Successful avoidance of superior vena cava injury during transvenous lead extraction using a tandem femoral-superior approach

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经自然腔道取标本手术在结直肠外科手术中的应用进展

随着腔镜技术的进一步发展以及微创理念应用于结直肠外科疾病的诊治中,结直肠相关疾病的诊治发生了翻天覆地的变化。由传统的经腹手术到腹腔镜手术、经自然腔道手术,再到经自然腔道取标本手术(NOSES),结直肠疾病的外科诊治在微创领域取得了巨大成果。NOSES技术是目前结直肠外科在微创领域前沿的手术方式之一,它通过经直肠、阴道取标本来避免了腹壁的辅助取标本切口,从而将结直肠外科手术进一步微创化。NOSES技术集传统腹腔镜手术的优势与现代微创外科的理念于一体,它在确保手术效果的基础上集中体现了微创、加速康复外科、功能外科、"无疤"等理念的特点。本文主要就国内外各中心开展NOSES技术在结直肠外科诊治开展中的相关经验、心得和体会进行综述。     

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??There are various causes for irreversible damage and lack of alveolar bone??including systemic factors and local factors??and the damage caused by alveolar surgery is one of the most common local factors. In order to provide guidance for dentists in the clinics??this paper describes the causes??preventive measures and treatments of damage caused by alveolar surgery.     

FS-LASIK与SMILE术后角膜上皮重塑的比较

目的观察飞秒激光制瓣联合准分子激光原位角膜磨镶术(femtosecond laser in situ keratomileusis,FS-LASIK)与飞秒激光小切口角膜基质透镜取出术(small incision lenticular extraction,SMILE)术后角膜上皮重塑的特征。方法按照手术方式分为两组,FS-LASIK组29例(58眼),SMILE组31例(61眼),年龄(26±6.5)岁,术前等效球镜度数为(-5.25±2)D,分别于术前,术后1个月、3个月及6个月应用眼前节OCT对患者角膜中央2 mm、2~5 mm上皮厚度进行测量。结果术后1个月FS-LAISK组角膜中央2 mm与角膜2~5 mm范围内的平均角膜上皮增厚差异存在统计学意义(P=0.036);术后3个月2~5 mm范围,角膜上皮在上方、鼻上方、颞上方与下方、颞下方、鼻下方相比,增厚更轻微,差异均有统计学意义(P=0.042,P=0.031,P=0.049);术后6个月SMILE组角膜中央2 mm、角膜2~5 mm的角膜上皮增厚差异存在统计学意义(P=0.047),2~5 mm范围内,角膜上皮在上方、鼻上方、颞上方与下方、颞下方、鼻下方相比,增厚更轻微,差异均有统计学意义(P=0.012,P=0.035,P=0.009),上方与鼻侧、颞侧相比,增厚更少,差异有统计学意义(P=0.045,P=0.017);FS-LASIK组,术后1至6个月角膜上皮增厚在0~2 mm内逐渐下降,差异有统计学意义(P=0.035);术后各个时间段中,FS-LASIK组与SMILE组角膜上皮厚度在0~5 mm范围内各个位点差异均有统计学意义(P<0.05)。结论FS-LASIK术后角膜上皮增厚较SMILE术后更加明显。FS-LASIK术后角膜上皮增厚在角膜切削中央区域变化更加明显,SMILE术后角膜上皮增厚在角膜切除周边区域变化更加明显。随着时间推移,两种手术术后均出现与切口位置相反的角膜上皮局部继续增厚的表现。     

The impact of donor pancreas extraction time on graft survival and postoperative complications in pancreas transplant recipients

BackgroundSimultaneous pancreas kidney transplantation (SPK) is the best therapeutic option for patients with diabetes mellitus type 1 and end-stage renal disease. Recently, donor organ extraction time has been shown to affect kidney and liver graft survival. This study aimed to assess the effect of pancreas donor extraction time on graft survival and postoperative complications.MethodsWe retrospectively analyzed all pancreas transplants performed in two Eurotransplant centers. The association of pancreas extraction time with pancreas graft survival was analyzed by a Cox proportional hazards regression analysis after 3 months, 1 and 5 year. Besides, the effect of pancreas extraction time on the incidence of severe postoperative complications was analyzed.ResultsA total of 317 pancreas transplants were included in this study. Death-censored pancreas graft survival was 85.7% after one year and 76.7% after five years. Median pancreas donor extraction time was 64 min [IQR: 52–79 min]. After adjustment for potential confounders, death censored graft survival after 30 days (HR 1.01, 95% CI 0.9–1.03 (p = 0.23), 1 year (HR 1.01, 95% CI 0.99–1.03 (p = 0.22) and 5 years (HR 1.00, 95% CI 0.99–1.02 (p = 0.57) was not associated with pancreas donor extraction time. However, extraction time was significantly associated with a higher incidence of Clavien-Dindo ≥3 complications compared to Clavien-Dindo 1 + 2 complications: OR 1.012, 95% CI 1.00–1.02 (p = 0.039).ConclusionsOur findings suggest that although no effect on graft survival was found, limiting pancreas extraction time can have a significant impact on lowering postoperative complications.     

Preprocedural computed tomography before cardiac implanted electronic device lead extraction: Indication,technique, and approach to interpretation

Cardiac implantable electronic devices (CIEDs) frequently need to be extracted due to infection, hardware failure, and other causes. The extraction of the CIED is typically performed using percutaneous methods. While these procedures are mostly performed without incident there is a small risk of significant complications. Dedicated imaging pre‐CEID removal to include the central veins and heart with multidetector computed tomography (MDCT) can be utilized to evaluate the lead course and termination, the integrity of the central veins and cardiac chambers, and identify potential complications that may alter the lead extraction procedure as well as reimplantation of subsequent leads. Indications for preprocedural imaging, the technique of dedicated preprocedural lead extraction MDCT, and the approach to the interpretation of the images is discussed in this review.     

中低度近视SMILE术后超早期视觉质量变化的研究

目的观察飞秒激光小切口角膜基质透镜取出术(SMILE)术后超早期患者视觉质量变化,探讨其变化发生的可能原因。方法选取中低度近视患者23例46眼行SMILE术,术前及术后24 h超早期行主观视觉质量问卷,测量最佳矫正视力的全程视力(远视力5 m,中视力60 cm,近视力33 cm)、对比敏感度(CS)、眩光敏感度(GS)及集合近点(NPC)和调节幅度(AA)。结果视觉质量主观问卷显示术后超早期主观视觉质量较术前下降(P=0.001)。术后裸眼视力(UCVA)明显提高(P=0.0001)。术前与术后最佳矫正视力(BCVA)中远视力没有变化(P=0.096),而中视力和近视力均较术前下降(P=0.039,0.003)。术后CS、GS降低(PCS=0.0001,PGS=0.04),NPC、AA较术前无明显变化(P=0.68,0.13)。结论SMILE术后超早期患者可获得预期理想远视力,但中、近视力尚未恢复。超早期中出现的异常视觉质量改变可能与对比敏感度和眩光敏感度的改变有关。     

A systematic review of the complications of high-risk third molar removal and coronectomy: development of a decision tree model and preliminary health economic analysis to assist in treatment planning

Coronectomy is an alternative surgical technique for the management of high-risk third molars. It involves the removal of the crown of a tooth and the deliberate retention of the roots, thereby avoiding injury to the inferior alveolar nerve (IAN). Previous studies have suggested that it reduces the risk of nerve injury when compared with surgical extraction. The purpose of this study was to systematically review the incidence of complications following coronectomy such as IAN injury, pain, dry socket, infection, root migration, and need for re-operation. A comparative cost analysis of coronectomy and surgical extraction was done based on the results of the review. This provides an insight into the economic implications of the two procedures. A search through the MEDLINE database via Ovid, PubMed, Scopus, EMBASE via Ovid, and Web of Science, was carried out to extract randomised and non-randomised controlled trials. Four studies fulfilled the inclusion criteria. A meta-analysis was conducted to measure the overall effect of each outcome. The pooled odds ratio (OR) for IAN injury was 0.16 (95% CI 0.01 to 0.39). Coronectomy reduced this risk by 84%. Dry socket may occur less frequently following coronectomy whereas infection did not show a higher incidence with either intervention. Root migration was found to occur in 13%–85% of cases and the average incidence of re-operation was 2.2%. The ratio of the average costs was 1.12 favouring coronectomy if cone-beam computed tomography (CBCT) was not done prior to the procedure. If a scan was taken routinely for coronectomy, the cost ratio marginally favoured extraction. Coronectomy reduced the risk of nerve injury in high-risk third molars. Definitive conclusions, however, cannot be made for outcomes such as the need for re-operation, which may alter the cost ratio of coronectomy:extraction, as higher quality studies with longer follow-up are needed.