ObjectiveTo explore the causes of bile duct injury due to laparoscopic cholecystectomy (LC) and the preventive methods. MethodsA total of 18 patients with bile duct injury (with the occurrence rate of 0.4%) after LC between January 2003 and December 2012 were included. The patients included 5 males and 13 females with the age of 29-63 years old[averaging (42.3±3.6) years old]. The clinical data of the patients were retrospectively analyzed. ResultsIn the 18 cases of bile duct injury, 5 cases occur in emergency operation, 13 cases in selective operation. The operators were attending physician in 13 cases, and senior position in the other 5 cases. The reasons of the injury included misjudgment of the cystic duct in 9, duct aberrance in 3, excessive stretch of cystic duct in 2, 2 Mirizzi syndrome withⅠ-type surgical injury in 2, and right liver duct injury because of inappropriate stripping of gallbladder in 1. ConclusionThe operator's experience, severe conglutination and the bile duct aberrance are the chief causes. Preventive methods include strict system of operation accession, careful selection of candidates, timely laparotomy, and paying attention to the accumulation of operation experience and skills.
Objective To investigate infertile inpatients hospitalized in Pingjin Hospital in Tianjin from 2008 to 2010, so as to provide baseline data for further research. Methods According to diagnosis criteria of WHO, we collected demographical characteristics, disease cause and cost constitution of infertility inpatients hospitalized in Pingjin Hospital in Tianjin from 2008 to 2010. The data of each patient were input into ACCESS database and SPSS 13.0 was used for statistical analysis. Results a) From 2008 to 2010, there were 1 452 infertile patients from 33 different areas of mainland China, 79.7% of which was from the north of China. b) The mean age was 31.2±4.3 years old. The percentage of patients aged 30 to 34 years accounted for the most (40.3%). Mental laborers (23.3%) were more than physical laborers (7.2%). 36.7% of patients received education from universities and 83.1% of patients had family income ranging from 20,000 yuan to 190,000 yuan. c) The mean age of the first sexual activity was 21.4±2.9 years old. 53.7% of patients had only one sexual partner and most couples had sexual activities twice every week. The mean age of husbands was 32.9±5.5 years old with the highest percentage of 30 to 35 years old (39.2%). The percent of intellectual work of husband was the highest (35.9%). 64.9% of patients had normal semen analysis results and 23.0% never took related examination. d) 29.9% of patients was primary infertility and 70.1% was secondary infertility, of which 57.6% had either induced or medical abortion. The mean duration of infertility was 5.2±3.5 years (range 1 to 21 year). e) 76.3% of infertile patients had pelvic adhesion and 88.6% suffered from tubal disease. Among the tubal infertile patients, 23.6% had uterine disease, 5.2% had ovarian disease, 5.0% had endometriosis, 6.7% had multiple problems, and 4.8% had unexplained infertility. In patients with tubal infertility, the incidence of distal fimbria atresia (45.8%) was higher than that of proximal block (32.9%). 24.7% of patients with fimbria atresia had hydrosalpinx and among of them, 21.1% had no hydrosalpinx. 15.2% had congenital tubal defects. f) The average hospital stay was 10.5 days and the cost was 14 253.3 yuan per person. The percentage of material cost was 29.1% and that of drugs was 18.2%. Conclusion a) The total number of infertile inpatients was 1 452 in gynecology department of Pingjin Hospital of Tianjin from 2008 to 2010. 79.7% of patient was from North China. Most of them were 30 to 34 years old and 44.3% had no job. The percentage of patients had university education and that of low-middle family income was the highest. Sexual activity was relatively traditional. Most husbands were 30 to 35 years old and intellectual workers, and 23.0% of them had never taken an examination of semen analysis. More patients were secondary infertile, and the duration of infertility was 1 to 21 years. b) 76.3% of patients had pelvic adhesion and 88.6% had tubal disease. The incidence of distal tubal fimbria atresia was higher than proximal tubal occlusion. c) The average hospital stay was 10.5 days and the cost was 14 253.3 yuan per person which was further lower than each cycle cost of assisted reproductive technology. The overall costs included materials and drugs (47.3%), which were mainly at patients’ own expense.
ObjectiveTo explore the corresponding intervention measures to reduce maternal mortality rate by analyzing the causes and problems of maternal deaths. MethodsA retrospective analysis was conducted to analyze all cases of maternal mortality from January 2005 to June 2013 in West China Second University Hospital. ResultsAmong the 14 cases of maternal deaths, the main diseases of the patients were pregnancy complicated with heart disease, hypertensive disorders, obstetric hemorrhage, amniotic fluid embolism and ectopic pregnancy. Four cases got prescriptive prenatal care during pregnancy, accounting for 28.6% (4/14), while 10 cases did not, accounting for 71.4% (10/14). Six patients died in prenatal period which accounted for 42.9% (6/14), while 8 died in postnatal period which accounted for 57.1% (6/14) and 5 died within 24 hours which accounted for 62.5% (5/8). Seven underwent cesarean section and 6 fetuses survived. Two went through trial of labor and no fetus survived. There was no ordered postmortem. ConclusionIntensifying education of prenatal care during pregnancy, improving quality of obstetrical service and diathesis of healthcare professionals, strengthening the supervision of high-risk pregnancy and timely choosing the time and manner of delivery are the main measures to decrease the maternal mortality.
Objective To explore the causes and solutions of dissatisfied complaints about frame glasses wearing after medical optometry to improve service quality. Methods Patients with dissatisfied complaints about frame glasses wearing after medical optometry in West China Medical Center of Optometry Glasses between January 2013 and December 2014 were selected. Targeted re-examination and corresponding treatment was performed on them. The causes of their complaints were clustered and analyzed. Result There were 105 cases of complaints out of the 58 278 patients with frame glasses wearing after medical optometry, including complaints about wearing glasses uncomfortable in 58 cases (55.2%), mainly related to abnormal binocular vision, high myopia and progressive glasses lens fitting; quality of glasses in 23 cases (21.9%), in whom 16 were dissatisfied with the frame; quality of service in 10 cases (9.5%); glasses assembly / calibration in 7 cases (6.7%); and other dissatisfaction in 7 cases (6.7%). Conclusions In medical optometry, optometrists and sales staff should establish a good communication with patients according to individual differences, attach importance to the selection of right frame and lens in patients with high myopia or progressive piece of glasses, introduce the right wearing method of progressive piece of glasses, and enhance the follow-up service. For patients with obvious eye fatigue, it is needed to check the binocular visual function, if the visual fatigue is closely related to abnormal binocular visual function, special glasses fitting and functional training should be instructed to the patients.
Serum concentration of follicularstimulating hormone(FSH),lutenizing hormone(LH),prolactin（PRL），estradio(E2),erstriol(E3) and progesterong(P) of 56 women with gallstones and 53 other female patients were measured by radioimmunoassqy.It was found that the levels of serum estrogen were not only in reproductive aged or postmenopausal women, but also in women with or without gallstones. So it is not certain of the relation between estrogen and gallstone from this study.
Objective To analyze death causes and relevant factors in victims of Wenchuan earthquake．Methods Medical records of 27 dead patients admitted to W est China Hospital during the first 30 days after Wenchuan earthquake were analyzed retrospectively．Patient census data，diagnoses，dispositions，and prognoses were collected． Results A total of 2702 patients with earthquake related injuries were admitted to West China Hospital．The overall mortality rate was 1％(27／2702 patients)．The death were associated with age≥70．severe cerebral injuries and severe underlying illness．Mortality rate was highest in aged patients with comorbidities．Conclusions Insufficient pre-hospital treatment and inappropriate transfer procedure may contribute to the early death．Complicated with comorbidities is the leading cause of late death．Earlier involvement of intensivist in medical intervention in such a disaster is demanded．
Objective To retrospectively analyze the characteristics and death causes among the Wenchuan earthquake victims in The Third People’s Hospital of Chengdu so as to provide information for reducing mortality in future earthquake disasters. Methods The analysis was based on the data provided by the Department of Information, the Medical Record Library, and the Emergency Room of the hospital through July 12. Microsoft EXCEL was used for data input and SPSS 13.0 was used for statistical analyses. Results Through July 12, 9 (1.57%) out of the 575 wounded patients died, comprising 3 males and 6 females. Of those, 5 died in the outpatient department. The death causes were all related to severe cerebral injuries. The other 4 died in the inpatient department and the death causes were related to severe underlying illnesses and infection. Conclusion Screening and early treatment for cerebral injuries is very important in the period directly following the earthquake. Later, more attention should be paid to the treatment of underlying illnesses as well as the prevention and control of infection.
ObjectiveTo explore the causes and prevention measures of the cracking of skin tissue expander applied for ear deformity surgery. MethodsWe retrospectively analyzed the clinical data of the patients who underwent ear reconstruction surgery with skin tissue expander which cracked during water injection after surgery between January 2013 and March 2015. And then we analyzed the causes and summarized the preventive measures, such as strengthening health education, protective ear cap application, and correct water injection. ResultsWe collected a total of 149 patients including 153 deformity ears, and 151 skin tissue expanders were used. Skin tissue expander cracking occurred in 7 ears during water injection after surgery with an incidence of 4.64%. Among the seven cases, 5 cases of cracking occurred in the late water injection period when the skin flap size was almost close to expectations; these 5 patients underwent stage-two surgery after the expanders were taken out, and the results were satisfactory. The other 2 ears had expander cracking in the early water injection period, so we took out the skin tissue expander and implanted it again, and the second phase surgery was also satisfactory. The third-stage surgery for the seven cases was all successful. After the third-stage surgery, all patients were followed up for 3 to 6 months, and the outcomes were satisfying without any complications. ConclusionTo reduce or avoid skin tissue expander cracking, we should master strict terms of water injection and take effective health education and preventive measures.
ObjectiveTo examine the cause of failure of mitral valve repair. MethodWe retrospectively anal-yzed the clinical data of 89 consecutive patients with non-rheumatic mitral valve diseases who underwent reoperation for failure of mitral valve repair in our hospital from January 2009 through January 2016. There were 54 males and 35 females at age of 36.2±17.4 years. ResultsThere were 16 patients with reoperation of mitral valve repairs and 73 patients of mitral valve replacements. The failure reasons of initial mitral valve repair were technique-related in 63 patients (70.8%) and valve-related in 18 patients (20.2%). Technique-related causes of repair failure included leaflet suture dehiscence (20 patients, 22.5%), edge-to-edge procedure (11 patients, 12.4%), leaflet thickening or retraction (11 patients, 12.4%), ring dehiscence (8 patients, 9.0%), inappropriate annuloplasty (6 patients, 6.7%), incomplete repair (4 patients, 4.5%), and chordal elongation or rupture (3 patients, 3.4%). Median interval since previous repair was 4.0 (0.04-18.0) years for the technique-related failure group, and 9.7 (0.21-35.6) years for valve-related failure group (P < 0.05). ConclusionTechnique-related factors are main causes of repair failure, which include leaflet suture dehiscence, edge-to-edge procedure, and leaflet thickening or retraction. Reoperation for technique-related failure needs to be adopted early.