OBJECTIVETo evaluate the influence of extended hepatic pedicle occlusion (HPO) on hepatic ischemic/reperfusion (I/R) injury and intraoperative blood loss in major hepatectomy for primary liver cancer (PLC).

METHODSBetween June 2001 and December 2005, a total number of 843 patients with PLC had been operated on. Those whose hepatic pedicle were occluded continuously for or longer than 30 min during hepatectomy were retrospectively reviewed (continuous HPO group) and compared to the patients whose hepatic pedicle were occluded for the same length of time but intermittently (intermittent HPO group). The amount of intraoperative blood loss, the percentage of the patients who needed blood transfusion and postoperative liver biochemical tests were compared between the two groups.

RESULTSThere were 35 cases in continuous HPO group and 38 cases in intermittent HPO group with occlusion time between 30 min and 45 min. The two groups were matched for underlying liver disease ,preoperative liver function, tumor size and location, major intrahepatic vessel involvements and the types and extensions of the hepatectomies. The mean intraoperative blood loss in continuous HPO group was significantly less than that in intermittent HPO group (660 ml vs. 1054 ml, P < 0.05); accordingly, the percentage of patients who need blood transfusion in continuous HPO group was significantly lower than that in intermittent HPO group (48.6% vs. 78.9%, P < 0.01). Patients in both of the groups were recovered smoothly after operation, with no occurrence of liver failure.

CONCLUSIONSThe hepatic pedicle can be continuously occluded for 3045 min in cirrhotic patients with well compensated liver function, and when compared to routine intermittent HPO, continuous HPO significantly decreases the intraoperative blood loss and reduces the need for transfusion. Meanwhile it does not increase the hepatic I/R injury.

Adult ; Aged ; Blood Loss, Surgical ; prevention & control ; Female ; Hepatectomy ; methods ; Humans ; Liver ; blood supply ; physiopathology ; Liver Neoplasms ; physiopathology ; surgery ; Male ; Middle Aged ; Retrospective Studies

Visual loss and field defects commonly occur after acute blood loss. We present a case of bilateral permanent visual field defect in a 30-year-old man after a massive hemorrhage caused by large vessel injury during a right nephrectomy. His postoperative visual acuity decreased significantly, and his visual field showed peripheral constriction and inferior altitudinal field defect in both eyes. A year and a half after the operation, visual acuity recovered to the preoperative level, but the field did not show improvement. We advance that this is a possible result of extensive injury to the occipital area, excluding the corresponding area of the macula.
Acute Disease ; Adult ; Blindness/*etiology ; Blood Loss, Surgical/*physiopathology ; Cerebral Infarction/complications/*etiology ; Humans ; Male ; Nephrectomy ; Occipital Lobe/pathology ; Vena Cava, Inferior/injuries ; Vision Disorders/*etiology ; *Visual Fields

OBJECTIVETo compare the effect on surgical indicators and functional outcome between preoperative skeletal traction and skin traction for adult femoral fracture and guide the choice of preoperative traction method of adult femoral fractures.

METHODSFrom February 2008 to September 2012, 68 patients aged greater than 18-year-old with femoral fractures were treated and randomly divided into two groups according hospitalization order,the odd with skeletal traction of tibial tubercle (group A) and the even with skin traction (group B). In group A, there were 25 males and 9 females with an average age of (36.3±9.9) years old,including 11 cases with transverse fracture, 15 cases with oblique fracture, 8 cases with spiral fracture. In group B, there 26 males and 8 females with an average age of (37.1±11.0) years old,including 10 cases with transverse fracture, 13 cases with oblique fracture,11 cases with spiral fracture. The operative time,blood loss,the number and amount of blood transfusion ,fracture healing time, hemoglobin, pain scores and functional scores between two groups were analyzed and compared. Results:All patients were followed up, the follow-up time was (33.5±6.5) months in group A, (31.3±7.5) months in groupB. In group A,the operation time was (108.8±14.2) min and the intraoperative blood loss was (383.1±117.1) ml and the postoperative blood transfusion was 14 cases and the blood transfusion was (350.0±122.5) ml and the average bone healing time was(15.0±3.3) weeks. In group B, the operation time was (111.6±12.7) min and the intraoperative blood loss was (392.0± 116.7) ml and the blood transfusion was 11 cases and the blood transfusion was(327.3±129.1) ml and the average healing time was (15.5±3.4) weeks. These obseration indicators had no significant difference between two groups. There was no significant difference between two groups in terms of Hemoglobin, the pain scores before and after traction, the femoral fractures efficacy score,knee function score and knee range.

CONCLUSIONPreoperative skeletal traction does not reduce surgery time, blood loss and pain and so on. The bone healing time and limb functional outcomes were also not significantly improved.

Adult ; Blood Loss, Surgical ; Bone and Bones ; surgery ; Dermatologic Surgical Procedures ; Female ; Femoral Fractures ; physiopathology ; surgery ; Fracture Fixation, Internal ; Fracture Healing ; Humans ; Male ; Middle Aged ; Preoperative Period ; Traction ; Young Adult

OBJECTIVETo study the technique and outcomes of laparoscopic radical cystectomy (LRC) and evaluate the efficacy of the urinary reservoir constructed with ileum in patients with invasive bladder cancer.

METHODSFrom 2005 - 2010, A total of 11 patients with bladder cancer were enrolled in this study. Laparoscopy was performed with 5 trocars. Urodynamic examination was performed, the function of upper urinary tract was tested, and complications were evaluated in all the eleven cases.

RESULTSThe mean operation time was 420 minutes (ranged 350 to 490 min) and mean blood loss was 410 ml (ranged 300 to 700 ml). Ten of the 11 patients had complete continence, and one case had incontinence. The average flow rate was 11.5 ml/s. The first pressure of the reservoir was 29 cm H2O, and the maximum pressure was 36 cm H2O. The average capacity was 162 ml and 410 ml, respectively. The outlet pressure was 49 cm H2O. The volume of residual urine was 0 - 35 ml. No evidence of ureteral reflux was noted.

CONCLUSIONSLaparoscopic radical cystectomy is a promising method for the treatment of bladder cancer. Orthotopic ileal neobladder is considered as an ideal form of urinary diversion characterized with low pressure, larger capacity and continence.

Aged ; Blood Loss, Surgical ; Carcinoma, Squamous Cell ; physiopathology ; surgery ; Cystectomy ; methods ; Follow-Up Studies ; Humans ; Ileum ; surgery ; Laparoscopy ; Male ; Middle Aged ; Urinary Bladder Neoplasms ; physiopathology ; surgery ; Urinary Diversion ; methods ; Urinary Reservoirs, Continent ; Urodynamics

UNLABELLEDABSTRA CT OBJECTIVE To compare the complications and clinical outcome of titanium elastic nail (TEN) versus plate-screw fixation (PF) for the treatment of upper segment fractures of femoral shaft in children.

METHODSFrom May 2006 and August 2012,32 consecutive children with upper segment fractures of femoral shaft were studied prospectively. They were randomly divided into TEN group and PF group. Ninteen patients were treated with titanic elastic nail (TEN) fixation including 11 males and 8 females with an average age of (6.9?2.2) years old ranging from 3 to 11,11 cases of them were type A, 6 cases were type B,2 cases were type C according to AO classification. The other 13 patients were treated with plate-screw fixation (PF) including 9 males and 4 females with an average age of (7.5±2.1) years old ranging from 5 to 12 years, and 3 cases of them were type A,6 cases were type B,2 cases were type C. Operative time, blood loss,incision length,the time of hospitalization,fracture healing time, postoperative complications and function recovery between two groups were compared and evaluated.

RESULTSThe average follow-up period of the patients was 25.3 months (ranging from 15 to 48 months) in TEN group, and 36.2 months (ranging from 13 to 36 months) in the PF group. The operation time, time of hospitalization, the time of implants removed after the initial surgery, fracture healing time in TEN group were respectively (56.7±11.2) min, (6.6±3.9) d, (8.1±2.3) months, (12.6+3.8) weeks; and in PF group were respectively (51.5±8.3) min, (7.8±4.8) d, (7.8±1.6) months, (11.8±2.8) weeks, there was no significant difference between two groups (P>0.05). However, the length of incisions was (4.3±1.7) cm and the intraoperative blood loss was (12.7+3.2) ml in TEN group,which were significantly less than that in PF group respectively (89.2±21.1) ml and (11.6?2.3) cm (P<0.05). There was no statistically difference in postoperative in complication between two groups, but the patients in TEN group had a higher incidence of soft tissue irritation and misalignment. Outcome scores according to Sanders had no significant difference between two groups (P>0.05). In TEN group,the result was excellent in 13 cases, good in 3,fair in 2, and poor in 1, while in PF group excellent in 10, good in 2, fair in 1.

CONCLUSIONThere is no significant difference in therapeutic effects between TEN and PF for children with upper segment fractures of femoral shaft. The internal fixation should be selected according to the associated fracture type, weight, the expected value of the parents, scars, and so on.

Blood Loss, Surgical ; Bone Nails ; Bone Plates ; Bone Screws ; Child ; Child, Preschool ; Female ; Femoral Fractures ; complications ; physiopathology ; surgery ; Fracture Fixation, Intramedullary ; instrumentation ; Fracture Healing ; Hip ; physiopathology ; Humans ; Male ; Operative Time ; Postoperative Complications ; epidemiology ; Prospective Studies ; Treatment Outcome

OBJECTIVETo evaluate the effificacy of dual antiplatelet therapy combined with Naoxintong Capsule ([see text], NXTC) in a rat model of coronary microembolization (CME).

METHODSA total of 95 rats were randomly divided into 6 groups: control, sham-operation, CME model, NXTC, dual antiplatelet (clopidogrel and aspirin) intervention (DA), and NXTC combined with DA (NDA) groups. The complete data in 69 rats were obtained. The number of CME, myocardial apoptosis rate, bleeding time, clotting time, and adensosine diphosphate (ADP)-induced platelet aggregation were assessed.

RESULTSCompared with the CME group, the number of CME and myocardial apoptosis rates were signifificantly decreased in the NXTC, DA, and NDA groups (P <0.01). Compared with other intervention groups, the number of CME and myocardial apoptosis rates were the least in the NDA group (P <0.01), and the incidence of surgical bleeding was the highest in the DA group (P <0.01). Compared with the CME group, ADP-induced maximum platelet aggregation rate was significantly inhibited in the NXTC, DA, and NDA groups (P <0.01), both bleeding time and clotting time were signifificantly increased in the NXTC, DA, and NDA groups (P <0.01), while the above parameters were the highest in the DA group (P <0.05).

CONCLUSIONThe combination therapy of NXTC and DA enhanced the anti-CME effect of either therapy alone and reduced the risk of the DA therapy-associated bleeding, demonstrating an improved benefifit/ risk ratio in the rat model of CME.

Animals ; Apoptosis ; drug effects ; Blood Coagulation ; drug effects ; Blood Loss, Surgical ; physiopathology ; Capsules ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Embolism ; complications ; drug therapy ; pathology ; physiopathology ; Male ; Myocardium ; pathology ; Platelet Aggregation Inhibitors ; pharmacology ; therapeutic use ; Rats ; Rats, Sprague-Dawley ; Survival Analysis ; Thrombosis ; complications ; drug therapy ; pathology ; physiopathology

Integrated resection of the pancreatic head is the most difficult step in radical pancreaticoduodenectomy (RPD) in patients with the portal vein (PV) and superior mesenteric vein (SMV) invasion or oppression by the tumor. This study introduced a new idea and skill named the "total arterial devascularization first" (TADF) technique and its applications in RPD. Three arterial blood supplies of pancreatic head were obstructed before dissection of veins. The critical steps included exposure of the anterior surface of the abdominal aorta (AA) by completely transecting neural and connective tissue between superior mesenteric artery (SMA) and pancreatic mesounsinate, and transection of the mesounsinate from the origin of SMA to the root of the celiac trunk. From January 2012 through May 2013, a total of 58 patients with PV/SMV invasion or oppression underwent RPD using this technique. The median operative time was 5.1 h (ranging 4.5-8.1 h). The median intraoperative blood loss was 450 mL (ranging 200-900 mL). No intraoperative and postoperative bleeding of pancreatic head region occurred. Among the 58 patients, 21 were subjected to vessel lateral wall angiectomy or angiorrhaphy, and 10 to angiectomy and end-to-end anastomosis. The incidence of postoperative bleeding, postoperative pancreatic fistula and biliary fistula was 5.2%, 6.8%, and 1.7%, respectively. No patients died 3 months after operation. The TADF technique is a new method for intricate RPD and could improve the security of surgery and reduce intraoperative bleeding, which is expected to become standardized surgical approach for RPD.
Adult ; Aged ; Arteries ; physiopathology ; Blood Loss, Surgical ; prevention & control ; Female ; Humans ; Male ; Mesenteric Veins ; pathology ; surgery ; Neoplasm Invasiveness ; Pancreatic Neoplasms ; blood supply ; surgery ; Pancreaticoduodenectomy ; methods ; Portal Vein ; pathology ; surgery ; Postoperative Hemorrhage ; prevention & control ; Reproducibility of Results ; Time Factors ; Vascular Surgical Procedures ; methods

OBJECTIVETo explore the application of mesoesophagus suspension technique to improve the upper mediastinal lymph node dissection during thoracoscopic esophagectomy in the treatment of esophageal cancer.

METHODSClinical data of 164 thoracic esophageal cancer patients who underwent combined thoracoscopic and laparoscopic esophagectomy with two-field lymph node dissection in the Union Hospital of Fujian Medical University between October 2012 and June 2015 were retrospectively analyzed. Among 164 patients, 80 cases underwent upper mediastinal lymph node dissection by traditional method (traditional group), and the remaining 84 cases underwent upper mediastinal lymph node dissection by mesoesophagus suspension technique (suspension group). The operation time, estimated blood loss, number of excised lymph nodes and postoperative complications were compared between the two groups.

RESULTSThere were no significant differences in gender, age, location of tumor and pathology stage between the two groups. The operation time in the two groups was similar. The suspension group had significantly less thoracic blood loss than traditional group [(85±5) ml vs.(140±7) ml, P=0.000]. The number of dissected lymph nodes of bilateral recurrent laryngeal nerve was more in suspension group [median (interquartile range): left: 3 (2 to 4) vs. 2 (1 to 3), P=0.013; right: 3(2 to 6) vs. 2(1 to 3), P=0.007]. There was no significant difference in metastatic rate of lymph node in different sites between the two groups. The highest metastatic rate of suspension and traditional group was found at paracardia lymph nodes[22.6%(19/84) and 22.5%(18/80)], the next was at right laryngeal nerve lymph nodes [17.9%(15/84) and 15.0%(12/80)] and left laryngeal nerve lymph nodes [16.7%(14/84) and 12.5%(10/80)]. There were no significant differences with regard to the incidence of major postoperative complications between two groups, including respiratory complication, anastomotic leakage, vocal cord palsy.

CONCLUSIONSUpper mediastinal bilateral recurrent laryngeal nerve lymph node is the predilection site of lymphatic metastasis of thoracic esophageal cancer. Application of mesoesophagus suspension technique in thoracoscopic esophagectomy can improve the clearance quality of bilateral recurrent laryngeal nerve lymph nodes.

Anastomotic Leak ; Blood Loss, Surgical ; Esophageal Neoplasms ; surgery ; Esophagectomy ; adverse effects ; methods ; Female ; Humans ; Laparoscopy ; Lymph Node Excision ; adverse effects ; methods ; Lymph Nodes ; anatomy & histology ; pathology ; surgery ; Lymphatic Metastasis ; physiopathology ; Male ; Mediastinum ; surgery ; Operative Time ; Postoperative Complications ; Recurrent Laryngeal Nerve ; physiopathology ; Retrospective Studies ; Treatment Outcome