Few potentially curative treatment options exist apart from hepatic resection for patients with huge hepatocellular carcinoma (HCC). Proton radiotherapy is a promising new modality which has an inherent antitumor effe...Few potentially curative treatment options exist apart from hepatic resection for patients with huge hepatocellular carcinoma (HCC). Proton radiotherapy is a promising new modality which has an inherent antitumor effect against HCC. However, the application of proton radiotherapy for tumors adjacent to the gastrointestinal tract is restricted because the tolerance dose of the intestine is extremely low. A novel two-step treatment was developed with surgical spacer placement and subsequent proton radiotherapy to administer proton radiotherapy with curative intent. This report presents a case of a patient with a huge unresectable HCC treated by this method who achieved disease-free survival of more than 2 years. This new strategy may potentially be an innovative and standard therapy for unresectable HCC in the near future.展开更多
BACKGROUND: Portal hypertension is a common diseasewith a high mortality and serious effect on the life quality ofpatients. Presently, shunt and disconnection are commonlyused for surgical treatment of portal hyperten...BACKGROUND: Portal hypertension is a common diseasewith a high mortality and serious effect on the life quality ofpatients. Presently, shunt and disconnection are commonlyused for surgical treatment of portal hypertension. The aimof this study was conducted to analyze the results of a modi-fied Sugiura procedure for the management of 160 cirrhoticpatients with portal hypertension.METHODS: The results of a modified Sugiura procedurefor the treatment of 160 cirrhotic patients with portal hyper-tension from January 1991 to July 2002 were retrospectivelyanalyzed.RESULTS: The operative mortality for the procedure waszero. Postoperative intra-abdominal bleeding was noted in2 patients, drowned lung in 1, pneumonia in 1, and splenicvenous thrombosis in 4. Of the 160 patients, 157 (98%)were followed up from 6 months to 11.5 years. Of the 157patients, only one died of hepatic coma 6 years after opera-tion, and 3 of rebleeding. The absolute and relative survivalrates were 97.5% (156/160) and 99% (159/160), respective-ly. The absolute and relative occurrence rates of hepatic co-ma were 2.5% (4/160) and 0.6% (1/157), respectively. Theabsolute and relative occurrence rates of rebleeding were3.8% (6/160) and 1.9% (3/157) , respectively. In 96 of 116Child B patients (82.8%), liver function improved frompreoperative class B to A 3 months after operation. Sixty-five patients were subjected to gastroscopy and 22 patients,esophageal barium photography 6 months after operation.Gastro-esophageal varices disappeared in 56 patients(64.4%, 56/87), obviously improved in 30 (34.5%, 30/87),and unchanged in 1 (1.2%, 1/87). The occurrence rate ofportal hypertensive gastropathy (PHG) was 13.9% (9/65).CONCLUSION: Our results showed that the modifiedSugiura procedure is effective in the treatment of portal hy-pertension, with a low rate of operative complication,bleeding recurrence, and hepatic coma.展开更多
BACKGROUND： Presently, there have been craniocerebral operation, interventional embolization,stereotactic radiotherapy and other methods in treating cerebral arteriovenous malformation （AVM）.However, the standard o...BACKGROUND： Presently, there have been craniocerebral operation, interventional embolization,stereotactic radiotherapy and other methods in treating cerebral arteriovenous malformation （AVM）.However, the standard of different therapeutic regimens of cerebral AVM at the acute stage of hemorrhage has not been completely identified.OBJECTIVE： To observe the clinical characteristics and therapeutic effects of AVM at the acute stage of hemorrhage in patients, and to analyze corresponding therapeutic strategies.DESIGN： Non-randomized clinical observation.SETTING： Department of Neurosurgery, Foshan First People＇s Hospital, Sun Yat-sen University.PARTICIPANTS： Forty-six patients with cerebral AVM complicated by hemorrhage admitted to Department of Neurosurgery, Foshan First People＇s Hospital between January 1999 and December 2006,were involved in this study. All the patients were confirmed as cerebral AVM complicated by hemorrhage by brain angiography or/and postoperational pathology. The involved patients, 32 males and 14 females,averaged 25 years old, ranging from 6 to 62 years. Informed consents of therapeutic items were obtained from the relatives of all the patients.METHODS： ①On admission, skull CT and brain angiography were conducted in the involved subjects. ②The therapeutic method was confirmed according to the consciousness, hematoma region, hematoma volume,imageological results following comprehensive analysis： DSA examination was permitted to identify the size and position of abnormal vessel mass, and the distribution of feeding artery and draining vein. Craniocerebral operation was carried out as early as possible in patients with severe or progressive conscious disturbance, in which most of hematoma with obvious occupied effect or cerebral hernia was located in lobe of brain. The primary thing was to clean intracerebral hematoma for in time decompression. According to different situations, corresponding therapeutic measures were used for resecting abnormal vessel mass, and the treatments of patients were observed. ③The therapeutic effects were assessed following Glasgow outcome scale（GOS） at 3 months after hemorrhage.MAIN OUTCOME MEASURES： ①The examination results of skull CT and brain angiography of patients on admission. ②Treatment of patients. ③GOS results at 3 months after hemorrhage.RESULTS： Forty-six patients were involved, and all of them participated in the final analysis. ① Examination results of skull CT and brain angiography： Bleeding part： frontal lobe in 7 cases, parietal lobe 15, temporal lobe 19, occipital lobe 3, cerebellar hemisphere 2, and hemorrhage rupturing into ventricle 10. Haematoma volume： small volume of hematoma （〈20 mL） in 4 cases, moderate volume of hematoma （20 - 50 mL） 14, large volume of hematoma （ 50 - 80 mL） 21, great volume of hematoma （〉80 mL） 7; Abnormal vessel mass： Among 17 patients undergoing aortocranial angiography, abnormal vessel mass was found in 16 patients, including cortex 13 patients, basal ganglia and thalamencephalon（deep part） 2 patients, and posterior cranial fossa 1 patient. The size of abnormal vessel mass： small （〈3 cm） 4 patients, moderate （3 -6 cm） 9 patients, and large （〉6 cm） 3 patients. The type of feeding artery： perforating branch blood-supply 1 patient, cortical branch blood supply 13 patients, mixed branch blood supply 2 patients. The type of draining vein： cortical draining （superficial part） 10 patients, deep part draining 2 patients, and mixed draining 4 patients. ② Treatment condition： Among 17 patients undergoing brain angiography followed by craniocerebral operation, hematoma was removed and AVM was completely resected in 12 patients, hematoma was removed and AVM was partially resected in 3 patients, and only hematoma was resected in 2 patients; Among 24 patients undergoing emergent craniocerebral operation, hematoma was removed and AVM was completely resected in 5 patients, hematoma was removed and AVM was partially resected in 9 patients, and only hematoma was resected in 10 patients; Expectant treatment was carried out in the early stage in 5 patients. When disease condition was stable, AVM resection was separately or complicatedly conducted in 13 patients, embolization in 4 patients, and γ - radiotherapy in 5 patients. ③GOS： 5 patients died in postoperative complications, and among the other patients, 19 had moderate or had not functional impairment, 13 had moderate disability, 6 had severe disability, 2 were vegetative state, and 2 died. ④Post-operative re-examination of brain angiography： Among 16 patients undergoing AVM, vessel mass disappeared in 9 patients.CONCLUSION： Good therapeutic effects can be obtained by choosing proper therapeutic regimen according to clinical and imageological characteristics of patients with arteriovenous malformation complicated by hemorrhage at the acute stage.展开更多
目的探讨经口腔前庭入路腔镜甲状腺切除术(endoscopic thyroidectomy using the oral vestibular approach,ETOVA)与传统颈部开放手术治疗女性甲状腺乳头状癌的安全性、有效性及美容效果。方法回顾性分析2019年1~12月行甲状腺乳头状癌...目的探讨经口腔前庭入路腔镜甲状腺切除术(endoscopic thyroidectomy using the oral vestibular approach,ETOVA)与传统颈部开放手术治疗女性甲状腺乳头状癌的安全性、有效性及美容效果。方法回顾性分析2019年1~12月行甲状腺乳头状癌根治术的120例女性患者的临床资料,分为经口腔前庭入路腔镜甲状腺手术组(腔镜组,n=60)和传统颈部开放手术组(开放组,n=60),对比两组患者术中及术后相关临床资料。结果两组患者年龄、肿瘤直径、中央区淋巴结清扫时间、中央区淋巴结清扫总数、中央区转移淋巴结数量、术后并发症、术后24 h疼痛评分、术后6个月疼痛评分均无统计学差异(P均>0.05)腔镜组手术总时长、术中失血量、术后引流量均大于开放组(P均<0.001),腔镜组术后满意度高。结论ETOVA在治疗甲状腺乳头状癌是安全、有效的,具有更好的美容效果,患者满意度高,可以考虑作为部分患者,尤其是年轻女性甲状腺乳头状癌患者的首选手术方案。展开更多
This study was designed to compare the approaches and efficacies of two different ways of neurosurgical management for spontaneous putaminal hemorrhage(SPH):computed tomographic-guided aspiration(CTGA)and the key-hole...This study was designed to compare the approaches and efficacies of two different ways of neurosurgical management for spontaneous putaminal hemorrhage(SPH):computed tomographic-guided aspiration(CTGA)and the key-hole approach(KHA).The indications of the two approaches are also explored.From September 2001 to 2003,a total of 1077 cases of SPH distributed in 135 hospitals all over the mainland of China were included for analysis.All cases had three-month follow-up data.The study was designed in a single-blinded manner to compare the efficacies of the different approaches.There were 563 cases in the CTGA group,165 in the KHA group,and 217 cases in the conventional open craniotomy(COC)group.In the CTGA and KHA groups,the mortalities at one month after operation(M1m)were 17.9% and 18.3%,respectively,while the mortalities at three months after operation(M3m)were 19.4% and 19.4%,respectively(P>0.05).The postoperative complications due to CTGA(23.7%)were not significantly different from those due to KHA(25.7%)(P=0.420).The M3m of patients with Glasgow coma scale(GCS)h8 was 3.45 and 4.0 times as much as those with GCS>8,respectively.The M3m of patients with complications was 3.92 times as much as those without complications.The M3m of patients with hemorrhage volume ≥70 mL was 2.67 times as much as those<70 mL.The CTGA is not better than KHA in the treatment of SPH in terms of a more favorable outcome or less mor tality and morbidity,but CTGA could be the first choice for those with bleeding volumes ≤50mL,while KHA is the first choice for those with bleeding volumes>50 mL.展开更多
Background The relationship between inflammation and delirium remains to be determined.The purposes of this study were to investigate the association between serum interleukin-6 levels and the occurrence of delirium i...Background The relationship between inflammation and delirium remains to be determined.The purposes of this study were to investigate the association between serum interleukin-6 levels and the occurrence of delirium in elderly patients after major noncardiac surgery.Methods A total of 338 elderly patients （60 years of age and over） undergoing major noncardiac surgery were enrolled.Blood samples were obtained before anesthesia and in the first postoperative morning and serum interleukin-6 concentrations were measured.Delirium was assessed twice daily by the confusion assessment method for the Intensive Care Unit during the first three postoperative days.Survival analyses were performed to assess the relationship between the serum IL-6 level and the occurrence of postoperative delirium.Results Postoperative delirium occurred in 14.8% （50 of 338） of patients.High serum interleukin-6 levelsafter surgery were significantly associated with increased risk of the occurrence of postoperative delirium （hazard ratio 1.514,95% confidence interval 1.155-1.985,P=0.003）.Other independent predictors of delirium included increasing age,poor preoperative New York Heart Association classification,low preoperative Mini-Mental State Examination score,and high total postoperative Visual Analogue Scale pain score.Patients who developed delirium had a prolonged hospital stay after surgery.Conclusions Delirium is a frequent complication in elderly patients after noncardiac surgery.High serum interleukin-6 level after surgery is associated with increased risk of the occurrence of postoperative delirium.展开更多
Background A large transmural myocardial infarction often results in a dyskinetic or akinetic left ventricular aneurysm （LVA）. This study aimed to explore the early and long-term clinical outcomes and to identify pr...Background A large transmural myocardial infarction often results in a dyskinetic or akinetic left ventricular aneurysm （LVA）. This study aimed to explore the early and long-term clinical outcomes and to identify predictors for survivals and hospital re-admission after the repair of left ventricular aneurysm. Methods We followed up 497 patients who had undergone LVA repair from a single center in China between 1995 and 2005. The perioperative parameters were recorded. Risk factors for early mortality and long-term results were analyzed by multivariate Logistic regression. Cox＇s proportional hazard model was used to calculate risk factors for major adverse cardiac and cerebrovascular events, cause of death and re-admission. Kaplan-Meier curve was employed to analyze long-term survival. Results The operative mortality was 2.0%. The long-term mortality was 11.1% and cardiac causes contributed to 61.8% of the overall long-term mortality. Four hundred and thirty-two patients survived during the follow-up period and 37.5% of them had been re-admitted at least one time. One hundred and five patients experienced major adverse cardiac and cerebrovascular events. Survival analysis exhibited that the probability of survival at 1 and 5 years after operation was 96% and 86% respectively. Previous atrial fibrillation was the independent risk factor for early mortality. Independent risk factors for long-term mortality were poor left ventricular ejection fraction and stroke, and risk factors for cardiac mortality were intraventricular block, stroke and poor left ventricular ejection fraction. Stroke, intraventricular block and advanced age were independent risk factors for major adverse cardiac and cerebrovascular events, and New York Heart Association （NYHA） class Ill-IV was the only risk factor for hospital re-admission. Conclusions Postinfarction LVA can be repaired and satisfying early and long-term clinical outcome can be obtained. Endoventricular circular plasty technique is the better choice than linear repair in patients with large LVA. Survival is affected in patients with poor heart function, intraventricular block and stroke.展开更多
Abdominal aortic aneurysm （AAA） has a high propensity to rupture. Repair of AAA by conventional surgical replacement with a graft has been the standard of treatment since the mid 1960s. Because of advances in surgic...Abdominal aortic aneurysm （AAA） has a high propensity to rupture. Repair of AAA by conventional surgical replacement with a graft has been the standard of treatment since the mid 1960s. Because of advances in surgical, anaesthetic and intensive care techniques, the outcome of elective open AAA repair has improved constantly. However, with the improvement of endovascular techniques, the role of open repair is being challenged. More and more stents are being deployed in patients because of their less invasive characteristics. We reviewed our ten years of experience with elective open AAA repair and recent papers about endoluminal and open repair for AAA to discuss status and future of open repair for AAA in China.展开更多
Surgical resection is preferred in the treatment of gastrointestinal stromal tumor （GIST）. Duodenal GIST comprises 4.5% of all GISTs, but the optimal surgical procedure for it remains uncertain. Since GISTs grow ext...Surgical resection is preferred in the treatment of gastrointestinal stromal tumor （GIST）. Duodenal GIST comprises 4.5% of all GISTs, but the optimal surgical procedure for it remains uncertain. Since GISTs grow extensively and rarely give rise to lymph node metastasis, pancreatoduodenectomy, which has been used to treat duodenal GIST, may be excessive for this disease. On the contrary, pancreas-sparing duodenectomy has only been performed in a few hospitals because the procedure requires precise anatomical knowledge of the pancreatic head. We successfully performed partial duodenectomy and translocation of the distal common bile duct as a patch to repair the defect in a patient with duodenal GIST close to the papilla of Vater.展开更多
文摘Few potentially curative treatment options exist apart from hepatic resection for patients with huge hepatocellular carcinoma (HCC). Proton radiotherapy is a promising new modality which has an inherent antitumor effect against HCC. However, the application of proton radiotherapy for tumors adjacent to the gastrointestinal tract is restricted because the tolerance dose of the intestine is extremely low. A novel two-step treatment was developed with surgical spacer placement and subsequent proton radiotherapy to administer proton radiotherapy with curative intent. This report presents a case of a patient with a huge unresectable HCC treated by this method who achieved disease-free survival of more than 2 years. This new strategy may potentially be an innovative and standard therapy for unresectable HCC in the near future.
文摘BACKGROUND: Portal hypertension is a common diseasewith a high mortality and serious effect on the life quality ofpatients. Presently, shunt and disconnection are commonlyused for surgical treatment of portal hypertension. The aimof this study was conducted to analyze the results of a modi-fied Sugiura procedure for the management of 160 cirrhoticpatients with portal hypertension.METHODS: The results of a modified Sugiura procedurefor the treatment of 160 cirrhotic patients with portal hyper-tension from January 1991 to July 2002 were retrospectivelyanalyzed.RESULTS: The operative mortality for the procedure waszero. Postoperative intra-abdominal bleeding was noted in2 patients, drowned lung in 1, pneumonia in 1, and splenicvenous thrombosis in 4. Of the 160 patients, 157 (98%)were followed up from 6 months to 11.5 years. Of the 157patients, only one died of hepatic coma 6 years after opera-tion, and 3 of rebleeding. The absolute and relative survivalrates were 97.5% (156/160) and 99% (159/160), respective-ly. The absolute and relative occurrence rates of hepatic co-ma were 2.5% (4/160) and 0.6% (1/157), respectively. Theabsolute and relative occurrence rates of rebleeding were3.8% (6/160) and 1.9% (3/157) , respectively. In 96 of 116Child B patients (82.8%), liver function improved frompreoperative class B to A 3 months after operation. Sixty-five patients were subjected to gastroscopy and 22 patients,esophageal barium photography 6 months after operation.Gastro-esophageal varices disappeared in 56 patients(64.4%, 56/87), obviously improved in 30 (34.5%, 30/87),and unchanged in 1 (1.2%, 1/87). The occurrence rate ofportal hypertensive gastropathy (PHG) was 13.9% (9/65).CONCLUSION: Our results showed that the modifiedSugiura procedure is effective in the treatment of portal hy-pertension, with a low rate of operative complication,bleeding recurrence, and hepatic coma.
文摘BACKGROUND： Presently, there have been craniocerebral operation, interventional embolization,stereotactic radiotherapy and other methods in treating cerebral arteriovenous malformation （AVM）.However, the standard of different therapeutic regimens of cerebral AVM at the acute stage of hemorrhage has not been completely identified.OBJECTIVE： To observe the clinical characteristics and therapeutic effects of AVM at the acute stage of hemorrhage in patients, and to analyze corresponding therapeutic strategies.DESIGN： Non-randomized clinical observation.SETTING： Department of Neurosurgery, Foshan First People＇s Hospital, Sun Yat-sen University.PARTICIPANTS： Forty-six patients with cerebral AVM complicated by hemorrhage admitted to Department of Neurosurgery, Foshan First People＇s Hospital between January 1999 and December 2006,were involved in this study. All the patients were confirmed as cerebral AVM complicated by hemorrhage by brain angiography or/and postoperational pathology. The involved patients, 32 males and 14 females,averaged 25 years old, ranging from 6 to 62 years. Informed consents of therapeutic items were obtained from the relatives of all the patients.METHODS： ①On admission, skull CT and brain angiography were conducted in the involved subjects. ②The therapeutic method was confirmed according to the consciousness, hematoma region, hematoma volume,imageological results following comprehensive analysis： DSA examination was permitted to identify the size and position of abnormal vessel mass, and the distribution of feeding artery and draining vein. Craniocerebral operation was carried out as early as possible in patients with severe or progressive conscious disturbance, in which most of hematoma with obvious occupied effect or cerebral hernia was located in lobe of brain. The primary thing was to clean intracerebral hematoma for in time decompression. According to different situations, corresponding therapeutic measures were used for resecting abnormal vessel mass, and the treatments of patients were observed. ③The therapeutic effects were assessed following Glasgow outcome scale（GOS） at 3 months after hemorrhage.MAIN OUTCOME MEASURES： ①The examination results of skull CT and brain angiography of patients on admission. ②Treatment of patients. ③GOS results at 3 months after hemorrhage.RESULTS： Forty-six patients were involved, and all of them participated in the final analysis. ① Examination results of skull CT and brain angiography： Bleeding part： frontal lobe in 7 cases, parietal lobe 15, temporal lobe 19, occipital lobe 3, cerebellar hemisphere 2, and hemorrhage rupturing into ventricle 10. Haematoma volume： small volume of hematoma （〈20 mL） in 4 cases, moderate volume of hematoma （20 - 50 mL） 14, large volume of hematoma （ 50 - 80 mL） 21, great volume of hematoma （〉80 mL） 7; Abnormal vessel mass： Among 17 patients undergoing aortocranial angiography, abnormal vessel mass was found in 16 patients, including cortex 13 patients, basal ganglia and thalamencephalon（deep part） 2 patients, and posterior cranial fossa 1 patient. The size of abnormal vessel mass： small （〈3 cm） 4 patients, moderate （3 -6 cm） 9 patients, and large （〉6 cm） 3 patients. The type of feeding artery： perforating branch blood-supply 1 patient, cortical branch blood supply 13 patients, mixed branch blood supply 2 patients. The type of draining vein： cortical draining （superficial part） 10 patients, deep part draining 2 patients, and mixed draining 4 patients. ② Treatment condition： Among 17 patients undergoing brain angiography followed by craniocerebral operation, hematoma was removed and AVM was completely resected in 12 patients, hematoma was removed and AVM was partially resected in 3 patients, and only hematoma was resected in 2 patients; Among 24 patients undergoing emergent craniocerebral operation, hematoma was removed and AVM was completely resected in 5 patients, hematoma was removed and AVM was partially resected in 9 patients, and only hematoma was resected in 10 patients; Expectant treatment was carried out in the early stage in 5 patients. When disease condition was stable, AVM resection was separately or complicatedly conducted in 13 patients, embolization in 4 patients, and γ - radiotherapy in 5 patients. ③GOS： 5 patients died in postoperative complications, and among the other patients, 19 had moderate or had not functional impairment, 13 had moderate disability, 6 had severe disability, 2 were vegetative state, and 2 died. ④Post-operative re-examination of brain angiography： Among 16 patients undergoing AVM, vessel mass disappeared in 9 patients.CONCLUSION： Good therapeutic effects can be obtained by choosing proper therapeutic regimen according to clinical and imageological characteristics of patients with arteriovenous malformation complicated by hemorrhage at the acute stage.
文摘目的探讨经口腔前庭入路腔镜甲状腺切除术(endoscopic thyroidectomy using the oral vestibular approach,ETOVA)与传统颈部开放手术治疗女性甲状腺乳头状癌的安全性、有效性及美容效果。方法回顾性分析2019年1~12月行甲状腺乳头状癌根治术的120例女性患者的临床资料,分为经口腔前庭入路腔镜甲状腺手术组(腔镜组,n=60)和传统颈部开放手术组(开放组,n=60),对比两组患者术中及术后相关临床资料。结果两组患者年龄、肿瘤直径、中央区淋巴结清扫时间、中央区淋巴结清扫总数、中央区转移淋巴结数量、术后并发症、术后24 h疼痛评分、术后6个月疼痛评分均无统计学差异(P均>0.05)腔镜组手术总时长、术中失血量、术后引流量均大于开放组(P均<0.001),腔镜组术后满意度高。结论ETOVA在治疗甲状腺乳头状癌是安全、有效的,具有更好的美容效果,患者满意度高,可以考虑作为部分患者,尤其是年轻女性甲状腺乳头状癌患者的首选手术方案。
文摘This study was designed to compare the approaches and efficacies of two different ways of neurosurgical management for spontaneous putaminal hemorrhage(SPH):computed tomographic-guided aspiration(CTGA)and the key-hole approach(KHA).The indications of the two approaches are also explored.From September 2001 to 2003,a total of 1077 cases of SPH distributed in 135 hospitals all over the mainland of China were included for analysis.All cases had three-month follow-up data.The study was designed in a single-blinded manner to compare the efficacies of the different approaches.There were 563 cases in the CTGA group,165 in the KHA group,and 217 cases in the conventional open craniotomy(COC)group.In the CTGA and KHA groups,the mortalities at one month after operation(M1m)were 17.9% and 18.3%,respectively,while the mortalities at three months after operation(M3m)were 19.4% and 19.4%,respectively(P>0.05).The postoperative complications due to CTGA(23.7%)were not significantly different from those due to KHA(25.7%)(P=0.420).The M3m of patients with Glasgow coma scale(GCS)h8 was 3.45 and 4.0 times as much as those with GCS>8,respectively.The M3m of patients with complications was 3.92 times as much as those without complications.The M3m of patients with hemorrhage volume ≥70 mL was 2.67 times as much as those<70 mL.The CTGA is not better than KHA in the treatment of SPH in terms of a more favorable outcome or less mor tality and morbidity,but CTGA could be the first choice for those with bleeding volumes ≤50mL,while KHA is the first choice for those with bleeding volumes>50 mL.
文摘Background The relationship between inflammation and delirium remains to be determined.The purposes of this study were to investigate the association between serum interleukin-6 levels and the occurrence of delirium in elderly patients after major noncardiac surgery.Methods A total of 338 elderly patients （60 years of age and over） undergoing major noncardiac surgery were enrolled.Blood samples were obtained before anesthesia and in the first postoperative morning and serum interleukin-6 concentrations were measured.Delirium was assessed twice daily by the confusion assessment method for the Intensive Care Unit during the first three postoperative days.Survival analyses were performed to assess the relationship between the serum IL-6 level and the occurrence of postoperative delirium.Results Postoperative delirium occurred in 14.8% （50 of 338） of patients.High serum interleukin-6 levelsafter surgery were significantly associated with increased risk of the occurrence of postoperative delirium （hazard ratio 1.514,95% confidence interval 1.155-1.985,P=0.003）.Other independent predictors of delirium included increasing age,poor preoperative New York Heart Association classification,low preoperative Mini-Mental State Examination score,and high total postoperative Visual Analogue Scale pain score.Patients who developed delirium had a prolonged hospital stay after surgery.Conclusions Delirium is a frequent complication in elderly patients after noncardiac surgery.High serum interleukin-6 level after surgery is associated with increased risk of the occurrence of postoperative delirium.
文摘Background A large transmural myocardial infarction often results in a dyskinetic or akinetic left ventricular aneurysm （LVA）. This study aimed to explore the early and long-term clinical outcomes and to identify predictors for survivals and hospital re-admission after the repair of left ventricular aneurysm. Methods We followed up 497 patients who had undergone LVA repair from a single center in China between 1995 and 2005. The perioperative parameters were recorded. Risk factors for early mortality and long-term results were analyzed by multivariate Logistic regression. Cox＇s proportional hazard model was used to calculate risk factors for major adverse cardiac and cerebrovascular events, cause of death and re-admission. Kaplan-Meier curve was employed to analyze long-term survival. Results The operative mortality was 2.0%. The long-term mortality was 11.1% and cardiac causes contributed to 61.8% of the overall long-term mortality. Four hundred and thirty-two patients survived during the follow-up period and 37.5% of them had been re-admitted at least one time. One hundred and five patients experienced major adverse cardiac and cerebrovascular events. Survival analysis exhibited that the probability of survival at 1 and 5 years after operation was 96% and 86% respectively. Previous atrial fibrillation was the independent risk factor for early mortality. Independent risk factors for long-term mortality were poor left ventricular ejection fraction and stroke, and risk factors for cardiac mortality were intraventricular block, stroke and poor left ventricular ejection fraction. Stroke, intraventricular block and advanced age were independent risk factors for major adverse cardiac and cerebrovascular events, and New York Heart Association （NYHA） class Ill-IV was the only risk factor for hospital re-admission. Conclusions Postinfarction LVA can be repaired and satisfying early and long-term clinical outcome can be obtained. Endoventricular circular plasty technique is the better choice than linear repair in patients with large LVA. Survival is affected in patients with poor heart function, intraventricular block and stroke.
文摘Abdominal aortic aneurysm （AAA） has a high propensity to rupture. Repair of AAA by conventional surgical replacement with a graft has been the standard of treatment since the mid 1960s. Because of advances in surgical, anaesthetic and intensive care techniques, the outcome of elective open AAA repair has improved constantly. However, with the improvement of endovascular techniques, the role of open repair is being challenged. More and more stents are being deployed in patients because of their less invasive characteristics. We reviewed our ten years of experience with elective open AAA repair and recent papers about endoluminal and open repair for AAA to discuss status and future of open repair for AAA in China.
文摘Surgical resection is preferred in the treatment of gastrointestinal stromal tumor （GIST）. Duodenal GIST comprises 4.5% of all GISTs, but the optimal surgical procedure for it remains uncertain. Since GISTs grow extensively and rarely give rise to lymph node metastasis, pancreatoduodenectomy, which has been used to treat duodenal GIST, may be excessive for this disease. On the contrary, pancreas-sparing duodenectomy has only been performed in a few hospitals because the procedure requires precise anatomical knowledge of the pancreatic head. We successfully performed partial duodenectomy and translocation of the distal common bile duct as a patch to repair the defect in a patient with duodenal GIST close to the papilla of Vater.
