10 patients in the ERAS and control groups underwent gastrointestinal decompression, 6 and 8 patients in the ERAS and control groups underwent retreatment in the intensive care unit (ICU), 3 and 2 patients in the ERAS and control groups were readmitted to the hospital at 3 weeks after discharge, with no significant difference in the above indexes (χ2=0.185, 2.892, P>0.05). (5)The duration of postoperative hospital stay and treatment expenses were (6.8±2.4)days and (25 088±10 336)yuan in the ERAS group, (11.1±3.4)days and (38 819±14 854)yuan in the control group, showing significant differences between the 2 groups (t=-12.782, -9.452, P 10%, tumor staging, tumor differentiation, neoadjuvant chemotherapy and time of food intake were risk factors affecting incidence of postoperative complication in patients with esophageal cancer by the univariate analysis (χ2=2.484, 2.333, 0.061, 8.553, 2.459, 0.163, 3.462, P 10%, tumor staging and neoadjuvant chemotherapy were independent risk factors affecting incidence of postoperative complication in patients with esophageal cancer by the multivariate analysis (OR=0.365, 10.761, 0.290, 8.140, 95% confidence interval : 0.198-0.671, 4.122-28.095, 0.130-0.645, 3.946-16.791, P 0.05). Conclusions ERAS in the esophageal minimally invasive surgery for esophageal cancer is safe and feasible, with the advantages of shorter recovery time of gastrointestinal function and duration of hospital stay, lower treatment expenses and a better application value compared with traditional treatment. Key words: Esophageal neoplasms; Thoracoscopic and laparoscopic esophagectomy; Enhanced recovery after surgery

Impact of Severe Postoperative Complications after Cardiac Surgery on Mortality in Patients Aged over 80 Years

The aims of this study are (1) to investigate the occurrence rate of postoperative complications in patients ≥ 80 years old after cardiac surgery and (2) to elucidate the impact of the most common postoperative complications on mortality. Between January 1998 and December 2007, 649 patients aged over 80 years received isolated first-time coronary artery bypass graft (CABG), isolated aortic valve replacement (AVR) or a combination of both in our institute. Prospectively entered patient data were analyzed with respect to major complications and outcome parameters. Acute renal failure (55.0% vs. 7.5%, p = 0.0001), low cardiac out-put syndrome (43.1% vs. 8.8%, p = 0.0001), sepsis (52.0% vs. 10.3%, p = 0.0001), prolonged respiratory failure with tracheotomy (29.0% vs. 11.0%, p = 0.002), re-thoracotomy due to bleeding (26.9% vs. 10.6%, p = 0.0001), and postoperative laparotomy (30.8% vs. 11.5%, p = 0.033) had a significant impact on mortality. A multivariate analysis revealed that advanced age (OR 1.130, 95%CI; 1.017-1.256, p = 0.023), low output syndrome (OR 5.094, 95%CI; 1.1635-15.871, p = 0.005), renal failure (OR 8.128, 95%CI; 3.347-19.742, p = 0.0001) and sepsis (OR 4.975, 95%CI; 1.420-17.426, p = 0.012) as independent risk factors. The present study demonstrates that among major complications, low output syndrome, renal failure requiring renal replacement therapy and sepsis, dramatically impaired the postoperative course patients aged over 80 years undergoing CABG, AVR or combined CABG and AVR.

Long-Term Follow-Up Study and Comparison of Meso-Atrial Shunts and Meso-Cavo-Atrial Shunts for Treatment of Combined Budd-Chiari Syndrome

To investigate therapeutic effects of meso-atrial shunts (MASs) and meso-cavo-atrial shunt (MCASs) in combined Budd-Chiari syndrome (BCS). We retrospectively gathered 29 cases of combined BCS with all or bilateral hepatic vein occlusion and long range occlusion or obstruction of inferior vena cava (IVC). Of them, 12 were treated with a MAS and 17 with a MCAS. We analyzed pre- and postoperative clinical symptoms, IVC, and portal venous (PV) pressure, occurrence rate of postoperative complications, patency rate of artificial vessels, and survival rate. One patient in the MAS group died in the preoperative period. During the follow-up period from 3 d to 60 mo, 96.6% were included. The effective rates were 54% in MAS and 90.8% in MCAS. The occurrence rates of postoperative complications were 12.5% and 1.8%, respectively. The average decreases in IVC and PV pressure were 15.5 mm saline and 62.4 mm saline for MAS, and 12.3 mm saline and 184.7 mm saline for MCAS. The survival rates at 1, 3, and 5 y were 41.7%, 41.7%, and 16.7% for MAS, and 94.1%, 88.2%, and 82.4% for MCAS. The 5-y patency rates were 41.7% and 94.1%. Comparing these two groups, all of the studied factors, with the exception of PV pressure, were significantly different (P<0.05). Thus, the therapeutic effects of MCASs were better than those of MASs. MCAS can simultaneously relieve high IVC and PV pressure in combined BCS. Compared with MASs, MCASs showed a decreased postoperative complication rate, a higher 5-y survival and artificial vessel patency rate.

Sparing of saphenous vein during inguinal lymphadenectomy for vulval malignancies

Objective This work was set out to investigate the effect of saphenous vein preservation during inguinal lymphadenectomy for patients with vulval malignancies. Methods 64 patients with vulval malignancies were allocated into two groups depending on their clinical stages, with one of them (31 patients included) being subjected to sparing of saphenous vein and the other to saphenous vein ligated surgery while treated with inguinal lymphadenectomy. The operative time, blood loss, 5-year survival rate, short- and long-term postoperative complications, 5-year survival rate and groin recurrence were selected as the monitored parameters, through which the above two groups were compared with each other using t test, χ 2 and life table analysis. Results (1) The median operative time for bilateral inguinal lymphadenectomy was 155 min (130–170 min) in the sparing group, compared to 140 min (120–170 min) in the excision group ( P > 0.05). The median intraoperative blood loss was 295 mL (100–450 mL) in the sparing group, and 270 mL (150–390 mL) in the excision group ( P > 0.05). (2) Short-term lower extremity lymphedema occurred with 27 patients (43.5%) in the sparing group and 44 patients (66.7%) in the excision group ( P < 0.01). Still, short-term lower extremity phlebitis was observed with 7 patients (11.3%) in the sparing group while 17 developed phlebitis (25.8%) in the excision group ( P < 0.05). However, there was no statistical difference in postoperative fever, acute cellulites, seroma, or lymphocyst formation. (3) Long-term complication occurrence rate decreased by about 50% in patients subjected to saphenous vein sparing surgery compared with those to ligated surgery, while there was no remarkable difference between two groups in the occurrence rates of phlebitis and deep venous thrombosis ( P > 0.05). (4) The overall 5-year survival rate was 67.3%, with 66.7% and 68.0% for the excision group and the sparing group, respectively ( P > 0.05). Conclusion The application of saphenous vein preservation technique during inguinal lymphadenectomy for patients with vulval malignancies could significantly decrease the occurrence rate of postoperative complications without compromising outcomes and should be widely put into clinical practice.