This is a retrospective, noncomparative analysis of a case series to explore the safety and effectiveness of retrograde canaliculotomy and punctoplasty for treating epiphora due to upper and lower lacrimal punctal occ...This is a retrospective, noncomparative analysis of a case series to explore the safety and effectiveness of retrograde canaliculotomy and punctoplasty for treating epiphora due to upper and lower lacrimal punctal occlusion. During the procedure, the horizontal portion of the normal lower canaliculus was identified;the corresponding punctum was reconstructed via retrograde canaliculotomy and punctoplasty. Intubation was performed to prevent postoperative reocclusion. Patients were followed up for 12 to 24 mo. A total of 16 patients with unilateral upper and lower lacrimal punctal occlusion were included. Satisfactory outcomes were achieved: all 16 patients exhibited improvement of epiphora;31 rebuilt punctal openings and canaliculi achieved recanalization. Only one upper punctal opening could not be reconstructed because the corresponding canaliculus exhibited severe injury. No significant complications occurred as a result of the treatments. Retrograde canaliculotomy and punctoplasty appears to effective, safe, and minimally invasive for treatment of upper and lower punctal occlusion.展开更多
BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD...BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.CASE SUMMARY A 50-year-old male patient had developed obstructive jaundice,and ERCP procedure need to be performed to treat the obstructive jaundice.But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum.We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy,and bile duct intubation was successfully completed.CONCLUSION The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.展开更多
AIM: To compare the success rate of monocanalicular versus pushed monocanalicular silicone intubation(PMCI)of the nasolacrimal duct for congenital nasolacrimal duct obstruction(CNLDO).METHODS: In a prospective randomi...AIM: To compare the success rate of monocanalicular versus pushed monocanalicular silicone intubation(PMCI)of the nasolacrimal duct for congenital nasolacrimal duct obstruction(CNLDO).METHODS: In a prospective randomized clinical trial 53 eyes of 49 patients with CNLDO underwent either monocanalicular silicone intubation(MCI)(n =28 eyes) or PMCI(n =25 eyes). All procedures were performed by 1oculoplastic surgeon. Treatment success was defined as the complete resolution of epiphora at 3mo after tube removal.RESULTS: The surgical outcome was assessed in 20 eyes with MCI and 20 eyes with PMCI. The mean age of treatment was 26.25 ±10.08mo(range, 13-49mo) for MCI and 26.85±12.25mo(range, 16-68mo) for PMCI. Treatment success was achieved in 18 of 20 eyes(90.0%) in the MCI group compared with 10 of 20 eyes(50%) in the PMCI group(P =0.01). In the PMCI group, the tube loss(30%)was greater than the MCI group(5%), however the differences between the 2 groups proved to be not significant(P =0.91).CONCLUSION: Our results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.展开更多
Background Animal models of myocardial infarction （MI） have been widely used to study the pathologi- cal and physiological changes that occur in MI, and to objectively evaluate the efficacy of new treatments. They a...Background Animal models of myocardial infarction （MI） have been widely used to study the pathologi- cal and physiological changes that occur in MI, and to objectively evaluate the efficacy of new treatments. They are an important tool in this procedure. However, the mortality rate of MI animal models has so far been higher than in real-life situations. The aim of this study was to explore the use of a modified retrograde traction tracheal intubation （MRTI） method for increasing the success rate of MI models in rats. Methods Sixty male Sprague-Dawley rats were used in the experiment. Using the MRTI method of artificial airway generation, we established the MI model by ligation of the left anterior descending branch of the coronary artery. We analyzed the effects of MRTI, the use of lidocaine, operative details, nursing considerations during the operation, and post-operative factors on the success rate of the MI model in rats. Results The success rate of generating an MI model in rats can be significantly increased using the following methods： 1） Setting up the artificial airway through the use of MRTI by using a single-lumen central venous catheter; 2） Selecting a ligation site 2 mm be- low the midpoint of the connection between the left atrial appendage and the pulmonary cone; 3） Adding a drop of lidocaine to the surface of the heart to slow down the heart rate, make the operation easier to perform, and prevent arrhythmias postoperatively; 4） Clearing up airway secretions timely both intra and postoperative- ly; 5） Making sure that rats are in a warm state both intra and postoperatively; 6） Preventing wound infection. Conclusions Use of the MRTI method can quickly establish an artificial airway in rats. Intraoperative use of lidocaine, selecting a precise vascular ligation site, and appropriate care both intra and postoperatively can in- crease the success rate of MI model generation.展开更多
Objective： To evaluate the clinical effects of onepassage, double-passage and circular canalicular intubations in repairing lacerations of canaliculus. Methods： Atotal of 109 eyes in 109 cases ofcanalicular lacerat...Objective： To evaluate the clinical effects of onepassage, double-passage and circular canalicular intubations in repairing lacerations of canaliculus. Methods： Atotal of 109 eyes in 109 cases ofcanalicular laceration were repaired with three types of silicone intubations, among which 23 with one-passage canalicular intubation, 51 with double-passage canalicular intubation, and 35 with circular canalicular intubation. The average follow-up period was 12-15 months. Results： The wound/junction of the lacrimal canaliculi was ruptured in 5 cases （9.80%） of the double-passage group, 3 cases （8.57%） of the circular group, and 8 cases （34.78%） of the one-passage group. The rupture incidence of the one-passage group was significantly higher than that of the other two groups （ χ^2=9.416, P〈0.01）. During the inmbation, canaliculitis was observed in 12 cases （23.53%） of the double-passage group, while only 3 cases （8.57%） in the circular group and 8 cases （34.78%） in the one-passage group. The circular group had significantly lower incidence of canaliculitis than the other two groups （ χ^2=6.095, P〈0.05）. After extubation 6 months after laceration repair, the lacrimal passage remained patent with canalicular irrigation in 46 cases （90.20%） in the double-passage group, 30 cases （85.71%） in the circular group and 15 cases （65.22%） in the one-passage group. Six months after surgery, the canalicular patency in the one-passage group was significantly lower than that of the other two groups （ χ^2=7.390, P〈0.05）. Conclusions： Circular canalicular intubation is more stable and has less surgical complications than the doublepassage and one-passage canalicular intubations. It is also more effective clinically 12-15 months after laceration surgery.展开更多
Objective： To investigate the necessity of modification to the traditional pigtail probe and evaluate its efficiency and therapeutic effect in searching the nasal cut ends and anastomosing the lacerated lacrimal cana...Objective： To investigate the necessity of modification to the traditional pigtail probe and evaluate its efficiency and therapeutic effect in searching the nasal cut ends and anastomosing the lacerated lacrimal canaliculus. Methods： Eighty-seven patients （including 87 eyes） suffering from canalicular laceration were randomized into two groups： 41 patients treated with traditional pigtail probes （Group A） and 46 with modified pigtail probes （Group B）. During the reconstruction of the lacerated canaliculi, the traditional pigtail probe and the modified pigtail probe were used respectively to seek for the nasal cut ends of lacerated lacrimal canaliculi. Peripherally inserted central catheter （PICCTM） silicone tube with diameter of 0.95 mm was intubated as a stent for 4-6 months. The surgical outcomes were retrospectively analyzed after stent removal. Results： In Group B, the primary success rate of searching the nasal cut ends of lacerated lacrimal canaliculi was 93.48% （43/46） and the final success rate was 97.83% （45/46）. No false passage formed in Group B. Statistical sig- nificance was found between Group A and Group B as the primary success rates of searching the nasal cut ends （ x^2 = 10.522, P〈0.01） and the false passage forming rates were concerned （ x^2=4.704, P〈0.05）, whereas no significance was found between the two groups as the final success rates were concerned （ x^2=0.007, P〉0.05）. The mean time of searching the nasal cut ends of lacerated lacrimal canaliculi in Group B was （5.02±2.73） minutes and the mean time of operation was （33.90±4.84） minutes, and both were significantly shorter than those of Group A （t1=9.779, t2=10.700, P〈0.01）. The cure rate of Group B was 95.65%, though higher than that of Group A, no statistical significance was found （Z=-1.007, P〉0.05）. Totally, 2 patients （2.30%） were found to be absent of common canaliculus and underwent bicanalicular nasal intubation in the two groups. Conclusions： Pigtail probes are efficient and convenient apparatus for searching the nasal cut ends of the lacerated lacrimal canaliculi in the reconstruction of canalicular laceration. Necessary or proper modifications to the pigtail probes can minimize the risk of iatrogenic damages or complications and enhance the efficiency and therapeutic effect of canalicular repair.展开更多
目的研究气管插管全身麻醉下治疗性内镜逆行胰胆管造影术的安全性及患者术后不良事件发生的危险因素。方法回顾性选取2020年3月—2022年3月泗洪中信医院收治的40例气管插管全身麻醉下治疗性内镜逆行胰胆管造影术患者的临床资料,根据是...目的研究气管插管全身麻醉下治疗性内镜逆行胰胆管造影术的安全性及患者术后不良事件发生的危险因素。方法回顾性选取2020年3月—2022年3月泗洪中信医院收治的40例气管插管全身麻醉下治疗性内镜逆行胰胆管造影术患者的临床资料,根据是否发生术后不良事件进行分组,分为对照组(无术后不良事件)、观察组(发生术后不良事件),各20例。统计导致患者术后不良事件发生的相关因素。结果单因素分析结果显示,观察组患者年龄≥65岁、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅲ级、高血压史、心血管病史、脑血管病史、糖尿病史、术中出血量增加和手术时间延长占比均高于对照组,差异有统计学意义(P均<0.05)。多因素分析显示,年龄≥65岁(OR=1.865,95%CI:1.129~3.079)、ASA分级为Ⅲ级(OR=1.972、95%CI:1.247~3.119)、高血压史(OR=1.533、95%CI:1.245~1.887)、手术时间延长(OR=1.237、95%CI:1.117~1.887)、手术出血量增加(OR=1.586、95%CI:1.134~2.217)为患者术后发生不良事件的危险因素,差异有统计学意义(P均<0.05)。结论年龄、ASAⅢ级、手术时间延长、术中出血量增加以及高血压史为导致气管插管全身麻醉下治疗性内镜逆行胰胆管造影术不良事件发生的主要危险因素。展开更多
基金Supported by the National Natural Science Foundation of China(No.81600766 No.31600971)+1 种基金Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology,the Science and Technology Commission of Shanghai(No.17DZ2260100)Shanghai Young Doctor Training Program
文摘This is a retrospective, noncomparative analysis of a case series to explore the safety and effectiveness of retrograde canaliculotomy and punctoplasty for treating epiphora due to upper and lower lacrimal punctal occlusion. During the procedure, the horizontal portion of the normal lower canaliculus was identified;the corresponding punctum was reconstructed via retrograde canaliculotomy and punctoplasty. Intubation was performed to prevent postoperative reocclusion. Patients were followed up for 12 to 24 mo. A total of 16 patients with unilateral upper and lower lacrimal punctal occlusion were included. Satisfactory outcomes were achieved: all 16 patients exhibited improvement of epiphora;31 rebuilt punctal openings and canaliculi achieved recanalization. Only one upper punctal opening could not be reconstructed because the corresponding canaliculus exhibited severe injury. No significant complications occurred as a result of the treatments. Retrograde canaliculotomy and punctoplasty appears to effective, safe, and minimally invasive for treatment of upper and lower punctal occlusion.
文摘BACKGROUND Difficult bile duct intubation is a big challenge for endoscopists during endoscopic retrograde cholangiopancreatography(ERCP)procedure.We report a case of percutaneous transhepatic cholangial drainage(PTCD)-guided methylene blue for fistulotomy using dual-knife for bile duct intubation.CASE SUMMARY A 50-year-old male patient had developed obstructive jaundice,and ERCP procedure need to be performed to treat the obstructive jaundice.But intubation cannot be performed if the duodenal papilla cannot be identified because of previous surgery for a perforated descending duodenal diverticulum.We used PTCD-guided methylene blue to identify the intramural common bile duct before dual-knife fistulotomy,and bile duct intubation was successfully completed.CONCLUSION The method that combing methylene blue and dual-knife fistulotomy to achieve bile duct intubation during difficult ERCP is safe and effective.
文摘AIM: To compare the success rate of monocanalicular versus pushed monocanalicular silicone intubation(PMCI)of the nasolacrimal duct for congenital nasolacrimal duct obstruction(CNLDO).METHODS: In a prospective randomized clinical trial 53 eyes of 49 patients with CNLDO underwent either monocanalicular silicone intubation(MCI)(n =28 eyes) or PMCI(n =25 eyes). All procedures were performed by 1oculoplastic surgeon. Treatment success was defined as the complete resolution of epiphora at 3mo after tube removal.RESULTS: The surgical outcome was assessed in 20 eyes with MCI and 20 eyes with PMCI. The mean age of treatment was 26.25 ±10.08mo(range, 13-49mo) for MCI and 26.85±12.25mo(range, 16-68mo) for PMCI. Treatment success was achieved in 18 of 20 eyes(90.0%) in the MCI group compared with 10 of 20 eyes(50%) in the PMCI group(P =0.01). In the PMCI group, the tube loss(30%)was greater than the MCI group(5%), however the differences between the 2 groups proved to be not significant(P =0.91).CONCLUSION: Our results indicate that MCI has higher success rate in CNLDO treatment compared with PMCI in this small series of patients.
基金supported by Guangdong Medical Scientific Research Funds(No.B2012304)Guangzhou Medical and Health Technology Projects(No.20141A011019)
文摘Background Animal models of myocardial infarction （MI） have been widely used to study the pathologi- cal and physiological changes that occur in MI, and to objectively evaluate the efficacy of new treatments. They are an important tool in this procedure. However, the mortality rate of MI animal models has so far been higher than in real-life situations. The aim of this study was to explore the use of a modified retrograde traction tracheal intubation （MRTI） method for increasing the success rate of MI models in rats. Methods Sixty male Sprague-Dawley rats were used in the experiment. Using the MRTI method of artificial airway generation, we established the MI model by ligation of the left anterior descending branch of the coronary artery. We analyzed the effects of MRTI, the use of lidocaine, operative details, nursing considerations during the operation, and post-operative factors on the success rate of the MI model in rats. Results The success rate of generating an MI model in rats can be significantly increased using the following methods： 1） Setting up the artificial airway through the use of MRTI by using a single-lumen central venous catheter; 2） Selecting a ligation site 2 mm be- low the midpoint of the connection between the left atrial appendage and the pulmonary cone; 3） Adding a drop of lidocaine to the surface of the heart to slow down the heart rate, make the operation easier to perform, and prevent arrhythmias postoperatively; 4） Clearing up airway secretions timely both intra and postoperative- ly; 5） Making sure that rats are in a warm state both intra and postoperatively; 6） Preventing wound infection. Conclusions Use of the MRTI method can quickly establish an artificial airway in rats. Intraoperative use of lidocaine, selecting a precise vascular ligation site, and appropriate care both intra and postoperatively can in- crease the success rate of MI model generation.
文摘Objective： To evaluate the clinical effects of onepassage, double-passage and circular canalicular intubations in repairing lacerations of canaliculus. Methods： Atotal of 109 eyes in 109 cases ofcanalicular laceration were repaired with three types of silicone intubations, among which 23 with one-passage canalicular intubation, 51 with double-passage canalicular intubation, and 35 with circular canalicular intubation. The average follow-up period was 12-15 months. Results： The wound/junction of the lacrimal canaliculi was ruptured in 5 cases （9.80%） of the double-passage group, 3 cases （8.57%） of the circular group, and 8 cases （34.78%） of the one-passage group. The rupture incidence of the one-passage group was significantly higher than that of the other two groups （ χ^2=9.416, P〈0.01）. During the inmbation, canaliculitis was observed in 12 cases （23.53%） of the double-passage group, while only 3 cases （8.57%） in the circular group and 8 cases （34.78%） in the one-passage group. The circular group had significantly lower incidence of canaliculitis than the other two groups （ χ^2=6.095, P〈0.05）. After extubation 6 months after laceration repair, the lacrimal passage remained patent with canalicular irrigation in 46 cases （90.20%） in the double-passage group, 30 cases （85.71%） in the circular group and 15 cases （65.22%） in the one-passage group. Six months after surgery, the canalicular patency in the one-passage group was significantly lower than that of the other two groups （ χ^2=7.390, P〈0.05）. Conclusions： Circular canalicular intubation is more stable and has less surgical complications than the doublepassage and one-passage canalicular intubations. It is also more effective clinically 12-15 months after laceration surgery.
文摘Objective： To investigate the necessity of modification to the traditional pigtail probe and evaluate its efficiency and therapeutic effect in searching the nasal cut ends and anastomosing the lacerated lacrimal canaliculus. Methods： Eighty-seven patients （including 87 eyes） suffering from canalicular laceration were randomized into two groups： 41 patients treated with traditional pigtail probes （Group A） and 46 with modified pigtail probes （Group B）. During the reconstruction of the lacerated canaliculi, the traditional pigtail probe and the modified pigtail probe were used respectively to seek for the nasal cut ends of lacerated lacrimal canaliculi. Peripherally inserted central catheter （PICCTM） silicone tube with diameter of 0.95 mm was intubated as a stent for 4-6 months. The surgical outcomes were retrospectively analyzed after stent removal. Results： In Group B, the primary success rate of searching the nasal cut ends of lacerated lacrimal canaliculi was 93.48% （43/46） and the final success rate was 97.83% （45/46）. No false passage formed in Group B. Statistical sig- nificance was found between Group A and Group B as the primary success rates of searching the nasal cut ends （ x^2 = 10.522, P〈0.01） and the false passage forming rates were concerned （ x^2=4.704, P〈0.05）, whereas no significance was found between the two groups as the final success rates were concerned （ x^2=0.007, P〉0.05）. The mean time of searching the nasal cut ends of lacerated lacrimal canaliculi in Group B was （5.02±2.73） minutes and the mean time of operation was （33.90±4.84） minutes, and both were significantly shorter than those of Group A （t1=9.779, t2=10.700, P〈0.01）. The cure rate of Group B was 95.65%, though higher than that of Group A, no statistical significance was found （Z=-1.007, P〉0.05）. Totally, 2 patients （2.30%） were found to be absent of common canaliculus and underwent bicanalicular nasal intubation in the two groups. Conclusions： Pigtail probes are efficient and convenient apparatus for searching the nasal cut ends of the lacerated lacrimal canaliculi in the reconstruction of canalicular laceration. Necessary or proper modifications to the pigtail probes can minimize the risk of iatrogenic damages or complications and enhance the efficiency and therapeutic effect of canalicular repair.
文摘目的研究气管插管全身麻醉下治疗性内镜逆行胰胆管造影术的安全性及患者术后不良事件发生的危险因素。方法回顾性选取2020年3月—2022年3月泗洪中信医院收治的40例气管插管全身麻醉下治疗性内镜逆行胰胆管造影术患者的临床资料,根据是否发生术后不良事件进行分组,分为对照组(无术后不良事件)、观察组(发生术后不良事件),各20例。统计导致患者术后不良事件发生的相关因素。结果单因素分析结果显示,观察组患者年龄≥65岁、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅲ级、高血压史、心血管病史、脑血管病史、糖尿病史、术中出血量增加和手术时间延长占比均高于对照组,差异有统计学意义(P均<0.05)。多因素分析显示,年龄≥65岁(OR=1.865,95%CI:1.129~3.079)、ASA分级为Ⅲ级(OR=1.972、95%CI:1.247~3.119)、高血压史(OR=1.533、95%CI:1.245~1.887)、手术时间延长(OR=1.237、95%CI:1.117~1.887)、手术出血量增加(OR=1.586、95%CI:1.134~2.217)为患者术后发生不良事件的危险因素,差异有统计学意义(P均<0.05)。结论年龄、ASAⅢ级、手术时间延长、术中出血量增加以及高血压史为导致气管插管全身麻醉下治疗性内镜逆行胰胆管造影术不良事件发生的主要危险因素。
