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Table of Content

    01 July 2021, Volume 9 Issue 3
    A comparative study in the treatment of postoperative low extremity deep vein thrombosis
    QI Haoshan, ZHAO Juncheng, ZHANG Kun, LI Dalin, CHEN Yunhui, YAN Jingqiang, HUANG Shujie
    2021, 9(3):  2. 
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    Abstract: Objective To estimate the risk of bleeding after thrombolytic therapy in patients with secondary deep venous thrombosis, in order to find a better therapy for higher bleeding risk postoperative patients. Methods 48 patients diagnosed postoperative DVT were divided into PMT group included 27 patients and CDT group included 21 patients. The PMT group was treated by PMT or PMT+CDT, the CDT group given thrombolysis only directed by catheterization. The effects of thrombus removal and later follow-up effects in the two groups were compared. Results Thrombus degradation was obviously better in PMT group compared with the CDT group [(90.21±17.28)% vs (75.65±27.59)%]. Lower dosage of urokinase [(105.45±126.34)WU vs (345.87±118.38)WU] and shorter hospital stays [(6.72±1.88)d vs (8.82±2.97)d],less time in bed[(2.90±2.71)d vs( 5.40±2.06)d]was also detected in PMT group patients. There is nonmajor bleeding occurred in both groups. Nonmajor bleeding was higher in PMT group, but they did not achieve statistical significance(P>0.05). In later follow-up, PTS Villalta scores of 12 and 24 months in PMT were better than CDT. Conclusion Both PMT and single CDT were both effective and safety methods in treating postoperative DVT more than one week, associated low bleeding risk,however the strategy combined PMT had the advantage in low dosage of urokinase using, better thrombus eliminating, and reducing the hospital stays and time in bed. Villalta score was lower in PMT-group, connected with lower risk of PTS morbidity.

    Clinical study on combined treatment of laparoscopy, choledochoscope and duodenoscopy for senile mild biliary pancreatitis
    JIAO Zhendong, GUO Zhihua, LIU Yimin
    2021, 9(3):  8. 
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    Abstract: Objective To evaluate the safety and effectiveness of combination of laparoscopy, choledochoscope and duodenoscope combination of three glasses in the treatment of senile mild biliary pancreatitis and traditional open cholecystectomy plus choledocholithotomy. Methods 80 patients with mild biliary pancreatitis from January 2013 to December 2020 in the Hepatobiliary Surgery Department of Baoji People's Hospital were retrospectively analyzed. The patients received laparotomy or threemirror combined surgery respectively. According to different surgical methods, they were divided into control group (traditional laparotomy) and observation group (combined therapy of three mirrors) with 40 cases each. Two groups’ postoperative complications, intraoperative blood loss, stone removal success rate, surgical success rate, severe pancreatitis rate, gastrointestinal function recovery time, blood amylase recovery time, hospitalization time and hospitalization expenses were compared. Results The incidence rate of postoperative complications and intraoperative blood loss of observation group were lower than that of control group. However, there was no significant difference between the two groups in stone clearance rate, severe pancreatitis rate and operation success rate. The hospitalization time and gastrointestinal function recovery time of the observation group are lower than those of the control group. In addition, compared with endoscopic retrograde cholangiopancreatography treatment and laparoscopic cholecystectomy + laparoscopic common bile duct exploration sequential inertia treatment after 1~2 weeks, the recovery time of blood amylase in the open surgery is significantly prolonged. However, there was no significant difference in hospitalization expenses between the two groups. Conclusion Combined treatment of three glasses for elderly senile biliary pancreatitis is a safer and more effective method. It has fewer surgical complications, shorter hospital stay, but requires secondary surgery.

    Effect of laparoscopic appendectomy and open appendectomy for acute perforating appendicitis on the recovery of gastrointestinal function and inflammatory response in patients
    LIN Yongyan, PAN Jiao
    2021, 9(3):  14. 
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    Abstract: Objective To analyze the efficacy of laparoscopic appendectomy and open appendectomy in the treatment of acute perforating appendicitis. Methods From February 2018 to January 2021, 63 patients with acute perforating appendicitis admitted to the General Surgery Department of People's Hospital of Zhaoqing High-tech Zone were randomly divided into an open group (30 cases) and a laparoscopic group (33 cases). The laparotomy group was treated with open appendectomy, and the laparoscopic group was treated with laparoscopic appendectomy. The recovery of gastrointestinal function, inflammation and complications were compared between the two groups. Results During the postoperative hospitalization, the recovery time of gastrointestinal function in the laparoscopic group was significantly shorter than that in the open group (P<0.05). Compared with preoperatively, the levels of serum CRP, PCT in the two groups increased after operation, and the laparoscopic group was lower than the open group (P<0.05). During the postoperative hospitalization, the total complication rate in the laparoscopic group was 6.06%, which was significantly lower than that in the open group 18.18%(P<0.05). Conclusion Laparoscopic appendectomy can effectively promote the recovery of gastrointestinal function in patients with acute perforating appendicitis, with less body inflammation, fewer postoperative complications, and better safety.

    Clinical observation on the treatment of giant indirect inguinal hernia under laparoscopy
    ZHANG Xiaoguan, LI Yongquan, TANG Caiyan
    2021, 9(3):  19. 
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    Abstract: Objective To study the value of laparoscopic extraperitoneal space inner ring orifice narrowing combined with patch therapy in surgical treatment of patients with huge inguinal hernia. Methods According to the random number table method, 82 patients with giant indirect inguinal hernia treated by General Surgery of Dongguan Dalang Hospital from January 2020 to September 2020 were divided into observation group and control group with 41 cases each. The observation group took laparoscopic peritoneum constriction of the inner ring of the outer space and patch treatment, the control group took complete extraperitoneal space hernia repair treatment, and compared the effective rate of surgical treatment, the length of operation, the length of time to get out of bed after the operation, the length of hospitalization, and the postoperative period of the two groups. Results The effective rate of surgical treatment in the observation group was improved compared with the statistical results of the control group (P<0.05); the overall time spent getting out of bed and walking after the operation in the observation group, the overall time spent in hospitalization and the statistical results of the control group were lower. The duration is longer (P<0.05); the incidence of postoperative complications in the observation group is lower than the statistical results of the control group (P<0.05); the recurrence rate of the observation group after surgery is not significantly different from the statistical results of the control group (P>0.05). Conclusion For patients with huge indirect inguinal hernia, laparoscopic extraperitoneal space internal ring orifice narrowing combined with patch treatment has a better surgical treatment effect, reduction of the related complications.

    Non-surgical treatment of duodenal stump fistula
    YU Anxing, LIU Dongdong
    2021, 9(3):  24. 
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    Abstract: Objective To explore the non-surgical treatment of duodenal stump fistula and its effect. Methods A retrospective analysis about clinical data was made on 21 cases of patients with duodenal stump fistula from January 2006 to December 2019 in Pingdu People's Hospital Affiliated to Weifang Medical College. Results 21 cases were treated with non-surgical treatment, 20 cases were cured, 1 case died of multiple organ failure due to multiple abdominal, urinary and pulmonary infections. Conclusion It is effective for duodenal stump fistula to keep the abdominal cavity drainage unobstructed, timely decompression of duodenal cavity, anti infection and strengthening nutrition in this study.

    Prognostic analysis of gastric cancer patients with vascular invasion
    DU Guangjin, GAO Zhenwu, LIAN Enying
    2021, 9(3):  28. 
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    Abstract: Objective To evaluate the prognostic value of patients with vascular infiltration after radical gastrectomy for gastric cancer. Methods The clinical data of 303 patients (129 with vascular infiltration and 174 without vascular infiltration) who underwent radical gastrectomy in Wenshang County People's Hospital from January 2003 to June 2015 were analyzed retrospectively. To compare the differences of clinicopathological features and prognosis between patients with positive and negative vascular infiltration. Results There were significant differences in tumor size, pT stage, pN stage and tissue differentiation between the positive and negative groups of vascular infiltration (P<0.05). There was no significant difference in age and gender (P>0.05). Univariate survival analysis showed that the 5-year survival rate of patients with vascular infiltration was 33.3%(43/129), and that of patients without vascular infiltration was 56.9%(99/174), and the difference was statistically significant (P<0.001). Multivariate survival analysis showed that vascular invasion and pN stage were independent risk factors affecting the prognosis of gastric cancer patients. Conclusion Vascular infiltration is an independent risk factor affecting the prognosis of gastric cancer patients.

    Analysis of breast cancer diseases and surgical encoding
    ZHAN Kai, MENG Weiguang
    2021, 9(3):  35. 
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    Abstract: Objective Through this case, we can discuss the diagnosis and operation of breast cancer, which is helpful for a correct understanding of breast cancer and operation and making the correct encoding. Methods 10 breast surgery cases were selected from breast cancer department,using the international statistical classification of diseases(ICD)-10 and related health problems and surgical procedures of international classification of diseases(ICD-9-CM-3),improve the accuracy of the coding, the causes of the wrong diagnosis and operation coding were found and analyzed. Results Main diagnosis of 2 cases of breast malignancy, full mastectomy code (unilateral / bilateral) was 85.41/85.42, revised from 1 to 2, modified radical breast cancer code (unilateral / bilateral) was 85.43/85.44, revised from 5 to 8, radical breast cancer code (unilateral / bilateral) was 85.45/85.46, revised from 3 to 0, revised breast cancer enlarged radical coding (unilateral / bilateral) 85.47/85.48, reduced from 1 to 0. Conclusion Accurate diagnosis and surgical coding must be performed according to the type and extent of mastectomy, this enables the electronic medical record audit system to better serve clinicians and coding workers

    Perioperative nursing care of 38 patients with acute superior mesenteric artery ischemia receiving endovascular treatment
    SUN Haiyan, QIN Shaohua, ZHAO Tanghai, GAO Xuequn, MA Weiwei, WANG Hongjuan, YU Jie, WANG Meili
    2021, 9(3):  52. 
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    Abstract: Objective To discuss the nursing of patients with acute superior mesenteric artery ischemia (ASMAI). Methods The clinical data of 38 patients with ASMAI receiving endovascular treatment were retrospectively analyzed,and the nursing problems in the perioperative period of endovascular treatment mainly with catheter-directed thrombolysis (CDT) were discussed,and the corresponding nursing measures were formulated.Results The technical success rate was 100.0%(38/38), and the average time of CDT was (45.2±7.4) h. The abdominal pain symptoms and signs of 36 patients were completely disappeared or significantly relieved after endovascular treatment, the other 2 patients were invalid after CDT treatment, and were cured by open surgery. The survival rate was 100%. There were 1 case of sacrococcygeal pressure injury, 1 case of conjunctival hemorrhage,1 case of fever , 2 cases of hematoma at puncture point and other perioperative complications. Conclusion Comprehensive and meticulous perioperative observation and nursing is an important guarantee for endovascular technique in the treatment of ASMAI patients.

    Application of M.O. I. S. T. theory in the clinical practice of stage 3 and stage 4 stress injury
    LIU Liandi, ZHOU Xuezhen, LIANG Mingjuan, LI Wenhong, HE Wenguang, WANG Lixiang
    2021, 9(3):  57. 
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    Abstract: Objective Study application of M. O. I. S.T. theory in the clinical practice of stage 3 and stage 4 stress injury. Methods A total of 64 patients with stage 3 and stage 4 stress injury who were hospitalized in The Fourth Affiliated Hospital of Guangzhou Medical University from July 2019 to October 2019 were randomly divided into observation group and control group (32 cases in each group) . The control group was treated with vacuum-assisted closure (VAC) and the observation group was treated with VAC combined with continuous micro-oxygen therapy. Results After intervention, the wound shrinkage rate of the observation group was higher than that of the control group (P<0.05). After intervention, the observation group's granulation tissue coverage rate increased, the wound healing rate increased, the wound pain score decreased, the wound bacterial culture rate decreased, the difference was statistically significant (P<0.05) ; After intervention, there were significant differences in wound pH,CD34+T Cell and proliferating cell nuclear antigen (P<0.05). Conclusion VAC combined with microoxygen therapy can accelerate wound area reduction, promote granulation tissue growth and wound healing, reduce wound pain, and reduce wound bacterial residue in patients with pressure ulcer of stage 3 and 4, to improve the pH of the wound and the tissue immunology.