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简介：摘要：在中介或先进的胰腺的头癌上改进辩解的效果。方法：手术与intermediated或先进的胰腺的头癌在26个病人被动。在癌上与一根电子横梁与intraoperative放射疗法相结合的Cholecystojejunostomy或choledochojejunostomy从1996年5月被执行到1998年5月。同时，多功能的可植入的药交货系统的导管为手术后的灌注化疗经由胃与十二指肠的动脉被插入。结果：327月后续调查建议肿瘤在治疗的功课以后在不同的度缩小了。所有病人疼痛被减轻。6月、12月、24月的幸存率是100%，93.9%和20%分别地。5个死了的病人的平均幸存时间是17.8个月。结论：这操作是很完成与中介或先进的胰腺的头癌延长病人的生活。

简介：AIM:Toevaluateshort-termoutcomesfollowingintraoperativebiliarylavageforhepatolithiasis.METHODS:Atotalof932patientswhowereadmittedtotheWestChinaMedicalCenterofSichuanUniversitybetweenJanuary2010andJanuary2014andunderwentbileductexplorationandlithotomywereretrospectivelyincludedinourstudy.Thepatientsweredividedintothelavagegroupandthecontrolgroup.Relatedpre-,intra-,andpostoperativefactorswererecorded,analyzed,andcomparedbetweenthetwogroupsinordertoverifytheeffectsofbiliarylavageontheshort-termoutcomeofpatientswithhepatolithiasis.RESULTS:Amongstthepatientswhowereincluded,678patientswithhepatolithiasiswereincludedinthelavagegroup,andtheother254patientswereenrolledinthecontrolgroup.Dataanalysesrevealedthatpreoperativebaselineandrelatedintraoperativevariableswerenotsignificantlydifferent.However,patientswhounderwentintraoperativebiliarylavagehadprolongedpostoperativehospitalstays(6.67dvs7.82d,P=0.024),higherhospitalizationfees(RMB28437.1vsRMB32264.2,P=0.043),higherpositiveratesofbacterialculturesfromblood(13.3%vs25.8%,P=0.001)andbile(23.6%vs40.7%,P=0.001)samples,andincreasedusageofadvancedantibiotics(26.3%vs38.2%,P=0.001).Inaddition,inthelavagegroup,morepatientshadfever(>37.5℃,81.4%vs91.1%,P=0.001)andhyperthermia(>38.5℃,39.7%vs54.9%,P=0.001),andhigherwhitebloodcellcountswithin7daftertheoperationcomparedtothecontrolgroup.CONCLUSION:Intraoperativebiliarylavagemightincreasetheriskofpostoperativeinfection,whilenotsignificantlyincreasinggallstoneremovalrate.

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简介：Insularlesionsremainsurgicallychallengingbecauseoftheneedtobalanceaggressiveresectionandfunctionalprotection.Motorfunctiondeficitsduetocorticospinaltractinjuryareacommoncomplicationofsurgeryforlesionsadjacenttotheinternalcapsuleanditisthereforeessentialtoevaluatethecorticospinaltractadjacenttothelesion.Weuseddiffusiontensorimagingtoevaluatethecorticospinaltractin89patientswithinsularlobelesionswhounderwentsurgeryinChinesePLAGeneralHospitalfromFebruary2009toMay2011.Postoperativemotorfunctionevaluationrevealedthat57patientshadnochangesinmotorfunction,and32patientssufferedmotordysfunctionoraggravatedmotordysfunction.Oftheaffectedpatients,20recoveredmotorfunctionduringthe6-12-monthfollow-up,andanadditional12patientsdidnotrecoverovermorethan12monthsoffollow-up.Followingreconstructionofthecorticospinaltract,fractionalanisotropycomparisondemonstratedthatpreoperative,intraoperativeandfollow-upnormalizedfractionalanisotropyinthestablegroupwashigherthaninthetransientdeficitsgrouporthelong-termdeficitsgroup.Comparedwiththetransientdeficitsgroup,intraoperativenormalizedfractionalanisotropysignificantlydecreasedinthelong-termdeficitsgroup.Weconcludethatintraoperativefractionalanisotropyvaluesofthecorticospinaltractscanbeusedasaprognosticindicatorofmotorfunctionoutcome.

简介：AbstractBackground:Endoscopic resection bleeding (ERB) classification was proposed by the authors’ team to evaluate the severity of intraoperative bleeding (IB) during endoscopic submucosal dissection (ESD). This study aimed to evaluate the application of ERB classification and to analyze the risk factors of major IB (MIB) and postoperative bleeding (PB) associated with ESD for gastric neoplastic lesions.Methods:We retrospectively enrolled a total of 1334 patients who underwent ESD between November 2006 and September 2019 at The First Medical Center of Chinese People’s Liberation Army General Hospital. All patients were divided into the non-MIB group (including ERB-0, ERB-controlled 1 [ERB-c1], and ERB-c2) and the MIB group (including ERB-c3 and ERB-uncontrolled [ERB-unc]) according to the ERB classification. Risk factors of major MIB and risk factors of PB were analyzed using a logistic regression model.Results:Among the 1334 patients, 773 (57.95%) had ERB-0, 477 (35.76%) had ERB-c1, 77 (5.77%) had ERB-c2, 7 (0.52%) had ERB-c3, and no patients had ERB-unc. The rate of PB in patients with IB classifications of ERB-0, ERB-c1, ERB-c2, and ERB-c3 were 2.20% (17/773), 3.35% (16/477), 9.09% (7/77), and 2/7, respectively. In multivariate analysis, proximal location (odds ratio [OR]: 1.488; 95% confidence interval [CI]: 1.045-3.645; P = 0.047) was the only significant risk factor of MIB. Chronic kidney disease (CKD) (OR: 7.844; 95% CI: 1.637-37.583; P = 0.010) and MIB (ERB-c3) (OR: 13.932; 95% CI: 2.585-74.794; P = 0.002) were independent risk factors of PB.Conclusions:Proximal location of lesions was a significant risk factor of MIB. Additionally, CKD and MIB (ERB-c3) were independent risk factors of PB. More attention should be paid to these high-risk patients for MIB and PB.

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简介：AbstractBackground:Arteriovenous malformation(AVM) have long-term "blood stealing" characteristics, which result in complicated hemodynamic features. To analyze the application of intraoperative indocyanine green angiography with FLOW 800 software in AVM surgeries.Methods:Data on 17 patients undergoing surgery with ICG fluorescence were collected in Beijing Tiantan Hospital. To analyze the hemodynamic features of AVM and the influence on the peripheral cortex of AVM resection, we assessed the following hemodynamic parameters: maximum intensity, slope of rise, time to half-maximal fluorescence, and transit time from arteries to veins.Results:In the 17 superficial AVMs studied, the time-delay color mode of the FLOW 800 software was superior to the traditional playback mode for identifying feeding arteries, draining veins, and their relation to normal cortical vessels. The maximum fluorescence intensity and slope of the ICG fluorescence curve of feeder arteries and draining veins were higher than those of normal peripheral vessels (P < 0.05). The transit times in AVMs were significantly shorter than those in normal peripheral vessels (P < 0.05). After AVM resection, cerebral flow increased in the cortex, and local cycle time becomes longer, although the differences were not significant (P > 0.05).Conclusions:Hemodynamic parameter analysis provided quality guidance for the resection of AVMs and could also be used in estimating changes in blood flow in the local cortex to identify abnormal hyperperfusion and residual nidus.

简介：AbstractBackground:Indocyanine green video angiography (ICG-VA) is a safe and effective instrument to assess changes in cerebral blood flow during cerebrovascular surgery. After ICG-VA, FLOW 800 provides a color-coded map to directly observe the dynamic distribution of blood flow and to calculate semiquantitative blood flow parameters later. The purpose of our study is to assess whether FLOW 800 is useful for surgery of complex intracranial aneurysms and to provide reliable evidence for intraoperative decision-making.Methods:We retrospectively reviewed patients with complex aneurysms that underwent microsurgical and intraoperative evaluation of ICG-VA and FLOW 800 color-coded maps from February 2019 to May 2020. FLOW 800 data were correlated with patient characteristics, clinical outcomes, and intraoperative decision-making.Results:The study included 32 patients with 42 complex aneurysms. All patients underwent ICG-VA FLOW 800 data provided semiquantitative data regarding localization, flow status in major feeding arteries; color maps confirmed relative adequate flow in parent, branching, and bypass vessels.Conclusions:FLOW 800 is a useful supplement to ICG-VA for intraoperative cerebral blood flow assessment. ICG-VA and FLOW 800 can help to determine the blood flow status of the parent artery after aneurysm clipping and the bypass vessels after aneurysm bypass surgery.

简介：5α；-reductase禁止者(5α；-RIs),包括finasteride和dutasteride，是为良性的prostatic增生(BPH)的通常使用的医药治疗。许多研究报导了那外科手术前5α；-RI为BPH在外科期间在intraoperative出血上有影响，但是它仍然在争论。那么，我们进行了效果的系统的评论和5α的机制；为BPH流血的intraoperative上的-RIs。MEDLINE，EMBASE，控制试用的控制小道收款机和参考检索研究列出的Cochrane在分析被寻找。包含15不同使随机化的控制试用(RCT)和1156个病人的一个总数的十六份出版物在分析被使用，包括为finasteride的10RCT和为dutasteride的五RCT。我们在resected前列腺标本发现那外科手术前的finasteride治疗减少microvessel密度(MVD)。全部的血损失，血损失都极大地作为与控制相比在finasteride组每在血色素的resected前列腺织物和减少的克被减少。Dutasteride看起来没在流血上有效果。这元分析证明外科手术前的finasteride治疗能减少intraoperative出血在为BPH的外科期间。外科手术前的dutasteride没在intraoperative上有效果出血，而是进一步高质量的未来的研究仍然被需要证实这观察。

简介：AbstractImportance:Dexmedetomidine inhibits the inflammatory response associated with cardiopulmonary bypass (CPB) and protects neural function. However, the mechanism of dexmedetomidine’s anti-inflammatory pathway is unclear.Objective:To investigate the effect of dexmedetomidine on the cognitive level and expression of inflammatory factors in children with congenital heart disease undergoing intraoperative CPB.Methods:Ninety children with congenital heart disease were recruited and randomly divided into 3 groups of 30 children in each. In Group 1, a 1.0 µg·kg-1·h-1 intravenous bolus of dexmedetomidine was administered 10 minutes after induction of anesthesia, followed by a 0.2 µg·kg-1·h-1 infusion until the surgical incision. In Group 2, a 0.5 µg/kg intravenous bolus of dexmedetomidine was administered 10 minutes after induction of anesthesia, followed by a 0.1 µg·kg-1·h-1 infusion until the surgical incision. The control group was given physiological saline using the same method as in Groups 1 and 2. The serum levels of nuclear factor-kappa B (NF-κB), S-100β protein, neuron-specific enolase (NSE), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were measured before the surgery (T1), at the end of CPB (T2), 2 hours after CPB (T3), 6 hours after CPB (T4), and 24 hours after CPB (T5). The Wechsler Intelligence Scale for children (WISC) was measured before the operation and at 3, 6, and 12 months after the operation to evaluate the neurodevelopmental state of the children.Results:The levels of the NF-κB, S-100β protein, NSE, TNF-α, IL-6 were significantly higher at T2, T3, or T4 than before the surgery (T1) in the control group or the dexmedetomidine groups. However, the increases of NF-κB, TNF-α, IL-6, S-100β and NSE levels were significantly smaller in the dexmedetomidine groups than those in the control group (P < 0.017). The WISC scores were similar among the three groups before or after the operation.Interpretation:The increases in NF-κB, TNF-α, and IL-6 levels indicated aggravation of the inflammatory reaction and the increase S-100β protein and NSE levels indicated that the nervous system was damaged. Administration of dexmedetomidine to children with congenital heart disease undergoing intraoperative CPB can inhibit the inflammatory response and may ameliorate the neurodevelopmental damage caused by CPB.

简介：AbstractIntracapsular fractures of the proximal femur are one of the most common fractures of the lower limbs. Most cases require osteosynthesis with suitable implants, and intraoperative positioning of the patient on the fracture table is a prerequisite to facilitate fracture manipulation, traction, reduction and fluoroscopy assessment. However, positioning the limbs of bilateral above-knee amputees for internal fixation of related proximal femoral fractures is a difficult task, which requires customized inventory for effective limb positioning and fracture manipulation. This study reported a rare case following a crush injury of bilateral lower limb in a road traffic accident, and described some technical tips of acute femoral neck fractures in bilateral above-knee amputation. The patient was managed with immediate guillotine amputation and later secondary wound closure followed by internal fixation of the right-sided femoral neck fracture with multiple cancellous cannulated screws.

简介：瞄准：与颜色在病人在肝切除术期间发现秘密转移表面的癌症肝转移(CRCLM)，提高对比的intraoperativeultrasonography(CE-IOUS)用一个新微水泡代理人被执行，sonazoid，它在Kupffer房间基于它的累积提供一幅实质特定的对比图象。方法：有CRCLM的八个病人在肝切除术前用sonazoid经历了CE-IOUS。肝在迟了的Kupffer阶段成像期间被调查，它是sonazoid的一个珍贵特征。结果：用sonazoid的CE-IOUS提供了早脉管阶段并且为10min的正弦曲线阶段图象在sonazoid的注射以后由迟了的Kupffer阶段图象列在后面直到30min。IOUS没在8个病人提供变形损害的新调查结果。在sonazoid的迟了的Kupffer阶段图象期间，然而，变形损害最新在8个病人中的二个被发现。这些最新检测的损害被作为转移诊断的另外的肝切除术和组织病理学说的联盟者移开。结论：用sonazoid的CE-IOUS能允许外科医生与足够的时间调查整个肝并且intraoperatively发现新转移。