Objective. To investigate retrospectively the complications and associated factors of gynecological laparoscopies.Methods. 1 769 laparoscopic surgeries were carried out from January 1994 to October 1999 at our department.The procedures included 1421 surgeries of ovary and t utbe, 52 myomectomies and 296 cases of laproscopic-assisted vaginal hysterectomy (LAVH). A total of 312 patients had a history of prior laparotomy ( 17.6% ).Results. Complications occured in 34 cases, the overall complication rate was 1.92%. Unintended laparotomies occured in 6 cases(0.34% ). 12 complications were associated with insertion of Veress needle or trocar and creation of pneumoperitoneum, including 5 severe emphysema and 7 vascular injuries, this figure represents 35.3% of all complications of this series. Five intraoperative complications ( 14.7% ) occured during the laparoscopic surgery (3severe bleedings, one bladder injury and one skin burn of leg caused by damaged electrode plate), laparotomy was requied in four of these cases. Seventeen complications occured during postoperative stage: 2 intraperitoneal hemorrhages needing laparotomy, 2 bowel injuries, 4 nerve paresis and 9 febrile morbidities.Conlusions. Operative gynecologic laparoscopy is associated with acceptable morbidity rate, but can not be overlooked. Complication rate seems to be higher in advanced procedures such as LAVH.

急性颈脊髓损伤行气管切开患者鼻饲并发症的观察与护理

目的 探讨急性颈脊髓损伤气管切开患者鼻饲行肠内营养时并发症的观察与护理.方法 对30例急性颈脊髓损伤气管切开患者鼻饲行肠内营养的并发症进行分析,给予针对性的护理措施并观察效果.结果 30例患者中,发生腹泻3例、便秘2例、返流2例.经过有针对性的护理,30例患者均无严重不良结果发生.结论 对于行鼻饲肠内营养支持的急性颈脊髓损伤并行气管切开术的患者,就鼻饲常见并发症的预防、出现原因应分析总结,采取适当的鼻饲护理方法,以预防和降低鼻饲肠内营养相关并发症.

尘肺患者的生存时间及死因分析

[目的]研究尘肺患者的生存情况并进行死因分析.[方法]追踪观察386名已经被诊断为Ⅰ、Ⅱ、Ⅲ期的尘肺患者,记录死亡的137名尘肺患者的死亡时间,死因和尘肺的期别.用K-M法进行生存分析.[结果]已确诊为Ⅰ、Ⅱ、Ⅲ期的137名尘肺患者的生存时间分别为29.3年、27.3年、14.0年,Ⅰ、Ⅱ与Ⅲ比较,差别非常显著(P《0.001);与Ⅰ期相比,Ⅱ期患者的危险度为1.03倍(95% CI 0.77-1.36),Ⅲ期患者的危险度为1.57倍(95%CI 1.09-2.16);冬季死亡63例,其次是春季40例,共103例,占75.1%;死因分别为肺炎37例(27.0%),肺结核21例(15.3%),非特异性肺感染7例(5.1%),肺癌22例(16.1%),其他癌症10例(7.3%),脑血管意外和其他病因12例(8.8%);386名尘肺患者并发肺结核占14.3%,在Ⅰ、Ⅱ、Ⅲ期矽肺患者中,分别有10.0%、20.2%、32.4%合并肺结核.[结论]冬春两季是尘肺患者死亡较多的季节;尘肺期别越高,生存时间越短;肺炎、肺结核、肺癌是尘肺患者的主要死因.

Because of unavoidable complications of vasectomy, this study was undertaken to assess the efifcacy and safety of male sterilization with a nonobstructive intravas device (IVD) implanted into the vas lumen by a mini-surgical method compared with no-scalpel vasectomy (NSV). IVDs were categorized into two types:IVD-B has a tail used for ifxing to the vas deferens (ifxed wing) whereas IVD-A does not. A multicenter prospective randomized controlled clinical trial was conducted in China. The study was comprised of 1459 male volunteers seeking vasectomy who were randomly assigned to the IVD-A (n= 487), IVD-B (n= 485) or NSV (n=487) groups and underwent operation. Follow-up included visits at the 3rd-6th and 12th postoperative months. The assessments of the subjects involved regular physical examinations (including general and andrological examinations) and semen analysis. The subjects’ partners also underwent monitoring for pregnancy by monthly interviews regarding menstruation and if necessary, urine tests. There were no signiifcant differences in pregnancy rates (0.65% for IVD-A, 0 for IVD-B and 0.21% for NSV) among the three groups (P>0.05). The cumulative rates of complications at the 12th postoperative month were zero, 0.9%and 1.7%in the three groups, respectively. In conclusion, IVD male sterilization exhibits a low risk of long-term adverse events and was found to be effective as a male sterilization method, similar to the NSV technique. IVD male sterilization is expected to be a novel contraceptive method.

Objective:The purpose of the study is to investigate the technical points, ef ects and complications of fiducial marker implantation within target areas before the CyberKnife treatment on body malignant solid tumors. Methods:Five hundred and four cases of patients with body malignant solid tumors accepted fiducial implantation within target areas under CT guidance before the treatment of CyberKnife. Observe the complications and ef ect. Results:Among the 504 cases, 500 cases successful y accepted the implantation (a success rate of 99.2%). 158 patients felt pain at the punctured sites and 3 patients had tachycardia. 33 patients had abdominal pain after the surgery due to a smal amount of bleeding in the needle passage during liver puncturing process. Among the 19 lung cancer patients who accepted lung paracentesis, 1 case had light pneumothorax and 1 case got light haemothorax. Among the 453 patients who accepted liver paracentesis, 6 had fiducial migration. Conclusion:The method of fiducial implantation within target areas before treating body malignant solid tumor with CyberKnife is minimal y invasive and comparatively secure.

The reporting of complications fol owing transperitoneal and retroperitoneal open radical nephrectomy (RN) is nonstandardized. This study aimed to compare early complications between the two approaches using a standardized reporting methodology in a large contemporary cohort. Between 1996 and 2009, 558 patients underwent open RN for renal cel carcinoma (RCC) in our two centers (424 from Sun Yat-sen University Cancer Center and 134 from the First Affiliated Hospital of Sun Yat-sen University). Records were reviewed for clinicopathologic features and complications. Complications were graded using the Clavien system based on the severity of impact. One hundred and five patients (18.8%) had one or more early complications (168 complications overal ). The overal rates of grades I to V complications were 5.6%, 10.8%, 2.2%, 0.4%, and 0.2%, respectively. Patients who underwent transperitoneal RN did not experience more overal or procedure-related complications than those who underwent retroperitoneal RN (P=0.911 and P=0.851, respectively). On subgroup analysis, neither grade I/II nor grades III-V complications were significantly different between the transperitonal RN and retroperitoneal RN groups. Multivariate analysis showed that for any grade of complication, age (P = 0.016) and estimated blood loss (P = 0.001) were significant predictors. We concluded that open RN is a safe procedure associated with low rates of serious morbidity and mortality. Compared with retroperitoneal RN, transperitoneal RN was not associated with more complications. Older patient and more blood loss at surgery were independent predictors for higher early postoperative complication rates.

Purpose:The surgical risk and complication rate after cataract surgery are extremely high in patients with nanophthalmos. This study is designed to compare the visual and refractive outcomes before and after coaxial micro-incision phacoemulsi-fication and evaluate postoperative complications. Methods:.Fifty nine patients (89 eyes) with axial length (AL)< 21 mm diagnosed with nanophthalmos were enrolled in this retrospective study. All patients underwent coaxial micro-inci-sion phacoemulsification and IOL implantation..The main outcome measures included anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (A CA), intraocular pressure(IOP) and best corrected visual acu-ity (BCVA). Wilcoxon signed rank test or Mann-Whitney test, and Chi-square test and logistic regression analysis were per-formed for statistical tests as appropriate. Results:.The median AL was 19.63 mm...Sixty-six eyes (74.16%) had a history of surgical intervention. Postoperative ACD, ACV and ACA were increased significantly (all P<0.001), whereas postoperative IOP was decreased significantly. (P<0.001) after surgery. Previous surgical intervention was related to a reduction in the postoperative ACD and ACA (P<0.01), and both preoperative and postoperative IOP. (P<0.001). Postoperative BCVA was improved in 94.38% of the cases. Intraoperative complications mainly included iridoschisis (6 eyes, 6.74%). Early postoperative complications included tem-porary corneal edema (TCE) (23 eyes, 25.84%), anterior in-flammatory response (AIR)(19 eyes, 21.35%), cystoid mac-ular edema (CME) (14 eyes, 15.73%), and uveal effusion (4 eyes, 4.49%). Late postoperative complications included CME (8 eyes, 8.99%), uveal effusion (8 eyes, 8.99%), malignant glaucoma (2 eyes, 2.25%) and posterior capsular opacification (PCO) (10 eyes, 11.24%). The majority of complications (80%) were successfully resolved by pharma-cotherapy or operation. The risk of surgical complications was greater in patients with lower AL,ACD,ACV or ACA and higher nuclear hardness or mean keratometry (Km). Conclusion: With reasonable preoperative management, pru-dent selection of the lens,.rigorous surgical technique and unerring cognition of potential complications, coaxial micro-incision phacoemulsification lens surgery can be performed in patients with nanophthalmos and yield favorable outcomes and a low incidence of complications.