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1.
Am Surg ; 86(2): 158-163, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32106910

RESUMO

Obesity is a major health issue in the modern world population and a risk factor for surgical procedures. This study examined perioperative and oncologic results of gastrectomy in obese patients diagnosed with gastric cancer. BMI ≥30 kg/m² was used to designate obesity. Five hundred and one patients were operated throughout the study period (2009-2018). The outcomes in obese patients (n = 205) were compared with those with normal weight (n = 171) and overweight (n = 125). The mean BMI was significantly different between the groups: 21.9 versus 26.7 versus 33.3 kg/m² (P < 0.01), respectively. Obesity was associated with higher incidence of comorbidities, longer operative time, and increased blood loss. Postoperative and short-term oncologic outcomes were similar. Median follow-up was 24 months with similar recurrence rates in the three groups. Median survival was comparable between the normal weight, overweight, and obese patients-36 (27-45) versus 42 (30-53) versus 32 (17-47) months, respectively (P = 0.63). Obesity itself does not deteriorate the surgical outcomes of gastrectomy in patients with gastric cancer. Although technically demanding in obese patients, adequate lymph node yield and satisfactory long-term oncologic outcomes can be achieved in this group.


Assuntos
Índice de Massa Corporal , Gastrectomia , Obesidade/complicações , Neoplasias Gástricas/cirurgia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Comorbidade , Feminino , Gastrectomia/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Obesidade/mortalidade , Duração da Cirurgia , Sobrepeso/complicações , Neoplasias Gástricas/complicações , Neoplasias Gástricas/mortalidade , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(7): e19104, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049819

RESUMO

Hemodynamic stability is one of the most critical aspects of adrenal surgery for pheochromocytoma. Few articles have evaluated the hemodynamic status of patients undergoing posterior retroperitoneal adrenalectomy (PRA) for pheochromocytoma. The aim of this study is to compare the intraoperative hemodynamic parameters between lateral transperitoneal adrenalectomy (TPA) and PRA in this groups of patients.This report describes a retrospective study of 53 pheochromocytoma patients who underwent endoscopic adrenalectomy via transperitoneal (22 patients) or posterior retroperitoneal (31 patients) approaches from January 2008 to March 2015. Data from these patients were compared to investigate the differences in hemodynamic parameters between the 2 approaches.Clinical parameters at presentation were similar between the 2 groups, except for tumor size, which was larger in the TPA group. The PRA group is associated with reduced operative time, blood loss, and length of hospital stay compared to TPA even after adjusting for the tumor size. There was greater BP fluctuations and higher maximum systolic and diastolic blood pressure (BP) within the TPA group compared to PRA during univariate analysis. This was however not significant after adjusting for tumor size. There was no difference in the intraoperative inotropic support requirement between the 2 groups.PRA is associated with stable intraoperative hemodynamic status, as well as favorable perioperative outcomes compared to TPA in patients with small pheochromocytomas.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Adrenalectomia/métodos , Feocromocitoma/cirurgia , Neoplasias das Glândulas Suprarrenais/patologia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Pressão Sanguínea , Estudos de Casos e Controles , Endoscopia , Humanos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Duração da Cirurgia , Feocromocitoma/patologia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos
3.
Medicine (Baltimore) ; 99(8): e19259, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080133

RESUMO

BACKGROUND: The aim of this study was to evaluate the effectiveness and safety of surgical treatment of intra-articular distal radius fractures (DRFs) with the assistance of three-dimensional (3D) printing technique. METHODS: Patients with intra-articular DRFs in our hospital from February 2017 to November 2018 were enrolled in this study, and were randomly assigned to 2 parallel groups to receive surgical treatment with the assistance of 3D printing technique or not. For patients in the 3D printing group, the surgical procedure was simulated with 3D physical model before surgery. Volar plate and K-wire fixation were performed in all patients. Patients in the 2 groups were compared in terms of intraoperative indexes and postoperative function. RESULTS: A total of 32 patients were included in our study. During surgery, mean operation time in the 3D model group was significantly lower than that in the routine group (P < .001). Besides, significantly less blood was lost in the 3D model group than that in the routine group (P < .001). Furthermore, the 3D model group had a significantly less times of intraoperative fluoroscopy than that in the routine group (P = .002). However, the 3D model group showed no significant difference in visual analog scale (VAS) score, the disabilities of the arm, shoulder, and hand (DASH) score, or active wrist range of motion (ROM) in comparison with the routine group (P > .05). CONCLUSION: With the assistance of 3D printing technique, the operation time, amount of intraoperative bleeding, and times of intraoperative fluoroscopy can be reduced during the surgical treatment of intra-articular DRFs with volar plating and K-wire fixation. This technique is safe and effective, and is worth spreading in other orthopedic surgeries.


Assuntos
Simulação por Computador , Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Impressão Tridimensional , Fraturas do Rádio/cirurgia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Placas Ósseas , Fios Ortopédicos , Avaliação da Deficiência , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Duração da Cirurgia , Cuidados Pré-Operatórios , Fraturas do Rádio/diagnóstico por imagem , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X , Escala Visual Analógica
4.
Artigo em Chinês | MEDLINE | ID: mdl-32086917

RESUMO

Objective:The aim of this study is to explore the application and advantages of combined intrathecal and extrathecal hypothermic plasma tonsillectomy in reducing intraoperative and postoperative hemorrhage in OSA children. Method:We retrospectively reviewed 726 cases who were diagnosed as OSA. All patients were divided into two groups according to the surgical method: 320 cases by total tonsillectomy and 406 cases by combined extracapsular and intracapsular tonsillectomy. The intro operative bleeding volume, post operative haemorrhage data as time, location and degree in the two groups were compared. Result:There was no statistical difference in the intro operative bleeding volume in the two groups [(9.3±4.6) mL]vs [(7.6±3.5) mL], t=12.687, P=0.235. Two patients who underwent combined extracapsular and intracapsular tonsillectomy presented with post operative haemorrhage, the total post operative haemorrhage rate was significantly decreased that in the total tonsillectomy group(14 cases)(χ²=10.779, P=0.001). The 2 patients in combined extracapsular and intracapsular tonsillectomy group were secondary haemorrhage, with location in the upper pole and medium, grade A haemorrhage; while in the 14 cases in in the total tonsillectomy group, there were 2 cases presented with primary haemorrhage and 12 cases with secondary haemorrhage; with regard to location of haemorrhage, 1 in the upper pole, 2 in the medium, 11 in the lower pole; 5 cases presented with grade A haemorrhage, 8 with grade B haemorrhage and 1 with grade C haemorrhage. The haemorrhage rate at 7 days after surgery (χ²=5.697, P=0.017), at the lower pole(χ²=11.961, P=0.001) and grade B(χ²=8.097, P=0.004) were all significantly decreases in the combined extracapsular and intracapsular tonsillectomy group. Conclusion:Plasma tonsillectomy combined with intrathecal and extrathecal hypothermic tonsillectomy is a safe and effective method, which has obvious advantages in reducing the postoperative hemorrhage, especially the secondary hemorrhage of Subtonsillar Pole.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Hemorragia Pós-Operatória/prevenção & controle , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia , Criança , Humanos , Período Pós-Operatório , Estudos Retrospectivos
5.
Bone Joint J ; 102-B(1): 11-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888358

RESUMO

AIMS: Debate continues about whether it is better to use a cemented or uncemented hemiarthroplasty to treat a displaced intracapsular fracture of the hip. The aim of this study was to attempt to resolve this issue for contemporary prostheses. METHODS: A total of 400 patients with a displaced intracapsular fracture of the hip were randomized to receive either a cemented polished tapered stem hemiarthroplasty or an uncemented Furlong hydroxyapatite-coated hemiarthroplasty. Follow-up was conducted by a nurse blinded to the implant at set intervals for up to one year from surgery. RESULTS: A total of 115 patients died in the year after surgery. There was a tendency towards a slightly higher mortality in those treated with the uncemented prosthesis after one year (64 vs 51; p = 0.18). For the survivors, there was no significant difference in pain score at any of the time intervals. Patients treated using the cemented hemiarthroplasty recovered mobility better than those treated with the uncemented hemiarthroplasty (mean decrease in mobility score at one year: 1.7 vs 1.1, SD 1.9; p = 0.008). There was a tendency to more periprosthetic fractures in the uncemented group (five vs two cases; p = 0.45), but overall the need for further surgery was similar in both groups (nine vs seven cases). There were four perioperative deaths in the cemented group. CONCLUSION: These results indicate that a contemporary cemented hemiarthroplasty gives better results than an uncemented hemiarthroplasty for patients with a displaced intracapsular fracture of the hip. When the condition of the patient permits, a cemented hemiarthroplasty should be used. Cite this article: Bone Joint J. 2020;102-B(1):11-16.


Assuntos
Hemiartroplastia/métodos , Fraturas do Quadril/cirurgia , Fraturas Periprotéticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Cimentos para Ossos/uso terapêutico , Cimentação , Feminino , Prótese de Quadril , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Resultado do Tratamento
6.
Bone Joint J ; 102-B(1): 5-10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888369

RESUMO

AIMS: Intraoperative 3D navigation (ION) allows high accuracy to be achieved in spinal surgery, but poor workflow has prevented its widespread uptake. The technical demands on ION when used in patients with adolescent idiopathic scoliosis (AIS) are higher than for other more established indications. Lean principles have been applied to industry and to health care with good effects. While ensuring optimal accuracy of instrumentation and safety, the implementation of ION and its associated productivity was evaluated in this study for AIS surgery in order to enhance the workflow of this technique. The aim was to optimize the use of ION by the application of lean principles in AIS surgery. METHODS: A total of 20 consecutive patients with AIS were treated with ION corrective spinal surgery. Both qualitative and quantitative analysis was performed with real-time modifications. Operating time, scan time, dose length product (measure of CT radiation exposure), use of fluoroscopy, the influence of the reference frame, blood loss, and neuromonitoring were assessed. RESULTS: The greatest gains in productivity were in avoiding repeat intraoperative scans (a mean of 248 minutes for patients who had two scans, and a mean 180 minutes for those who had a single scan). Optimizing accuracy was the biggest factor influencing this, which was reliant on incremental changes to the operating setup and technique. CONCLUSION: The application of lean principles to the introduction of ION for AIS surgery helps assimilate this method into the environment of the operating theatre. Data and stakeholder analysis identified a reproducible technique for using ION for AIS surgery, reducing operating time, and radiation exposure. Cite this article: Bone Joint J. 2020;102-B(1):5-10.


Assuntos
Neuronavegação/métodos , Escoliose/cirurgia , Adolescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Parafusos Ósseos/estatística & dados numéricos , Desenho de Equipamento , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Bloqueadores Neuromusculares/administração & dosagem , Neuronavegação/instrumentação , Duração da Cirurgia , Posicionamento do Paciente , Doses de Radiação , Resultado do Tratamento
7.
Br J Anaesth ; 124(1): 35-43, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31607387

RESUMO

BACKGROUND: Bleeding and transfusions affect mortality in aortic surgery. Although tranexamic acid significantly reduced bleeding in multiple settings, its role in major vascular surgery was never studied. The aim of this study was to determine if tranexamic acid reduces blood loss in open abdominal aortic aneurysm (AAA) surgery. METHODS: A total of 100 patients undergoing elective open AAA repair were randomised to receive tranexamic acid (a loading dose of 500 mg and a continuous infusion of 250 mg h-1) or placebo. The primary outcome was intraoperative blood loss, and the secondary outcomes were the number of patients receiving red blood cells, occurrence of thromboembolic events, and mortality. Data were analysed using the intention-to-treat principle. RESULTS: Fifty patients were randomised into each group. Median (inter-quartile range) intraoperative blood loss was 400 (300-1050) ml in the tranexamic acid group vs 500 (360-1000) ml in the placebo group (P=0.44). Transfusion rate was seven/50 (14%) in the tranexamic group vs 12/50 (24%) in the placebo group (P=0.20). No thrombosis was recorded. In a post hoc analysis, postoperative blood loss was reduced in the tranexamic group both at 4 h (60 [40-80] ml vs 100 [60-140] ml, P<0.001) and 24 h (180 [120-275] vs 275 [190-395] ml, P=0.003) after surgery. At 1 yr, three patients were dead, all in the placebo group (P=0.24) and all after 28 days. CONCLUSIONS: Tranexamic acid did not reduce intraoperative blood loss or blood transfusions in open AAA repair, although it may reduce postoperative blood loss without increasing adverse effects. CLINICAL TRIAL REGISTRATION: NCT02335359.


Assuntos
Antifibrinolíticos/uso terapêutico , Aneurisma Aórtico/cirurgia , Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/métodos , Ácido Tranexâmico/uso terapêutico , Idoso , Antifibrinolíticos/efeitos adversos , Aneurisma Aórtico/mortalidade , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Método Duplo-Cego , Transfusão de Eritrócitos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Tromboembolia/epidemiologia , Tromboembolia/prevenção & controle , Ácido Tranexâmico/efeitos adversos
8.
J Surg Res ; 246: 42-51, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31561177

RESUMO

BACKGROUND: Patient blood management aims to maintain hemoglobin level, minimize blood loss, and avoid unnecessary blood transfusion. Ferric carboxymaltose, an intravenous iron agent, was included as a part of surgical patient blood management strategy. However, it is still controversial that ferric carboxymaltose can reduce transfusion requirements. The purpose of this systematic review and meta-analysis is to evaluate the benefits of perioperative ferric carboxymaltose on the postoperative hematological parameters and transfusion requirements. METHODS: Randomized controlled trials evaluating the effects of ferric carboxymaltose were searched through databases: MEDLINE, EMBASE, CENTRAL, CINAHL, Scopus, Web of Science, and KoreaMed. Meta-analysis was performed using random effect models. RESULTS: A total of 8 studies (n = 471) were included in the final analysis. Postoperative hemoglobin was higher in the ferric carboxymaltose group than in the control group (mean difference [MD], 0.58 g/dL; 95% confidence interval [CI], 0.36 to 0.80; P < 0.00001). Postoperative serum ferritin and transferrin saturation were also higher in the ferric carboxymaltose group (MD, 373.85 µg/L; 95% CI, 298.13 to 449.56; P < 0.00001; MD, 10.35%; 95% CI, 4.59 to 16.10; P < 0.00001, respectively). However, there were no significant differences in the number of transfused patients, length of hospital stay, and adverse events between groups. Subgroup analysis revealed that adverse events were lower in the ferric carboxymaltose group than the oral iron group. CONCLUSIONS: This study supports that ferric carboxymaltose may increase the postoperative hemoglobin level in surgical patients. However, transfusion requirements could not be reduced by ferric carboxymaltose. Optimal dose and time should be further analyzed.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Compostos Férricos/administração & dosagem , Hemoglobinas/análise , Maltose/análogos & derivados , Assistência Perioperatória/métodos , Hemorragia Pós-Operatória/sangue , Administração Intravenosa , Administração Oral , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Humanos , Maltose/administração & dosagem , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia , Período Pós-Operatório , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
9.
J Surg Res ; 246: 52-61, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31561178

RESUMO

BACKGROUND: Low-density neutrophils (LDN) have been shown to be increased in peripheral blood in patients with various diseases and closely related to immune-mediated pathology. However, the frequency and function of LDN in circulating blood of the patients following abdominal surgery have not been well understood. METHODS: LDN were determined by CD66b(+) cells, which were copurified with mononuclear cells by density gradient preparations of peripheral blood of surgical patients. The effects of the purified LDN on T cell proliferation and tumor cell lysis were examined in vitro. Neutrophil extracellular traps (NETs) production was examined by extracellular nuclear staining. RESULTS: The number of LDN with an immature phenotype is markedly increased in peripheral blood samples in patients after abdominal surgery. The frequency of LDN correlated positively with operative time and intraoperative blood loss. The purified LDN significantly suppressed the proliferation of autologous T cells stimulated with anti-CD3 mAb coated on plate and partially inhibited the cytotoxicity of lymphocytes activated with recombinant interleukin-2 against a human gastric cancer cell, OCUM-1. The LDN also produced NETs after short-term culture in vitro, which efficiently trap many OCUM-1. These results suggest that surgical stress recruits immunosuppressive LDN in the circulation in the early postoperative period. CONCLUSIONS: The LDN may support the lodging of circulating tumor cells via NETs formation and inhibit T cell-mediated antitumor response in target organs, which may promote postoperative cancer metastases. Functional blockade of LDN might be an effective strategy to reduce tumor recurrence after abdominal surgery.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Neoplasias Gastrointestinais/cirurgia , Recidiva Local de Neoplasia/imunologia , Neutrófilos/imunologia , Estresse Fisiológico/imunologia , Antígenos CD/imunologia , Antígenos CD/metabolismo , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Moléculas de Adesão Celular/imunologia , Moléculas de Adesão Celular/metabolismo , Comunicação Celular/imunologia , Linhagem Celular Tumoral , Proliferação de Células , Técnicas de Cocultura , Armadilhas Extracelulares/imunologia , Armadilhas Extracelulares/metabolismo , Proteínas Ligadas por GPI/imunologia , Proteínas Ligadas por GPI/metabolismo , Neoplasias Gastrointestinais/imunologia , Neoplasias Gastrointestinais/patologia , Humanos , Contagem de Leucócitos , Recidiva Local de Neoplasia/epidemiologia , Células Neoplásicas Circulantes/imunologia , Neutrófilos/metabolismo , Duração da Cirurgia , Linfócitos T/imunologia
10.
World Neurosurg ; 135: e671-e678, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31884124

RESUMO

OBJECTIVE: The purposes of the present study were to introduce an indirect decompression using oblique lateral lumbar interbody fusion combined with anterolateral screw fixation (OLIF-AF) for the treatment of lumbar degenerative disc disease and examine the clinical efficacy and radiographic outcomes. METHODS: A total of 65 patients had undergone single-level OLIF-AF at L2-L5 from December 2017 to August 2018. The cross-sectional area of the thecal sac was evaluated using magnetic resonance imaging. The disk height, foraminal height (FH), and degree of upper vertebral slippage were evaluated using computed tomography. The visual analog scale score and Oswestry disability index were recorded pre- and postoperatively. RESULTS: The visual analog scale scores and Oswestry disability index had significantly improved after surgery (P < 0.001). At 3 days postoperatively, the cross-sectional area had improved from 93.2 ± 14.4 mm2 to 124.2 ± 7.5 mm2 (P < 0.001), the disk height had increased from 9.9 ± 1.7 mm to 12.7 ± 1.0 mm (P < 0.001), the left FH had increased from 16.6 ± 2.0 mm to 19.6 ± 2.0 mm (P < 0.001). In contrast, the right FH had increased from 16.7 ± 2.1 mm to 19.9 ± 2.0 mm (P < 0.001), and the degree of upper vertebral slippage had decreased from 14.2% ± 3.1% to 4.6% ± 2.8% (P < 0.001), respectively. At the 12-month follow-up examination, these parameters showed no statistically significant differences compared with the values at 3 days postoperatively (P > 0.05). Adverse events were observed in 15 patients (23.1%) patients and included pain at the iliac bone donor site in 1 (1.5%), left thigh pain/numbness in 2 (3.1%), quadriceps weakness in 2 (3.1%), psoas weakness in 3 (4.6%), intraoperative endplate injury in 2 (3.1%) and cage subsidence in 5 (7.7%). CONCLUSIONS: Our results have shown that OLIF-AF surgery is a relatively safe and effective surgical option for LDDD at L2-L5. Cage subsidence was the most common operative complication.


Assuntos
Parafusos Ósseos , Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transplante Ósseo/métodos , Descompressão Cirúrgica/métodos , Feminino , Humanos , Ílio/transplante , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Dor Pós-Operatória/etiologia , Cuidados Pós-Operatórios/métodos , Implantação de Prótese/métodos , Estudos Retrospectivos , Estenose Espinal/cirurgia , Espondilolistese/cirurgia , Sítio Doador de Transplante , Resultado do Tratamento
11.
World Neurosurg ; 135: e679-e685, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31884126

RESUMO

BACKGROUND: Preoperative embolization of meningiomas to reduce tumor vascularity and intraoperative blood loss remains controversial. Incomplete devascularization on angiography is not significantly correlated with intraoperative estimated blood loss (EBL). Magnetic resonance imaging (MRI) may provide a better assessment of devascularization and prediction of EBL. METHODS: We retrospectively analyzed patients undergoing preoperative embolization for intracranial meningiomas. Cohorts based on postembolization devascularization (>50% vs. ≤50%) were compared. RESULTS: Of 84 patients with meningioma undergoing preoperative embolization, 35 (42%) had a postembolization MRI before resection and met study inclusion criteria. The mean tumor diameter was 4.9 ± 1.3 cm, and mean intraoperative EBL was 576 ± 341 mL. Compared with MRI, angiography overestimated devascularization in 22 patients (63%). Using pre- versus postembolization MRIs, 17 (49%) patients had a >50% decrease in enhancement, which was associated with lower mean intraoperative blood loss (444 ± 255 mL) compared with 17 patients with ≤50% devascularization (700 ± 374 mL) (P = 0.03). On angiography, the 22 (63%) patients who demonstrated >50% devascularization during embolization did not statistically differ in intraoperative EBL when compared with 13 (37%) patients with <50% angiographic devascularization. Patients with a ≤50% decrease in contrast enhancement on postembolization MRI were 9 times more likely to lose >500 mL blood intraoperatively during resection (95% confidence interval 1.6-54, P = 0.01). CONCLUSIONS: Postembolization contrast-enhanced MRI is a better predictor of intraoperative blood loss during meningioma resection than postembolization angiography, which overestimates the degree of embolic devascularization. Postembolization preoperative MRI is warranted for optimal patient management.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Embolização Terapêutica/métodos , Neoplasias Meníngeas/terapia , Meningioma/terapia , Angiografia/métodos , Meios de Contraste , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Neoplasias Meníngeas/irrigação sanguínea , Meningioma/irrigação sanguínea , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos
12.
Int J Gynaecol Obstet ; 148(1): 65-71, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31593302

RESUMO

OBJECTIVE: To determine maternal outcomes for women with abnormally invasive placenta (AIP) managed using the Triple P Procedure and establish its safety as a conservative surgical management option. METHODS: A retrospective study of the outcomes of the first 50 patients who underwent the Triple P Procedure for AIP from September 2010 to May 2017 at St George's Maternity Unit. Maternity case notes and the database were reviewed to determine the volume of bleeding, procedure-related complications, hysterectomy rate, and postoperative hospitalization. RESULTS: Mean operative blood loss was 2318 mL (range, 400-7300 mL and the incidence of bladder and ureteric injuries was 2% (n=1) and 0%, respectively. Median length of hospital stay was 4 days (range, 2-8 days). Three women (6.0%) developed arterial thrombosis without any long-term complications and none of the patients required peripartum hysterectomy. CONCLUSION: The Triple P Procedure should be considered as a conservative, less risky alternative to a peripartum hysterectomy during counselling prior to surgery for women with AIP.


Assuntos
Cesárea/métodos , Tratamento Conservador/métodos , Placenta Acreta/cirurgia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Gravidez , Estudos Retrospectivos
14.
Medicine (Baltimore) ; 98(46): e17796, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725622

RESUMO

BACKGROUND: Intravenous (IV), topical and combination of both application of tranexamic acid (TXA) can reduce blood loss, hemoglobin drop, and transfusion rate in patients following total hip arthroplasty (THA). Lately, published articles reported that oral TXA had as similar blood-saving as IV and topical TXA in THA. The purpose of this meta-analysis is to investigate the efficiency and safety of oral TXA in THA. METHODS: We systematically searched articles about oral administration of TXA in THA from PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and the Chinese Wanfang database. STUDY ELIGIBILITY CRITERIA: The outcomes were collected and analyzed by the Review Manager 5.3. RESULTS: Nine RCTs and 1 CCT, containing 1305 patients, were ultimately included according to the inclusion criteria and exclusion criteria in the meta-analysis. The effectiveness of oral TXA was as similar as the IV or topical TXA in regard to hemoglobin drop (SMD = -0.14; 95% CI, [-0.28, 0.01]; P = .06), total blood loss (SMD = 0.01; 95% CI, [-0.13, 0.16]; P = .84), transfusion rate (OR = 0.76; 95% CI, [0.38, 1.55]; P = .37). Compared with single oral TXA or blank group, multiple oral TXA effectively reduced hemoglobin drop (SMD = -1.06; 95% CI, [-1.36, -0.77]; P < .05), total blood loss (SMD = -1.30; 95% CI, [-1.66, -0.94]; P < .05), transfusion rate (OR = 0.53; 95% CI, [0.29, 0.95]; P = .03). There were no significant difference in terms of length of stay and complication among all of enrolled studies. CONCLUSION: Oral TXA has favorable effect of blood-saving and do not increase risk of complication in patients following THA. Oral TXA may have no effect in the length of stay. More high quality RCTs are necessary.


Assuntos
Antifibrinolíticos/uso terapêutico , Artroplastia de Quadril/métodos , Ácido Tranexâmico/uso terapêutico , Administração Oral , Antifibrinolíticos/administração & dosagem , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Ensaios Clínicos como Assunto , Hemoglobinas/efeitos dos fármacos , Humanos , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Ácido Tranexâmico/administração & dosagem
15.
Medicine (Baltimore) ; 98(46): e17884, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725633

RESUMO

Our study is aim to explore predictors for failure of anterolateral thigh (ALT) flap in the reconstruction of upper extremity.We performed a retrospective study for 509 patients who underwent ALT flap in the reconstruction of upper extremity. Among them, 27 patients suffered from necrosis of ALT flap (necrosis group, NG) and 482 gained survival of this flap (survival group, SG). We collected possible factors including 3 aspects: demographic variables - age, sex, body mass index (BMI), history of hypertension, diabetes, heart disease, smoking and alcohol, trauma mechanism, and postmenopausal; surgical-related variables - surgical duration, blood loss, number of reconstructed veins, flap size, perforator type, diameter of perforator, and vein graft; blooding variables - hemoglobin, D-dimer, white blood cell, red blood cell, and platelet count (PLT). We compared the above data between NG and SG by univariate, multivariate, and Kaplan-Meier method coupled with a log-rank test linear regression analysis.The survival incidence of ALT flap repairing upper extremity was 94.7% (482 of 509). The outcome of univariate analysis showed that age (53.5 ±â€Š9.2), BMI (26.7 ±â€Š4.5), larger flap size (24.3*9.2), D-dimer (0.58 ±â€Š0.10), and PLT (278.1 ±â€Š34.4) in NG were significantly higher than these (44.2 ±â€Š7.9, 22.3 ±â€Š4.2, 19.1*7.9, 0.48 ±â€Š0.08, 236.6 ±â€Š30.5) in SG. However, diameter of perforator (1.07 ±â€Š0.02) in NG was markedly smaller than that (1.12 ±â€Š0.02) in SG. Additionally, female patients, postmenopausal, patients with using venous stapler or 1 reconstructed vein had a higher failure rate. Multivariate and Kaplan-Meier method implied the same results.In summary, many factors were related with failure of ALT in the reconstruction of upper extremity. Postmenopausal, D-dimer, and PLT were the first considered as risk factors for ALT flap repairing upper extremity.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Coxa da Perna/cirurgia , Extremidade Superior/cirurgia , Adulto , Fatores Etários , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Índice de Massa Corporal , Comorbidade , Feminino , Sobrevivência de Enxerto/fisiologia , Testes Hematológicos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Necrose/epidemiologia , Estudos Retrospectivos , Fatores Sexuais
16.
Medicine (Baltimore) ; 98(46): e17952, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725653

RESUMO

BACKGROUND: There is no consensus regarding the surgical treatment of humeral shaft fracture. The present meta-analysis was performed to compare the efficacy and safety between antegrade intramedullary nailing (IMN) and plating for humeral shaft fracture. METHODS: PubMed, MEDLINE, Cochrane Library, EMBASE, Clinical Trails, Ovid, ISI Web of Science, and Chinese databases including WanFang Data, China National Knowledge Infrastructure were searched through March 10, 2019. The Review Manager software was adapted to perform statistical analysis and relative risk (RR) were used for the binary variables, and weighted mean difference and standardized mean difference (SMD) were used to measure the continuous variables. Each variable included its 95% confidence interval (CI). RESULTS: A total of 15 trials with 839 patients were included in the analysis. There was significant difference between IMN group and plate group in blood loss (SMD = 3.49, 95% CI: 1.19, 5.79, P = .003) and postoperative infections (RR = 3.04, 95% CI: 1.49, 6.24, P = .002). Additionally, significant difference was observed between minimally invasive plate osteosynthesis (MIPO) group and IMN group in nonunion rate (RR = 3.20, 95% CI: 0.12, 0.84, P = .02). Statistical significance was also observed between the open reduction plate fixation group and IMN group in restriction of shoulder and elbow joints results (RR = 0.49, 95% CI: 0.26, 0.96, P < .05). No significant difference was observed for the operation time, American Shoulder and Elbow Surgeons score, nerve injury, delayed union, reoperation in either group. CONCLUSION: IMN may be superior to plate in reducing blood loss and postoperative infections for the treatment of humeral shaft fracture. However, MIPO was superior to IMN group in nonunion and equal to IMN in other parameters. Further research is required and future studies should include analysis of assessments at different stages and follow-up after removal of the implants.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Complicações Pós-Operatórias/epidemiologia , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Placas Ósseas , Fixação Interna de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Humanos , Duração da Cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Reoperação/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia
17.
Am Surg ; 85(11): 1239-1245, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775965

RESUMO

The purpose of this meta-analysis was to compare the clinical outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP). PubMed, Web of Knowledge, and Ovid's database were searched for studies published in English language between January 1990 and December 2018. A meta-analysis was performed to compare the clinical outcomes of CP versus DP. Nineteen trials with 1440 patients were analyzed. Although there were no significant differences in the rate of intraoperative blood transfusion between two groups, CP costs more operative time as well as had more intraoperative blood loss than DP. Furthermore, the overall complication rate, pancreatic fistula rate, and the clinically significant pancreatic fistula rate were significantly higher in the CP group. On the other hand, CP had a lower risk of endocrine (odds ratio: 0.17; 95% confidence interval: 0.10, 0.29; P < 0.05) and exocrine insufficiency (odds ratio: 0.22; 95% confidence interval: 0.10, 0.48; P < 0.05). CP was associated with a higher pancreatic fistula rate, and it should be performed in selected patients who need preservation of the pancreas, which is of utmost importance.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Duração da Cirurgia , Pancreatectomia/efeitos adversos , Pancreatectomia/métodos , Fístula Pancreática/etiologia , Neoplasias Pancreáticas/cirurgia , Complicações Pós-Operatórias/etiologia , Transfusão de Sangue/estatística & dados numéricos , Intervalos de Confiança , Diabetes Mellitus/etiologia , Humanos , Tempo de Internação , Resultado do Tratamento
18.
Curr Med Sci ; 39(5): 778-783, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612396

RESUMO

Laparoscopic hepatectomy (LH) is a newly developed technique associated with advantages as open surgery, but the study on outcome of liver function recovery was scarce. This preliminary report was aimed to comparatively assess the short-term outcomes between LH and open hepatectomy (OH) for primary hepatocellular carcinoma (PHC). This study retrospectively analyzed the demographic data and short-term outcomes of 81 patients who underwent LH or OH for the primary treatment of PHC between Oct. 2017 and May 2018 at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (China). A total of 81 PHC patients who received major liver resection were enrolled. There were 38 (47%) patients in the LH group and 43 (53%) patients in the OH group. The operative time was significantly longer (373.53±173.38 vs. 225.43±55.08, P<0.01), and hospital stay (17.34±5.93 vs. 21.70±6.89, P=0.003), exhaust time (2.32±0.62 vs. 3.07±0.59, P<0.01) and defecation time (2.92±0.78 vs. 3.63±0.58, P<0.01) were significantly shorter in LH group than in OH group. The recovery of liver function was significantly faster in LH group, including higher serum albumin (P=0.002), higher ratio of albumin/globulin (P=0.029) and lower direct bilirubin (P=0.001) than in OH group. It is suggested that LH can serve as a fast recovery and cheap surgical procedure in the treatment of PHC, which is safe and feasible.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Adulto , Ascite/diagnóstico , Ascite/etiologia , Ascite/patologia , Bilirrubina/sangue , Carcinoma Hepatocelular/patologia , Feminino , Hepatectomia/instrumentação , Humanos , Laparoscopia/instrumentação , Tempo de Internação/estatística & dados numéricos , Testes de Função Hepática , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/patologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Estudos Prospectivos , Albumina Sérica/metabolismo , Soroglobulinas/metabolismo , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/patologia , Fatores de Tempo , Resultado do Tratamento
19.
Medicine (Baltimore) ; 98(41): e17533, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593128

RESUMO

BACKGROUND: With the improvements of surgical instruments and surgeons' experience, laparoscopic liver resection has been applied for recurrent tumors. However, the value of laparoscopic repeat liver resection (LRLR) is still controversial nowadays, which compelled us to conduct this meta-analysis to provide a comprehensive evidence about the efficacy of LRLR for recurrent liver cancer. METHODS: A computerized search was performed to identify all eligible trials published up to April 2019. This meta-analysis was conducted to estimate the perioperative data and oncological outcomes of LRLR by compared with open repeat liver resection (ORLR) and laparoscopic primary liver resection (LPLR). A fixed or random-effect modal was established to collect the data. RESULTS: A total of 1232 patients were included in this meta-analysis (LRLR: n = 364; ORLR: n = 396; LPLR: n = 472). LRLR did not increase the operative time compared to ORLR (WMD = 15.92 min; 95%CI: -33.53 to 65.37; P = .53). Conversely, LRLR for patients with recurrent tumors was associated with less intraoperative blood loss (WMD = -187.33 mL; 95%CI: -249.62 to -125.02; P < .00001), lower transfusion requirement (OR = 0.24; 95%CI: 0.06-1.03; P = .05), fewer major complications (OR = 0.42; 95%CI: 0.23-0.76; P = .004), and shorter hospital stays (WMD = -2.31; 95%CI: -3.55 to -1.07; P = .0003). In addition, the oncological outcomes were comparable between the two groups. However, as for the safety of LRLR compared with LPLR, although the operative time in LRLR group was longer than LPLR group (WMD = 58.63 min; 95%CI: 2.99-114.27; P = .04), the blood loss, transfusion rates, R0 resection, conversion, postoperative complications, and mortality were similar between the two groups. CONCLUSIONS: LRLR for recurrent liver cancer could be safe and feasible in selected patients when performed by experienced surgeons.


Assuntos
Laparoscopia/efeitos adversos , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/cirurgia , Reoperação/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/métodos , Hepatectomia/tendências , Humanos , Laparoscopia/métodos , Tempo de Internação/tendências , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Seleção de Pacientes , Período Perioperatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Reoperação/métodos , Resultado do Tratamento
20.
Medicine (Baltimore) ; 98(43): e17420, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651845

RESUMO

BACKGROUND & AIMS: Open-transforaminal lumbar interbody fusion (O-TLIF) is regarded as the standard (S) approach which is currently available for patients with degenerative lumbar diseases patients. In addition, minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) has proposed and gradually obtained popularity compared with O-TLIF procedures due to its beneficial outcomes in minimized tissue injury and quicker recovery. Nonetheless, debates exist concerning the use of MI-TLIF with its conflicting outcomes of clinical effect and safety in several publications. The purpose of the current study is to conduct an updated meta-analysis to provide eligible and systematical assessment available for the evaluation of the efficacy and safety of MI-TLIF in comparison with O-TLIF. METHODS: Publications on the comparison of O-TLIF and MI-TLIF in treating degenerative lumbar diseases in last 5 years were collected. After rigorous reviewing on the eligibility of publications, the available data was further extracted from qualified trials. All trials were conducted with the analysis of the summary hazard ratios (HRs) of the interest endpoints, including intraoperative and postoperative outcomes. RESULTS: Admittedly, it is hard to run a clinical RCT to compare the prognosis of patients undergoing O-TLIF and MI-TLIF. A total of 10 trials including non-randomized trials in the current study were collected according to our inclusion criteria. The pooled results of surgery duration indicated that MI-TLIF was highly associated with shorter length of hospital stay, less blood loss, and less complications. However, there were no remarkable differences in the operate time, VAS-BP, VAS-LP, and ODI between the 2 study groups. CONCLUSION: The quantitative analysis and combined results of our study suggest that MI-TLIF may be a valid and alternative method with safe profile in comparison of O-TLIF, with reduced blood loss, decreased length of stay, and complication rates. While, no remarkable differences were found or observed in the operate time, VAS-BP, VAS-LP, and ODI. Considering the limited available data and sample size, more RCTs with high quality are demanded to confirm the role of MI-TLIF as a standard approach in treating degenerative lumbar diseases.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fusão Vertebral/métodos , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Duração da Cirurgia , Resultado do Tratamento
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