Urgent one-stage endoscopic treatment for choledocholithiasis related moderate to severe acute cholangitis: A propensity scorematched analysis

BACKGROUND During emergency endoscopic retrograde cholangiopancreatography(ERCP),the safety and feasibility of performing one-stage endoscopic treatment for patients with acute cholangitis(AC)due to choledocholithiasis are unclear.AIM To investigate the safety and feasibility of one-stage endoscopic treatment for moderate to severe AC.METHODS We enrolled all patients diagnosed with moderate to severe cholangitis due to common bile duct stones from January 2019 to July 2023.The outcomes were compared in this study between patients who underwent ERCP within 24 h and those who underwent ERCP 24 h later,employing a propensity score(PS)frame-work.Our primary outcomes were intensive care unit(ICU)admission rates,ICU length of stay,and duration of antibiotic use.RESULTS In total,we included 254 patients and categorized them into two groups based on the time elapsed between admission and intervention:The urgent group(≤24 h,n=102)and the elective group(>24 h,n=152).Ninety-three pairs of patients with similar characteristics were selected by PS matching.The urgent ERCP group had more ICU admissions(34.4%vs 21.5%,P=0.05),shorter ICU stays(3 d vs 9 d,P<0.001),fewer antibiotic use(6 d vs 9 d,P<0.001),and shorter hospital stays(9 d vs 18.5 d,P<0.001).There were no significant differences observed in adverse events,in-hospital mortality,recurrent cholangitis occurrence,30-d readmission rate or 30-d mortality.CONCLUSION Urgent one-stage ERCP provides the advantages of a shorter ICU stay,a shorter duration of antibiotic use,and a shorter hospital stay.

A Rare Long Term Survival Case of Complete Pentalogy of Cantrell in Adult after One-Staged Surgery

Pentalogy of Cantrell is a rare congenital abnormality.Even with high-quality medical care and staged corrective surgeries in professional hospitals,the mortality rate is still very high and long-term prognosis is poor.Survival is largely determined by the complexity and severity of cardiac abnormalities,the efficiency of abdominal wall closure and postoperative complications.A 24-year-old male patient with complete pentalogy of Cantrell was diagnosed.One-stage surgical repair of all abnormalities were completed.The patient recovered well and had been follow-up for 7 years.He has a good cosmetic outcome,with no signs of cardiac dysfunction.No complications were noted.

One-stage revision arthroplasty in a patient with ochronotic arthropathy accompanied by joint infection:A case report

BACKGROUND Ochronotic arthropathy(OcA)is a rare disease,which is caused by the accumulation of homogentisic acid in the joint.Patients with OcA have obvious joint pain and the disease progresses rapidly,eventually resulting in disability.Arthroplasty is an efficacious treatment in patients with OcA.However,when OcA patients have joint infection,is joint replacement an option?In the present report,we performed total knee arthroplasty in a patient with OcA and knee infection under the guidance of one-stage revision theory.CASE SUMMARY A 64-year-old male was referred to our hospital due to severe left knee pain with limited mobility for 2 years.On physical examination,the patient was found to have dark brown pigmentation of the sclera and auricle.Laboratory test results showed elevations in C-reactive protein level(65.79 mg/L)and erythrocyte sedimentation rate(90.00 mm/h).The patient underwent debridement of the left knee joint,during which the cartilage surface of the knee joint was found to be black-brown in color.Bacterial culture of synovial fluid revealed Achromobacter xylosoxidans.We then carried out arthroplasty under the guidance of the theory of one-stage revision.After surgery,the patient’s left knee joint pain disappeared and function recovered without joint infection.CONCLUSION OcA accompanied by joint infection is rare.One-stage revision arthroplasty may be a treatment option for this disease.

Should we use similar perioperative protocols in patients undergoing unilateral and bilateral one-stage total knee arthroplasty?

BACKGROUND Bilateral one-stage total knee arthroplasty(BTKA)is now in greater use as an alternative option for patients with bilateral end-stage knee arthropathy.However,postoperative pain and disablement during convalescence from BTKA,and procedure-related complications have been concerning issues for patients and surgeons.Although some studies reported that BTKA in selected patients is as safe as the staged procedure,well-defined guidelines for patient screening,and perioperative care and monitoring to avoid procedure-related complications are still controversial.AIM To compare the perioperative outcomes including perioperative blood loss(PBL),cardiac biomarkers,pain intensity,functional recovery,and complications between unilateral total knee arthroplasty(UTKA)and BTKA performed with a similar perioperative protocol.METHODS We conducted a retrospective study on consecutive patients undergoing UTKA and BTKA that had been performed by a single surgeon with identical perioperative protocols.The exclusion criteria of this study included patients with an American Society of Anesthesiologists score>3,and known cardiopulmonary comorbidity or high-sensitivity Troponin-T(hs-TnT)>14 ng/L.Outcome measures included visual analogue scale(VAS)score of postoperative pain,morphine consumption,range of knee motion,straight leg raise(SLR),length of stay(LOS),and serum hemoglobin(Hb)and hs-TnT monitored during hospitalization.RESULTS Of 210 UTKA and 137 BTKA patients,those in the BTKA group were younger and more predominately female.The PBL of the UTKA vs BTKA group was 646.45±272.26 mL vs 1012.40±391.95 mL(P<0.01),and blood transfusion rates were 10.48%and 40.88%(P<0.01),respectively.Preoperative Hb and body mass index were predictive factors for blood transfusion in BTKA,whereas preoperative Hb was only a determinant in UTKA patients.The BTKA group had significantly higher VAS scores than the UTKA group at 48,72,and 96 h after surgery,and also had a significantly lower degree of SLR at 72 h.The BTKA group also had a significantly longer LOS than the UTKA group.Of the patients who had undergone the procedure,5.71%of the UTKA patients and 12.41%of the BTKA patients(P=0.04)had hs-TnT>14 ng/L during the first 72 h postoperatively.However,there was no difference in other outcome measures and complications.CONCLUSION Following similar perioperative management,the blood transfusion rate in BTKA is 4-fold that required in UTKA.Also,BTKA is associated with higher pain intensity at 48 h postoperatively and prolonged LOS when compared to the UTKA.Hence,BTKA patients may require more extensive perioperative management for blood loss and pain,even if having no higher risk of complications than UTKA.

One-Stage Bilateral Total Hip Arthroplasty for Hemophilic Spontaneous Ankylotic Hip: A Case Report

Total hip arthroplastys (THAs) for hemophilic spontaneous ankylotic hips are rare. We performed one-stage bilateral THA for hemophilic patient and I would like to report the results of the case. A 61-year-old male had been diagnosed with mild hemophilia A as a neonate. He had severe pain in both hips and moderate pain in both knees. His hips were ankylotic and had no mobility. Uncemented simultaneous bilateral THAs were performed under general anesthesia. This case suggests that one-stage THA can be a good option for hemophilic hips, provided that sufficient substitution therapy is used.

One-stage urethroplasty with circumferential vascular pedicle preputial island flap for perineal hypospadias

Objective To report the treatment of perineal hypospadias with one - stage urethroplaty with circumferential vascular pedicle preputial island flap. Methods A circumferential incision was made proximal to the cprona and the urethral plate to correct chordee. A U - shaped skin incision was then made surrounding the meatus。

早期吞咽训练对急性脑卒中气管切开患者拔管成功率的影响探讨

目的探究早期吞咽训练对急性脑卒中气管切开患者拔管成功率的影响。方法34例急性脑卒中气管切开患者,按照随机数字表法分为常规治疗组和吞咽训练组,每组17例。常规治疗组进行常规治疗(脱水药物、神经保护剂、改善脑循环药物、化痰、维持内环境稳定等药物)以及常规护理(气道湿化、吸痰及每2小时翻身扣背等),吞咽训练组在常规治疗组基础上加用早期吞咽功能训练。比较两组一次拔管成功率、临床肺部感染评分(CPIS)、留管时间以及吞咽功能评分。结果吞咽训练组一次拔管成功率100.00%高于常规治疗组的70.59%,差异具有统计学意义(P<0.05)。治疗后,常规治疗组与吞咽训练组临床肺部感染评分均低于治疗前,且吞咽训练组临床肺部感染评分(2.24±0.43)分低于常规治疗组的(4.76±0.66)分,差异具有统计学意义(P<0.05)。吞咽训练组留管时间(28.12±12.18)d短于常规治疗组的(36.82±10.49)d,差异具有统计学意义(P<0.05)。治疗后,两组患者吞咽功能评分均低于治疗前,且吞咽训练组吞咽功能评分(2.47±1.17)分低于常规治疗组的(4.35±0.78)分,差异具有统计学意义(P<0.05)。结论急性脑卒中气管切开患者早期进行吞咽训练,可显著改善患者吞咽功能,提高一次性拔管成功率,降低肺炎发生率,缩短留管时间,最终提高患者生活质量,值得临床广泛推广应用。

Simultaneous type III congenital esophageal atresia and patent ductus arteriosus in a low-weight patient: A case report

BACKGROUND We report a low-birth-weight child(1.8 kg)with neonatal type III congenital esophageal atresia(CEA)combined with symptomatic patent ductus arteriosus(PDA).After comprehensive evaluation,esophageal anastomosis was performed on postnatal day 11 after excluding surgical contraindications,and arterial catheter ligation was performed at the same time.Concurrent surgery for CEA combined with PDA has not been clearly reported in the literature.CASE SUMMARY We report a 6-day-old female child with type III CEA and PDA.The patient presented with foam at the mouth after birth,cough and shortness of breath after feeding.At another hospital,she was considered to have neonatal pneumonia,neonatal jaundice and congenital heart disease and transferred to our hospital.After iodine oil radiography of the esophagus and echocardiography we con-firmed diagnosis of CEA and PDA.The diameter of the PDA was 8 mm,with obvious left to right shunting.We performed right rear extrapleural orificium fistula ligation and esophageal anastomosis,and ligation of PDA via left axilla straight incision after 5 d of hospitalization.The operations were successful,and the incision healed after 12 d,and the patient was discharged.We re-examined the patient 1 mo after surgery.She did not vomit when she ate rice flour.Esophageal angiography showed no stricture of the anastomotic stoma.The patient weighed 3.2 kg.CONCLUSION For CEA patients with multiple risk factors,comprehensive,timely and accurate diagnosis and evaluation,and early treatment may improve prognosis.

气管切开术后拔管困难患者成功拔除气切套管的相关因素分析

目的:探讨气管切开术后拔管困难患者成功拔除气切套管的相关影响因素。方法:回顾性纳入2020年1月—2022年1月于首都医科大学附属北京康复医院呼吸与危重症医学科收治的拟行拔管的气管切开术后拔管困难患者,给予呼吸康复治疗后,按照是否成功拔除气切套管分为拔管组和未拔管组。收集纳入患者的基线资料,以及拔管前或出院时的意识水平、氧分压、机械通气时间、上气道通畅情况、分泌物管理能力、能否耐受连续佩戴语音阀4h、咳嗽能力、吞咽能力等信息,采用二元logistic回归分析成功拔除气切套管的相关因素。结果:共纳入96例气管切开术后拔管困难患者,男性67例,女性29例,平均年龄(63.99±15.69)岁,拔管组60例和未拔管组36例。logistic回归分析显示,上气道通畅(OR 11.882,95%CI 1.181—119.519)、分泌物管理良好(OR11.512,95%CI 1.866—71.021)、能耐受4h语音阀佩戴(OR 49.217,95%CI 5.040—480.594)、PCF>100L/min(OR11.527,95%CI 1.053—126.121)有显著性意义。结论:气管切开术后困难拔管患者中,上气道通畅、分泌物管理良好、能耐受4h语音阀佩戴、咳嗽能力良好是成功拔除患者气切套管的独立预测因素。

气管切开患者拔管相关影响因素的研究进展

气管切开是保持呼吸道通畅、防止呼吸衰竭、抢救生命的重要手段之一,在临床上已得到越来越广泛的应用。然而,长期留置气管套管将会增加肺部感染、气道狭窄、气管食管瘘等并发症的发生率,都直接或间接影响患者康复进程,增加医疗费用。本文对气管切开患者拔管的相关影响因素进行综述,为正确把握拔管时机和条件提供参考。

脑损害气管切开患者拔管情况的临床分析

目的:分析影响脑损害合并气管切开患者拔管成功率的因素。方法:回顾85例脑损害气管切开患者拔管所需的条件及拔除方法,分析拔管后切口愈合情况及并发症发生率,分析成功拔管及并发症发生的因素。结果:85例患者中获成功拔管74例(87.1%),出现并发症11例(12.9%)。成功拔管患者的年龄和留管时间均明显低于有并发症患者(P<0.05);原发疾病及意识状态对于是否拔管成功无明显影响。结论:脑损害气管切开患者,在正确把握拔管的时机及条件时,应尽早拔管,可明显减少并发症的发生。

保留杓状软骨喉次全切除喉功能重建的体会

目的 探讨应用保留杓状软骨的喉次全切除喉功能重建术治疗T3 喉癌 (声门及声门上型 )的拔管率和 3、5年生存率。方法 对 2 0例T3 级喉癌 ,其中声门型 3例 (T3 N0 M0 )、声门上型 17例(T3 N1 M0 5例 ,T3 N0 M0 12例 ) ,根据病变范围行保留单侧或双侧杓状软骨喉次全切除及功能重建术 ,并设计环咽吻合术式。结果 3、5年生存率分别为 16/ 17(94 1% )和 11/ 12 (91 8% )。全部患者均恢复了吞咽和发音功能 ,拔管率为 95 0 %。结论 保留杓状软骨喉次全切除及功能重建术是治疗T3 喉癌的一种很好术式。手术的关键是不能损伤杓状软骨及喉返神经 ,设计好环咽吻合方案。

更新鼻胆管固定方法提高患者非计划性拔管的依从性

目的:探讨更新鼻胆管固定方法可有效降低患者非计划性拔管率,提高患者非计划性拔管依从性的临床意义。方法:按入院先后顺序将512例放置鼻胆管患者分为对照组256例和实验组256例。对照组采用常规鼻胆管固定法;实验组采用自制鼻胆管固定带,更新鼻胆管固定法。然后将两组患者的固定效果,舒适度反应,以及对护理工作满意程度进行比较。结果:鼻胆管固定效果在实验组的患者较对照组患者明显改善(P=0.006,P=0.025);实验组的患者舒适度反应明显优于对照组,差异具有统计学意义,而且实验组患者对护理工作的满意度明显高于对照组(P=0.005);结论:自制鼻胆管固定带的固定方法优于常规鼻胆管的固定法,从而提高了患者的依从性。

留置胃管非计划性拔管原因分析与对策

目的探讨留置胃管患者发生非计划性拔管的原因与有效的应对措施。方法对笔者所在医院发生的14例留置胃管非计划性拔(脱)管情况进行统计分析。结果置管后第3～4天非计划性拔管的发生率最高达64.29%;同时夜班也是发生非计划性拔管的高危因素,发生率高达78.57%。结论对留置胃管的患者在护理工作中应加强责任心,做好护患沟通,改进固定胃管方法 ,加强护理管理,才能有效地预防非计划性拔管的发生,保证患者的治疗安全。

纤维蛋白鞘形成导致患儿外周静脉置入中心静脉导管拔管困难的临床分析

目的探讨患儿外周静脉置入中心静脉导管(PICC)拔管困难的原因及应对办法。方法回顾性分析2015年3月至2016年3月在本中心进行的237例患者PICC置入的临床资料。按PICC留置时间共分为4组,统计PICC纤维蛋白鞘发生率,拔管困难发生率,以及D-二聚体水平差异。结果237例的PICC纤维蛋白鞘发生率100%;PICC置入拔管困难发生率3.38%,均发生于PICC留置的200天后,4组不同时间段拔管困难情况差异有统计学意义(P=0.035);4个PICC留置时间组间D-二聚体水平差异无统计学意义(P=0.077)。结论 PICC拔管困难可能与置管时间有关,随着时间的推移PICC形成黏附更坚固的纤维蛋白鞘,拔管困难与PICC相关血栓形成无明显相关性。目前应对PICC拔管困难的手段较多,但较被动,缺乏主动预防措施。

脑损伤患者气管切开术后直接拔管的临床研究

目的：探讨脑损伤患者气管切开术后直接拔除气管套管的可行性。方法：收集我院自2011年6月～2013年12月脑损伤气管切开术后直接拔除气管套管患者26例作为观察组，同等条件下先行堵管后拔除套管者26例作为对照组，比较2组的拔管成功率及并发症发生率；另将观察组与对照组组内各按昏迷与非昏迷分为两组，比较各组的拔管结果。结果：观察组拔管成功率96．16％，拔管后并发症发生率15．38％，对照组拔管成功率96．16％，拔管后并发症发生率30．77％；2组拔管成功率及并发症发生率比较均差异无统计学意义。2组昏迷与非昏迷患者，拔管成功率及并发症发生率较均差异无统计学意义。结论：直接拔除气管套管成功率高，时间短，具有可行性，脑损伤严重程度并不影响拔管结果，因此当拔管时机成熟后可采用直接拔管法，使患者早日进入康复阶段。

输尿管内支架管滞留后拔除困难的临床处理进展

输尿管内支架管(双J管)的长期滞留会导致双J管移位、断裂以及管周结石形成等并发症,是造成常规膀胱镜下双J管拔除困难的主要原因,其临床处理较为复杂,涉及不同的微创内镜技术,甚至需要通过传统开放手术方式取管。近年来,关于双J管滞留后拔除困难的报道越来越多,其中,多镜联合的手术方式得到了众多专家学者的推荐,而基于影像学检查的KUB评分系统有助于术前充分评估手术的难度及患者的预后。文章就双J管滞留的诊断方法、拔除困难的原因、术前准备以及手术处理进展等方面进行综述。

气管切开术后拔管困难31例原因分析

目的 探讨气管切开术后拔管困难的原因及其对策 ,以减少其发生 ,提高拔管成功率。方法 对 31例气管切开术后拔管困难患者的临床资料进行回顾性分析。结果 经过喉镜、X线检查、支气管镜检查及手术探查发现气管切开术后拔管困难的原因包括 :气管狭窄 1 6例 (51 .3 % ) ,喉声门下狭窄 7例 (2 2 .6 % ) ,原发病未愈 6例 (1 9.4 % ) ,气管套管过大 1例 (8.4 % ) ,拔管方法不当 1例 (8.3 % ) ,其中 <5岁 2 3例 (74.2 % )。经对症处理后 ,2 4例拔管成功 (77.4 % ) ,7例未能拔管 (2 2 .6 % ) ,无因气管切开后拔管困难死亡的病例。结论 操作技术不当导致气管、喉声门下狭窄是气管切开术后拔管困难的主要原因 ,其次是原发病未愈、气管套管过大和拔管方法不当 ,拔管困难更多见于小儿。

双J管拔除困难12例临床分析

目的探讨双J管拔除困难的常见原因及相应的预防措施及处理方法。方法回顾性分析12例双J管拔除困难患者的临床资料。结果 7例双J管结石形成,3例放置不到位或上移,1例双J管上端被可吸收线误缝,1例术后遗忘拔管2年致双J管断裂。12例均经微创治疗方式成功拔除双J管。结论双J管拔除困难有多种原因,针对原因进行预防是减少双J管拔除困难发生的关键,应联合多种手段,以达微创处理的目的。

综合护理干预在预防ICU气管插管患者非计划性拔管中的应用

目的:探讨综合护理干预在预防ICU患者非计划性拔管中的应用效果。方法:将2010年7月～2011年4月91例在我院ICU接受治疗的患者随机分为实验组46例和对照组45例。对照组按照常规进行护理,实验组在常规护理的基础上给予加强心理护理,并使用手写板、音乐疗法、按摩、图文示意卡、做好医护沟通、合理使用镇静剂等综合护理干预措施,比较两组患者非计划性拔管率。结果:实验组非计划性拔管率低于对照组(P<0.01)。结论:综合护理干预措施可以显著降低患者非计划性拔管发生率,改善患者的预后。