The effect of intraoperative goal-directed fluid therapy in patients under anesthesia for gastrointestinal surgery

BACKGROUND Intraoperative fluid management is an important aspect of anesthesia mana-gement in gastrointestinal surgery.Intraoperative goal-directed fluid therapy(GDFT)is a method for optimizing a patient's physiological state by monitoring and regulating fluid input in real-time.AIM To evaluate the efficacy of intraoperative GDFT in patients under anesthesia for gastrointestinal surgery.METHODS This study utilized a retrospective comparative study design and included 60 patients who underwent gastrointestinal surgery at a hospital.The experimental group(GDFT group)and the control group,each comprising 30 patients,received intraoperative GDFT and traditional fluid management strategies,respectively.The effect of GDFT was evaluated by comparing postoperative recovery,com-plication rates,hospitalization time,and other indicators between the two patient groups.RESULTS Intraoperative blood loss in the experimental and control groups was 296.64±46.71 mL and 470.05±73.26 mL(P<0.001),and urine volume was 415.13±96.72 mL and 239.15±94.69 mL(P<0.001),respectively.The postoperative recovery time was 5.44±1.1 days for the experimental group compared to 7.59±1.45 days(P<0.001)for the control group.Hospitalization time for the experimental group was 10.87±2.36 days vs 13.65±3 days for the control group(P<0.001).The visual analogue scale scores of the experimental and control groups at 24 h and 48 h INTRODUCTION Gastrointestinal surgery is one of the most common procedures in the field of general surgery[1],involving the stomach,intestines,liver,pancreas,spleen,and other internal abdominal organs[2,3].With advancements in surgical technology and anesthesia methods,the safety and success rates of surgery have significantly improved[4,5].However,intraop-erative fluid management remains a critical challenge[6].Traditional fluid management strategies often rely on experience and basic physiological parameters,which may lead to excessive or insufficient fluid input,thereby affecting postoperative recovery and complication rates.Intraoperative goal-directed fluid therapy(GDFT)is an emerging fluid management strategy that dynamically adjusts fluid input volume by monitoring the patient's hemodynamic parameters in real-time to optimize the patient's physiological state[7,8].GDFT has shown superiority in many surgical fields;however,its application in gastrointestinal surgery requires further research and verification[9,10].The application of intraoperative GDFT in clinical settings has gradually increased in recent years[11,12].Studies have demonstrated that GDFT can optimize tissue perfusion and oxygenation by precisely controlling fluid input and reducing the occurrence of postoperative complications[13,14].For example,in cardiac and major vascular surgeries,GDFT significantly reduced the incidence of postoperative acute kidney injury and cardiovascular events[15,16].Similarly,in abdominal surgery,GDFT effectively reduced postoperative infections and expedited recovery[17].However,studies on the utilization of GDFT in gastrointestinal surgery are relatively limited and they are confounded by contradictory findings[18].Traditional fluid management strategies typically rely on estimating fluid input volume based on the patient's weight,preoperative status,and basic physiological parameters[19].However,this method lacks real-time dynamic adjustment,which may result in either insufficient or excessive fluid input,consequently affecting postoperative recovery.Insufficient fluid input can lead to hypovolemia and inadequate tissue perfusion,whereas excessive fluid input can cause tissue edema and postoperative complications,such as pulmonary edema and heart failure.GDFT involves dynamically adjusting fluid input volume by monitoring the patient's hemodynamic parameters in real-time,such as cardiac output,pulse pressure variability,and central venous pressure.Commonly used monitoring equipment include esophageal Doppler and pulse wave profile analyzers[20].These devices provide real-time hemo-dynamic data to assist anesthesiologists in tailoring fluid therapy to a patient's specific condition.Firstly,the patient's volume responsiveness is assessed by preloading fluid;secondly,fluid input volume is dynamically adjusted based on real-time monitoring data;finally,vasoactive and inotropic drugs are administered in combination to further optimize the patient’s hemodynamic status.Through personalized fluid management,GDFT can more accurately maintain intraop-erative hemodynamic stability and reduce complications[21].Gastrointestinal surgery involves procedures on multiple organs,often requiring prolonged operative times and extensive tissue trauma,which presents challenges for intraop-erative fluid management.Surgical procedures can lead to significant bleeding and fluid loss,requiring prompt and effective fluid replenishment.In addition,the slow recovery of gastrointestinal function after surgery and susceptibility to complications such as intestinal obstruction and delayed gastric emptying elevate the necessity for postoperative fluid management.

SMILE intraoperative complications: incidence and management

AIM: To report the intraoperative complications associated with small incision lenticule extraction(SMILE) and their management. METHODS: This was a retrospective consecutive interventional clinical study, carried out on patients with myopia and myopic astigmatism, who underwent SMILE procedure. Type of intraoperative complications and their management were recorded. RESULTS: Our study comprised 282 eyes of 141 patients who were enrolled for SMILE surgeries. The intraoperative complications included lost vacuum(18 eyes, 6.38%), treatment decentration(6 eyes, 2.12%), wound bleeding(21 eyes, 7.45%), incomplete bubble separation(black islands)(3 eyes, 1.06%), the epithelial defects(15 eyes, 5.32%). Incision tear(27 eyes, 9.57%), lenticule adherence to the cap(6 eyes, 2.12%), and cap perforation occurred in 2 eyes(0.7%). CONCLUSION: Although SMILE is a promising technique for the correction of myopia and myopic astigmatism with predictable, efficient, safe refractive and visual outcomes, complications can occur. However, most of them are related to inexperience and are included in the learning curve of the technique. More studies with a bigger number of eyes are required to efficiently evaluate the intraoperative complications and standardize their management strategies.

Intraoperative laparoscopic complications for urological cancer procedures

AIM: To structure the rate of intraoperative complications that requires an intraoperative or perioperative resolution. METHODS: We perform a literature review of Medline database. The research was focused on intraoperative laparoscopic procedures inside the field of urological oncology. General rate of perioperative complications in laparoscopic urologic surgery is described to be around 12.4%. Most of the manuscripts published do not make differences between pure intraoperative, intraoperative with postoperative consequences and postoperative complications. RESULTS: We expose a narrative statement of complications, possible solutions and possible preventions for most frequent retroperitoneal and pelvic laparoscopic surgery. We expose the results with the following order: retroperitoneal laparoscopic surgery(radical nephrectomy, partial nephrectomy, nephroureterectomy and adrenalectomy) and pelvic laparoscopic surgery(radical prostatectomy and radical cystectomy).CONCLUSION: Intraoperative complications vary from different series. More scheduled reports should be done in order to better understand the real rates of complications.

Intraoperative complication rates in cataract surgery performed by resident trainees and staff surgeons in a tertiary eyecare center in Hungary

AIM: To compare the incidence of intraoperative complications during primary phacoemulsification(phaco) surgery between resident surgeons(residents) and staff surgeons(specialists) and to objectively determine the difficulty of stages in phaco surgery. METHODS: This retrospective study included cases of phaco cataract surgery performed between January and December 2019. There were no exclusion criteria. For each patient, demographics, clinical history, case complexity, type of surgeon, and operative details were reviewed. Primary outcomes included intraoperative complication rates and the objective measure of difficulty in the steps of the surgery performed by residents and specialists.RESULTS: A total of 3272 cases were included;7.4%(n=241) of cases were performed by residents. The overall complication rate was 5.4%(n=177). The intraoperative complication rate was significantly higher(P<0.001) in residents(n=33, 13.7%) than in specialists(n=144, 4.8%). The most frequent complications were posterior capsule tear(n=85, 2.6%), anterior capsule tear(n=50, 1.53%), zonular fiber loss(n=45, 1.38%), and dropped nucleus(n=15, 0.46%). Objectively, the most difficult steps during surgery were phaco in 66(60.0%), capsulorhexis in 21(19.1%), irrigation/aspiration in 13(11.8%), hydrodissection in 9(8.2%), and intraocular lens(IOL) implantation in 1(0.9%) case. CONCLUSION: Intraoperative complication rates are higher in residents than in specialists. The order of objective difficulty in phaco surgery steps is in line with the subjective findings of other surveys, revealing that the most challenging parts of phaco surgery are phaco and capsulorhexis.

Impact of intraoperative blood loss on survival after curative resection for gastric cancer

AIM:To elucidate the potential impact of intraoperative blood loss(IBL)on long-term survival of gastric cancer patients after curative surgery.METHODS:A total of 845 stageⅠ-Ⅲgastric cancer patients who underwent curative gastrectomy between January 2003 and December 2007 in our center were enrolled in this study.Patients were divided into 3groups according to the amount of IBL:group 1(<200mL),group 2(200-400 mL)and group 3(>400 mL).Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed.The Log-rank test was used to assess statistical differences between the groups.Independent prognostic factors were identified by the Cox proportional hazards regression model.Stratified analysis was used to investigate the impact of IBL on survival in each stage.Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer.Finally,we explored the possible factors associated with IBL and identified the independent risk factors for IBL≥200 mL.RESULTS:Overall survival was significantly influenced by the amount of IBL.The 5-year overall survival rates were 51.2%,39.4%and 23.4%for IBL less than 200mL,200 to 400 mL and more than 400 mL,respectively(<200 mL vs 200-400 mL,P<0.001;200-400 mL vs>400 mL,P=0.003).Age,tumor size,Borrmann type,extranodal metastasis,tumour-node-metastasis(TNM)stage,chemotherapy,extent of lymphadenectomy,IBL and postoperative complications were found to be independent prognostic factors in multivariable analysis.Following stratified analysis,patients staged TNMⅠ-Ⅱand those with IBL less than 200 mL tended to have better survival than those with IBL not less than 200mL,while patients staged TNMⅢ,whose IBL was less than 400 mL had better survival.Tumor location,tumor size,TNM stage,type of gastrectomy,combined organ resection,extent of lymphadenectomy and year of surgery were found to be factors associated with the amount of IBL,while tumor location,type of gastrectomy,combined organ resection and year of surgery were independently associated with IBL≥200 mL.CONCLUSION:IBL is an independent prognostic factor for gastric cancer after curative resection.Reducing IBL can improve the long-term outcome of gastric cancer patients following curative gastrectomy.

Intraoperative intraperitoneal chemotherapy increases the incidence of anastomotic leakage after anterior resection of rectal tumors

BACKGROUND Intraoperative intraperitoneal chemotherapy is an emerging treatment modality for locally advanced rectal neoplasms. However, its impacts on postoperative complications remain unknown. Anastomotic leakage (AL) is one of the most common and serious complications associated with the anterior resection of rectal tumors. Therefore, we designed this study to determine the effects of intraoperative intraperitoneal chemotherapy on AL. AIM To investigate whether intraoperative intraperitoneal chemotherapy increases the incidence of AL after the anterior resection of rectal neoplasms. METHODS This retrospective cohort study collected information from 477 consecutive patients who underwent an anterior resection of rectal carcinoma using the double stapling technique at our institution from September 2016 to September 2017. Based on the administration of intraoperative intraperitoneal chemotherapy or not, the patients were divided into a chemotherapy group (171 cases with intraperitoneal implantation of chemotherapy agents during the operation) or a control group (306 cases without intraoperative intraperitoneal chemotherapy). Clinicopathologic features, intraoperative treatment, and postoperative complications were recorded and analyzed to determine the effects of intraoperative intraperitoneal chemotherapy on the incidence of AL. The clinical outcomes of the two groups were also compared through survival analysis. RESULTS The univariate analysis showed a significantly higher incidence of AL in the patients who received intraoperative intraperitoneal chemotherapy, with 13 (7.6%) cases in the chemotherapy group and 5 (1.6%) cases in the control group (P = 0.001). As for the severity of AL, the AL patients who underwent intraoperative intraperitoneal chemotherapy tended to be more severe cases, and 12 (92.3%) out of 13 AL patients in the chemotherapy group and 2 (40.0%) out of 5 AL patients in the control group required a secondary operation (P = 0.044). A multivariate analysis was subsequently performed to adjust for the confounding factors and also showed that intraoperative intraperitoneal chemotherapy increased the incidence of AL (odds ratio = 5.386;95%CI: 1.808-16.042;P = 0.002). However, the survival analysis demonstrated that intraoperative intraperitoneal chemotherapy could also improve the disease-free survival rates for patients with locally advanced rectal cancer. CONCLUSION Intraoperative intraperitoneal chemotherapy can improve the prognosis of patients with locally advanced rectal carcinoma, but it also increases the risk of AL following the anterior resection of rectal neoplasms.

Doppler ultrasonography in living donor liver transplantation recipients: Intra- and post-operative vascular complications

Living-donor liver transplantation has provided a solution to the severe lack of cadaver grafts for the replacement of liver afflicted with end-stage cirrhosis, fulminant disease, or inborn errors of metabolism. Vascular complications remain the most serious complications and a common cause for graft failure after hepatic transplantation. Doppler ultrasound remains the primary radiological imaging modality for the diagnosis of such complications. This article presents a brief review of intra- and post-operative living donor liver transplantation anatomy and a synopsis of the role of ultrasonography and color Doppler in evaluating the graft vascular haemodynamics both during surgery and post-operatively in accurately defining the early vascular complications. Intra-operative ultrasonography of the liver graft provides the surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach and corrections of surgical complications during the procedure of vascular anastomoses. The relevant intraoperative anatomy and the spectrum of normal and abnormal findings are described. Ultrasonography and color Doppler also provides the clinicians and surgeons early post-operative potential developmental complications that may occur during hospital stay. Early detection and thus early problem solving can make the difference between graft survival and failure.

Intraoperative Periprosthetic Femoral Fractures Related to Austin Moore Hemiarthroplasty—A Retrospective Review of 365 Patients

Intraoperative periprosthetic femoral fractures (IPFF) have been studied extensively for total hip arthroplasties, but not for hemiarthroplasties. Recent series in the literature show an IPFF rate for hemiarthroplasties ranging from 0% to 14%. The present study was designed to determine the prevalence and outcome after IPFF during non-cemented hemiarthroplasty. In addition, the surgical step at higher risk to produce these fractures was evaluated in an attempt to identify strategies that could minimize the prevalence of this complication. We performed an observational study of 365 consecutive patients undergoing and Austin-Moore hemiarthroplasty from 2005 to 2006 at our institution. The institutional IPFF rate was 6.8% (twenty-five out of 365). The moment at which the fracture was detected was collected: 1) intraoperatively and 2) in the postoperative radiological control. The surgical step in which the fracture occurred was collected: 1) neck osteotomy, 2) broaching, 3) prosthesis introduction, and 4) reduction. Results were compared to a control group according to blood transfusion rate, mortality rate and revision surgery rate. The fractures were detected during the surgery in twenty cases (80%);for the five remaining cases the fracture was only detected in the postoperative radiology. For those detected during the surgery, the two most common manouvers in which the fracture occurred was hip reduction (10 cases) and prosthesis introduction (7 cases). The blood transfusion rate, first-month mortality rate and revision surgery rate showed no statistical difference between the two groups (p = 0.3). In the present series, most of IPFF during Austin-Moore hemiarthroplasty implantation, occurred during arthroplasty reduction. Difficulties during this step should lead the surgeon to reconsider if technical mistakes are present and can be solved. However, if fracture occurs, adequate treatment of IPFF should provide satisfactory results without increasing blood transfusion needs, mortality or revision surgery.

Prediction of Intraoperative Trifecta Achievement during Laparoscopic Partial Nephrectomy

Purpose: We introduce the concept of intraoperative Trifecta during laparoscopic partial nephrectomy (LPN) as the simultaneous achievement of estimated blood loss (EBL) < 500 ml, warm ischemia time (WIT) < 20 minutes and minimal changes of the intraoperative course. The study’s aim was to find preoperative factors that could predict the likelihood of achieving intraoperative Trifecta and build a surgical nomogram. Methods: We retrospectively evaluated 122 patients who underwent LPN. Preoperative factors like age, sex, body-mass index (BMI), kidney function, tumor characteristics (R.E.N.A.L. score) and Charlson-Comorbidity-Index (CCI) were recorded. Intraoperative complication (IOC) was graded according to the Rosenthal classification. R software was used to find a predicting model for achievement of Trifecta using preoperative variables and a nomogram was built. Results: The surgical features include median EBL of 100 ml having 6.5% bleed > 500 ml, median WIT of 12 minutes having 7.3% more than 20 minutes. There was recorded a 12.3% IOC with a mean Rosenthal’s grade of 0.2. Intraoperative Trifecta was achieved in 105 patients (86%) and three preoperative factors were chosen for the predictive model: BMI (p = 0.041), CCI (p = 0.037) and RENAL score (p = 0.002). A nomogram was generated and the ROC-AUC of the model was 75.8%. Conclusion: We have defined an intraoperative Trifecta concept as the achievement of EBL < 500 ml, WIT < 20 minutes and minimal changes of the intraoperative course. A nomogram was developed from preoperative factors like BMI, CCI and R.E.N.A.L. score. It can be used to estimate the probability of Trifecta achievement in patients treated with LPN.

How to Deal with an Intraoperative Thrombosis of Microvascular Anastomosis

Background: Intraoperative thrombosis during microvascular surgery is a nasty complication. Most intraoperative thromboses occur at the proximity of the anastomosis and microsurgical salvage techniques are needed to correct the complication. The aim of this article is to provide an overview of basic clinical patency testing and microsurgical salvage techniques. Methods: A search of the literature up to November 2020 was performed, using PubMed and Web of Science databases. Articles reporting on clinical intraoperative patency testing and/or salvage techniques in microvascular surgery were included. Results: Comprehensive illustrations of intraoperative clinical patency testing include: pulsation pattern, flicker test and milking test. The following surgical salvage techniques for both end-to-end and end-to-side intraoperative microvascular occlusion management are described: suture-line thrombectomy, thrombectomy through arteriotomy, anastomotic resection with complete re-anastomosis and, balloon extraction. Conclusion: Decision making in surgical salvage techniques for microvascular thrombosis depends on localization of the thrombus and the surgeon’s experience and preference. In case of any doubt, it is better to reopen a few sutures and have a clear inspection of the anastomosis in order to prevent redo surgeries. This paper serves as a guide for especially the starting microsurgeon to clinically and surgically identify and handle an intraoperative microvascular anastomosis thrombosis and occlusion.

关注儿童肾盂输尿管连接处梗阻手术并发症及肾损伤问题

肾盂输尿管连接处梗阻是儿童常见的泌尿系统畸形。离断式肾盂成形术因其适应证广、易操作、并发症少等特点,目前被认为是手术治疗的金标准。尽管总体手术成功率在90%以上,但如何进一步降低术后并发症发生率,避免出现高等级并发症,使患儿术后恢复更顺利,获得更好的预后,仍然是小儿泌尿外科医师追求的目标。对于肾功能损伤程度的判定,也是目前临床关注的热点问题。本文就儿童肾盂输尿管连接处梗阻手术并发症以及肾功能损伤的研究进展进行述评。

腹腔镜下子宫切除术与经腹子宫切除术治疗子宫肌瘤患者的疗效对比

目的探讨腹腔镜下子宫切除术与经腹子宫切除术治疗子宫肌瘤患者的疗效。方法80例子宫肌瘤患者,采用随机数字表法分为开腹组和腔镜组,每组40例。开腹组采用经腹子宫切除术完成疾病治疗,腔镜组采用腹腔镜下子宫切除术完成疾病治疗。对比两组的治疗效果、手术相关指标及并发症发生率。结果腔镜组子宫肌瘤患者治疗总有效率95.00%相较于开腹组的70.00%显著提升(P<0.05)。腔镜组子宫肌瘤患者术中出血量(60.25±5.23)ml相较于开腹组(160.19±3.11)ml显著减少,手术时间(90.25±2.25)min、术后拆线时间(5.22±1.36)d、住院时间(7.65±0.28)d、术后肛门排气时间(30.25±2.25)h相较于开腹组的(120.36±5.26)min、(7.25±1.49)d、(9.29±1.33)d、(45.69±5.29)h显著缩短(P<0.05)。腔镜组子宫肌瘤患者并发症总发生率7.50%相较于开腹组的25.00%显著降低(P<0.05)。结论经腹子宫切除术以及腹腔镜下子宫切除术治疗子宫肌瘤均获得广泛应用,同前者比较,后者的治疗优势明显,可显著提升子宫肌瘤患者总体预后。

儿童肾盂输尿管连接处梗阻手术并发症的认识与思考

肾盂输尿管连接处梗阻是儿童最常见的先天性上尿路梗阻,离断式肾盂输尿管成形术是治疗该病的金标准,手术成功率达90%以上。然而如何避免手术并发症(特别是严重并发症)仍然充满了挑战。随着外科技术的不断创新,外科医师应在更精准把握手术指征、全面认识和正确处理手术并发症上提高认识,从而使患儿从手术治疗中最大化获益。本文阐述肾盂输尿管连接处梗阻患儿肾盂输尿管成形术后并发症的类型、病因、预防和处理,并对相关危险因素提出思考。

阴道骶棘韧带悬吊术治疗盆腔脏器脱垂的临床效果及术后并发症观察

目的探讨阴道骶棘韧带悬吊术(SSLF)治疗盆腔器官脱垂(POP)的临床效果及术后并发症发生情况。方法选取2018年1月—2022年2月收治的POP患者68例,采用随机数字表法分为观察组34例和对照组34例,观察组采用阴道子宫切除联合SSLF治疗,对照组采用阴道子宫切除联合阴道前或后壁修补术治疗。比较2组手术时间、术中出血量、术后住院时间,手术前后盆底功能障碍问卷(PFDI-20)、盆底障碍影响简易问卷-7(PFIQ-7)评分,以及术后并发症发生率。结果观察组手术时间及术后住院时间均较对照组缩短,术中出血量也较对照组显著减少(P<0.01)。2组患者术前盆腔器官脱垂定量分度法(POP-Q)各指示点测量值均无显著差异(P>0.05);与术前POP-Q各指示点测量值相比,2组患者术后测量值均明显降低,其中观察组测量值更低(P<0.05)。术前PFDI-20、PFIQ-7评分2组患者均无显著差异(P>0.05);术后2组患者PFDI-20、PFIQ-7评分均明显下降,其中观察组下降更明显(P<0.05)。观察组术后并发症发生率为5.88%(2/34)低于对照组的26.47%(9/34),差异有统计学意义(P<0.05)。结论SSLF治疗POP临床效果显著,能显著改善患者盆底功能,且术后并发症发生率较低。

超声刀在开放性甲状腺手术中的应用价值研究

目的探究超声刀在开放性甲状腺手术中的作用。方法选取2022年5月—2023年8月于临淄区妇幼保健院(齐都医院)行开放性甲状腺手术的86例患者为研究对象,按手术器械的不同分为对照组(n=43)、研究组(n=43)。两组均行开放性甲状腺手术,对照组术中使用传统电刀,研究组使用超声刀。对比两组手术指标、并发症发生率及住院时间。结果研究组手术时间、术中出血量、术后24 h引流量、切口长度均少于对照组,差异有统计学意义(P均<0.05)。研究组并发症发生率为2.33%(1/43),低于对照组的13.95%(6/43),差异有统计学意义(χ^(2)=3.888,P<0.05)。研究组住院时间短于对照组,差异有统计学意义(P<0.05)。结论开放性甲状腺手术中应用超声刀手术指标较优,并发症风险较低,有助于患者术后康复。

镜疝修补术与开放式无张力疝修补术治疗腹股沟疝疗效对比研究

目的对比研究镜疝修补术治疗腹股沟疝的临床疗效。方法方便选取2019年6月—2023年10月启东市第二人民医院收治的123例腹股沟疝患者,采用密闭信封法分为对照组(n=61)、研究组(n=62)。对照组行开放式无张力疝修补术,研究组行镜疝修补术。比较两组围术期指标及并发症发生率。结果研究组手术时间长于对照组,其他指标优于对照组,差异有统计学意义(P均<0.05)。研究组并发症发生率(3.23%)低于对照组(14.75%),差异有统计学意义(χ^(2)=4.768,P<0.05)。结论镜疝修补术治疗腹股沟疝的效果优于传统术式,该手术方式具有微创性,对患者机体损伤较轻,同时,该种术式能够降低并发症风险,具有较高的安全性,有利于患者术后机体康复,从而改善患者预后。

腹腔镜及开放手术治疗儿童先天性肾盂输尿管连接处梗阻性肾积水的并发症对比

目的比较腹腔镜及开放离断式肾盂成形术治疗儿童先天性肾盂输尿管连接处梗阻(ureteropelvic junction obstruction,UPJO)性肾积水的术中及术后并发症特点,探讨导致两种手术方式并发症差异的影响因素。方法回顾性分析2016年7月至2018年12月首次于首都医科大学附属北京儿童医院接受腹腔镜或开放离断式肾盂成形术治疗的美国胎儿泌尿外科协会(Society for Fetal Urology,SFU)分级为Ⅳ级的UPJO肾积水患儿临床资料,共560例患儿583例肾。按照手术方式分为腹腔镜组(355例肾)和开放组(228例肾),对比分析两组并发症发生率、发生次数以及并发症等级和类型。比较不同引流方式、有无术中并发症以及不同年龄、体重、术前肾盂前后径(anteroposterior pelvic diameter,APD)及术者经验分层因素下的并发症差异。结果开放组患儿年龄16.37(9.73,61.37)个月,体重11.00(9.32,20.00)kg,明显小于腹腔镜组[年龄46.87(19.08,90.49)个月,体重16.50(12.00,25.00)kg]。开放组术前中位肾盂前后径为39.00(27.00,52.00)mm,长于腹腔镜组的28.00(22.00,36.00)mm,差异有统计学意义(P<0.05)。腹腔镜组和开放组术中并发症发生率(分别为7.61%和4.39%)、术后并发症发生率(分别为17.15%和15.56%)、术后并发症发生次数占总发生次数比例(分别为23.84%和20.88%)以及吻合口再狭窄发生率(分别为2.62%和1.33%)比较,差异均无统计学意义(P>0.05)。两组最常见的术后并发症均为泌尿系感染。存在术中并发症的肾脏术后更易发生高等级并发症(χ^(2)=5.600,P=0.018)及泌尿系感染(χ^(2)=8.891,P=0.003)。腹腔镜组较开放组更易出现高等级(ClavienⅢb)术后并发症(χ^(2)=6.595,P=0.010)和除泌尿系感染以外的其他术后并发症(χ^(2)=10.289,P=0.001)。结论腹腔镜和开放离断式肾盂成形术治疗儿童UPJO性肾积水安全有效,两种手术方式的术后并发症发生率无差异。腹腔镜手术较开放手术应更加注意除泌尿系感染以外的其他术后并发症以及高等级术后并发症的发生。

急诊多发伤的诊断与救治模式研究进展

多发伤是常见的急诊危重症,其发生率、致残率和死亡率均极高,已成为我国45岁以下人群死亡的首要因素。对于多发伤的诊断,应遵循损伤的诊断、并发症的诊断、合并症的诊断。对于多发伤的分级和评估,主要依据AIS-ISS评分系统。多发伤的救治包括院前急救和院内急救,院内急救主要包括分科分诊模式、一体化模式、创伤中心主导模式、急诊科独立模式。本文将对急诊多发伤的诊断与救治模式进行整理并总结,旨在提高多发伤患者诊断的精准度和救治的成功率。

铒激光治疗对颌骨囊肿患者疗效、疼痛、舒适度、疼痛介质的影响

目的观察比较铒激光、传统方法对颌骨囊肿患者疗效、疼痛、舒适度、疼痛介质的影响。方法选取2018年10月—2022年10月收治的300例颌骨囊肿,根据手术方案分为铒激光组150例和传统组150例,分别采取铒激光治疗、传统刮治术治疗。统计2组围术期情况,治疗前后疼痛介质、口腔微生物群菌落数,以及术后舒适度、临床疗效、术后并发症。结果铒激光组术后24 h疼痛程度轻于传统组,术中出血量少于传统组,舒适度优于传统组(P<0.01);术后12 h铒激光组血清P物质、前列腺素E_(2)、神经肽Y水平低于传统组(P<0.05);术后3个月、6个月铒激光组双歧杆菌菌落数高于传统组,放线杆菌、牙龈卟啉单胞菌菌落数低于传统组(P<0.05);术后6个月2组治疗总有效率、术后并发症比较差异无统计学意义(P>0.05)。结论铒激光、传统方法在颌骨囊肿患者治疗中效果相当,铒激光治疗可减少患者术中出血量,缓解疼痛程度,维持口腔微生物群平衡,提高舒适度,减轻应激反应。

术前针对性心理干预结合术中保温策略在行全身麻醉手术患者中的应用价值

目的 分析术前针对性心理干预结合术中保温策略在行全身麻醉(简称“全麻”)手术患者中的应用效果。方法 选取东南大学附属中大医院2020年3月至2023年3月收治的116例拟行全麻手术的患者,按简单随机法分为观察组(58例)和对照组(58例)。2组均接受围手术期综合护理及术中保温,观察组加用术前针对性心理干预。对比2组患者的麻醉苏醒状况、体温变化、心理状态以及并发症发生率。结果 与对照组相比,观察组的麻醉后清醒时间和拔管时间均更早,麻醉苏醒室滞留时间和麻醉药物作用时间均更短(P均<0.05)。2组的手术时间未见统计学差异(P>0.05)。与对照组相比,观察组在麻醉后5 min和手术开始时的体温均更低,出室时的体温更高(P均<0.05)。2组于术前1 d、入室时、手术40 min和80 min时的体温均未见统计学差异(P均>0.05)。观察组在术前1 d的焦虑和抑郁自评量表(SAS和SDS)评分均低于对照组,且2组均较入组时更低,比较均有统计学差异(P均<0.05)。观察组的术后并发症合计发生率低于对照组(P<0.05)。结论 术前针对性心理干预结合术中保温策略有助于行全麻手术的患者维持术中体温稳定,缩短麻醉苏醒时间,且对于改善患者的术前心理状态、降低并发症发生率均有益。