Resection of polyps involving the appendiceal orifice by combined endo-laparoscopic surgery: Two case reports

BACKGROUND The management of polyps involving the appendiceal orifice(AO)presents notable challenges.Endoscopic resection is frequently hindered by operational complexities,a heightened risk of incomplete removal,and an elevated risk of procedural complications,including appendicitis.Conversely,surgical resection may entail unnecessary excision of intestinal segments,leading to potential morbidity.CASE SUMMARY Here,we reported two patients who presented with polyps deeply situated within the AO,with indistinct boundaries making it challenging to ensure completeness using traditional endoscopic resection.To overcome these challenges,we em-ployed combined endo-laparoscopic surgery(CELS),achieving curative resection without postoperative complications.CONCLUSION The application of CELS in managing polyps involving the AO is emerging as a safe and effective treatment modality.

Roles of combined femoral and acetabular anteversion in pathological changes of hip dysplasia and hip reconstructive surgery

Combined femoral and acetabular anteversion is the sum of femoral and acetabular anteversion,representing their morphological relationship in the axial plane.Along with the increasing understanding of hip dysplasia in recent years,numerous scholars have confirmed the role of combined femoral and acetabular anteversion in the pathological changes of hip dysplasia.At present,the reconstructive surgery for hip dysplasia includes total hip replacement and redirectional hip preservation surgery.As an important surgery index,combined femoral and acetabular anteversion have a crucial role in these surgeries.Herein,we discuss the role of combined femoral and acetabular anteversion in pathological changes of hip dysplasia,total hip replacement,and redirectional hip preservation surgery.

Early Application Study of Intravenous Pain Pump Combined with Parecoxib Injection in Relieving Pain in Patients after Thoracoscopy

Objective: To explore the clinical effectiveness of combined use of intravenous pain pump with Parecoxib injection in alleviating pain in patients during the early postoperative period after thoracoscopic surgery. Methods: Eighty patients who underwent thoracoscopic surgery in a tertiary hospital were selected as the study subjects and randomly divided into two groups, with 40 patients in each group. The control group received routine postoperative treatment with intravenous pain pump, while the experimental group received Parecoxib in addition to the standard postoperative pain pump treatment. Visual Analog Scale (VAS) pain scores were used to evaluate postoperative pain relief in both groups, along with adverse reactions, postoperative complications, and patient satisfaction with pain relief. Results: Patients who received Parecoxib injection in addition to the routine use of intravenous pain pump had VAS pain scores lower than 3 points at 6 h, 12 h, 24 h, and 36 h postoperatively compared to those in the control group. The incidence of postoperative lung collapse, pleural effusion, and pulmonary infections was also significantly lower in the experimental group. The differences between the two groups were statistically significant (P Conclusion: Early combined use of Parecoxib injection in the early postoperative period after thoracoscopic surgery has shown good clinical efficacy. It can reduce the level of pain in patients, promote effective coughing and expectoration, facilitate early mobilization of patients, improve patient compliance, reduce complications, shorten hospital stay, and expedite patient recovery. Therefore, it is worth promoting the widespread clinical application of Parecoxib injection in this setting.

Novel combined endoscopic and laparoscopic surgery for advanced T2 gastric cancer:Two case reports

BACKGROUND The standard treatment for advanced T2 gastric cancer(GC)is laparoscopic or surgical gastrectomy(either partial or total)and D2 lymphadenectomy.A novel combined endoscopic and laparoscopic surgery(NCELS)has recently been proposed as a better option for T2 GC.Here we describe two case studies demonstrating the efficacy and safety of NCELS.CASE SUMMARY Two T2 GC cases were both resected by endoscopic submucosal dissection and full-thickness resection and laparoscopic lymph nodes dissection.This method has the advantage of being more precise and minimally invasive compared to current methods.The treatment of these 2 patients was safe and effective with no complications.These cases were followed up for nearly 4 years without recurrence or metastasis.CONCLUSION This novel method provides a minimally invasive treatment option for T2 GC,and its potential indications,effectiveness and safety needs to be further evaluated in controlled studies.

Analgesic Effect of Combined Spinal-Epidural Anesthesia and its Effect on TNF-α and CRP Levels in Elderly Patients with Hip Fracture During Surgical Treatment

Objective:To observe the analgesic effect of combined spinal and epidural anesthesia on older patients undergoing hip fracture surgery.Method:One hundred and twenty elderly hip fracture surgery patients treated in our hospital from January 2021 to December 2022 were selected and randomly divided into two groups,with 60 cases in the experimental group and 60 in the control group.The experimental group was given combined spinal-epidural anesthesia intervention measures,while the control group was given epidural anesthesia intervention measures.The analgesic effect,tumor necrosis factor-alpha(TNF-α),C-reactive protein(CRP)levels,and other observation indicators were analyzed after anesthesia intervention.Result:After the intervention,the analgesic effect and the evaluation results of the subjects in the experimental group were better than those in the control group(P<0.05);the obtained values of TNF-αand CRP levels in the experimental group were higher than those of the control group(P<0.05).Conclusion:The combined spinal-epidural anesthesia intervention demonstrated positive outcomes.The analgesic effect of patients during surgery and their inflammatory factor levels improved,which makes this intervention worthy of clinical application and promotion.

Simultaneous laparoscopic multi-organ resection combined with colorectal cancer:Comparison with non-combined surgery

AIM: To access the short-term outcomes of simultaneous laparoscopic surgery combined with resection for synchronous lesions in patients with colorectal cancer. METHODS: Between March 1996 and April 2010 prospectively collected data were reviewed from 93 consecutive patients who had colorectal cancer and underwent simultaneous multiple organ resection (combined group) and 1090 patients who underwent conventional laparoscopic right hemicolectomy or laparoscopic low/ anterior resection for colorectal cancer (non-combined group). In the combined group, there were nine gastric resections, three nephrectomies, nine adrenalectomies, 56 cholecystectomies, and 21 gynecologic resections. In addition, f ive patients underwent simultaneous laparoscopic resection for three organs. The patient demographics, intra-operative outcomes, surgical morbidity, and short-term outcomes were compared between thetwo groups (the combined and non-combined groups). RESULTS: There were no signifi cant differences in the clinicopathological variables between the two groups. The operating time was signifi cantly longer in the combined group than in the non-combined group, regardless of tumor location (laparoscopic right hemicolectomy and laparoscopic low/anterior resection groups; P = 0.048 and P < 0.001, respectively). The other intraoperative outcomes, such as the complications and open conversion rate, were similar in both groups. The rate of post-operative morbidity in the combined group was similar to the non-combined group (combined vs non-combined, 15.1% vs 13.5%, P = 0.667). Oncological safety for the colon and synchronous lesions were obtained in the combined group. CONCLUSION: Simultaneous laparoscopic multiple organ resection combined with colorectal cancer is a safe and feasible option in selected patients.

Evaluation of the Ex-PRESS~ P-50 implant under scleral flap in combined cataract and glaucoma surgery

AIM： To evaluate the efficacy and safety of glaucoma drainage device Ex-PRESS~ P-50 for combined cataract surgery and glaucoma.·METHODS： Patients having cataract and open angle glaucoma or patients with open advanced glaucoma which needed two or more antiglaucoma medications were included. Combined cataract surgery and glaucoma with Ex-PRESS~ P-50 model placed under scleral flap was performed.·RESULTS： Out of 40 eyes of 40 patients（55% male and45% female） completed the study during one-year follow-up. The mean of age was 76.6 ±11.02 y. The intraocular pressure（IOP） decreased significantly during the 12-month follow-up from 23.5 mm Hg to 16.8 mm Hg（Wilcoxon signed ranks test, P 〈0.001）. A 59.5% of patients did not need any topical treatment, 10.8% of them needed one active principle, 27% needed two active principles, and 2.7% of them needed three active principles for successful IOP control（〈21 mm Hg）.·CONCLUSION：Combinedsurgeryofphacoemulsification with Ex PRESS~ P-50 lowers IOP from the preoperative baseline and reduces significantly the number of antiglaucoma active principles for IOP control after the operation.

Successful treatment of eyebrow intradermal nevi by shearing combined with electrocautery and curettage:Two case reports

BACKGROUND An intradermal nevus is a common skin tumour,and the classical method of removal has a risk of recurrence and scarring.It is a challenge for dermatologists to treat eyebrow intradermal nevi quickly and efficiently.This study focused on investigating the efficacy and safety of shearing combined with electrocautery and curettage in the treatment of eyebrow intradermal nevi.CASE SUMMARY We describe two adult patients with eyebrow intradermal nevi treated by shearing combined with electrocautery and curettage.Both patients were followed up regularly after surgery.At follow-up,no recurrence of eyebrow intradermal nevus and no obvious scars or hypopigmentation were found in either patient.The results indicated that shearing combined with electrocautery and curettage could remove eyebrow intradermal nevus without side effects and confirmed the efficacy and safety of this modality for treating these skin lesions.CONCLUSION Shearing combined with electrocautery and curettage has superior merits,including simple operation,good cosmetic effects,and high patient satisfaction,presenting great application potential for treating intracutaneous nevus.

Effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury

BACKGROUND Thoracolumbar fractures are generally combined with spinal cord injury to varying degrees,which may cause deterioration of the patients’condition and increase the difficulty of clinical treatment.At present,anterior or combined anterior-posterior surgery is preferred for severe thoracolumbar fractures.AIM To investigate the effectiveness and postoperative rehabilitation of one-stage combined anterior-posterior surgery for severe thoracolumbar fractures with spinal cord injury.METHODS One-hundred-and-twenty patients who received surgery for severe thoracolumbar fractures with spinal cord injury at our hospital from February 2018 to February 2020 were randomly enrolled.They were randomly divided into group 1(one-stage combined anterior-posterior surgery,n=60)and group 2(onestage anterior-approach surgery,n=60).Treatment efficacy was compared between the two groups.RESULTS Blood loss was greater and the operation time was longer in group 1 than in group 2,and the differences were statistically significant(P<0.05).Incision length,intraoperative X-rays,and length of hospital stay were not significantly different between the two groups(P>0.05).Preoperative function of the affected vertebrae was not significantly different between the two groups(P>0.05).In each group,the patients showed significant improvement after surgery.The anterior vertebral height ratio and the posterior vertebral height ratio in group 1 after surgery were significantly higher than those in group 2.The Cobb angle after surgery was significantly lower in group 1 than in group 2(P<0.05).The canal-occupying ratio of the affected vertebrae was not significantly different between the two groups(P>0.05).Before surgery,there was no significant difference in the quality of life scores between the two groups(P>0.05).The above indicators were significantly improved after surgery compared with before surgery in each group.In addition,these indicators were markedly better in group 1 than in group 2 after surgery(P<0.05 for each).CONCLUSION One-stage combined anterior-posterior surgery effectively improves the function of the affected vertebrae and the life quality of patients with severe thoracolumbar fractures and spinal cord injury.This surgical approach is worthy of popularization in clinical use.

A new combined therapy to 15 patients with multiple organ failure in abdominal surgery

AIMS We report 15 cases of abdominal-surgical multiple organ failure(MOF)treated successfully by a new combined therapy four high doses in volume and one support“FHDOS”short period high doses in large volume anJsodaminum;short period high doses in large volume dexamethasonum;high doses in large volume of dis- infectant antibiotics;high doses in large volume of abdominal cav- ity washing liquor and support of nutrition metabolism.The mortal- ity rate and cost of MOF were decreased.It is simple,practical and effective. METHODS The study group consisted of 15 patients(10 wom- en,5 men;average age,42.7)who were hospitalized in our hospital.All patients were given“FHDOS”:short period high in large volume Anisodaminum:intravenous injection 40 mg once; another 40rag may be added 30 minutes later according to condition.The total amount may reach 120-240 mg a day,or,in- travenous injection 40 mg every 15 minutes until condition being under control.Short period high doses in large volume Dexamethasonum:intravenous injection 100-200 mg once;this remedy may be continued for 1-3 days;the amount also may de- crease according to condition.High doses in large volume of dis- infectant Antibiotics:select and use antibiotics according to clini- cal condition,inference of Gram's stain;it is necessary to re- peatedly culture bacteria in many parts,and then,to make ad- justment according to culture result and drug-resistance,and to prevent carefully the dual infections from occurring.High doses in large volume of abdominal cavity washing liquor:generally adopt- ing physiological saline 6000o8000ml in washing abdominal cavity. “One support”means full support of nutrition metabolism. RESULTS All the patients in this group survive well after the rescue without any complication. CONCLUSIONS MOF should be prevented,if possible,by stopping or controlling the injury,removing as much necrotic tis- sue as possible,improving blood flow and oxygen consumption, supporting metabolism,and preventing infection or treating it ear- ly and adequately.“FHDOS”is a combined therapy and plays a key role in treating MOF.

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.

Comment on visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery

Dear Editor,We read with interest the article by Chen etaitlj on the visual impact of sub-Tenon anesthesia during combined phacoemulsification and vitrectomy surgery. The authors reported that 93.3% of patients in the study experienced loss of perception of light at least during one of the surgical steps after the contralateral eye was covered intraoperatively. Most of the patients （81%） reported losing light perception between 6min and 30min from the commencement of the surgery.

Comparison of the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi

Objective: To compare the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi. Methods: Patients with upper ureteral calculi who received lithotripsy in Pengzhou Hospital of Traditional Chinese Medicine between February 2015 and March 2017 were selected and randomly divided into two groups;RIRS group received combined retrograde intrarenal surgery and the Mini-PCNL group received mini-percutaneous nephrolithotomy. 3 d after surgery;the contents of liver and kidney function indexes and stress hormones in serum as well as the expression of CD4+T cell transcription factors in peripheral blood were measured. Results: Serum ALT;AST;γ-GT;BUN and Cr contents of RIRS group 3 d after surgery were not significantly different from those of Mini-PCNL group;and HO-1;ET-1;ACTH;Cor and YKL-40 contents in serum as well as RORγt and T-bet mRNA expression in peripheral blood were significantly lower than those of Mini-PCNL group while Gata-3 and Foxp3 mRNA expression in peripheral blood were higher than those of Mini-PCNL group. Conclusion: Combined retrograde intrarenal surgery for upper ureteral calculi activates less stress response and inflammatory response than mini-percutaneous nephrolithotomy.

Combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation in the treatment of PACG with cataract

AIM:To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation(PGE group and PG group)for the treatment of patients with coexisting primary angle-closure glaucoma(PACG)and cataracts.METHODS:The clinical data of patients with PACG and cataract were retrospectively reviewed.There was a total of 88 eyes in the study and were divided into two groups,42 eyes in PGE group and 46 eyes in PG group.Surgery success cumulative survival,preoperative and postoperative intraocular pressure(IOP),number of IOPlowering medications,best corrected visual acuity(BCVA)in the two groups were observed for more than 12 mo and compared within each group and between two groups.RESULTS:The mean IOP in PGE group declined from24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation(P<0.001)and at the last visit 16.2 mm Hg(P<0.001).Meanwhile PG group also showed significant decrease,from 24.1 mm Hg preoperatively to 13.0 mm Hg at Imo after operation(P<0.001)and 15.3 mm Hg at the last visit(P=0.004).The mean medications reliance reduced in both groups,in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit(P<0.001),in PG group from 0.87 to 0.10(P<0.001).At the last visit,BCVA increased from 0.21 to 0.60 in PGE group(P<0.001)and from 0.24 to 0.67 in PG group(P<0.001).The success rate of PGE group at 1 mo was95.2%,then decreased to 70.7%at the last visit,whereas in PG group,the success rate at 1 mo was 100%,at the last visit was 73.4%.CONCLUSION:PGE shows promise for PACG patients with cataracts to reduce IOP,lighten the medication burden and improve visual acuity,and PG still has its value in specific patients.

Effects of Total Intravenous Anesthesia and Static Aspiration Combined General Anesthesia on Postoperative Cognitive Function and Psychological State of Elderly Patients with Esophageal Cancer

Objective: To compare the effects of total intravenous anesthesia and static aspiration combined general anesthesia on postoperative cognitive function and psychological state of elderly esophageal cancer patients. Methods: From July 2020 to April 2021, 180 elderly patients who underwent radical esophageal cancer surgery in our hospital were randomly divided into 90 cases in the control group and 90 in the observation group. The control group used static aspiration compound general anesthesia, and the patients in the observation group used intravenous anesthesia to compare the cognitive function and psychological state of the two groups of patients. Results: There was no statistical difference in the cognitive function score of patients in the observation group 30 minutes before anesthesia, 1 h and 24 hours after anesthesia compared with that in the control group, P > 0.05;there was no statistical difference between the Hamilton Anxiety Scale (HAMA) scores 30 minutes before and 24 hours after anesthesia in the observation group compared with the control group, P > 0.05;the cognitive function score of patients in the observation group of 4 h after surgery and 12 h after operation was significantly higher than that of the control group;the HAMA scores of patients in the observation group of 1 h, 4 h and 12 h after surgery were significantly lower than that of the control group, P Conclusion: The application of total intravenous anesthesia in elderly patients with esophageal cancer surgery can reduce the impact of anesthesia on their cognitive function and psychological state, which is worth popularizing and applying in clinical practice.

STAGE IB, HA AND PROXIMAL IIB, CARCINOMA OF THE UTERINE CERVIX, TREATED BY IRRADIATION ALONE OR IN COMBINATION WITH SURGERY

This is a report of a nonrandomized comparison of treatment results of 139 patients with stage IB, HA and proximal IIB carcinoma of the uterine cervix treated by radiation alone and 113 treated with a combination of radiation and surgery. The five-year tumor free acturial survival for the patients with stage IB either with irradiation alone (RT) or combined with surgery (RS) was approximately 87%. For stage Ⅱ the tumor free actuarial five-year survival 79% with patients of RS, and 76% with RT. In the 113 patients treated with RS there were 18 (16%). In the 139 patients treated by RT there were 18 (13%) recurrences of pelvic, 4 local recurrences, 11 combined with parametrial, and free parametrial recurrences. There was no significant difference in the survival and recurrence rate of the patients treated with either method. Major complications were comparable in both groups (RT approximately 25% and RS approximately 10%), but 2/3 of those complications recovered without sequelae. The most frequent minor complication in the patients treated with RT was rectosigmoiditis.

Effect of combined spinal and epidural anesthesia on the level of pain media, stress indicators and inflammatory factors in patients undergoing high altitude cesarean section

Objective: To discuss the effect of combined spinal and epidural anesthesia on the levels of pain media, stress indicators and inflammatory factors in patients undergoing high altitude cesarean section. Methods: Eighty patients who underwent cesarean section in our hospital from January 2017 to April 2019 were enrolled in the hospital. They were divided into two groups according to the patient's anesthesia. Fourty patients receiving epidural anesthesia were included in the control group, and another 40 patients received lumbar stiffness. The combined anesthesia patient was included in the observation group. Changes in pain mediators [Serum neuropeptide Y (NPY), endorphin (β-EP), substance P (SP)], stress indicators [Serum cortisol (Cor), C-peptide (C-P), advanced oxidative protein product (AOPP)], inflammatory factor levels [Hypersensitive C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α)], and immunoglobulin levels [Serum IgA, IgG, IgM] were compared between the two groups. Results: Before anesthesia, there were no significant difference in pain media, stress index, inflammatory factor level and immunoglobulin level between the two groups (P>0.05). At 12 h after operation, the two groups of patients were NPY, β-EP, SP, Cor. The levels of C-P, AOPP, hs-CRP and TNF-α were higher than those before operation (P<0.05). The levels of IgA, IgG and IgM were lower than those before operation (P<0.05). Among them, observation group NPY, β-EP, SP, Cor, C-P, AOPP, hs-CRP and TNF-α were significantly lower than those of the control group (P<0.05). The serum levels of IgA, IgG and IgM were significantly higher than those of the control group (P<0.05). Conclusion: Combined spinal and epidural anesthesia can more effectively alleviate maternal pain in high altitude cesarean section, more effectively reduce the inflammatory stress response of patients, promote the humoral immune function of patients, and is beneficial to the early recovery of maternal postoperative, and has high clinical value.

Effects of lornoxicam combining with fentanyl on postoperative arrhythmia and platelet function in patients with coronary artery disease after abdominal surgery

To investigate the effects of patient-controlled intravenous analgesia (PCIA) with lornoxicam and fentanyl on arrhythmia and the expression of platelet membrane glycoproteins in patients with coronary artery disease (CAD) after abdominal surgery.Methods Eighty ASA Ⅱ or Ⅲ patients with CAD aged 51～66 yrs weighing 59～68 kg presenting for abdominal surgery participated in this study.CAD was diagnosed by clinical symptoms and ischemic changes on ECG.The patients were premedicated with intramuscular henobarbital 0.1 g and scopolamine 0.3 mg.Anesthesia was induced with fentanyl,droperidol,propofol and vecuronium and maintained with propofol,fentanyl and vecuronium.The patients received PCIA after operation.The PCIA solution contained fentanyl 0.9 mg and droperidol 5 mg in 100 ml of normal saline (N.S.) in group A (n=40) or lornoxicam 56 mg,fentanyl 0.2 mg and droperidol 5 mg in 100 ml N.S. in group B (n=40).In group A the loading dose was fentanyl 0.05 mg and group B lornoxicam 4 mg.PCIA included a background infusion at 2 ml·h -1 and a bolus of 0.5 ml with a 15 min lock-out.VAS(0=no pain,10= worst pain) was used to measure pain intensity.In addition to BP,HR and SpO2 monitoring ECG was continuously monitored with a Holter monitor after operation.Blood samples were taken from peripheral vein before and 6 h after operation and on the 1st,2nd,7th and 8th postoperative days for determination of the expression of CD 62p ,CD 63 and CD 41 /CD 61 on the platelet membrane,platelet count,prothrombin time (PT) thrombin time (TT) and partial thromboplastin time (PTT).Results The two groups were comparable with respect to sex,age,body weight,severity of CAD,duration of operation and intraoperative blood loss.The patients received no blood transfusion during operation.There was no significant difference in VAS score,platelet count,PT,TT and PTT between the two groups.The incidence of atrial and ventricular premature beat on ECG and the expression of CD 41 /CD 61 ,CD 62p and CD 63 on the platelet membrane were significantly lower in group B than in group A on the 7th and 8th postoperative days(P<0.05 or 0.01).Conclusion Postoperative PCIA with lornoxicam and fentanyl can more effectively reduce the incidence of postoperative arrhythmia in patients with CAD.Suppression of activation of platelets by lornoxicam may contribute to the mechanism.10 refs,3 tabs.

靶盏预处理技术在双镜联合治疗完全型鹿角形结石中的应用价值

目的探讨采用输尿管软镜靶盏预处理技术行一期输尿管软镜联合经皮肾镜钬激光碎石治疗完全型鹿角形结石的安全性和有效性。方法回顾性分析2019年10月~2021年9月采用输尿管软镜联合经皮肾镜手术治疗21例完全型鹿角形结石的临床资料,结石位于左侧8例,右侧12例,双侧结石一期处理右肾结石1例。结石密度(1101±185)HU。手术采用双人双镜操作,全身麻醉,斜仰卧截石位,结合术前影像学检查设计肾穿刺靶盏,输尿管软镜将靶盏内结石击碎,暴露乳头穹隆位置,经皮对靶盏穹隆精准穿刺扩张,直视下建立F_(18)或F_(20)经皮肾通道,双镜联合完成手术。结果本组21例手术均一期顺利完成,手术时间85~158(121.8±21.2)min,术后血红蛋白降低值(9.38±4.36)g/L,术后住院时间3~7(4.4±1.4)d,一期结石清除率85.7%(18/21)。并发症6例,包括术中出血需输血1例,发热3例,胸腔积液1例,术后术区疼痛需要镇痛治疗1例。结论对于完全型鹿角形结石,利用输尿管软镜将靶盏结石预处理后再穿刺建立经皮肾工作通道,手术成功率及一期结石清除率高,经皮肾通道数量少,提高手术安全性。

基于SELECT理念腹腔镜下保留脾脏的胰体尾切除

腹腔镜下胰体尾切除术目前已经成为治疗胰腺体尾部肿瘤的标准术式。而腹腔镜下保留脾脏的胰体尾切除术由于可保留脾脏功能,减少脾切除术后并发症,越来越受到重视。然而,胰腺肿瘤发病隐匿、解剖位置复杂,这些对其诊断和保留脾脏的胰体尾切除术带来了挑战。近年来,我们团队积累了丰富的胰腺肿瘤诊疗经验,创新提出“SELECT”(S-Single-Operator Cholangiopancreatoscopy,E-ERCP,L-Laparoscopy,E-Endoscopic ultrasound,C-Choledochoscopy/Confocal laser endomicroscopy,T-Traditional Chinese medicine)多镜组合中西医微创诊治理念。根据胰腺肿瘤的类型及特点,应用多种内镜和腹腔镜技术,多种不同微创诊疗方法的优选组合,围手术期采用中医药,进行中西医结合加速康复。将SELECT理念充分应用于腹腔镜下保留脾脏的胰体尾切除术,有利于术前精准诊断、术中精准切除、术后并发症预判和治疗,一站式诊治胰腺肿瘤,使病人利益最大化。