Despite significant improvements in medical management of inflammatory bowel disease, many of these patients still require surgery at some point in the course of their disease. Their young age and poor general conditi...Despite significant improvements in medical management of inflammatory bowel disease, many of these patients still require surgery at some point in the course of their disease. Their young age and poor general conditions, worsened by the aggressive medical treatments, make minimally invasive approaches particularly enticing to this patient population. However, the typical inflammatory changes that characterize these diseases have hindered wide diffusion of laparoscopy in this setting, currently mostly pursued in high-volume referral centers, despite accumulating evidences in the literature supporting the benefits of minimally invasive surgery. The largest body of evidence currently available for terminal ileal Crohn's disease shows improved short term outcomes after laparoscopic surgery, with prolonged operative times. For Crohn's colitis, high quality evidence supporting laparoscopic surgery is lacking.Encouraging preliminary results have been obtained with the adoption of laparoscopic restorative total proctocolectomy for the treatment of ulcerative colitis. A consensus about patients' selection and the need for staging has not been reached yet. Despite the lack of conclusive evidence, a wave of enthusiasm is pushing towards less invasive strategies, to further minimize surgical trauma, with single incision laparoscopic surgery being the most realistic future development.展开更多
Objective To investigate the changes of blood coagulation status and the safety of emergency microsurgery in patients with acute trauma to their extremities. Methods Forty seven patients with open injuries to the extr...Objective To investigate the changes of blood coagulation status and the safety of emergency microsurgery in patients with acute trauma to their extremities. Methods Forty seven patients with open injuries to the extremities were divided into 3 groups: in Group Ia (n=20), the patients presented with open injury to a single limb without traumatic shock and chest or head injuries, and they did not undergo microsurgery; while in Group Ib (n=13), an emergency microsurgery was done. In Group Ⅱ , the patients suffered from multiple compound fractures of the extremities with traumatic shock and chest or head injuries. The blood coagulation status of all the patients was evaluated by testing platelet count (PLC), platelet adhesiveness (PadT), serum antithrombin Ⅲ (AT- Ⅲ ), and D-dimer (D-Di) level. Results In Groups Ia and Ib, only PadT was increased and AT- Ⅲ declined preoperatively, then they returned to normal 24h postoperatively. In Group Ⅱ, at different periods after trauma, there was significant evidence of Pg and AT-Ⅲ decline accompanied by high increase of PadT and D-Di level; at 24h postoperatively, the mean values were 49.3% (PadT), 2.7mg/L (D-Di), 1..1g/L (Pg), and 69.1% (AT-Ⅲ), respectively. All these changes got significant difference (P<0.05) when compared with the normal value and those of Groups Ia and Ib, and did not completely return to normal even 72h after operation. Conclusion An emergency microsurgery could be safely performed in patients with ordinary open injuries to their limbs without traumatic shock, however it should be done with caution in cases of severe injuries with traumatic shock, because hypercoagulation status would follow in several hours after injuries. D-Di measurement may be used as a screening test to predict and assess hypercoagulation status more early after trauma.展开更多
Objective To report the results of treatment of osteoid osteomas with wide surgical excision and CT-guided less invasive surgeries.Methods Forty-two patients were entered into this prospective study between Jan.1998 a...Objective To report the results of treatment of osteoid osteomas with wide surgical excision and CT-guided less invasive surgeries.Methods Forty-two patients were entered into this prospective study between Jan.1998 and Jan.2008.Nineteen patients underwent wide surgical excision.The lesions were in the femur(n=9),tibia(n=7),and humerus(n=3).The mean lesion diameter was(9.2±2.3)mm(range,7-16mm).Twenty-three patients(15 males and 8 females)underwent CT-guided less invasive surgeries procedures.The lesions were in the femur(n=9),tibia(n=6),acetabulum(n=4)and humerus(n=4).The mean lesion diameter was(8.1±2.7)mm(range,6-15mm).Among these 23 patients,20 patients were performed by core drill excision.Three patients were performed by radiofrequency ablation.Follow-up ranged from 16 to 68 months(mean,35 months)to assess pain,neurovascular damage,pathological fracture,movement,and recurrence.Results were categorized as success(persistent complete relief of pain)and failure(absent or incomplete relief of pain,requiring additional treatment).Results The success rates were 89%(17/19)after wide surgical excision and 96%(22/23)after less invasive surgeries,respectively,and the difference was not significant(P>0.05).Patients were hospitalized for average 8.3 d(5-15d)after wide surgical excision and 3.2d(3-5d)after less invasive surgeries(P<0.05).There were no complications such as sepsis,pathological fracture,or neurovascular damage.No further recurrences were observed during follow-up.Conclusion Less invasive surgeries has obvious advantages such as reduced cost,shorter stay in hospital and rapid convalescence.Core-drill excision can obtain sufficient material for pathologic examination.展开更多
Objective： To sum up our experience in percutaneous dilatational tracheostomy （PDT） in ICU patient with severe brain injury. Methods： Between November 2011 and April 2014, PDTs were performed on 32 severe brain i...Objective： To sum up our experience in percutaneous dilatational tracheostomy （PDT） in ICU patient with severe brain injury. Methods： Between November 2011 and April 2014, PDTs were performed on 32 severe brain injury patients in ICU by a team of physicians and intensivists. The success rate, efficacy, safety, and complications including stomal infection and bleeding, paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, as well as clinically significant tracheal stenosis were carefully monitored and recorded respectively. Results： The operations took 4-15 minutes （mean 9.1 minutes±4.2 minutes）. Totally 4 cases suffered from complications in the operations： 3 cases of stomal bleeding, and 1 case of intratracheal bloody secretion, but none required intervention. Paratracheal insertion,pneumothorax, pneumomediastinum, tracheal laceration, or clinically significant tracheal stenosis were not found in PDT patients. There was no procedure-related death occurring during or after PDT. Conclusion： Our study demonstrats that PDT is a safe, highly effective, and minimally invasive procedure. The appropriate sedation and airway management perioperatively help to reduce complication rates. PDT should be performed or supervised by a team of physicians with extensive experience in this procedure, and also an intensivist with experience in difficult airway management.展开更多
This article aims to expound the essence of minimally invasive surgery as well as when and how to use it in craniocerebral trauma surgery according to the characteristics of the disease. In neurosurgery, the importanc...This article aims to expound the essence of minimally invasive surgery as well as when and how to use it in craniocerebral trauma surgery according to the characteristics of the disease. In neurosurgery, the importance of tissue protection should be from the inside to the outside, i.e. brain→dura→skull→scalp. In this article, I want to share my opinion and our team＇s experience in terms of selecting surgical approaches and incision, surgical treatment of the skull, dura handling, intracranial operation and placement of drainage based on the above theory. I hope this will be helpful for trauma surgeons.展开更多
文摘Despite significant improvements in medical management of inflammatory bowel disease, many of these patients still require surgery at some point in the course of their disease. Their young age and poor general conditions, worsened by the aggressive medical treatments, make minimally invasive approaches particularly enticing to this patient population. However, the typical inflammatory changes that characterize these diseases have hindered wide diffusion of laparoscopy in this setting, currently mostly pursued in high-volume referral centers, despite accumulating evidences in the literature supporting the benefits of minimally invasive surgery. The largest body of evidence currently available for terminal ileal Crohn's disease shows improved short term outcomes after laparoscopic surgery, with prolonged operative times. For Crohn's colitis, high quality evidence supporting laparoscopic surgery is lacking.Encouraging preliminary results have been obtained with the adoption of laparoscopic restorative total proctocolectomy for the treatment of ulcerative colitis. A consensus about patients' selection and the need for staging has not been reached yet. Despite the lack of conclusive evidence, a wave of enthusiasm is pushing towards less invasive strategies, to further minimize surgical trauma, with single incision laparoscopic surgery being the most realistic future development.
文摘Objective To investigate the changes of blood coagulation status and the safety of emergency microsurgery in patients with acute trauma to their extremities. Methods Forty seven patients with open injuries to the extremities were divided into 3 groups: in Group Ia (n=20), the patients presented with open injury to a single limb without traumatic shock and chest or head injuries, and they did not undergo microsurgery; while in Group Ib (n=13), an emergency microsurgery was done. In Group Ⅱ , the patients suffered from multiple compound fractures of the extremities with traumatic shock and chest or head injuries. The blood coagulation status of all the patients was evaluated by testing platelet count (PLC), platelet adhesiveness (PadT), serum antithrombin Ⅲ (AT- Ⅲ ), and D-dimer (D-Di) level. Results In Groups Ia and Ib, only PadT was increased and AT- Ⅲ declined preoperatively, then they returned to normal 24h postoperatively. In Group Ⅱ, at different periods after trauma, there was significant evidence of Pg and AT-Ⅲ decline accompanied by high increase of PadT and D-Di level; at 24h postoperatively, the mean values were 49.3% (PadT), 2.7mg/L (D-Di), 1..1g/L (Pg), and 69.1% (AT-Ⅲ), respectively. All these changes got significant difference (P<0.05) when compared with the normal value and those of Groups Ia and Ib, and did not completely return to normal even 72h after operation. Conclusion An emergency microsurgery could be safely performed in patients with ordinary open injuries to their limbs without traumatic shock, however it should be done with caution in cases of severe injuries with traumatic shock, because hypercoagulation status would follow in several hours after injuries. D-Di measurement may be used as a screening test to predict and assess hypercoagulation status more early after trauma.
文摘Objective To report the results of treatment of osteoid osteomas with wide surgical excision and CT-guided less invasive surgeries.Methods Forty-two patients were entered into this prospective study between Jan.1998 and Jan.2008.Nineteen patients underwent wide surgical excision.The lesions were in the femur(n=9),tibia(n=7),and humerus(n=3).The mean lesion diameter was(9.2±2.3)mm(range,7-16mm).Twenty-three patients(15 males and 8 females)underwent CT-guided less invasive surgeries procedures.The lesions were in the femur(n=9),tibia(n=6),acetabulum(n=4)and humerus(n=4).The mean lesion diameter was(8.1±2.7)mm(range,6-15mm).Among these 23 patients,20 patients were performed by core drill excision.Three patients were performed by radiofrequency ablation.Follow-up ranged from 16 to 68 months(mean,35 months)to assess pain,neurovascular damage,pathological fracture,movement,and recurrence.Results were categorized as success(persistent complete relief of pain)and failure(absent or incomplete relief of pain,requiring additional treatment).Results The success rates were 89%(17/19)after wide surgical excision and 96%(22/23)after less invasive surgeries,respectively,and the difference was not significant(P>0.05).Patients were hospitalized for average 8.3 d(5-15d)after wide surgical excision and 3.2d(3-5d)after less invasive surgeries(P<0.05).There were no complications such as sepsis,pathological fracture,or neurovascular damage.No further recurrences were observed during follow-up.Conclusion Less invasive surgeries has obvious advantages such as reduced cost,shorter stay in hospital and rapid convalescence.Core-drill excision can obtain sufficient material for pathologic examination.
文摘Objective： To sum up our experience in percutaneous dilatational tracheostomy （PDT） in ICU patient with severe brain injury. Methods： Between November 2011 and April 2014, PDTs were performed on 32 severe brain injury patients in ICU by a team of physicians and intensivists. The success rate, efficacy, safety, and complications including stomal infection and bleeding, paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, as well as clinically significant tracheal stenosis were carefully monitored and recorded respectively. Results： The operations took 4-15 minutes （mean 9.1 minutes±4.2 minutes）. Totally 4 cases suffered from complications in the operations： 3 cases of stomal bleeding, and 1 case of intratracheal bloody secretion, but none required intervention. Paratracheal insertion,pneumothorax, pneumomediastinum, tracheal laceration, or clinically significant tracheal stenosis were not found in PDT patients. There was no procedure-related death occurring during or after PDT. Conclusion： Our study demonstrats that PDT is a safe, highly effective, and minimally invasive procedure. The appropriate sedation and airway management perioperatively help to reduce complication rates. PDT should be performed or supervised by a team of physicians with extensive experience in this procedure, and also an intensivist with experience in difficult airway management.
基金This work was supported by research grants from the National Natural Science Foundation of China （No. 81171144, No. 81471238）
文摘This article aims to expound the essence of minimally invasive surgery as well as when and how to use it in craniocerebral trauma surgery according to the characteristics of the disease. In neurosurgery, the importance of tissue protection should be from the inside to the outside, i.e. brain→dura→skull→scalp. In this article, I want to share my opinion and our team＇s experience in terms of selecting surgical approaches and incision, surgical treatment of the skull, dura handling, intracranial operation and placement of drainage based on the above theory. I hope this will be helpful for trauma surgeons.
