穿透性角膜移植术后散光的成因及其处理

本文主要从供体材料、受体情况及手术中的钻取、缝合方法等方面探讨其对穿透性角膜移植术后散光的影响，并对目前应用的几种散光检测手段进行比较和评价，探讨了术中预防散光的方法。在手术后利用调整缝线、手术及激光等方法矫正术后散光，能使患者在不很复杂的穿透性角膜移植术后，其散光度数达到最小。

Local anesthesia with ropivacaine for patients undergoing laparoscopic cholecystectomy

AIM:To investigate the effect of pain relief after infu-sion of ropivacaine at port sites at the end of surgery.METHODS:From October 2006 to September 2007,72 patients undergoing laparoscopic cholecystectomy(LC) were randomized into two groups of 36 patients.One group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline.A visual analog scale was used to assess postoperative pain when the patient awakened in the operating room,6 and 24 h after surgery,and before discharge.The amount of analgesics use was also recorded.The demographics,laboratory data,hospital stay,and perioperative complications were compared between the two groups.RESULTS:There was no difference between the two groups preoperatively in terms of demographic and lab-oratory data.After surgery,similar operation time,blood loss,and no postoperative morbidity and mortality were observed in the two groups.However,a significantly lower pain score was observed in the patients undergo-ing LC with local anesthesia infusion at 1 h after LC and at discharge.Regarding analgesic use,the amount of meperidine used 1 h after LC and the total used during admission were lower in patients undergoing LC with local anesthesia infusion.This group also had a shorter hospital stay.CONCLUSION:Local anesthesia with ropivacaine at the port site in LC patients signif icantly decreased post-operative pain immediately.This explains the lower meperidine use and earlier discharge for these patients.

Clinical utility of the platelet-lymphocyte ratio as a predictor of postoperative complications after radical gastrectomy for clinical T2-4 gastric cancer

AIMTo identify simple and sensitive markers for postoperative complications after gastrectomy, the predictive values were compared among candidate preoperative factors.METHODSThree-hundred and twelve patients with previously untreated clinical T2-4 gastric cancer who underwent a D2 standard gastrectomy (distal gastrectomy or total gastrectomy) were included in the analysis. Correlations between 21 parameters that can be determined by preoperative routine blood tests and clinically relevant postoperative complications (grade II or higher according to the Clavien-Dindo classification) were evaluated. The optimal cutoff values and clinical significance of the selected markers were further evaluated by subgroup analyses according to age, body mass index, operative procedure and clinical disease stage.RESULTSSixty-six patients (21.1%) experienced grade II or higher postoperative complications. The platelet-lymphocyte ratio (PLR, total lymphocyte count/platelet count × 100) exhibited the highest area under the curve value (0.639) for predicting postoperative complications among the 21 parameters, and the optimal cutoff value was determined to be 0.71 (sensitivity = 70%, specificity = 56%). In the univariate analysis, the odds ratio of a low PLR for the occurrence of postoperative complications was 2.94 (95%CI: 1.66-5.35, P < 0.001), and a multivariate binomial logistic analysis involving other potential risk factors identified a low PLR as an independent risk factor for postoperative complications (OR = 3.32, 95%CI: 1.82-6.25, P < 0.001). In subgroups classified according to age, body mass index, operative procedure and clinical disease stage, the low PLR group exhibited an increased incidence of postoperative complications.CONCLUSIONThe preoperative PLR is a simple and useful predictor of complications after curative gastrectomy in patients with clinical T2-4 gastric cancer.

Postmyotomy dysphagia after laparoscopic surgery for achalasia

AIM: To determine predictive factors for postoperative dysphagia after laparoscopic myotomy for achalasia.METHODS: Logistic regression was used to investigate the possible association between the response (postoperative dysphagia, with two levels: none/mild and moderate/severe)and several plausible predictive factors.RESULTS: Eight patients experienced severe or moderate postoperative dysphagia. The logistic regression revealed that only the severity of preoperative dysphagia (with four levels; mild, moderate, severe, and liquid) was a marginally significant (P=0.0575) predictive factor for postoperative dysphagia.CONCLUSION: The severity of postoperative dysphagia is strongly associated with preoperative dysphagia. Preoperative symptomatology can significantly impact patient outcome.

Model for end-stage liver disease score versus Child score in predicting the outcome of surgical procedures in patients with cirrhosis

AIM： To determine factors affecting the outcome of patients with cirrhosis undergoing surgery and to compare the capacities of the Child-Turcotte-Pugh （CTP） and model for end-stage liver disease （MELD） score to predict that outcome. METHODS： We reviewed the charts of 195 patients with cirrhosis who underwent surgery at two teaching hospitals over a five-year period. The combined endpoint of death or hepatic decompensation was considered to be the primary endpoint. RESULTS： Patients who reached the endpoint had a higher MELD score, a higher CTP score and were more likely to have undergone an urgent procedure. Among patients undergoing elective surgical procedures, no statistically significant difference was noted in the mean MELD （12.8 ＋ 3.9 vs 12.6 ＋ 4.7, P = 0.9） or in the mean CTP （7.6 ± 1.2 vs 7.7 ± 1.7, P = 0.8） between patients who reached the endpoint and those who did not. Both mean scores were higher in the patients reaching the endpoint in the case of urgent procedures （MELD： 22.4 ± 8.7 vs 15.2 ± 6.4, P = 0.0007; CTP： 9.9 ± 1.8 vs 8.5 ± 1.8, P = 0.008）. The performances of the MELD and CTP scores in predicting the outcome of urgent surgery were only fair, without a significant difference between them （AUC = 0.755 ± 0.066 for MELD vs AUC = 0.696 ± 0.070 for CTP, P = 0.3）. CONCLUSION： The CTP and MELD scores performed equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.equally, but only fairly in predicting the outcome of urgent surgical procedures. Larger studies are needed to better define the factors capable of predicting the outcome of elective surgical procedures in patients with cirrhosis.

Pre-operative hypoalbuminemia is a major risk factor for postoperative complications following rectal cancer surgery

AIM:To determine the relationship between pre-operative hypoalbuminemia and the development of complications following rectal cancer surgery, as well as postoperative bowel function and hospital stay. METHODS:The medical records of 244 patients undergoing elective oncological resection for rectal adenocarcinoma at Siriraj Hospital during 2003 and 2006 were reviewed. The patients had pre-operative serum albumin assessment. Albumin less than 35 g/L was recognized as hypoalbuminemia. Postoperative outcomes, including mortality, complications, time to first bowel movement, time to first defecation, time to resumption of normal diet and length of hospital stay, were analyzed. RESULTS:The patients were 139 males (57%) and 105 females (43%) with mean age of 62 years. Fifty-six patients (23%) had hypoalbuminemia. Hypoalbuminemic patients had a significantly larger tumor size and lower body mass index compared with non-hypoalbuminemic patients (5.5 vs 4.3 cm;P < 0.001 and 21.9 vs 23.2 kg/m2;P = 0.02, respectively). Thirty day postoperative mortality was 1.2%. Overall complication rate was 25%. Hypoalbuminemic patients had a significantly higher rate of postoperative complications (37.5% vs 21.3%;P = 0.014). In univariate analysis, hypoalbuminemia and ASA status were two risk factors for postoperative complications. In multivariate analysis, hypoalbuminemia was the only significant risk factor (odds ratio 2.22,95% CI 1.17-4.23;P < 0.015). Hospitalization in hypoalbuminemic patients was significantly longer than that in non-hypoalbuminemic patients (13 vs 10 d, P = 0.034), but the parameters of postoperative bowel function were not significantly different between the two groups. CONCLUSION:Pre-operative hypoalbuminemia is an independent risk factor for postoperative complications following rectal cancer surgery.

TREATMENT OF SODIUM DISORDERS AFTER SURGERY OF CRANIOPHARYNGIOMA

Objective.To study the treatment of the patients with blood sodium disorder after craniopharyngioma surgery. Method.The blood sodium in 44 patients with craniopharyngiomas was daily examined from operative to post-operative days. Hypernatremia is defined as [Na]>145 mmol/l, and hyponatremia as [Na]<135 mmol/L. Results.Of the 44 patients, 36 developed sodium disorder. Among them, simple hyponatremia was 16 patients, simple hypernatremia was 9 patients, and alternative sodium disorder was 11 patients. Conclusion.The blood sodium disorder in patients with craniopharyngiomas after surgery appears to present complicated changes. Three types of blood sodium disorder could be determined as simple hyponatremia, simple hypernatremia, and alternative sodium disorder. Treatment of the sodium disorder in patients with craniopharyngiomas after surgery could be carried in accordance with the above three types.

The Experimental Study on Implantation of Intraocular Lens in Different Animals

Objective: To prevent the complications in cataract surgeries, the eyes of rabbits and monkeys were implanted with intraocular lens for 360 days. Methods: The eyes of the rabbits were performed with phacoemulsification and soft intraocular lens implantation. The eyes of the monkeys were performed with extracapsular cataract extraction and hard intraocular lens implantation. Results: The postoperative reactions included corneal edema, anterior chamber exudation, posterior capsule opacification and so on. The complications in the eyes of the rabbits were more than that in the eyes of the monkeys. Conclusion: The different postoperative reactions happened in different animals. In clinical the choice of the operative method and intraocular lens depended on the case in order to acquire the best sight.

食管癌术后低氧的危险因素分析

目的分析食管癌手术患者发生术后低氧的危险因素。方法选择接受食管癌手术的376例患者，并以术后48h内出现氧合指数≤300的患者作为低氧组（101例），其他患者作为对照组（275例）。分别从年龄、吸烟史、体重、食管病变范围、手术时问、术前肺功能（第1秒用力呼气容积）等因素，应用单因素相关性分析评价各因素与术后氧合指数之间的相关性。结果吸烟史、年龄、手术时间、食管病变范围与食管癌术后低氧呈负相关（P〈0．05），低氧组患者年龄、吸烟史、手术时间、食管病变范围、术前肺功能与对照组比较差异均有统计学意义（P〈0．05），食管癌手术后低氧的相关危险因素有高龄、长期吸烟史、术前肺功能不佳、手术时间长、食管病变范围大等；而肥胖度与食管癌术后低氧并没有确定的相关关系。结论食管癌手术患者发生术后低氧的危险因素是多方面的。为了避免出现较严重的术后并发症，在术前、术中及术后应积极采取各种预防措施。

Effect of ear acupuncture plus injection at Zusanli(ST 36) on shoulder pain and cytokines after gynecologic laparoscopic surgery

Objective： To explore the clinical efficacy of ear acupuncture plus injection at Zusanli（ST 36） in treating shoulder pain after laparoscopic gynecological surgery, and to observe its effect on cytokines.Methods： Two hundred patients with shoulder pain after laparoscopic gynecological surgery were randomized into two groups based on their visiting sequence, 100 cases each. The observation group was intervened by ear acupuncture plus injection at Zusanli（ST 36）, and the control group was intervened by oral administration of Ibuprofen, 10 d as a treatment course. The clinical efficacies of the two groups were compared after 2 treatment courses; the visual analogue scale（VAS）,present pain intensity（PPI） and 36-item short-form health survey（SF-36） were measured before and after the treatment;the changes of interleukin（IL）-6 and IL-10 after the treatment were also observed.Results： The VAS and PPI scores were significantly changed after the treatment in both groups（both P〈0.01）. After the treatment, the VAS score in the observation group was significantly different from that in the control group（P〈0.05）. The component scores of SF-36 were significantly changed after the treatment in both groups（P〈0.01）; after the treatment, the scores of physical functioning（PF）, bodily pain（BP）, social functioning（SF）, and mental health（MH） in the observation group were significantly different from those in the control group（all P〈0.05）. The contents of IL-6 and IL-10 dropped significantly after the intervention in both groups（both P〈0.01）, and the between-group differences were also statistically significant（both P〈0.01）. The total effective rate of the observation group was higher than that of the control group（P〈0.05）.Conclusion： Ear acupuncture plus injection at Zusanli（ST 36） can significantly improve the shoulder pain after laparoscopic gynecological surgery, down-regulate the expressions of IL-6 and IL-10, and boost the recovery.

Observations on Electroacupuncture Treatment of 60 Patients with Urine Retention Following Cervical Cancer Operation

Objective： To investigate the curative effect of electroacupuncture on urine retention following cervical cancer operation. Methods. A treatment group was treated with electroacupuncture according to classification based on syndrome differentiation and a control group, by a conventional method. One course of treatment consisted of 5 days. Results： The curative rate and cure rate were 96.67% and 76.67%, respectively, in the treatment group and 70% and 36. 67%, respectively, in the control group. There were significant differences in curative rate and cure rate between the two groups （P〈 0. 01）. Conclusion： Electroacupuncture is a good method for treating urine retention subsequent to cervical cancer operation.

Effect of acupoint injection of Neostigmine on gastrointestinal function after cholecystectomy

Objective： To observe the effect of acupoint injection with Neostigmine Methylsulfate at Zusanli（ST 36） on gastrointestinal function of patients after laparoscopic cholecystectomy.Methods： Totally 120 patients undergone laparoscopic cholecystectomy were randomized into an acupoint injection group, a muscular injection group, and a blank control group at 1：1：1 by random number table, 40 cases in each group. The blank control group was intervened by conventional post-operation treatment, the acupoint injection group was by acupoint injection with Neostigmine Methylsulfate 2 m L at bilateral Zusanli（ST 36） in addition to the treatment given to the blank control group, and the muscular injection group was by muscular injection with Neostigmine Methylsulfate 2 m L in addition to the treatment given to the blank control group. The two injection groups both received injection twice a day, totally for 3 d at most. The restored time of bowel sounds, initial flatulence time, defecation time and clinical efficacy were observed. Results： After treatment, there were significant differences in comparing the restored time of bowel sounds among the three groups（F=17.30, P〈0.05）, the acupoint injection group and muscular injection group were significantly different from the blank control group（P〈0.05）, and there was a significant difference between the acupoint injection group and muscular injection group（P〈0.05）; there were significant differences in comparing the initial flatulence time among the three groups（F=19.12, P〈0.05）, and the acupoint injection group was significantly different from the muscular injection group and the blank control group（P〈0.05）; there were significant differences in comparing the initial defecation time among the three groups（χ^2=21.23, P〈0.05）, while the difference between the acupoint injection group and muscular injection group was statistically insignificant（P〈0.05）. The total effective rate was 87.5% in the acupoint injection group, versus 72.5% in the muscular injection group and 60.0% in the blank control group, and there were significant differences among the three groups（P〉0.05）. Conclusion： Acupoint injection with Neostigmine Methylsulfate at Zusanli（ST 36） can shorten the restored time of bowel sounds and flatulence time in patients undergone laparoscopic cholecystectomy, and the efficacy is more significant compared to muscular injection with Neostigmine Methylsulfate.

Effects of auricular point sticking on dry eye in myopia patients after SMILE surgery:a prospective randomized controlled clinical trial

Objective:To observe the intervention effect of auricular point sticking on dry eye in myopia patients after small-incision lenticule extraction(SMILE)surgery.Methods:This was a prospective randomized controlled study conducted among the myopia patients who received SMILE surgery at Eye and ENT Hospital of Fudan University.The post-SMILE operation patients who screened by the inclusion and exclusion criteria were randomized into a control group and a treatment group.Patients in the control group were given 0.1%fluorometholone and 0.5%carboxymethylcellulose sodium eye drops,while the treatment group was given additional unilateral auricular point sticking for 1 month.The patients were estimated using ocular surface disease index(OSDI),Schirmer tear test-1(STT-1),tear film break-up time(TF-BUT),corneal fluorescein staining(CFS)score,corneal sensitivity(CS)and visual quality(VQ)at 1 d,1 week and 1 month after surgery;the changes in anxiety and depression were also observed in the patients.Results:Compared with the first day after operation,CS in the nasal region was improved in the treatment group,and the VQ score increased in the control group patients at 1 week after operation(both P<0.05);at 1 month after operation,the TF-BUT increased,CFS score decreased,CS in the central and nasal regions increased(all P<0.05),and VQ score increased(P<0.01)in the treatment group,and the CS in the central,upper,lower and nasal regions were improved(all P<0.05),and VQ score increased(P<0.01)in the control group.The between-group comparison showed that the differences in the change of TF-BUT were statistically significant at 1 week and 1 month after surgery,respectively(both P<0.05).Conclusion:Auricular point sticking therapy can increase the TF-BUT and accelerate the repair of ocular surface function in post-SMILE patients.

Influence of clinical pathways used the hospitals of Traditional Chinese Medicine on patients hospitalized with stroke:a systematic review and Meta-analysis

OBJECTIVE:To evaluate the influence of clinical pathways in the hospitals using the Traditional Chinese Medicine in treatment of stroke in terms of postoperative complications, length of stay(LOS),costs incurred during hospitalization, compared with standard medical care.METHODS:Medline, Embase, China National Knowledge Infrastructure(CNKI) platforms, Wanfang databases and the Cochrane Central Register of Controlled Trials were searched.The search was performed up to August 2014.Each study was assessed independently by two reviewers.The assessment of methodological quality of the included studies was based on the Methodological index for non-randomized studies standard.Meta-analyses were performed using Rev Man software, version5.0.RESULTS:Six studies met the study inclusion criteria and were included in the Meta-analysis for a total sample of 710 patients.The aggregate overall results showed that shorter length of stay in the clinical pathway group was observed during hospital stay was associated with the use of the clinical pathways.No significant differences were found in other effects.CONCLUSION:Regardless the possible limitations,our findings show that clinical pathways can significantly reduce LOS.Although there is no clear evidence that clinical pathways can reduce hospital costs, but the cost of hospitalization path group for each included study were lower than the control group.

Warm Needling Moxibustion at Zhongji (CV 3) and Zusanli (ST 36) for Urinary Retention after Gynecological Surgery

Objective： To observe the clinical Zhongji （CV 3） and Zusanli （ST 36） gynecological surgery. effect of warm needling moxibustion at in treatment of urinary retention after Methods： Forty patients with urinary retention after gynecological surgery were randomly divided into two groups by the randomized method, 20 cases in each group. Patients in the treatment group were treated by warm needling moxibustion at Zhongji （CV 3） and Zusanli （ST 36）. Patients in the control group were treated by inductive urination. The therapeutic effects of the two groups were observed after one course of treatment. Results： The total effective rate was 95.0% in the treatment group and 70.0% in the control group. The difference in the total effective rate between the two groups was statistically significant （P〈O.05）. Conclusion： Warm needling moxibustion at Zhongji （CV 3） and Zusanli （ST 36） is more effective than inductive urination in treating urinary retention after gynecological surgery.

Effects of electroacupuncture plus drug anesthesia on pain and stress response in patients after radical surgery for stomach cancer

Objective:To observe the effect of electroacupuncture plus drug anesthesia on pain and stress response in patients after radical surgery for stomach cancer.Methods:A total of 60 patients were randomized into a control group and an observation group by the random number table,with 30 cases in each group.The control group was given conventional drug anesthesia.The observation group was given additional electroacupuncture intervention.Before anesthesia and 2 h,12 h and 24 h after surgery,the visual analog scale(VAS)was scored,the heart rate,the mean arterial pressure,and the levels of serumβ-endorphin(β-EP)and adrenocorticotrophic hormone(ACTH)were measured.Results:Two hours,12 h and 24 h after surgery,the VAS scores of both groups were higher than those before anesthesia(all P<0.05),and the VAS scores in the observation group were lower than those in the control group at the same time points(all P<0.05).Two hours,12 h and 24 h after surgery,the heart rates and mean arterial pressures in the control group were significantly higher than those before anesthesia(all P<0.05),while there were no significant intra-group differences in the observation group(all P>0.05),and the indicators were lower than those in the control group at the same time points(all P<0.05).Two hours,12 h and 24 h after surgery,the serumβ-EP levels in the observation group were significantly higher than those before anesthesia(all P<0.05),and significantly higher than those in the control group at the same time points(all P<0.05).Two hours,12 h and 24 h after surgery,the serum ACTH levels in the control group were significantly higher than those before anesthesia(all P<0.05),and were significantly higher than those in the observation group at the same time points(all P<0.05).Conclusion:Electroacupuncture plus drug anesthesia can significantly relieve pain and stress response in patients after radical surgery for stomach cancer.

Clinical Observation on Acupuncture Treating Functional Gastrointestinal Disorder after Gallstone Surgery

Objective： To observe the therapeutic effects of puncturing the lower He-Sea points in treatment of functional gastrointestinal disorder after gallstone removal surgery. Methods： Forty post-surgery patients were randomly allocated to two groups by stratified sampling, 20 in each group. The treatment group was given conventional post-surgery treatment as well as acupuncture at the lower He-Sea points of stomach, large intestine, small intestine and gallbladder; the control group only received conventional treatment. Result： Compared to the control group, it took a shorter time for the treatment group to restore the gastrointestinal function and the difference was statistically significant （P〈0.05）. Conclusion： Acupuncture at lower He-Sea points can shorten the healing process of gastro-intestinal function after gallstone removal surgery.