OBJECTIVE: To investigate the effect of vasostomy on apoptosis in the male rat spermatogenic cells after vasoligation. METHODS: Model of vasoligation and vasostomy in male rat was established, and then terminal deoxynucleotidyl transferase-mediated dUTP nick labelling technique to detect the apoptosis of spermatogenic cells at 4, 8, 12, 16 weeks after vasostomy. RESULTS: The number of apoptotic cells in vasostomy group was significantly lower than that of vasoligation group since 8 weeks after vasostomy(P lt; 0.05). The number of apoptotic cells in 8 and 12 weeks after vasostomy were significantly higher than that in prevasoligation(P lt; 0.05). 16 weeks after vasostomy, the number of apoptotic cells restored to the level same as that in prevasoligation stage. CONCLUSION: Vasostomy can reverse the apoptosis of spermatogenic cells due to vasoligation.
ObjectiveTo explore the causes of colon-anal anastomotic stenosis in patients with low rectal cancer after prophylactic ileostomy under complete laparoscopy. MethodsA total of 194 patients with low rectal cancer who received complete laparoscopic radical resection of rectal cancer combined with preventive ileostomy in our hospital from January 2020 to December 2020 were selected as the study objects, and were divided into non-stenosis group (n=136) and stenosis group (n=58) according to postoperative colon-anal anastomosis stenosis. The clinical data of the two groups were compared. Univariate and multivariate logistic regression were used to analyze the factors affecting postoperative colon-anal anastomotic stenosis, and stepwise regression was used to evaluate the importance of each factor. The risk prediction model of postoperative colon-anal anastomotic stenosis was constructed and evaluated. ResultsIn the stenosis group, the proportion of males, tumor diameter ＞3 cm, NRS2002 score >3 points, manual anastomosis, left colic artery not preserved, anastomotic leakage, pelvic infection and patients undergoing neoadjuvant radiotherapy and neoadjuvant chemotherapy were higher than those in the non-stenosis group (P<0.05). The results of univariate logistic analysis showed that female and preserving the left colonic artery were the protective factors for postoperative colon-anal anastomotic stenosis (P<0.05), and the tumor diameter >3 cm, NRS2002 score >3 points, manual anastomosis, anastomotic leakage, pelvic infection, neoadjuvant radiotherapy and neoadjuvant chemotherapy were the risk factors for postoperative colon-anal anastomotic stenosis (P<0.05). Multivariate logistic regression analysis showed that gender, tumor diameter, NRS 2002 score, anastomotic mode, anastomotic leakage, and pelvic infection were independent influencing factors for postoperative colon-anal anastomotic stenosis (P<0.05). Stepwise regression analysis showed that the top three factors affecting postoperative colon-anal anastomotic stenosis were NRS 2002 score, gender and anastomotic leakage. Multivariate Cox risk proportional model analysis showed that the multivariate model composed of NRS 2002 score, gender and anastomotic leakage had a good consistency in the risk assessment of postoperative colon-anal anastomotic stenosis. Based on this, a risk prediction model for postoperative colon-anal anastomotic stenosis was constructed. The results of strong influence point analysis show that there are no data points in the modeling data that have a strong influence on the model parameter estimation (Cook distance <1). Receiver operating characteristic curve results showed that the model had good differentiation ability, the area under curve was 0.917, 95%CI was (0.891, 0.942). The calibration curve was approximately a diagonal line, showing that the model has good predictive power (Brier value was 0.097). The results of the clinical decision curve showed that better clinical benefits can be obtained by using the predictive model to identify the corresponding risk population and implement clinical intervention. ConclusionThe prediction model based on NRS 2002 score, gender and anastomotic fistula can effectively evaluate the risk of colon-anal anastomotic stenosis after preventive ileostomy in patients with low rectal cancer under complete laparoscopy.
ObjectiveTo compare the efficacy and safety in the treatment of malignant gastric outlet obstruction between gastrojejunostomy (GJ) and self-expandable metallic stent (SEMS) placement.MethodsThe relevant literatures of efficacy and safety of GJ and SEMS placement in the treatment of malignant gastric outlet obstruction were searched in the PubMed, Embase, Cochrane Library, Web of Science, Clinical Trial, VIP, CNKI, Wanfang Data databases. The data were extracted and evaluated by the RevMan 5.3 software.ResultsA total of 12 articles with 1 505 patients were included, of which 620 underwent the GJ (GJ group) and 885 underwent the SEMS placement (SEMS group); 3 RCTs, 9 non-RCTs. The meta-analysis results showed: the length of hospital stay [MD=5.83, 95%CI (4.24, 7.42), P<0.000 01] and time of postoperative recovery diet [MD=3.41, 95%CI (1.79, 5.03), P<0.000 1] of the SEMS group were significantly shorter than those of the GJ group; Although the incidence of complications of the GJ group was significantly higher than that of the SEMS group [OR=1.85, 95%CI (1.27, 2.70), P=0.001], the technical success rate [OR=2.72, 95%CI (1.13, 6.53), P=0.03] and clinical success rate [OR=1.86, 95%CI (1.35, 2.57), P=0.000 2] were higher and the survival time was longer [MD=38.31, 95%CI (28.98, 47.64), P<0.000 01] of the GJ group as compared with the SEMS group.ConclusionsSEMS placement is more effective in recovering dietary capacity, length of hospital stay, and incidence of complications, while GJ is more effective in survival time, technical success rate, and clinical success rate. In clinical practice, we could choose different surgical method according to patient situation.
ObjectiveTo investigate the effects of health education pathway intervention on self-care agency and health lifestyle promotion in colostomy patients. MethodsEighty-eight rectal cancer patients who had undergone colostomy were randomly divided into control group and intervention group (with 44 patients in each) between March 2012 and September 2013. The control group received conventional nursing only, while the intervention group were given health education pathway intervention besides conventional nursing. The self-care agency and health lifestyle promotion in the two groups under pre-colostomy state, one week after colostomy and two weeks after colostomy were surveyed and compared based on the exercise of self-care agency scale and the health promotion lifestyle profile. ResultsAfter health education pathway intervention, the scores of self-care agency and health lifestyle promotion in the intervention group were significantly higher than those in the control group (P<0.05), and the hospitalization expenditure was also obviously lower. Furthermore, the satisfaction degree on nursing service was significantly higher than that of the control group (P<0.05). ConclusionThe health education pathway intervention can greatly improve self-care agency and quality of life in rectal cancer patients who have undergone colostomy.
ObjectiveTo evaluate clinical outcomes of real-time ultrasound-guided percutaneous dilatational tracheostomy (PDT)for patients after cardiac surgery. MethodsFrom July 2008 to August 2012, 51 patients received tracheostomy after cardiac surgery in Nanjing Drum Tower Hospital of Nanjing University Medical School, including 20 patients after heart valve replacement, 17 patients after aortic dissection (De Bakey type I)surgery, 11 patients after coronary artery bypass grafting and 3 patients after surgical correction of congenital heart diseases. According to different surgical methods, all the patients were divided into 3 groups. In surgical tracheostomy (ST)group, there were 17 patients including 10 males and 7 females with their average age of 58.0±15.2 years. In fiberoptic bronchoscope guided PDT (FOB-PDT)group, there were 21 patients including 15 males and 6 females with their average age of 63.5±13.5 years. In real-time ultrasound-guided PDT (US-PDT)group, there were 13 patients including 7 males and 6 females with their average age of 64.5±10.2 years. Surgical outcomes were compared among the 3 groups. ResultsAll PDT operations were successfully completed. There was 1 failed patient in ST group. The incidence of bleeding was 41.18% in ST group, 9.53% in FOB-PDT group and 7.70% in US-PDT group (P=0.038). The incidence of mediastinal infection was 17.65% in ST group, 0% in FOB-PDT and US-PDT group (P=0.046). There was no statistical difference in endotracheal tube retention time, length of ICU stay and hospitalization, mortality or morbidity (hypoxemia, pneumothorax, subcutaneous emphysema)among the 3 groups. One patient in ST group developed late tracheal stenosis. ConclusionReal-time ultrasound can provide information about cervical anatomy and help choose puncture site for PDT, which can improve the safety and reduce surgical difficulty and morbidity of PDT of patients after cardiac surgery.
Objective To explore the diagnostic and treating scheme of primary sclerotic cholangitis. Methods 24 cases of primary sclerotic cholangitis identified by radiological and pathological examinations from 1972 to 1998 were analysed retrospectively. According to Thompson, 1 case was classified as type Ⅰ, 5 cases were type Ⅱ, 10 cases were type Ⅲ and 8 cases were type Ⅳ. The operation were as follows,resection of gallbladder plus T tube drainage in 8 cases, plus Roux-en-Y anastomosis of bile duct and jejunum in 12 cases, plus U tube stent and drainage in 4 cases. Results The total mortality rate was 25% (6/24) in 2～18 years follow-up after operation. Conclusion Early diagnosis and operation may resolve the drainage of bile into the jejunum. When serious lesions and worse liver functions exist, liver transplantation should be considered.
To evaluate the feasibility, safety and effectiveness of enteral nutrition (EN) via jejunostomy in the early postoperative period in patients with acute hemorrhagic necrotizing pancreatitis (AHNP), 38 patients were divided into the early group (start EN 3 or 4 days after operation) and the later group (start EN 7 days after operation). All patients received parenteral nutrition at first, then were transited to EN. The enteral nutrition liquid was transfused by continuous drip via jejunostomy in both groups. Levels of serum amylase, blood glucose, as well as the liver function were used as indices of tolerance. Symptoms and physical signs of abdominal pain as well as the level of serum albumin were used as the indices of effectieness. Patients tolerated the therapy well in both groups. Moreover, they enjoyed an earlier correction of hypoalbuminemia with more quickly improved serum albumin and no abdominal pain. Starting enteral nutrition in the early postoperative period is feasible, safe and efficacious for acute hemorrhagic necrotizing pancreatitis patients. It plays an important role in treating AHNP and improving curing rate.
ObjectiveTo summarize the application and the complications of pancreaticogastrostomy (PG) after pancreaticoduodenectomy(PD). MethodThe domestic and international publications involving the theory, methods, and clinical application of PG were retrieved and reviewed. ResultsPG was gradually concerned on the choice of the method of the digestive tract reconstruction after PD, in view of its advantages in theory and operation. The literatures about PG were increased in recent years. But the discussion of decreasing complications of PG after PD had yet to be unified. ConclusionsPG is one of the important operations of digestive tract reconstruction after PD. The factors of operator and patient should be comprehensively considered in the choice of PG.
Objective To evaluate the clinical effectiveness of endoscopic third ventriculostomy (ETV) and ventriculal peritoneum shunt (VPS) for hydrocephalus. Methods A fully recursive literature search was conducted in PubMed (1996 to June, 2011), EMBASE (1996 to June, 2011), Cochrane Central Register of Controlled Trials (Issue 3, 2011), CBM (1996 to June, 2011), CNKI and Wanfang Database (1996 to June, 2011) in any language. The randomized or non-randomized controlled trials of hydrocephalus treated by endoscopic third ventriculostomy and ventriculal peritoneum shunt were considered for inclusion. The analyzed outcome variables were overall complications and the survival rate of all time points. Data related to clinical outcomes were extracted by two reviewers independently. Statistical analyses were carried out by using RevMan 5.0 software. Results Nine published reports of eligible studies involving 1 187 participants met the inclusion criteria. Compared with VPS, ETV had no significant differences in short-term (1 or 2 years) survival rate (RR=1.02, 95%CI 0.90 to 1.16, P=0.74; RR=1.14, 95%CI 1.00 to 1.30, P=0.06), but there were significant differences between the two groups in overall complication rate (RR=0.70, 95%CI 0.57 to 0.89, P=0.001), postoperative 3-year survival rate (RR=1.23, 95%CI 1.07 to 1.41, P=0.004), and postoperative 5-year survival rate (RR=1.14, 95%CI 1.29 to 1.66, P=0.05). So the outcomes indicated ETV was superior in controlling the overall complication rate and prolonging the long-term survival rate. Conclusion Current evidence suggests that endoscopic third ventriculostomy is superior to ventriculal peritoneum shunt in reducing the overall complications and prolonging the long-term survival rate, but there is no significant difference in short-term survival rate between the two methods. The effectiveness of the two operational methods for hydrocephalus caused by all specific reasons still has to be further proved by more high-quality, multi-centered and double-blind RCTs.
Objective To investigate the risk factors of infection after radiofrequency ablation in patients with liver metastases after choledochojejunostomy. Methods The clinical data of patients with liver metastases treated by radiofrequency ablation in our hospital from January 2010 to April 2022 were collected retrospectively and analyzed by univariate and multivariate logistic regression analysis. Results A total of 57 patients were included in the study, and the total number of postoperative infections was 19 (33.33%). Univariate logistic regression analysis showed that the tumor location, maximum tumor diameter, number of tumors, ablation times, and ablation duration were related to the occurrence of infection after radiofrequency ablation (P<0.01). The results of multivariate logistic regression analysis showed that the tumor location [OR=6.45, 95%CI (1.11, 37.35), P=0.037] and ablation duration [OR=1.49, 95%CI (1.16, 1.91), P=0.002] were independent risk factors for infection after radiofrequency ablation in patients with choledocho-jejunostomy. Conclusions For patients with metastatic liver cancer with a history of choledochojejunostomy, the tumor location and the duration of ablation are closely related to postoperative infection. We should strengthen the indivi-dualized management of such patients during and after operation should be strengthened to promote disease recovery.