The majority of ureteric injury is iatrogenic during surgical procedures especially pelvic and retroperitoneal operations. Approximately 10% of ureteric injury is associated with colorectal procedures. The major cause is anatomical anomaly. The types of injuries mainly include contusion, clamp injury, ligation injury, cautery, cut injury and distorted traction to an acute angle. The injuries are mainly located in the lower segment of the ureter. An accurate evaluation of the risk of ureteric injury before rectal cancer operation, a better understanding of anatomy in both normal and abnormal conditions, and ureteral stent placement, are important methods to prevent ureteric injury. Primary repair is the best treatment option.
Humans ; Intraoperative Complications ; prevention & control ; Rectal Neoplasms ; surgery ; Ureter ; injuries

The postoperative neurological complications is associated with intraoperative cerebral emboli, which results from extracorporeal circulation and operation. It can effectively reduce the incidence of neurological complications with ultrasonic radiation. In fluids, a particle will change it's motion trail when it is acted by the radiation force generated by the ultrasound. This article mainly discuss how to shielding emboli with ultrasound. The equipment can transmit phased ultrasonic signals, which is designed on a FPGA development board. The board can generate a square wave, which is converted into a sine wave through a power amplifier. In addition, the control software has been developed on Qt development environment. The result indicates it's feasible to shielding emboli with ultrasonic radiation force. This article builds a strong foundation for the future research.
Humans ; Intracranial Embolism ; diagnostic imaging ; prevention & control ; Intraoperative Complications ; prevention & control ; Postoperative Complications ; prevention & control ; Ultrasonics ; instrumentation ; Ultrasonography

Abdominal Injuries ; etiology ; prevention & control ; Humans ; Iatrogenic Disease ; Intraoperative Complications ; prevention & control

Blood Loss, Surgical ; prevention & control ; Humans ; Intraoperative Complications ; prevention & control ; Postoperative Complications ; prevention & control ; Scoliosis ; surgery ; Superior Mesenteric Artery Syndrome ; prevention & control ; Surgical Wound Infection ; prevention & control

Hip fracture patients preoperative and postoperative exist hidden blood loss which often affect patients' wound healing, increase the probability of infection, prolong rehabilitation exercise, influence postoperative effect. At the same time, the body's blood loss increase the activation of the blood clotting mechanism, promote the incidence of deep vein thrombosis, bleeding and deep vein thrombosis has become the main causes of high risk in hip operation. It is very important to stop bleeding, anticoagulation should not be ignored, so how to effectively deal with the prominent contradiction between the postoperative anticoagulation and bleeding or looking for a best balance has become a intractable problems in hip fracture treatment.
Anticoagulants ; therapeutic use ; Blood Loss, Surgical ; prevention & control ; Hip Fractures ; complications ; surgery ; Humans ; Intraoperative Complications ; drug therapy ; etiology ; prevention & control

The incidence of thyroid cancer has increased sharply year by year. Thyroid cancer ranked from the 14th in 2003 to the 4th in 2012 most common cancers in female in Beijing. Surgery is still main solution for thyroid cancer, there are two operative procedure for thyroid cancer: total thyroidectomy, lateral lobectomy and isthmus resection. The surgeon must pay attention to intraoperative recurrent laryngeal nerve and parathyroid injury, with particular emphasis on the prevention of total thyroidectomy complications. Precise dissection of thyroid capsule, intraoperative recurrent laryngeal nerve monitoring and application of lymphatic mapping to recognize and protect negative stained parathyroid by using carbon nanoparticles tracer is prone to reduce the incidence of recurrent laryngeal nerve and parathyroid injury in the total thyroidectomy.
Attention ; Beijing ; epidemiology ; Female ; Humans ; Incidence ; Intraoperative Complications ; prevention & control ; Monitoring, Intraoperative ; Nanoparticles ; Recurrent Laryngeal Nerve Injuries ; prevention & control ; Thyroid Neoplasms ; epidemiology ; Thyroidectomy ; adverse effects

OBJECTIVETo investigate the influence of using fluid warming and forced-air warming system on patient core temperature, blood loss, blood transfusion, extubation time, and postoperative shivering.

METHODSForty ASA (American Society of Anesthesiologists' Physical Status) I-II patients, aged 21-69 years, scheduled for elective abdominal surgery under general anesthesia, were enrolled in the study. The patients were premedicated with intramuscular dolantin 50 mg and atropine 0.5 mg. Anesthesia was induced with midazolam 1 mg, fentanyl 50-100 microg and propofol 1.5-2.0 mg/kg. Tracheal intubation was facilitated with vecuronium 1mg and succinylcholine 1.5-2.0 mg/kg. The patients were mechanically ventilated and anesthesia was maintained with isoflurane 1.5-2.0%, 50% N2O in oxygen and intermittent iv boluses of fentanyl (total dose 5-6 microg/kg). Vecuronium was used for muscle relaxation during maintenance of anesthesia. The patients were randomly divided into 2 groups: control group (n = 20) and warming group (n = 20). In both groups, the patients were covered with surgery blanket. In the warming group, patients were additionally warmed with fluid warming device and forced-air warming system during the operation. The core temperature was recorded every 20 minutes during the operation, as well as the blood loss, blood transfusion, extubation time and postoperative shivering.

RESULTSThe core temperature at the end of the surgery was (36.4 +/- 0.4) degrees C in the warming group and (35.3 +/- 0.5) degrees C in the control group. The difference was statistically significant (t = 7.547, P < 0.001). There was no significant difference of blood loss and blood transfusion between two groups. The extubation time was significantly shorter in the warming group [(18 +/- 6) vs (26 +/- 10) min, t = -3.364, P = 0.002]. 6 patients shivered postoperatively in the control group and none in the warming group (chi2 = 7.059, P = 0.008).

CONCLUSIONFluid warming system and forced-air warming system can effectively maintain normothermia during the surgery and then help to reduce the extubation time and postoperative shivering.

Abdomen ; surgery ; Adult ; Aged ; Anesthesia, General ; Body Temperature ; physiology ; Female ; Humans ; Hypothermia ; prevention & control ; Intraoperative Care ; methods ; Intraoperative Complications ; prevention & control ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; Shivering ; physiology

OBJECTIVETo evaluate the clinical significance and application value of the real-time intraoperative monitoring (RTIM) technique in preventing recurrent laryngeal nerve (RLN) from injury during operation.

METHODSThe RTIM of RLNs by nerve integrity monitor were used in 40 cases who underwent thyroid surgery under general anesthesia from Nov. 2002 to May 2005. The endotracheal intubation with laryngeal electrode sited on the tube nerve integrity monitor were adopted for general anesthesia. The RLNs in 7 cases who underwent thyroid gland lobectomy were exposed and explored and not exposed in other operations.

RESULTSThe function of RLNs in 39 cases remained well after-operation. Only 1 patient's left RLN was damaged during operation. The spontaneous non-in-phase CMAP (compound muscle action potential) of larynx muscle in both vocal cords were recorded in all 40 cases who underwent thyroid surgery under general anesthesia. The evoked in-phase CMAP of larynx muscle could be recorded while stimulating the exposed and explored RLNs by monopolar electrode. The minimal stimulus current intensity threshold ranged from 0.08 mA to 0.35 mA (average: 0.25 mA). The range of suitable stimulating current intensity was from 0. 2 mA to 1.0 mA.

CONCLUSIONSThis technology had been proved to be more sensitive, voracious and stable. It can provide fore part precaution so that remarkably reduce the damage rate of RLN in surgery and avoid the dispensable medical dissection. It is not necessary to anatomies RLN in surgery in advance.

Adult ; Aged ; Anesthesia, General ; Female ; Humans ; Intraoperative Complications ; prevention & control ; Male ; Middle Aged ; Monitoring, Intraoperative ; methods ; Recurrent Laryngeal Nerve Injuries ; Thyroid Diseases ; surgery ; Thyroidectomy ; methods ; Young Adult

OBJECTIVETo observe the effects of "wake-up correction" technique for preventing iatrogenic spinal cord injury in scoliosis surgery.

METHODSTwenty-one patients who had scoliosis with Cobb's angle 92 degrees - 145 degrees received operation of pedicle screw insertion in all or important vertebral bodies, release of stiff segments, decompression and osteotomy. All the patients were trained how to wake up before anesthesia. Maintenance of anesthesia was achieved with infusion of propofol at target-controlled concentration 3-4 mg/L and remifentanil at 0.15 microg/(kg.min). Fresh gas 2 L/min of N(2)O:O(2) 1:1 was inhaled during mechanical ventilation. Wake-up methods:the muscle relaxant was stopped injection 30 min before wake-up, decreasing propofol's target-controlled concentration to 1-2 mg/L and remifentanil to 0.05 - 0.10 microg/(kg x min). Once the spontaneous respiration returned, woke up the patients and asked them move both toes following our orders (the first wake-up). Then patients inhaled 6% sevoflurane in fresh gas 6 L/min (N(2)O:O(2) 1:1). When the end-tidal anesthetic gas concentration was arrived 1.3 - 1.5 MAC, all of the anesthetics were stopped. The correction operation was completed and the patient was woke up again (the second wake-up). Recorded data included time used to wake up, directive action returning time, whether the patient had memory of wake-up during operation when following up.

RESULTSAll patients woke up with satisfaction. The time taken the first wake-up was (10.3 + or - 4.5) min, and for the second was (4.3 + or - 2.3) min. There were two patients who had slightly agitation during correction. There was no one who had neurological injury. There was no memory of wake-up and no pain in all patients during operation. Cobb' angle was corrected to 22 degrees - 38 degrees (average 29 degrees ), and the correction rate was 74%.

CONCLUSIONThe "wake-up correction" is effective and satisfactory by detecting the cord function in time.

Adolescent ; Adult ; Female ; Humans ; Iatrogenic Disease ; prevention & control ; Intraoperative Complications ; prevention & control ; Male ; Scoliosis ; surgery ; Spinal Cord Injuries ; etiology ; prevention & control ; Spinal Fusion ; methods ; nursing ; Young Adult

OBJECTIVETo introduce a new procedure of laparoscopic adrenal surgery.

METHODSThirty patients with adrenal disease underwent surgery by a 70 degrees lateral decubital trans-abdominal laparoscopic approach, which wa compared with 30 degrees decubital laparoscopic operation in 26 patients.

RESULTSThe procedure is superior to open laparotomy. There was significant difference in average operative time (77.2 min vs. 215.7 min), blood lost volume (27.0 ml vs. 94.5 ml), and postoperative complications (13.3% vs. 46.0%). Postoperative feeding time and hospitalization time were shortened markedly.

CONCLUSIONSThis modified technique is safe, straightforward, with a good anatomic view during operation. It could be widely adopted for the treatment of benign adrenal disease, especially pheochromocytoma.

Adrenal Gland Diseases ; surgery ; Adrenalectomy ; methods ; Female ; Humans ; Intraoperative Complications ; prevention & control ; Laparoscopy ; methods ; Male ; Postoperative Complications ; prevention & control ; Posture ; Treatment Outcome