A NEW MIXED SURGICAL TREATMENT FOR GRADES III AND IV HEMORRHOIDS: MODIFIED SELECTIVE HEMORRHOIDECTOMY COMBINED WITH COMPLETE ANAL EPITHELIAL RETENTION

ABSTRACT Background: Varicose veins appear above and below the dentate line in mixed hemorrhoids, which seriously affects anal function and quality of life. Aim: To propose an improvement in tissue-selecting therapy repair of anal pad combined with complete anal canal epithelial retention comparing with Milligan-Morgan surgery. Methods: A prospective randomized controlled study was designed enrolling 200 patients with grade III and IV hemorrhoids. They were divided into control and observation groups. The control received Milligan-Morgan surgery, and the observation the modified tissue-selecting therapy stapler combined with complete anal canal preservation surgery. All patients were followed for six months to evaluate the treatment differences. Results: In final, control group included 82 and observation 87. The average operation time of the control group was significantly lower than that of the observation, while the bleeding volume was significantly lower in control group. The control group VAS score was 3 (1, 4), and observation 4 (2, 5). There was no significant difference in the incidence of urinary retention, bleeding and wound margin edema after surgery at one month postoperatively. Digital incidence of anal stenosis in the observation group was significantly lower than in control; the same occurred with residual anal margins. The postoperative anal canal diameter was significantly larger than the control group. Wexner anal incontinence score showed that no anal incontinence occurred in both groups, and the control group scored was significantly higher than observation. In final six months follow-up, the observation group did not experience any relapse and four cases were found among controls. The treatment satisfaction of the observation group was better. Conclusions: In grades III and IV hemorrhoids, modified tissue-selecting therapy combined with complete anal canal preservation had better prognosis and treatment satisfaction than Milligan-Morgan procedure, and it is a new surgical method for patients with advanced mixed hemorrhoids.

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Modified tissue-selecting therapy stapler combined with complete anal canal epithelial preservation operation for the treatment of circumferential mixed haemorrhoids: a protocol for single-blind randomised controlled study

BMJ Open ◽

10.1136/bmjopen-2021-052982 ◽

2021 ◽

Vol 11 (11) ◽

pp. e052982

Author(s):

Hua Huang ◽

Yunfei Gu ◽

Youran Li ◽

Lijiang Ji

Keyword(s):

Chinese Medicine ◽

Treatment Group ◽

Anal Canal ◽

Severity Score ◽

Operation Time ◽

Controlled Study ◽

Anal Stenosis ◽

Control Group ◽

Severe Bleeding ◽

Randomised Controlled

IntroductionThis protocol designed a randomised controlled trial (RCT) to evaluate the effectiveness, safety and prognostic outcomes of modified tissue selecting technique (M-TST) combined with complete anal canal epithelial preservation (CACP) among patients with circumferential mixed haemorrhoids.Methods and analysisThis study will be single-blinded, and recruit 348 patients who are admitted to the Changshu Hospital Affiliated to Nanjing University of Chinese Medicine and fulfil the inclusion criteria from January 2022 to December 2022. Patients will be randomly assigned to the treatment group and the control group in a 1:1 ratio. The statistician will be blinded for the allocation. The treatment group will receive M-TST combined with CACP (M-TST–CACP), while the control group will receive the procedure for prolapse and haemorrhoids. The two groups will receive the same preoperative and postoperative care. The primary outcome will be recurrence rate. The secondary outcomes will be operation time, intraoperative bleeding, incontinence, pain, postoperative complications (severe bleeding, perianal oedema, urinary retention, faecal urgency, skin tags and anal stenosis), prolapse, recovery time, quality of life, Haemorrhoid Severity Score, and Symptom Severity Score.Ethics and disseminationThis protocol has been approved by the Clinical Ethics Committee of the Changshu Hospital Affiliated to Nanjing University of Chinese Medicine (approval no. 202102001).Trial registration numberChiCTR2100042750.

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Observations on the Application of Nursing Risk Management in the Care of Critically Ill Patients in the Respiratory Unit

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v4i4.1352 ◽

2020 ◽

Vol 4 (4) ◽

Author(s):

Yannan Sun

Keyword(s):

Risk Management ◽

Critically Ill ◽

Critically Ill Patients ◽

Treatment Satisfaction ◽

Clinical Symptoms ◽

Statistical Significance ◽

Management Model ◽

Control Group ◽

Observation Group ◽

Significant Difference

Objective: Investigate the effectiveness of nursing risk management in the care of critically ill patients in the respiratory unit. Methods: Among the critically ill respiratory patients admitted to our hospital between May 2019 and April 2020, 78 patients were randomly selected and divided into an observation group and a control group, each consisting of 39 patients. In the observation group, a nursing risk management model was implemented, i.e., patients' clinical symptoms were observed at any time to monitor their treatment satisfaction and the effectiveness of their care and routine care was implemented for the control group. Results: The heart rate, respiratory rate, and pH of patients in the observation group were more stable than those in the control group, and their respiratory status was better, with differences in data. There was also significant statistical significance (P<0.05). The incidence of patient-provider disputes, unplanned extubation, and unplanned events were lower in the observation group compared to the control group, and their data difference was statistically significant (P<0.05). The treatment satisfaction as well as the total effective rate of patients in the observation group was also much higher than that of the control group, and there was also a statistically significant difference in the data (P<0.05). Conclusion: The nursing risk management model has a significant therapeutic effect in the care of critically ill respiratory patients. Therefore, it is worth popularizing to use in the clinical nursing of respiratory critical patients.

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Efficacy of carprostol tromethamine combined with mifepristone in the treatment of uterine fibroids

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v3i1.697 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Jun Wang ◽

Xian Zhang

Keyword(s):

Estrogen Receptor ◽

Progesterone Receptor ◽

Treatment Effect ◽

Uterine Fibroids ◽

Operation Time ◽

Clinical Treatment ◽

Control Group ◽

Observation Group ◽

Significant Difference ◽

Better Than

ã€Abstractã€‘Objective: To investigate the clinical efficacy of carboprost tromethamine combined with mifepristone in the treatment of uterine fibroids. METHODS: A total of 66 patients with uterine fibroids admitted to our hospital between April 2018 and January 2019 were selected as subjects. According to the two different treatment methods, patients were divided equally. The observation group and the control group, each group of 33 people. The oxytocin drug treatment was medicated to the control group, and the prostaglandin tromethamine combined with mifepristone was medicated to the observation group. The treatment effect, adverse reaction, operation, and uterine muscle before and after surgery were observed in these two groups. Tumor tissue progesterone receptor and estrogen receptor levels. Results: The clinical treatment effect of the observation group was 93.94%, and the clinical treatment effect of the control group was 60.61%. The clinical treatment effect of the observation group was significantly higher than that of the control group; also the incidence of adverse reactions in the observation group in terms of rash, fatigue, nausea and vomiting was much lower than the control group, and could observe a significant difference. Finally in observation group, the amount of intraoperative blood loss, operation time and hospitalization time were better than those of the control group. The progesterone receptor and estrogen receptor levels in the uterine fibroid tissue after surgery should also be better than the control group, it is worth to make further comparison. Conclusion: Carprostol tromethamine combined with mifepristone is effective in the treatment of uterine fibroids and can be further developed.

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Effects of Modified Subxiphoid Thoracoscopic Surgery and Traditional Surgery On Pain Mediators and Pain Stress Levels in Patients With Anterior Mediastinal Teratoma

10.21203/rs.3.rs-910430/v1 ◽

2021 ◽

Author(s):

Panpan Zhang ◽

Dan Liu ◽

Dong Luo ◽

Fuli Pang

Keyword(s):

Thoracoscopic Surgery ◽

Operation Time ◽

Control Group ◽

Observation Group ◽

Mediastinal Teratoma ◽

Extubation Time ◽

Significant Difference ◽

Stress Levels ◽

Grouping Method ◽

Better Than

Abstract Background To investigate the effects of modified subxiphoid thoracoscopic surgery and traditional surgery on pain mediators and pain stress levels in patients with anterior mediastinal teratoma. Method Eighty patients with anterior mediastinal teratoma who underwent surgery in our hospital from May 2019 to May 2021 were selected as the subjects of this prospective study. According to the random residue grouping method, they were divided into a control group and observation group with 40 cases each. Among them, the control group underwent traditional surgery, and the observation group underwent modified subxiphoid thoracoscopic surgery. Observe and compare the surgical indicators, pain-causing mediators, and pain stress levels of the two groups of patients. Result The intraoperative blood loss, postoperative extubation time, and total drainage volume of the observation group were significantly lower than those of the control group, while the operation time was significantly higher than that of the control group, which was statistically significant (P < 0.05). There was no statistically significant difference in the pain-causing mediators of the two groups before surgery (P > 0.05), while the NPY, PGE2 and 5-HT at 1 day after surgery were significantly different, and the observation group was better than the control group. The comparison was statistically significant. Significance (P < 0.05). There was no statistically significant difference in pain stress levels between the two groups before surgery (P > 0.05), while NO, IL-6, and IL-β 1 day after surgery were significantly different, and the observation group was better than the control group. Statistically significant (P < 0.05). Conclusion The modified subxiphoid thoracoscopic surgery has a significant effect, reduces the level of peripheral blood pain-causing factors, relieves the pain of the patient, and promotes the recovery of the patient. It provides a certain reference for the mediastinal teratoma before the clinical operation.

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Exploration and Discussion on the Clinical Therapeutic Effects of the Application of Cross-Injury Vertebral Fixation and Via-Injury Vertebrae Fixation in the Treatment of Bone Tumor with Thoracolumbar Spine Fracture

Journal of Advances in Medicine Science ◽

10.30564/jams.v3i1.1258 ◽

2020 ◽

Vol 3 (1) ◽

pp. 22

Author(s):

Haibin Wang

Keyword(s):

Cobb Angle ◽

Compression Ratio ◽

Bone Tumor ◽

Thoracolumbar Spine ◽

Operation Time ◽

Spine Fracture ◽

Control Group ◽

Therapeutic Effects ◽

Observation Group ◽

Significant Difference

Objective: To explore and discuss the clinical therapeutic effects of the application of cross-injury vertebral fixation and via-injury vertebrae fixation in the treatment of bone tumor with thoracolumbar spine fracture. Methods: A total of 58 patients with bone tumors and thoracolumbar spine fractures admitted to our hospital from February to February 2019 were selected as the study subjects. They were randomly divided into control group and observation group, with 29 cases in each group. The patients in the control group received cross-injury vertebral fixation treatment, while the patients in the observation group were treated with via-injury vertebral fixation. The therapeutic effects of the two groups were compared. Results: The operation time and hospitalization time of the observation group were significantly shorter than those of the control group (P<0.05), and the postoperative drainage volume of the intraoperative blood loss was significantly less than that of the control group (P<0.05). There was no significant difference in postoperative pain and spinal JOA scores between the two groups (P>0.05); there was no significant difference in the compression ratio of the injured vertebrae and the kyphosis Cobb angle between the two groups (P>0.05), after the operation, the two groups of patients were significantly reduced, and the compression ratio of the injured vertebrae and kyphosis Cobb angle of the observation group were more obvious (P<0.05); the vertebral height loss and Cobb angle loss in the observation group were significantly lower than those in the control group (P<0.05). Conclusion: In the treatment of bone tumor with thoracolumbar spine fracture, compared with cross-injury vertebral fixation, via-injury vertebral fixation has a more significant clinical effect and is more suitable for clinical application and promotion.

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Clinical study of pituitary tumors with EEA resection and its influence on the expression of tumor necrosis factor-α, interleukin-6, and interleukin-12 in patients

European Journal of Inflammation ◽

10.1177/2058739219837049 ◽

2019 ◽

Vol 17 ◽

pp. 205873921983704

Author(s):

Wentao Wang ◽

Dequan Zhong ◽

Hua Cheng ◽

Chengfu Ji ◽

Zhouming Shen ◽

...

Keyword(s):

Pituitary Adenoma ◽

Operation Time ◽

Serum Levels ◽

Inflammatory Factors ◽

Interleukin 12 ◽

Control Group ◽

Observation Group ◽

Tnf Α ◽

Significant Difference ◽

Factor Α

The aim of this study is to investigate the efficacy of expanded endonasal approaches (EEAs) in the treatment of pituitary adenoma, and the effects of serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-12 (IL-12) in patients were further analyzed. A total of 80 cases of patients with pituitary adenoma admitted to our hospital from January 2013 to May 2015 were randomly divided into the observation group and control group, with 40 cases in each group. The observation group was treated with EEA technique, while the control group was treated with transcranial microsurgery. The prolactin (PRL), growth hormone (GH) and other endocrine hormone indexes, as well as inflammatory factors such as TNF-α, IL-6, and IL-12 were compared before and 1 week after the operation between the two groups. Moreover, the scores of Karnofsky performance status (KPS) and Mini-Mental State Examination (MMSE) at preoperative and postoperative 1 week were also compared between the two groups. The operation time, hospitalization time, and postoperative complications were compared between the two groups. And the patients were followed up for 2 years to observe the recurrence rate. The operation time and hospital stay in the observation group were 62.8 ± 9.3 min and 12.5 ± 2.1 days, respectively, while the operation time and length of stay in the control group were 105.6 ± 15.7 min and 18.2 ± 3.4 days, respectively. The operation time and hospitalization time were shorter than those in the control group, and the differences were statistically significant ( P < 0.05). Before surgery, there was no significant difference in serum levels of PRL and GH between the two groups ( P > 0.05). At 1 week after surgery, the levels of PRL and GH in the two groups were significantly lower than those before surgery ( P < 0.05). And the serum levels of PRL and GH in the observation group were significantly lower than those in the observation group at 1 week after the operation ( P < 0.05). Before operation, there was no significant difference between the two groups of KPS and MMSE scores ( P > 0.05). At 1 week after operation, the scores of KPS and MMSE in both groups were significantly higher than those before the operation ( P < 0.05), and the scores of KPS and MMSE in the observation group were significantly higher than those in the control group ( P < 0.05). Furthermore, there was no significant difference in the serum levels of IL-6, IL-12, and TNF-α between the two groups before operation ( P > 0.05). At 1 week after surgery, the serum levels of IL-6, IL-12, and TNF-α in the two groups were significantly lower than those before surgery ( P < 0.05), while the serum levels of IL-6, IL-12, and TNF-α in the observation group were evidently lower than those in the control group at 1 week after the operation. Besides, the incidence of postoperative complications in the observation group was 7.5%, which was significantly lower than that in the control group (17.5%) ( P < 0.05). All the patients in the two groups were followed up for 2 years. And there was no recurrence in the observation group and one case in the control group. The therapeutic effect of EEAs on pituitary adenoma is better. It can improve the level of high endocrine hormone in patients with pituitary adenoma, improve the functional status of the patients, reduce the serum level of inflammatory factors, and shorten the hospital stay. Meanwhile, it also has the characteristics of fewer complications and low recurrence rate, so it can be popularized in clinical practice.

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A Simple and Effective Method for Bleeding Control During Percutaneous Dilatational Tracheostomies

10.21203/rs.3.rs-136108/v1 ◽

2020 ◽

Author(s):

Xiuyu Du ◽

Xiaodong Zhai ◽

Zhi Liu ◽

Jinliang Teng ◽

Chunyan Liu

Keyword(s):

Prospective Study ◽

Operation Time ◽

Intradermal Injection ◽

Control Group ◽

Injection Technique ◽

Observation Group ◽

Intraoperative Bleeding ◽

Significant Difference ◽

The Mean ◽

A Prospective Study

Abstract Objectives: This study describes an intradermal injection technique for reducing bleeding during a percutaneous dilatation tracheotomy (PDT).Methods: Fifty-two consecutively recruited patients who underwent PDTs were analysed in a prospective study that was conducted between May 2019 and January 2020. This is a prospective study and fifty-two patients who underwent PDT were recruited from May 2019 to January 2020. They were randomly divided into an observation group and a control group. The patients in the observation group accepted the execution of the intradermal injection technique during their local anaesthesia. A comparison was made between the two groups’ intraoperative bleeding, postoperative bleeding, operation time and length of incision.Results: A total of 52 patients were enrolled in this study, 33 males (63.5%) and 19 females. The mean age was 63.0±9.9 years, with the patients’ age ranging from 45 to 80 years. The mean BMI was 29.2±5.1 kg/m2. There was no significant difference in gender, age, BMI index and whether they had an endotracheal tube between the two groups (P > 0.05). The observation group’s intraoperative bleeding was less than that of control group (χ2 = 8.308, P = 0.009). There was no significant difference in operation time between the two groups (t = -0.904, P = 0.372). There was no PDT-related death.Conclusion: The intradermal injection technique can be used to effectively and safely reduce bleeding during PDTs. This technique provides a lower intraoperative bleeding grade without increased the procedure’s duration.

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Observation of the Efficacy of Laparoscopic Resection of Anterior Rectal Cancer in Treating Rectal Cancer

Proceedings of Anticancer Research ◽

10.26689/par.v3i4.1054 ◽

2019 ◽

Vol 3 (4) ◽

Author(s):

Hao Zhang

Keyword(s):

Rectal Cancer ◽

Hospital Stay ◽

Laparoscopic Resection ◽

Length Of Hospital Stay ◽

Operation Time ◽

Treatment Method ◽

Postoperative Recovery ◽

Control Group ◽

Observation Group ◽

Significant Difference

Objective: To analyze the efficacy of laparoscopic resection of anterior rectal cancer in treating rectal cancer. Methods: Fifty patients with rectal cancer who were treated in Gucheng County Hospital of Hebei Province from September 2017 to September 2019 were selected and recruited in the present study. These patients were divided into two groups, namely the control group and observation groups, by random number table method. Each group consisted of 25 patients. The control group underwent laparoscopic assisted transanorectal mesorectal excision, whereas the observation group underwent laparoscopic resection of anterior rectal cancer. The two groups were compared for related indicators, indicators pertaining to postoperative recovery, and complications. Results: There was no significant difference in the number of lymph node dissections between the two groups (P>0.05). The amount of intraoperative blood loss, surgical operation time, and incision length in the observation group were lower than those in the control group, and the differences were statistically significant (P<0.05). The time of getting out of bed, anal exhaust, and duration of hospital stay were shorter in the observation group than those of the control group, and the differences were statistically significant (P<0.05). In addition, the incidence of postoperative complications in the observation group was lower than that in the control group, and the differences were statistically significant (P<0.05). Conclusions: Laparoscopic resection of anterior rectal cancer is effective for rectal cancer patients. This treatment method can effectively reduce the amount of intraoperative bleeding, shorten the operation time, the time of anal exhaust, get out of bed, and the length of hospital stay, as well as improve condition of the patients.

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Preoperative planning by osteotomy master software helps to improve the accuracy of target limb alignment in high tibial osteotomy

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02033-6 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Axiang He ◽

Yanjie Mao ◽

Ying Zhou ◽

Qin Kong ◽

Hui zhang ◽

...

Keyword(s):

Blood Loss ◽

High Tibial Osteotomy ◽

Preoperative Planning ◽

Operation Time ◽

Control Group ◽

Tibial Osteotomy ◽

Observation Group ◽

Limb Alignment ◽

Correction Angle ◽

Significant Difference

Abstract Background The accuracy of targeted lower limb alignment correction following HTO is closely related to patients’ pain relief and knee joint survival time. How to accurately perform osteotomy and how to obtain the ideal target limb alignment to maximize the curative effect are the difficulty in HTO practice. The purpose of this study is to evaluate the predictive and application value of osteotomy master software (OsteoMaster) in coronal plane preoperative planning of high tibial osteotomy. Method Sixty-seven patients with medial compartment osteoarthritis and varus deformity treated by medial open-weight high tibial osteotomy were enrolled and divided into observation group (31 cases) and control group (36 cases). The observation group was planned by OsteoMaster, while the control group was planned by Miniaci. The preoperative predicted values of osteotomy depth, open height, correction angle, WBL ratio, and FTA of the observation group were compared with the actual intraoperative values to study their accuracy. The operative time, blood loss, number of fluoroscopy, and WBL ratio were compared between the observation group and the control group to study its application value. Result There was no significant difference between two groups in preoperative prediction and intraoperative reality of osteotomy depth, open height, correction angle, FTA, and WBL ratio (P > 0.05). The operation time and number of fluoroscopy in the observation group were significantly less than those in the control group (P < 0.05), while the difference in blood loss was not statistically significant (P > 0.05). The good rate of WBL ratio was 87.1% in the observation group and 75% in the control group. Conclusion OsteoMaster has predictive value in osteotomy depth, open height, correction angle, FTA, and WBL ratio of HTO, which is also helpful to reduce the number of fluoroscopy, shorten the operation time, and improve the accuracy of target limb alignment. The drawback of this approach is 2-dimensional approach in contrast to 3-dimensional preoperative planning that is including the more real study.

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Comparison of Left Lower Entrance and Traditional Laparoscopic Greater Omentum Resection for Stage I Ovarian Cancer

10.21203/rs.3.rs-934284/v1 ◽

2021 ◽

Author(s):

Aiwen Le ◽

Fan Yang ◽

Kai Kang ◽

Guna He

Keyword(s):

Ovarian Cancer ◽

Early Stage ◽

Operation Time ◽

Stage I ◽

Greater Omentum ◽

Control Group ◽

Observation Group ◽

Effective Technique ◽

Significant Difference ◽

Staging Surgery

Abstract Objective : To describe the surgical method, safety and convenience of " lower left entrance laparoscopic greater omentum resection" and evaluate its clinical application value for stage I ovarian cancer. Methods: 31 patients with early stage I ovarian cancer underwent with laparoscopic staging surgery adopted " lower left entrance laparoscopic omentum resection " as the observation group, and 29 cases underwent by conventional laparoscopy as control group. The intraoperative and postoperative indexes were compared. Results: During the greater omentum resection, there was no significant difference between two groups in the blood loss, but the operation time in observation group was significantly shorter than the control group. There was no difference in postoperative hospital stay、gastrointestinal exhaust time and postoperative severe complications.Conclusion: " lower left entrance laparoscopic greater omentum resection " may be a safe and effective technique in stage I ovarian cancer.

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