Zhonghua wai ke za zhi [Chinese journal of surgery]
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Zhonghua Wai Ke Za Zhi · Dec 2016
Meta Analysis[Mid- to long-term outcomes of cervical disc arthroplasty for symptomatic cervical disc disease: a meta-analysis].
Objective: To compare the benefits and harms of cervical disc arthroplasty (CDA) with anterior cervical discectomy and fusion(ACDF) for symptomatic cervical disc disease at mid- to long-term follow-up. Methods: Electronic searches were made in PubMed, EMBASE, and the Cochrane Library for randomized controlled trials with at least 48 moths follow-up. Outcomes were reported as relative risk or standardized mean difference. ⋯ Conclusions: CDA can significantly reduce the rates of secondary surgical procedures compared with ACDF. Meanwhile, CDA is superior or equivalent to ACDF in other aspects. As some studies without double-blind are included and some potential biases exites, more randomized controlled trials with high quality are required to get more reliable conclusions.
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Zhonghua Wai Ke Za Zhi · Dec 2016
Randomized Controlled Trial[Effect of ultrasound guided patient-controlled paravertebral block on pulmonary function in patients with multiple fractured ribs].
Objective: To investigated the effects of patient controlled intravenous analgesia and ultrasound guided patient-controlled paravertebral block on pulmonary function in patients with multiple fractured ribs. Methods: From May 2015 to March 2016, 60 patients with multiple rib fractures in Ningbo NO.6 Hospital with American Society of Anesthesiologists Ⅱ-Ⅲ underwent internal fixation, including 30 males and 30 females aged from 16 to 70 years(mean age (54.6±15.2) years). All patients were randomly divided into 2 groups (n=30 each): patient controlled intravenous analgesia(PCIA) group and patient controlled thoracic paravertebral block(PCPB) group. ⋯ The pulmonary function was also examined before and 3 days after the operation through FEV1 and FEV1%. Results: Compared with PCIA group at 30 minutes, 60 minutes, 1 day, 2 days, 3 days after analgesia, the level of PaO2 ((85.1±9.7)mmHg vs.(72.4±12.3)mmHg, (90.3±12.4)mmHg vs.(73.5±7.8)mmHg, (94.2±8.2)mmHg vs.(86.1±5.6)mmHg, (98.5±7.0)mmHg vs. (88.8±7.5)mmHg, (99.6±9.8)mmHg vs. (91.3±8.6)mmHg, P<0.05)) and PaO2/FiO2 were significantly increased ((405.1±46.0)mmHg vs. (340.1±58.9)mmHg, (430.5±59.1)mmHg vs. (344.0±65.4)mmHg, (448.3±39.1)mmHg vs. (410.1±26.7)mmHg, (460.1±33.5)mmHg vs. (423.2±36.5)mmHg, (465.1±28.2)mmHg vs. (435.1±40.8)mmHg, P<0.05)), the level of PA-aDO2 was decreased ((22.9±4.6)mmHg vs. (36.6±5.1)mmHg, (17.7±4.7)mmHg vs. (34.5±2.9)mmHg, (13.8±4.1)mmHg vs. (21.9±3.2)mmHg, (13.5±4.6)mmHg vs. (19.2±3.8)mmHg, (12.4±2.0)mmHg vs. (17.7±2.4)mmHg, P<0.05)), and FEV1, FEV1% were significantly increased at 3 days after operation in PCPB group ((2.9±0.4)mmHg vs.(2.2±0.5)mmHg, (78.1±4.7)mmHg vs.(64.8±4.3)mmHg; P<0.01)). Conclusion: Ultrasound guided patient-controlled paravertebral block improves the arterial oxygenation function and accelerates the recovery of pulmonary function in patients with multiple-fractured ribs after internal fixation operation.
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Zhonghua Wai Ke Za Zhi · Dec 2016
[The mid- to long-term effect of Wallis lumbar interspinous dynamic stabilization on the adjacent segment degeneration].
Objective: To explore the mid- to long-term effect of Wallis interspinous dynamic stabilization system on the adjacent segment degeneration. Methods: From March 2009 to June 2010, in Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, 24 patients with L4-5 monosegmental lumbar disc herniation were treated with posterior lumbar decompression combined with Wallis interspinous dynamic fixation. Clinical outcomes were evaluated with visual analogue score (VAS) (back pain), VAS (leg pain) and oswestry disability index (ODI) score. ⋯ The degeneration of intervertebral discs at the upper and lower segments showed no significant changes at the final follow-up (P>0.05). Conclusions: Posterior decompression combined with Wallis interspinous dynamic stabilization system for monosegmental lumbar disc herniation can achieve satisfactory clinical results. More than five years' follow-up confirmed that the Wallis system will not accelerate adjacent segment degeneration.
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Zhonghua Wai Ke Za Zhi · Dec 2016
[Progress of perioperative goal-directed fluid therapy on prognosis of patients].
Fluid therapy is an important part of perioperative period, also one of the most controversial issues. Having reviewed the relevant research in recent years as well as the large-scale meta-analysis, the perioperative goal-directed fluid therapy has been discussed from the aspects of evaluating indicators, new methods and latest progress, and the impact on the prognosis. It manifests that the development of goal-directed fluid therapy makes a better prognosis than traditional fluid therapy, therefore it has also became an important perioperative treatment strategy.
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Zhonghua Wai Ke Za Zhi · Nov 2016
[Recent advances and some consideration about the trans-oral laporascopic thyroidectomy].
Trans-oral laporascopic thyroidectomy is a innovative technique that incoporated the concept of natural orifice transluminal endoscopic surgery. Compare to other endoscopic thyroidectomy, trans-oral laporascopic thyroidectomy is characterised with no scar in the body surface, better cosmetic results and conforms to the concept of minimally invasive surgery. At present, trans-oral laporascopic thyroidectomy is still in the initial stages of clinical application and gains a great deal of attention from surgeons all over the world. ⋯ Proponents and researchers in this field have been attempting to use this technique for treatment of thyroid cancer and combine it with the robotics assisted surgical system. In the future, the indications and contraindications of trans-oral laporascopic thyroidectomy need to be further studied and evaluated. Complications and surgical procedures still have many issues need to be solved.