Open surgery:Still a great option to treat patients with posttraumatic arteriovenous fistulas:A case report

BACKGROUND In the modern era of endovascular surgery percutaneous interventions are being widely used to treat a number of vascular disorders including arteriovenous fistulas(AVF).Still,patients with hostile anatomy or complicated cases such as large post-traumatic AVFs may be successfully treated using conventional vascular surgery.CASE SUMMARY This paper presents state-of-the-art treatment options in subjects with posttraumatic AVFs and a case-report of a successful open surgical approach in a patient with a 25 year old history of a post-traumatic AVF between the common femoral artery and common femoral vein.CONCLUSION Open surgery is still a great option to treat patients with post-traumatic arteriovenous fistulas with hostile anatomy or in complicated cases.Concomitant conditions and complications should be addressed promptly.

Clinical effect of laparoscopic radical resection of colorectal cancer based on propensity score matching

BACKGROUND The incidence of colorectal cancer(CRC)is increasing annually.Laparoscopic radical resection of CRC is a minimally invasive procedure preferred in clinical practice.AIM To investigate the clinical effect of laparoscopic radical resection of CRC on the basis of propensity score matching(PSM).METHODS The clinical data of 100 patients who received inpatient treatment for CRC at Changde Hospital,Xiangya School of Medicine,Central South University(The First People’s Hospital of Changde City)were analyzed retrospectively.The control group included patients who underwent open surgery(n=43),and those who underwent laparoscopic surgery formed the observation group(n=57).The baseline information of both groups was equipoised using 1×1 PSM.Differences in the perioperative parameters,inflammatory response,immune function,degree of pain,and physical status between the groups were analyzed.RESULTS Thirty patients from both groups were successfully matched.After PSM,baseline data showed no statistically significant differences between the groups:(1)Periop-erative parameters:The observation group had a longer surgery time,less intra-operative blood loss,earlier first ambulation and first anal exhaust times,and shorter gastric tube indwelling time than the control group;(2)Inflammatory response:24 h after surgery,the levels of interleukin-6(IL-6),C-reactive protein(CRP),and tumor necrosis factor-α(TNF-α)between groups were higher than preoperatively.IL-6,CRP,and TNF-αlevels in the observation group were lower than in the control group;(3)Immune function:At 24 h after surgery,counts of CD4-positive T-lymphocytes(CD4+)and CD4+/CD8-positive T-lymphocytes(CD8+)in both groups were lower than those before surgery,whereas CD8+was higher than that before surgery.At 24 h after surgery,both CD4+counts and CD4+/CD8+in the observation group were higher than those in the control group,whereas CD8+counts were lower;(4)Degree of pain:The visual analog scale scores in the observation group were lower than those in the control group at 24 and 72 h after surgery;and(5)Physical status:One month after surgery,the Karnofsky performance score in the observation group was higher than that in the control group.CONCLUSION Laparoscopic radical resection of CRC has significant benefits,such as reducing postoperative pain and postoperative inflammatory response,avoiding excessive immune inhibition,and contributing to postoperative recovery.

LESS-OPEN理念创新及其在卵巢囊肿剥除中的应用和展望

卵巢囊肿是妇科最常见的疾病之一,腹腔镜手术是治疗良性卵巢肿瘤的重要手段,单孔腹腔镜手术(laparoendoscopic single-site surgery,LESS)因将瘢痕隐藏于肚脐而备受女性患者的青睐,而单孔腹腔镜结合开腹手术(open surgery)有望在保证美观的同时,降低手术难度,更好的保留卵巢功能。本团队在国内首创了单孔腹腔镜联合开腹手术(LESS-OPEN)理念,在卵巢囊肿的治疗上取得了很好的疗效,并在国际上率先构建了单孔腹腔镜体外(LESS-E)卵巢囊肿剥除术可行性预测评分系统,在此基础上建立了卵巢囊肿LESS-E手术适应证体系。本述评旨在讨论LESS-OPEN理念在卵巢囊肿剥除中的应用,并对该项技术的发展进行展望。

Short-and long-term outcomes following laparoscopic vs open surgery for pathological T4 colorectal cancer: 10 years of experience in a single center

AIM To evaluate the short-term and long-term outcomes following laparoscopic vs open surgery for pathological T4(pT 4) colorectal cancer.METHODS We retrospectively analyzed the short-and long-term outcomes of proven p T4 colorectal cancer patients who underwent complete resection by laparoscopic or open surgery from 2006 to 2015 at Guangdong General Hospital.RESULTS A total of 211 p T4 colorectal cancer patients were included in this analysis, including 101 cases in thelaparoscopy(LAP) group and 110 cases in the open surgery(OPEN) group [including 15(12.9%) cases of conversion to open surgery]. Clinical information(age, gender, body mass index, comorbidities, American Society of Anesthesiologists score, etc.) did not differ between the two groups. In terms of blood loss, postoperative complications and rate of recovery, the LAP group performed significantly more favorably(P < 0.05). With regard to p T4 a/b and combined organ resection, there were significantly more cases in the OPEN group(P < 0.05). The 3-and 5-year overall survival rates were 74.9% and 60.5%, respectively, for the LAP group and 62.4% and 46.5%, respectively, for the OPEN group(P = 0.060). The 3-and 5-year disease-free survival rates were 68.0% and 57.3%, respectively, for the LAP group and 55.8% and 39.8%, respectively, for the OPEN group(P = 0.053). Multivariate analysis showed that ⅢB/ⅢC stage, lymph node status, and CA19-9 were significant predictors of overall survival. PT4 a/b, ⅢC stage, histological subtypes, CA19-9, and adjuvant chemotherapy were independent factors affecting disease-free survival.CONCLUSION Laparoscopy is safely used in the treatment of p T4 colorectal cancer while offering advantages of minimal invasiveness and faster recovery. Laparoscopy is able to achieve good oncologic outcomes similar to those of open surgery. We recommend that laparoscopy be carried out in experienced centers. It is still required to screen the appropriate cases for laparoscopic surgery, optimize the preoperative diagnosis process, and reduce the conversion rate. Multi-center, prospective, and large-sample studies are required to assess these issues.

Clinical comparison of laparoscopy vs open surgery in a radical operation for rectal cancer: A retrospective casecontrol study

AIM: To assess the diverse immediate and longterm clinical outcomes, a retrospective comparison between laparoscopic and conventional operation was performed.METHODS: A total number of 916 clinical cases, from January 2006 to December 2013 in our hospital, were analyzed which covered 492 patients underwent the laparoscopy in radical resection(LRR) and 424 cases in open radical resection(ORR). A retrospective analysis was proceeded by comparing the general information, surgery performance, pathologic data, postoperative recovery and complications as well as long-term survival to investigate the diversity of immediate and long-term clinical outcomes of laparoscopic radical operation.RESULTS: There were no statistically significance differences between gender, age, height, weight, body mass index(BMI), tumor loci, tumor node metastasis stages, cell differentiation degree or American Society of Anesthesiologists scores of the patients(P > 0.05). In contrast to the ORR group, the LRR group experienced less operating time(P < 0.001), a lower blood loss(P < 0.001), and had a 2.44% probability of conversion to open surgery. Postoperative bowel function recovered more quickly, analgesic usage and the average hospital stay(P < 0.001) were reduced after LRR. Lymph node dissection during LRR appeared to be slightly more than in ORR(P = 0.338). There were no obvious differences in the lengths and margins(P = 0.182). And the occurrence rate in the two groups was similar(P = 0.081). Overall survival rate of ORR and LRR for 1, 3 and 5 years were 94.0% and 93.6%(P = 0.534), 78.1% and 80.9%(P = 0.284) and 75.2% and 77.0%(P = 0.416), respectively.CONCLUSION: Laparoscopy as a radical operation for rectal cancer was safe, produced better immediate outcomes. Long-term survival of laparoscopy revealed that it was similar to the open operation.

Evolving thoracic surgery: from open surgery to single port thoracoscopic surgery and future robotic

Thoracic Surgery is a continuous evolving specialty. In the past, thoracic surgeons had to make large incisions in order to operate any pathology inside the chest. This often meant big, painful and ugly scars and long recovery times after surgery. But he history of thoracic surgery changed since the begining of video-assisted thoracoscoDic surgery （VATg3

Effect of subconjunctival injection with conbercept as an adjuvant to filtration surgery for open angle glaucoma: a prospective randomized interventional 6-month follow-up study

AIM: To compare the safety and efficacy of subconjunctival injection with conbercept and 5-fluorouracil(5-FU) for open angle glaucoma(OAG) patients after filtration surgery. METHODS: As a prospective randomized interventional trial, 36 eyes from 36 patients after OAG surgery were collected and divided randomly into conbercept and 5-FU groups. All patients were subconjunctivally injected with either conbercept(0.2 mL) or 5-FU(0.2 mL) on the 5th day post-operatively. The intraocular pressure(IOP), number of medications used, type of conjunctival bleb, and complications were recorded and analyzed pre-operatively and 1d, 1wk, 1, 3 and 6mo post-injection. RESULTS: There were significant differences in IOP between the conbercept and 5-FU groups 1mo(conbercept group: 12.17±1.04 mm Hg; 5-FU group: 13.50±2.33 mm Hg, t=2.214, P=0.037), 3mo(conbercept group: 13.00±1.88 mm Hg; 5-FU group: 14.50±2.28 mm Hg, t=2.153, P=0.039), and 6mo post-injection(conbercept group: 13.28±2.95 mm Hg; 5-FU group: 15.22±2.49 mm Hg, t=2.140, P=0.040); however, in the number of medications, a prominent difference was not shown between groups on post-injection 6mo(t=1.312, P=0.200). Moreover, there was mild vascularity observed in the conbecept group than the 5-FU group 1d(3a, 3b, 3c: t=8.497, 6.693, 4.515, P=0.000), 1wk(3a, 3b, 3c: t=3.431, 6.408, 3.984, P=0.002, 0.000, 0.000), and 1mo post-injection(3a, 3b, 3c: t=2.466, 2.466, 2.503, P=0.019, 0.019, 0.017). Simultaneously, differences from other indicators between the two groups were not demonstrated. Also, there was a lower probability of corneal epithelial stripping in the conbercept group than the 5-FU group(χ2=4.500, P=0.034). CONCLUSION: Subconjunctival injection of conbercept has a safe, effective, and tolerable profile for open angle glaucoma patients with distinct conjunctival congestion after filtration surgery.

Meta Analysis of Non-penetrating Trabecular Surgery versus Trabeculectomy for the Treatment of Open Angle Glaucoma

This study compared the efficacy of non-penetrating trabecular surgery and trabeculectomy for the treatment of open angle glaucoma. We searched the Cochrane Library, PUBMED （1966 to 2009）, Embase （1980 to 2009） and CMB-disk （1979 to 2009） for the randomized clinical trials （RCT） concerning the two treatment strategies. The reports, including the papers listed in bibliographies, were evaluated against a set of quality criteria and the RCTs that satisfied the criteria were selected and subjected to Meta analysis by employing the Cochrane Collaboration＇s RevMan 4.5 software package. A total of nine RCTs were included in the study. The analyses of the reports showed that, 12 months after surgery, there was significant difference in the reduction of interocular pressure （IOP） between non-penetrating trabecular surgery and trabeculectomy （Z=6.05 P0.00001）. There also existed statistically significant difference in the reduction of IOP at the censored time between the two procedures （Z=4.92, P0.00001）. Difference in the success rate was also found between the two surgeries （Z=3.82, P=0.0001）. It is concluded that, compared with the non-penetrating trabeculectomy, the traditional trabeculectomy could reduce IOP more and had higher success rate while the non-penetrating trabecular surgery is associated with lower postoperative complications.

Open surgery in the era of minimally invasive surgery

The benefits and popularity of minimally invasive surgery are undeniable around the globe.However,open surgery is necessary and learning open surgery skills is still a necessity.Open surgery allows for better exposure to the surgical field and provides tactile sensation to facilitate the stereo visual assessment to precisely remove the lesion.Open surgery is still the key to surgical training,and the skills learned from open surgeries remain crucial for unforeseen circumstances and certain conditions like emergencies,challenge cases,or patients with compromised status.

Laparoscopic vs.open surgery for gastrointestinal stromal tumors of esophagogastric junction:A multicenter,retrospective cohort analysis with propensity score weighting

Objective:Laparoscopic resection is increasingly performed for gastrointestinal stromal tumors(GISTs).However,the laparoscopic approach for GISTs located in the esophagogastric junction(EGJ-GIST)is surgically challenging.This study compares the efficacy of laparoscopic surgery and the open procedure for EGJ-GIST through the propensity score weighting(PSW)method.Methods:Between April 2006 and April 2018,1,824 surgical patients were diagnosed with primary gastric GIST at four medical centers in South China.Of these patients,228 were identified as EGJ-GISTs and retrospectively reviewed clinicopathological characteristics,operative information,and long-term outcomes.PSW was used to create the balanced cohorts.Results:PSW was carried out in laparoscopic and open-surgery cohorts according to year of surgery,sex,age,body mass index(BMI),tumor size,mitotic rates and recurrence risk.After PSW,438 patients consisting of 213 laparoscopic(L group)and 225 open surgery(O group)patients were enrolled.After PSW,the following measures in the L group were superior to those in the O group:median operative time[interquartile range(IQR)]:100.0(64.5-141.5)vs.149.0(104.0-197.5)min,P<0.001;median blood loss(IQR):30.0(10.0-50.0)vs.50.0(20.0-100.0)mL,P=0.002;median time to liquid intake(IQR):3.0(2.0-4.0)vs.4.0(3.0-5.0)d,P<0.001;median hospital stay(IQR):6.0(4.0-8.0)vs.7.0(5.0-12.0)d,P<0.001;and postoperative complications(10.3%vs.22.7%,P=0.001).The median follow-up was 55(range,2-153)months in the entire cohort.No significant differences were detected in either relapse-free survival(RFS)[hazard ratio(HR):0.372,95%confidence interval(95%CI):0.072-1.910,P=0.236]or overall survival(OS)(HR:0.400,95%CI:0.119-1.343,P=0.138)between the two groups.Conclusions:Laparoscopic surgery for EGJ-GIST is associated with the advantages of shorter operative time,reduced blood loss,shorter time to liquid intake,and shorter length of stay,all without compromising postoperative outcomes and long-term survival.

Comparison of the Effects of Minimally Invasive Percutaneous Nephrolithotomy and Open Surgery on Kidney Stones

Objective:To compare the treatment effects of minimally invasive percutaneous nephrolithotomy and open surgery on kidney stones.Methods:From November 2018 to November 2019,80 patients with kidney stones who were treated in our hospital were selected and divided into two groups according to the random number table method.Each group contained 40 patients.The patients in control group were treated with open surgery while the patients in observation group were treated with minimally invasive percutaneous nephrolithotomy.The surgical indicators,rate of stone removal,and adverse events were compared between the two groups.Results:There was no statistically significant difference in surgical time between the two groups(P>0.05).Compared with the control group,the observation group had less intraoperative blood loss and shorter hospital stay,and the differences were statistically significant(P<0.05).The stone clearance rate(95.00%)in the observation group was higher than that in the control group(77.50%),and the difference was statistically significant(P<0.05).Compared with the control group,the incidence of postoperative adverse effects was lower in the observation group,and the difference was statistically significant(P<0.05).Conclusion:Minimally invasive percutaneous nephrolithotomy for kidney stones is effective in reducing the intraoperative blood loss,shortening the length of hospital stay,improving the rate of stone clearance and reducing the occurrence of adverse effects.Therefore,this treatment method should be promoted for clinical use.

Application of laparoscopic surgery in gallbladder carcinoma

Gallbladder carcinoma(GC)is a rare type of cancer of the digestive system,with an incidence that varies by region.Surgery plays a primary role in the comprehensive treatment of GC and is the only known cure.Compared with traditional open surgery,laparoscopic surgery has the advantages of convenient operation and magnified field of view.Laparoscopic surgery has been successful in many fields,including gastrointestinal medicine and gynecology.The gallbladder was one of the first organs to be treated by laparoscopic surgery,and laparoscopic cholecystectomy has become the gold standard surgical treatment for benign gallbladder diseases.However,the safety and feasibility of laparoscopic surgery for patients with GC remain controversial.Over the past several decades,research has focused on laparoscopic surgery for GC.The disadvantages of laparoscopic surgery include a high incidence of gallbladder perforation,possible port site metastasis,and potential tumor seeding.The advantages of laparoscopic surgery include less intraoperative blood loss,shorter postoperative hospital stay,and fewer complications.Nevertheless,studies have provided contrasting conclusions over time.In general,recent research has tended to support laparoscopic surgery.However,the application of laparoscopic surgery in GC is still in the exploratory stage.Here,we provide an overview of previous studies,with the aim of introducing the application of laparoscopy in GC.

Psychosocial Factors Associated with Transfer Anxiety among Open Heart Surgery Patients Transferred from the Intensive Care Unit to the General Ward

Introduction: Patient’s transfer from the intensive care unit (ICU) to the general ward indicates their improving health status. However, the transfer produces anxiety when patients enter an unfamiliar environment with different care protocols and circumstances. Objectives: This study aimed to examine the level of ICU transfer anxiety among open heart surgery patients and determine the psychosocial factors associated with ICU transfer anxiety among open heart surgery patients. Methods: Data were collected in a cardiac center in Kathmandu City, Nepal among 95 open heart surgery patients within 24 hours of their transfer from an ICU to a general ward. The study used four self-reported questionnaires, namely the modified Mishel Uncertainty in Illness Scale for Adults, modified Brief COPE Inventory, Nurses’ Support Questionnaire, and State Anxiety Inventory. Results: Fifty-two patients (54.7%) had a high level of transfer anxiety. Spearman’s rank correlation showed that uncertainty in illness, coping, and nurses’ support were significantly related to transfer anxiety (p < 0.001). Conclusion: The results of this study suggest nurses to address uncertainty in illness of the patients, improve their coping abilities, and provide need-based nursing support to them during the transitional phase. Besides, clinicians and governmental agencies should contribute to implication of transitional guidelines, which can reduce transfer anxiety and promote health and recovery of the patients.

Upper Urinary Tract Calculi in Senegal: A Comparative Study between Open Surgery and Endoscopy, a Review of 89 Cases

Objective: The aim was to assess the place of endourologic intervention in our practice and compare it to open surgery in the management of upper urinary tract calculi in Senegal. Patients and Methods: This was a retrospective study conducted at both the Principal and Grand Yoff Hospitals of Dakar from January 2009 to December 2013 in which 89 patients with upper urinary tract calculi were mobilized. All patients with symptomatic upper urinary tract colic symptoms were included. Results: Eighty-nine were followed up during the study period, 63 men and 36 women (sex of ratio 1.2). The average age was 44 years with extremes 22 - 75 years. Forty two patients, including 28 men and 14 women (sex ratio 1: 2) were treated with open surgery. The mean age was 42.75 years (4 - 75 years). The average duration of hospitalization after open surgery was 8 days (4 - 60 days). The mean stone size in open surgery was 23 mm (5 mm - 45 mm). Complications noted were: 2 cases of urinomas (4.76%), 1 case of lower back fistula (2.38%), 1 case of renal pelvis fistula (2.38%) and 1 case (2.38%) of infection. Forty seven patients including 35 men (55.6%) and 12 women (46.2%) were treated by endourology. The average length of hospital stay was 2 days (2 d - 3 d). The average stone size treated by endourology was 13 mm (5 mm - 40 mm). No complications were observed in this group. The cost of open surgery was a third of that of endourology. Conclusion: Endoscopic surgery, as is observed from industrialized countries occupies a prominent place in the treatment of upper urinary tract calculi in Senegal;however, the only limiting factor encountered is the cost which remains out of reach for patients and burdening the budgets of our hospitals with limited means.

Conversion Rate of Laparoscopic Cholecystectomy to Open Surgery at Al Karamah Teaching Hospital, Iraq

Background: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gall bladder disease. However, there still a substantial proportion of patients in whom Laparoscopic cholecystectomy cannot be successfully performed, and for whom conversion to open surgery is required. Method: In this study, 1600 laparoscopic cholecystectomy performed at Al karamah teaching hospital from January 2010 to January 2015, were prospectively analyzed. The patients studied included 1600, 1245 where females (78.4%) and 346 where males (21.6%) with a mean age of 41.2 years. From the data collected, only factors available to surgeon preoperatively were considered for analysis. These factors included: age, gender, history of acute Cholecystitis, jaundice, previous abdominal surgery, obesity and concomitant disease, ultrasound preoperatively & ERCP. Results: Of the 1600 patients in whom Laparoscopic cholecystectomy was attempted 56 patients (3.5%) required conversion to open surgery. The most common reason for conversion was difficult to define anatomy in patients with inflamed, contracted gall bladder (n = 42). Significant predictor factors for conversion were male gender, previous abdominal surgery, acute Cholecystitis, and obesity. Conclusion: An appreciation for these predictors for conversion will allow appropriate planning by the patient, the institution and the surgeon.

Peripheral Neuropathy after Open Abdominal Surgery with Self-Retaining Retractors. A Systematic Review of Randomised and Non-Randomised Clinical Trials

Objectives : A systematic review was undertaken to evaluate the effectiveness of incision retention available to surgeons conducting open abdominal or pelvic surgeries. Both the ability of the retractor to retain the wound and harm to the patient due to the retractor were reviewed. Methods : A search was conducted using the following databases: EMBASE, PubMed, BIOSIS, Engineering Village, Web of Science, Best practice, Science Direct, CRCnet BASE, Proquest, Wiley Online Library, and Comprehensive Biomaterial. Results : What the articles found were then narrowed down to those which matched the objective of the review. This resulted in ten articles to review. Two reviewers reviewed and summarized the articles. Femoral neuropathy was found to be a common complication due to Retractors. Other outcomes analysed or studied were found to be infected, postoperative pain and exposure provided. Femoral neuropathy can be estimated to occur at a rate between 2.6% and 7.5% in open pelvic and abdominal surgeries. The Alexis O-ring retractor was found to lower the required morphine intake following surgery when compared to the Belfour retractor. Conclusions : There is a lack of high quality/high levels of evidence studies that have been conducted on Retractors. Femoral neuropathy is the outcome most commonly documented in relation to Retractors. Surgeons need to be aware about the use and implementations of the retractors. Care should be taken in protecting the blades and during long surgery relocating retractors should be considered.

Effect of Oxygen Therapy by Venturi Mask versus Non Invasive Ventillation on the Outcome of Patients Who Devolope Hypoxia after Open Heart Surgery

Background: Cardiothoracic surgery is a common cause of acute respiratory failure and is associated with increased morbidity and mortality. We aimed to compare the outcomes of open heart surgery patients treated using oxygen delivery devices with patients who receive NIV as a first-line therapy for hypoxemic respiratory failure. Materials and Methods: 40 patients who developed acute hypoxemic respiratory failure after open heart surgery and admitted to cardiothoracic ICU 20 patients received NIV and 20 patient received oxygen by venture mask. For all patients the following measurements were performed before and after CPAP AND Venture use: CBC, blood urea, serum creatinine body temperature, chest X-ray, Arterial blood gases (arterial pH, sodium bicarbonate, pcO2, SpO2 and PaO2-to-FiO2 ratio). Results: Mean PO2 and SO2 have increased after using of both venture and Cpap, increase in both PCO2 and HCO3 levels after using Venturi mask, CPAP mask was superior to venturi mask in avoiding the need of intubation, decreasing The ICU stay median length and also median length of hospitalization, all were lower in CPAP group than venture group. Also the mortality rate was lower in CPAP group than the venturi group. Conclusion: Using CPAP mask in severe AHRF following open heart surgery can avoid intubation, decreases the levels of tachypnea and arterial hypoxemia, decreases ICU stay, the length of hospitalization and also decreases the mortality rate compared with patients receiving high-concentration oxygen therapy with venture mask.

Meta-analysis of the efficacy and safety of combined surgery in the management of eyes with coexisting cataract and open angle glaucoma

AIM： To conduct a systematic review and quantitative Meta-analysis of the efficacy and safety of combined surgery for the eyes with coexisting cataract and open angle glaucoma.METHODS： We performed a systematic search of the related literature in the Cochrane Library, PubM ed, EMBASE, Web of Science databases, CNKI, CBM and Wan Fang databases, with no limitations on language or publication date. The primary efficacy estimate was identified by weighted mean difference of the percentage of intraocular pressure reduction（IOPR%） from baseline to end-point, the percentage of number of glaucoma medications reduction from pre-to post-operation, and the secondary efficacy evaluations were performed by odds ratio（OR） and 95% confidence interval（CI） for complete and qualified success rate. Besides, ORs were applied to assess the tolerability of adverse incidents. Meta-analyses of fixed or random effect models were performed using Rev Man software 5.2 to gather the consequences. Heterogeneity was evaluated by Chi^2 test and the I^2 measure.RESULTS： Ten studies enrolling 3108 patients were included. The combined consequences indicated that both glaucoma and combined cataract and glaucoma surgery significantly decreased IOP. For deep sclerectomy vs deep sclerectomy plus phacoemulsification and canaloplasty vs phaco-canaloplasty, the differences in IOPR% were not all statistically significant while trabeculotomy was detected to gain a quantitatively greater IOPR% compared with trabeculotomy plus phacoemulsification. Furthermore, there was no statistical significance in the complete and qualified success rate, and the rates of adverse incidents for trabeculotomy vs trabeculotomy plus phacoemulsification.CONCLUSION： Compared with trabeculotomy plus phacoemulsification, trabeculectomy alone is more effective in lowering IOP and the number of glaucoma medications, while the two surgeries can not demonstrate statistical differences in the complete success rate, qualified success rate, or incidence of adverse incidents.

CHANGES ON RECEPTOR EXPRESSIONAND PRODUCTION OF INTERLEUKIN-2 IN CIRCULATING LYMPHOCYTE POPULATION AFTER OPEN HEART SURGERY

To evaluate the change of perioperative cell mediated immunity after cardiac operation with cardiopul-monary bypass (CPB), so as to provide some information for timely prevention and treatment against post-operative immunological disorder, 40 patients were studied. By searching for the effects of CPB and anes-thesia, interleukln-2 receptor (IL-2R) expression upon the surface of peripheral blood mononuclear cells(PBMC), as well as interleukin-2 (IL-2) production in vitro was traced 55 min after anesthesia, at end ofCPB, on postoperative 1, 7, and 14 day versus preanesthesia control. Our data demonstrated that expres-sion of IL-2R on PBMC was significantly suppressed in all comparing with the baseline value, meanwhile,IL-2 production in vitro also statistically dropped. However,no statistical difference was found on perioper-ative IL 2R expression and IL-2 synthesis in the cholecystectomy group. We conclude that postoperativeimmunological disorder seems to be the main factor, which could be denoted as reduced IL 2R expressionon PBMC and lL-2 synthesis in vitro for sepsis, even multiple system organ failure developed after cardiacsurgery.