甲状腺乳头状腺癌选择性颈清扫术后并发症

目的探讨甲状腺乳头状腺癌选择性颈清扫(selective neck dissection,SND)术后并发症的发生原因及预防措施。方法回顾性分析94例行甲状腺乳头状腺癌SND的患者的临床资料。结果颈后外侧淋巴清扫术(posterolateral neck dissection,PLND)组29例;PLND+甲状腺次全切除术组16例;PLND加颈前清扫(anterior compartment neck dissection,ACND)加甲状腺次全切除术组34例;PLND加ACND加甲状腺全切除术组15例。副神经损伤发生率为9.6%,喉返神经损伤发生率为10.7%,6例患者出现了乳糜漏,6例出现术后甲状旁腺功能减退。结论甲状腺乳头状腺癌SDN并发症发生率较低,手术是比较安全的。

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.

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.

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.

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.

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.

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 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.