Background: The morbidity of infectious spondylitis is increasing year by year in the elderly. Due to difficulties in coping with open surgery, we aim at presenting a treatment method for infectious spinal inflammation by the combination of Percutaneous Endoscopic Discectomy and Drainage (PEDD) and Percutaneous Pedicle Screw Fixation (PPSF) which obtained satisfactory outcomes in this study.Method: We have retrospectively analyzed 33 patients who had suffered from lumbar infectious spondylitis and undergone PEDD combined with the PPSF treatment. Biopsy specimen was taken from each of them during their operation and the specimen was submitted without delay for microculture. The dynamic change of patient clinical symptoms and their satisfaction degree were assessed by careful physical examination, regular serologic test, imaging study, Odom’s criteria, Frankel score, and visual analog scale (VAS).Result: Among the 33 patients, 22 (66.7%) had excellent symptom relief and the remaining 11 (33.3%) had good symptom relief after PEDD treatment according to Odom’s criteria. Additionally, PPSF was performed on 5 patients in the second stage, and yielded satisfactory result. There were no severe surgery-related complications. The microculture from 24 patients(72.7%)obtained from the operation were positive.Conclusion: PEDD and PPSF were under the influence of local anesthesia, which had lower requirements of patients’ general condition comparing to the traditional open surgery. In addition, PEDD obtained higher positive rate of microorganisms cultured comparing to other minimally invasive methods. PPSF was performed at the second stage to alleviate pain and further improve vertebral stability.
Introduction: This was a meta-analysis of studies on conjoined and separate anastomosis for urinary diversion after radical cystectomy due to bladder cancer. Methods: We searched databases (PubMed, Embase and the Cochrane Central Register of Controlled Trials) for studies regarding anastomosis for urinary diversion due to bladder cancer. The meta-analysis was designed to determine the difference between conjoined and separate anastomosis. Six studies including 1601 patients were considered in the meta-analysis (654 in the separate group and 947 in the conjoined group). Results: There were no significant differences with respect to age, gender or duration of follow-up. There were seven studies that compared the rate of stricture and the rate of hydronephrosis. For overall stricture, there were 186 of 1163 ureters in the separate group and 64 of 1718 ureters in the conjoined group (odds ratio, 4.53; 95% CI, 2.01-10.22; P = 0.0003). For overall hydronephrosis patients, there were 55 of 205 ureters in the separate group and 51 of 254 ureters in the conjoined group (odds ratio, 1.48; 95% CI, 0.95-2.29; P = 0.08). Conclusion: The separate anastomosis had a higher ratio of strictures than did the conjoined group. The separate anastomosis group experienced hydronephrosis more often than did the conjoined anastomosis group. The separate anastomosis is the better choice for surgery during the operation.
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